President Trump is reportedly poised to pull the United States out of the Paris Climate Agreement, fulfilling his campaign pledge but still sending shock waves through international and scientific circles.

While Mr. Trump has repeatedly criticized the agreement and promised to “cancel” it, many advisers in his inner circle – as well as top business leaders – had been urging him to remain in the accord, and there have been periodic reports that Trump was vacillating.

Now that the withdrawal seems imminent, the international community is trying to assess the impacts of such a major action. It would almost certainly have major ripple effects throughout the United States and around the globe, not just on climate action, but also on diplomatic relations and the US economy. At the same time, however, most observers say it is unlikely to derail the accord, or hamper more localized efforts currently being championed by communities, local leaders, and the private sector.

The diplomatic and economic repercussions for the US could be significant, but “we know that cities and states and businesses in the US and countries around the world are determined to move forward,” says David Waskow, director of the International Climate Initiative at the World Resources Institute. “Even with obstacles being thrown in their way, this is a course that many, many actors are intent on pursuing.”

When the Paris agreement was adopted at the end of 2015, it was hailed as a breakthrough by many and the best chance to limit greenhouse gas emissions and the global warming they cause. The goal – to be achieved through voluntary country-by-country targets for emission reduction – is to limit the increase in average global temperature to 3.6 degrees F (2 degrees Celsius).

The agreement was signed by 195 countries, and the US promised to reduce its own emissions by 26 to 28 percent of 2005 levels by 2025. It also pledged $3 billion to the Green Climate Fund to help poorer countries reduce their own emissions (and has fulfilled $1 billion of that pledge).

The US has the world’s largest economy and is the second-biggest polluter, behind China. Its withdrawal could clearly have a major impact on the chances of the Paris agreement succeeding, and the willingness of some other countries to live up to their promises.

Global implications

A decision to back out of a deal that has been ratified by almost every other nation could have both economic and diplomatic ramifications.

“Internationally, this will not be taken lightly in any sense,” says Mr. Waskow of WRI. “This will be seen as an attempt to blow up international cooperation on what the world sees as one of the most critical issues of our time.”

And that could affect relations on issues that extend well beyond environmental and energy policy.

“Climate change has become a top-level issue that could impede America’s ability to gain the cooperation of other countries over the typical top issues of security, trade, and the economy,” says Timmons Roberts, a professor of environmental studies at Brown University in Providence, R.I., and a nonresident senior fellow at the Brookings Institution.

But there are also important limits to potential impacts of US withdrawal. All other major signatories – including European nations, China, and India – have affirmed their commitment to climate action, even without US participation. And in the US, many of the efforts to lower emissions are coming from the private sector and from cities and states – efforts that may increase in the absence of federal climate leadership. 

“The Paris agreement itself is going to move forward with or without the United States,” says Brian Deese, who served as President Obama’s senior adviser on climate change and who played a key role in negotiating the Paris agreement. “The question is really not about whether Trump can ‘cancel’ Paris, it’s how much can Trump set the United States back.”

Mr. Deese and others say the US risks harming itself both economically and diplomatically with the move, and is likely to see diplomatic repercussions down the road, as well as economic consequences as the rules around clean energy get decided without US involvement.

Recognition of that fact, Deese says, is a major reason why so many business leaders – including dozens of Fortune 500 CEOs – have lobbied Trump to stay in the agreement.

“It’s ironic that it took Donald Trump to highlight in such clear terms how unanimous the United States private sector is in supporting climate action,” Deese says.

What withdrawal might mean

Trump has not yet confirmed the reports of the withdrawal, and questions remain about the form it would take. A formal withdrawal would take several years. The quicker “nuclear option” of dropping out of the United Nations Framework Convention on Climate Change completely would leave the US as the only country not part of the convention.

“Withdrawal from Paris Climate Agreement puts the USA with Nicaragua and Syria,” says Robert Stavins, director of the Harvard Environmental Economics Program, referring to the two countries that have not signed the accord. “Withdrawal from UNFCCC would put the USA with North Korea.” Moreover, he says in an email, withdrawal “hands leadership in this realm and others to China.”

For the past month, Trump has been pushed hard in both directions on the Paris decision, even with the Republican Party. Within his administration, those wanting him to pull out reportedly included Trump’s chief strategist, Stephen Bannon, and EPA administrator Scott Pruitt. And a week ago, 20 GOP senators sent Trump a letter urging him to abandon the agreement. The pro-Paris lobbyers, according to reports, have included Secretary of State Rex Tillerson, chief economic adviser Gary Cohn, and Jared Kushner, a senior adviser to Trump and his son-in-law.

But regardless of whether Trump opted to keep “a seat at the table,” as Mr. Tillerson urged on Paris, it has become clear that the US will not be a leader on climate action under Trump. The president has voiced skepticism about climate change himself and has appointed climate-change skeptics to key roles. He has made it clear he’s not planning to take any actions to help the US meet its voluntary commitments or to fulfill its funding pledges. At least a few analysts have even argued that it may actually be better for the Paris agreement to have the US publicly back out, rather than remain a signatory in name but not in action.

Forging ahead, with or without federal leadership

Trump began to roll back federal leadership on climate action almost immediately after his inauguration in January. But significant action at the state and city level – as well as in the private sector – has continued undeterred and in concert with global efforts.

Combined, the cities in the C40 Cities Climate Leadership Group – more than 80 “megacities” around the world who have pledged to tackle climate change – represent more than 600 million people and a quarter of the global economy.

“That’s an example of mayors around the world coordinating with each other without waiting for their respective national governments to catch up, and I think that’s what you’re going to see,” says Pete Buttigieg, the mayor of South Bend, Ind., which has retrofitted many of its police cars to run on natural gas and also re-engineered its sewage system to handle increased rainwater. “If the American federal government abandons its role, American cities aren’t going to go along with it.”

And Trump’s actions are likely to increase calls for local action.

“We all have our role to play in maintaining the overall commitment and pursuing that action to drive down emissions and make sure that President Trump isn’t the only measuring stick by which the world measures our contribution,” says Jeremy Symons, associate vice president on climate political affairs at the Environmental Defense Fund.

Staff writer Noelle Swan contributed to this report.

Eliot Blondet/Reuters

G7 Summit members, President of the European Commission President Jean-Claude Juncker (L), President Trump (L Rear), Italian Prime Minister Paolo Gentiloni, French President Emmanuel Macron (R) and President of the European Council Donald Tusk (R) attend the first working session in Taormina in Sicily, Italy, May 26, 2017.

This is not the first time that European leaders unhappy with the direction of US leadership have threatened to strike out on their own.

President George W. Bush’s post-9/11 “with us or against us” ultimatum – and above all his war in Iraq – caused a deep transatlantic rift and elicited calls in Europe for standing up more forcefully to oppose actions Europeans did not support.

But the Western partnership held, as Europeans ultimately reaffirmed the value of American leadership of the global order that the two sides of the Atlantic had built together.

During his European trip last week, President Trump’s “America First” orientation and unflagging pursuit of an interests-based foreign policy were on full display. The performance has kindled a renewed fervor for an independent Europe – one that, this time, some former and current officials and experts say, could endure and prompt profound changes in transatlantic relations.

Among those changes could be a Europe that develops its own contractual approach to foreign policy, as well as altered patterns of trade and military cooperation credited with underpinning decades of American prosperity.

If that happens, even if robust business ties keep the US and Europe from drifting too far apart, historians likely will look back at this president’s inaugural overseas trip as the watershed moment that set such change in motion.

Soon after commencing the European leg of a trip that began in the Middle East, Mr. Trump publicly dressed down America’s European allies for not paying their “fair share” of NATO alliance defense costs. Soon after, he castigated a “very bad” Germany for selling too many cars in the United States and maintaining a trade surplus with the US – warning he intended to even the score.

Next he refused to join Europeans in reconfirming an international commitment to tackling climate change – signaling a willingness to abandon the kinds of common causes that have cemented transatlantic relations and furthered a US-led international order for more than seven decades.

A more independent Europe

Indeed, reports Wednesday that Trump has decided to withdraw from the 2015 Paris climate accords would further cement the growing European consensus that US and European values are diverging – and that the US is pulling back from its global leadership role.

Trump’s applecart-upsetting comments during his first European visit as president sent shockwaves through the transatlantic community, with some observers like Ivo Daalder, the former US ambassador to NATO, calling the moment a turning point.

But for many European leaders, the business-mogul-turned-president’s unvarnished words in Europe merely confirmed what they have sensed for months was coming in the wake of his election: a transactional relationship propelled more by each sides’ interests than by American leadership and common values.

The result of such a shift in relations is likely to be a more independent Europe, very likely led by a robust Germany increasingly unencumbered by the restraints of World War II memories, some experts say. Increasingly Europe would look elsewhere for trade relations and like-minded partners for pursuing common goals, they add. A European defense, long envisioned by Europe powerhouses Germany and France, could be closer on the horizon.

“In the past when the United States led the international system forward, the world and certainly Europe moved forward with it, and if it paused, so usually did Europe,” says Heather Conley, director of the Center for Strategic and International Studies’ Europe program in Washington. “But the world has changed, and now no one is going to stop for the United States, not on trade, not on addressing other challenges like climate change,” she adds. “That’s the big difference.”

An opening for Russia?

Some worry that the shift in transatlantic relations could even open the door to a more influential Russian presence inside Europe, particularly in southern European countries that do not harbor the same suspicions of Russia as their neighbors farther east.

Others lament that a US turning away from its traditional leadership role would not simply result in a more multipolar world, but would undermine the pillars on which American security and prosperity were built over the past 70 years.

“Why did the United States organize the alliance system and the international trading system, the global order that prevails today?” says Ms. Conley. “It was very much a self-interested policy – one that protected the United States and assured American prosperity.”

Europe’s response to Trump’s test drive of a nationalist shift in US foreign policy came loud and clear from German Chancellor Angela Merkel, who concluded after three days with the new US president (at NATO and at a G7 summit in Sicily) that Germans and Europeans more broadly will have to “really take our fate into our own hands” and defend their own interests.

“The times in which we could rely fully on others – they are somewhat over,” Ms. Merkel said. “We have to know that we must fight for our future on our own, for our destiny as Europeans,” she said, adding, “This is what I experienced in the last few days.”

Indeed Merkel had made her position clear directly to NATO leaders (including Trump) assembled in Brussels last week, when she signaled her differences with the new president’s direction by stating that it is the building and nurturing of “open societies” that would deliver security and stability, not “the building of walls.”

Message in a handshake

And Merkel was not alone among European leaders in suggesting that the result of Trump’s narrowing of US foreign policy to national interests could be a Europe standing more freely on its own two feet.

France’s new president, Emmanuel Macron, made it clear in interviews following his Brussels one-on-one with Trump that his you-won’t-get-the-better-of-me handshake with the US president – the handshake viewed ’round the world – was indeed meant to send a message.

“My handshake with him – it wasn’t innocent,” Mr. Macron told the French daily Journal du Dimanche. “It’s not the be-all and end-all of a policy, but it was a moment of truth.”

The White House painted the reactions in Europe as exactly the kind of response Trump is looking for – a Europe that takes responsibility for more of its own affairs – and costs. Spokesman Sean Spicer said Merkel’s comments about no longer relying on others showed that the president’s demand for fairer “burden-sharing” was taking hold.

But European officials have been signaling for months that a more transactional and interests-based foreign policy under Trump would prompt the same from Europe.

After meeting in February with Trump administration officials – including Secretary of State Rex Tillerson and White House adviser Jared Kushner, the president’s son-in-law – Federica Mogherini, the European Union’s foreign policy chief, said her meetings had convinced her that the EU would pursue a “more pragmatic and transactional relationship” with the US.

The EU would continue to work with the US on as many issues as possible, she said, “but we will do it on the basis of our values and interests.”

A 'Europe first' response?

The EU is likely to pursue new and deeper trade ties with parts of the world it sees an inward-turning US neglecting – Southeast Asia, for example, which is looking for new trade partners after Trump abandoned the TPP trade deal. And some experts see Europe pressing ahead on a European defense with renewed vigor, especially if Germany’s Merkel wins a new term in September elections.

“In a multipolar world, American and European interests will coincide a lot less consistently,” says Sven Biscop, director of the Egmont Institute at Belgium’s Royal Institute for International Relations. With the US pursuing an “America First” policy, the response on the opposite side of the Atlantic must be “Europe First,” he says, with the aim of building a European defense whose hands are not tied but rather will be able to pursue Europe’s interests independently.

“That is going to lead to more interconnectivity” of European forces, more pooled defense investment “to deliver much more effectiveness,” Mr. Biscop says, pointing to German-French initiatives aimed at building a European army.

At the same time, some analysts say that the US and Europe are unlikely to drift too far apart in an “interests rule” shift, given that the US and the European Union remain each other’s best customers, together commanding about one-third of global trade and accounting for around 45 percent of the global economy.

The danger some see is that, if the two powers at the foundation of a West-inspired international order pull back from principles to a transactional relationship, other forces with other values are going to fill the void.

“The world moves in and fills any vacuum, but it doesn’t always fill them in ways that we would envision or that are in our interest,” says Conley. “We’re going to find that the West is weaker and leaving behind new vacuums if the United States withdraws and Europe goes it alone.”

Eric Gay/AP/File

An advocate works in a cubicle at the National Domestic Violence Hotline center's new facility in Austin, Texas. From Canada to Australia, labor unions have helped to build support for paid leave for domestic-violence victims, which can help them escape abusive relationships.

Like her mother, Michelle Gawronsky spent several years in an abusive marriage. One night, after an especially brutal fight, she packed up her four young children and drove to her mother’s house in Winnipeg, Manitoba. 

“I just looked at my kids and said they should not be going through this, especially not my daughters,” she recalls. 

Also like her mother, the late Kathleen St. Godard, Ms. Gawronsky escaped her marriage safely and found support within her community. But her road was easier, and a key difference was how her employer treated her. 

She explains that when Ms. St. Godard left her home and moved her children to a women’s shelter in the late 1980s, she asked for time off from her job as a teaching aide so she could find safer, more permanent housing. She was subsequently fired and spent 18 months living on social assistance.  

Years later, Gawronsky’s boss gave her a week of paid time off so she could move and go to court to get a restraining order. She continued work as a health care aide and, with her employer’s support, sought out family counseling and eventually put her marriage back together.

Now, as president of the Manitoba Government and General Employees’ Union, Grawonsky is part of a movement of provincial legislators and unions, in Canada and abroad,  advocating for measures to guarantee paid leave and job security for victims of domestic violence. If they succeed, the new rules would be a groundbreaking addition to resources already in place to help such victims. 

Proponents argue that such benefits help increase transparency around what has long been treated as a private issue. Furthermore, they say, surer economic footing clears away a major obstacle for people trying to move on from abusive situations. 

“It will give [the victim] time to make the move, to get things together and assess what to do next,” says Anuradha Dugal, director of violence prevention for the Canadian Women’s Foundation, a lobby group that helps raise funds for women’s shelters. “While she’s doing that, she needs to know she has a job to go back to,” she says.

An economic problem

Since the first Canadian women’s shelter opened in Toronto in 1973, activists here have made significant strides toward establishing resources for victims of domestic abuse. Women’s shelters across the country are publicly funded, police forces are trained to press charges and, Ms. Dugal says, women are less often blamed for the violence than they were in previous decades. 

Even so, women still face enormous barriers to leaving an abusive relationship. Among the most important is uncertainty over whether they will be able to provide for themselves and their children. According to a 2014 survey by the Washington-based National Network to End Domestic Violence (NNEDV), lower incomes, and higher rates of food and housing insecurity, are associated with higher incidences of abuse for both men and women. One in 10 women and 1 in 25 men who have experienced domestic abuse reported having missed school or work as a result. Despite improvements, a little over half of victims who need transitional housing in the United States can’t get it, according to NNEDV. 

Concerns about financial stability are often borne out. A separate 2014 survey of more than 8,000 Canadian workers, sponsored by the Canadian Labour Congress, found 34 percent of respondents reporting that they had been abused by their intimate partners, and that nearly 9 percent of those had been fired because of it. A 2009 survey estimated that victims of domestic violence lose a combined  $20 million a year in wages. 

“What we’re trying to establish is, this is a specific issue and it should be recognized as such,” says Barb MacQuarrie, the CLC survey’s architect and the community director of the Centre for Education on Violence Against Women and Children at the University of Western Ontario, in London, Ontario. “Instead of being a problem that an individual needs to be ashamed of, it becomes a problem for the workplace to solve.”

Gawronsky says that financial worries stopped her mother from leaving her marriage until it was almost too late. Their home in rural Manitoba was filled with guns and at times, St. Godard’s husband threatened her and their children at gunpoint. She tried to leave twice before leaving for good, but returned both times because of concerns about how she would support herself if she lost her job. 

Dugal of the Canadian Women's Foundation says that St. Godard’s experience is all too common. 

“Many women stare at this and say ‘how can it be a better choice for me, to put my child in poverty rather than stay with this partner and try to make things work?’ ” says Dugal.

Gawronsky’s own boss, meanwhile, “put me on vacation and never said anything to anybody.” She took four days and used the time to hire a lawyer and go to court to get a restraining order that forced her husband to move out of their home and allowed her and her children to move back in. She returned to work the next week. 

As things settled down, she got time off for family counseling. She and her husband eventually reconciled and were happily married until he passed away in 2009.  

“Without that time I would have taken short cuts, and that’s what a lot of women do because they needed to get back to work and then the violent person can very quickly come in and take control of your life again,” she says.

Should it be a workplace issue?

Several Canadian lawmakers and labor unions have taken up the cause. The province of Manitoba passed a law last year that offers eligible victims of domestic abuse up to five days of paid leave and up to 17 weeks of unpaid leave per year to deal with the impact of abuse. It also protects workers’ positions while on such leave.  A similar law is pending in the province of Ontario, and paid domestic-violence leave is now a standard demand in contract negotiations led by trade unions such as the United Steelworkers of Canada.

Getting employers on board has proven a challenge, however. Members of the business community in Manitoba objected to the legislation, saying they’re concerned about the cost. 

“Why domestic violence and not any other reason that you have to miss work? There’s many perfectly valid reasons for missing work and we don’t make the employer pay for those,” says William Gardner, a lawyer and head of the Manitoba Employers’ Council, which represents 23,000 employers in Manitoba. 

Adriane Paavo, head of education and equality for United Steelworkers Canada, says the biggest barrier is convincing businesses that domestic abuse should be a workplace issue at all. McQuarrie’s 2014 research, however, makes a strong case that it is. Fifty-four percent of abuse victims surveyed said the violence followed them to work, most commonly in the form of abusive phone calls or text messages and stalking or harassment near the workplace. About 82 percent said trouble at home negatively affected their performance because they were either distracted, tired, or unable to concentrate. 

“Because the majority of victims are women, it’s not something we’ve talked about enough or taken seriously enough,” Ms. Paavo says. “There is this notion that domestic abuse is a private matter.” 

Gardner, from the Manitoba Employers’ Council,  argues that most workplaces are willing to support an employee who is suffering from domestic violence if they know about it, and he’s concerned employees will take advantage of the time even if they don’t really need it. Furthermore, he says, legislation could have unintended consequences, such as making it harder for women to get work.  

But proponents of the legislation hold up Australia, where roughly 2 million employees have access to paid domestic-violence leave, as a success story. Unions there began negotiating domestic-violence leave into worker contracts beginning in 2011. And early data show that so far, employees take less time than they are entitled to – an average of two or three days off to deal with legal and medical concerns, move, or take steps to improve their safety, according to a survey commissioned by the Australian Council of Trade Unions. 

“If we agree that [domestic violence] is a societal problem, not an individual problem, then we have to attack it on all fronts,” says Dugal from the Canadian Women’s Foundation. “This will help to break down the silence and it will, hopefully, get around the impoverishment of domestic violence for many women.” 

Imagine a transcript that doesn't say anything about the courses a student took or the grades earned. Instead, there is a description of the qualitative skills and character traits that student mastered, along with examples in the form of essays, labs, and videos.

This is the vision of Scott Looney, head of Hawken School, outside of Cleveland, and the founder and board chair of the Mastery Transcript Consortium, a group of more than 100 of the most prestigious preparatory schools in the United States. The coalition is developing a digital transcript that tracks the whole progress of students, not just performance on tests and class assignments. It's a change that reformers say could free high school education from the century-long limitations of A-to-F grading.

“The problem with a grade is it doesn’t feel like coaching and guidance to kids – it feels like a judgment,” Mr. Looney tells The Christian Science Monitor in a phone interview. “Kids are not focusing ... on what they need to learn. They are just worrying about what the teacher wants from them.”

Many US schools have turned from A-to-F grades to more descriptive assessments of student mastery of skills. But only a handful of states and major cities have made competency-based assessments available at every grade level. Most schools have confined the movement to lower grades. On the high-school level, schools and parents alike worry that not granting A-to-F grades to students could hurt their college admissions chances.

But that could change if the Mastery Transcript Consortium, which includes some of the most highly regarded private schools in the US, succeeds. With members like Phillips Academy in Massachusetts, the Dalton School in New York, and the Cranbrook Schools in Michigan, the group's clout could force a broader acceptance of the new transcript.

The consortium has worked out a first pass of a new digital transcript. The document would be standard across schools but each school would determine for itself the competency areas and mastery credits it wants students to focus on. And letter grades would play no part in the assessment process.

“If we figure out how to make this work, this could be a really major change in education,” says Denise Pope, a senior lecturer at the Stanford Graduate School of Education. “I’m extremely excited and optimistic.”

An idea in progress

When the Carnegie Unit – the 120 hours students are expected to sit in class each year – and A-to-F grades became the standard for American high schools more than a century ago, they were viewed as revolutionary, too. No longer were students put through subjective oral or written examinations to gain entrance to college. Over the years, however, educators say the traditional transcript has turned high-school learning into a college-admissions game. Students strive to "win" by earning the highest grades in the hardest classes – but don't necessarily retain knowledge or skills.

The Hawken School has discussed experimenting with a pilot program with volunteer students, Looney tells the Monitor. Under the pilot, a teacher may, for example, attach a strong student essay to a transcript. Then a panel of faculty members would review the essay and either let it stand, or remove it and tell the student how to improve it.

“We know that if you want kids to get better at theater, at acting, or at basketball, you don’t give them a letter grade at the end of practice,” Looney says. “You just say, ‘Hey, you did a good job.... But at the next practice I really want you to work on this.’”

The Edward E. Ford Foundation announced last week that it will award the consortium $2 million, which members have pledged to match. Ultimately, the consortium says, it hopes to win over both public and parochial schools as well as the college admissions world.

Good or bad?

But the consortium could end up hurting the very public schools it says it wants to help, says Washington Post columnist Catherine Rampell.

“Admissions at top colleges is a zero-sum game, after all,” she wrote last week. “If signal-jamming by the [elite schools] of the world sufficiently confuses college admissions officers into accepting more of their students, fewer spots will be available for other schools. Additionally, less digestible transcripts might lead colleges to place more weight on something that’s more easily comparable across students: standardized test scores.”

Some other education professionals express a mix of caution and optimism.

“I think it’s a promising development,” says Michael Reilly, executive director of the American Association of Collegiate Registrars and Admissions Officers. “The concern that I would raise is if that’s the only document that is going to be produced by the school and handed to the student for colleges and universities, that could negatively impact students who are trying to go to schools that have not transitioned to be able to evaluate those and be able to make admissions decisions.”

But Randall Bass, the vice provost for education at Georgetown University, says a transcript like the consortium’s could offer value.

“In many ways the admissions process now is a game of trying to read in between the lines of transcripts to look for certain qualities that are not actually represented by high scores and good grades,” he says. “It could strengthen the process if they are successful in finding ways to represent, in a more explicit way, the qualities we’re continually trying to infer.”

It could also alleviate the pressure on high-school students, says Mark Hatch, vice president for enrollment management at Colorado College.

“We’re seeing an average 18-year-old that matriculates at our institutions a little bit more frazzled and a little bit less focused right now,” he says. “There is a growing concern among faculty at institutions that they are inheriting students who are very good at punching buttons and very good at collecting a 5 on AP scores and great grades, but are lacking the passion, curiosity, and freshness for learning that we’d like to have.”

Has it worked before?

Though competency-based transcripts are more often used in elementary schools in the US, some independent and public schools have expanded it to secondary school.

Wildwood School, an independent progressive school in Los Angeles, evaluates all of its K-12 students on academic and life skills. It also provides them with narrative assessments of their performance and standards-based evaluations. Most or all of their 65 or so graduating seniors go on to college the next year, with several attending the best institutions in the country.

Public schools in Windsor Locks, Conn. use standards-based evaluations for all students in ninth grade or younger, and will expand to the whole school system in the next three years.

Parent Ann Marie Charette says she has learned more about her sixth-grade daughter's progress at school than she ever gleaned from the traditional grades and transcripts of her two older sons.

“Do I care she has an A? Or do I care she knows what a right angle is?” says Ms. Charette, who is a human resources specialist in the district. “I’m more concerned about what she knows and is mastering versus the grade that is coming afterward.”

Jessica Mendoza/The Christian Science Monitor

Orange County pediatrician Maureen Villaseñor (left) and medical assistant Jessica Villegas stand at the Shop with Your Doc booth at Ralph's supermarket in Tustin, Calif., on May 10, 2017. The program, established by St. Joseph Hoag Health in 2015, sends medical professionals to supermarkets throughout the county to guide shoppers in their food choices. Shop with Your Doc is part of a growing movement across the country to reinforce the ties between food, health and wellbeing, and the medical community.

In her white lab coat and slacks, Maureen Villaseñor looked better suited to be handing out prescriptions at a clinic than talking salad dressing in a grocery store aisle.

But on a May afternoon, the Orange County pediatrician was at a Ralph’s supermarket in Tustin, Calif., dispensing shopping tips instead of pills. Inquiring shoppers got advice on everything from how to coax toddlers to eat more vegetables (she suggested mixing them with favorite foods) to how to make a tasty, low-calorie salad dressing at home. 

The endeavor, called “Shop with Your Doc,” is meant to help people make educated, healthy choices one grocery cart at a time. The program is about more than just nutrition.

Shop with Your Doc is part of a broader – and still growing – movement in US medicine to shift the focus away from simply treating disease toward caring for the whole person. Across the country, hospitals are setting up food banks and medical schools are putting cooking classes on the curriculum. Nonprofits are connecting medical centers with community resources to ensure that low-income Americans have access to fresh fruits and vegetables.

The common thread is an effort to incorporate into treatment the lifestyle choices, socioeconomic circumstances, environmental factors, and history that contribute to a person’s overall health.

“It’s about working to take care of the community where they’re at and about understanding the conditions affecting the community,” says Nisha Morris, executive director of public relations at St. Joseph Hoag Health, which started the program in 2015.

“In general, medicine has not recognized the role that lifestyle choices have played in the chronic disease epidemics we have now. [It’s] really sick care, it’s not health care,” adds Brenda Rea, assistant professor of family and preventive medicine at Loma Linda University, a private health-sciences institution just south of San Bernardino, Calif. “We want to shift that paradigm.”

Rethinking health care

For centuries, Western medicine’s mission was to cure disease. When patients felt sick they went to their doctor, who evaluated the problem and offered a solution. The patient typically only came back when something else was wrong. 

“That’s the type of care we’ve been doing for two millennia, and we’ve gotten really good at it,” says Tim Harlan, executive director of the Goldring Center for Culinary Medicine at Tulane University in New Orleans.

But over the past generation, he says, two significant trends took place that are of concern to the medical community: Health-care costs began to soar, and relatively inexpensive, poor-quality food became more ubiquitous. The result was a rise in chronic diseases that are preventable, Dr. Harlan says.  

“There’s a very straightforward … link between people improving their diets and improving the condition that they have,” he says.

The connection drove the medical and nonprofit communities to rethink their approach to health and disease. What emerged was the concept of the “social determinants of health” – the notion of taking into account the biological, physical, and socioeconomic circumstances surrounding a patient. A healthy person isn’t just someone who is free from disease, the theory goes; he or she also enjoys “a state of complete mental, physical, and social well-being.”

“Doctors are starting to recognize that we can hand out shots and antibiotics day in and day out, but people will not stay better or not necessarily get better – unless you pay attention to the social determinants,” says Deborah Frank, a professor of pediatrics at Boston University.

The question the medical community now faces is how to get patients – especially low-income families – to recognize those determinants and make it possible for them to eat and live healthier. 

“If you are a mom, and you don’t have enough to eat, your first concern is that nobody cries from hunger. So you go for stuff that is very cheap and very filling,” Dr. Frank says. Soda and french fries “are very filling and very cheap per calorie. Whereas broccoli is not.” 

From hospital to kitchen

In response to the problem, Frank in 2002 helped found an on-site food pantry at Boston Medical Center (BMC), which has since evolved into a kind of nutrition center where primary care providers at BMC send patients for food. Today the pantry hosts free cooking classes and serves about 7,000 people a month.

Among them is Marie, a mother in her late 20s who relies on the fruits and vegetables the pantry supplies to make healthier meals for her young children. 

“Food is very expensive, it’s helping us a lot,” she says in broken English. “I have two kids and it’s helped.” 

“We’re creating clinic-community bridges,” says Kathryn Brodowski, a physician of preventive medicine and director of public health and research for the Greater Boston Food Bank, which supplies the BMC pantry with 95 percent of its stock. (The rest comes from donations.) “Why reinvent the wheel? We can smartly leverage our resources and take better care of our patients.” 

The Greater Boston Food Bank has also launched its own initiatives, striking partnerships with four community health centers across the state to offer free mobile produce markets that have served more than 800 households. The organization also helped develop tool kits that map local pantries, markets that accept government food vouchers, and other resources. 

“We need to get to the root problem, and social needs are a big part of that,” Dr. Brodowski says. “If we can link together and bridge this community space with the health space, we can take better care of our patients.”

At Tulane in New Orleans, Harlan is leading the development of a curriculum that blends the science of medicine with the art of food preparation. His philosophy: Doctors who know their way around a kitchen are better at helping their patients. And empowering patients to take charge of their own diets is one way to help them deal with the staggering costs of health care, Harlan says.

“Although we know what works in ‘diet and nutrition,’ no one has done a very good job of translating that for a practical approach,” he says. “We take all of that information that we learn in the first two years of med school .... and we translate that into peanut butter and jelly sandwiches.”

The modules have since been adopted at 35 medical schools nationwide. They equip students with the language and skills to help patients tailor their diets to fit their lifestyles, says Ben Leong, who helped design the program and now applies its principles in his residency in Long Beach, Calif. His patients have told him they really appreciate the approach.

“They’ll say, ‘I’ve never had a doctor share with me their recipe for grilled chicken.’ ”

'No more pain'

For some people, the results have been transformative. Clarival Cruz, a registered nurse, says she has gone from being on crutches after being diagnosed with gout to moving freely, after working with Dr. Rea to reshape her approach to meals. “I feel more awake and energized. There’s no more pain,” she says.

Chipping away at bad habits is a good place to start getting patients to think about the choices they make for themselves and their families.  

“You don’t try to change anyone’s lifestyle completely,” says Ms. Villaseñor, the pediatrician. “When you have two working parents, and they’re coming home late, and one kid is picking up dinner, how can we make healthy choices within the lifestyle they have?” 

“It’s lost on people sometimes how much it means to us as physicians that our patients get better,” Harlan adds. “I want them to be healthier, take less medication, feel better. At the end of the day, that’s what we do for a living – and this is a fabulous strategy for doing that.”

Reuters

People dressed in traditional Ukrainian embroidered shirts take part in an embroidered shirt parade in Kiev, Ukraine, May 27.

Just three years ago, pro-democracy protesters in Ukraine were in the streets demanding their country start down the path to joining the European Union. After Russia objected and took pieces of its neighbor by force, thousands of Ukrainian soldiers were forced to fight for their country and its goal. Thousands have been killed in an ongoing war on Europe’s fringe.

Finally, on May 30 the 28-nation EU took the last major step in approving a pact that grants a close association with the Eastern European country, one that starts with opening trade and travel.

The critical approval came in a vote by the Dutch parliament, the last vote needed from each EU member state and the most difficult. Last year, during the peak of anti-EU populist sentiment in Europe, voters in the Netherlands passed a nonbinding referendum against any EU pact with Ukraine. Since then, the populist tide has ebbed. The EU promised the Dutch not to let Ukraine fully join the union without later approval. Dutch lawmakers then gave the nod. Now a formal acceptance of the pact is expected in July.

At a time when three major countries – the United States, Britain, and Turkey – are pulling away from Europe, Ukraine’s eagerness to embrace the EU and its values shows how much other countries want in. Ukraine still has far to go to cement full membership. The country’s wealthy elite still wield too much power in its democracy. The fight against corruption has only begun. And even as it struggles with each political reform, the government also struggles against Russian military aggression in its eastern region and the loss of Crimea.

Still, this victory will provide “a guarantee of our freedom, independence, and territorial integrity,” says Ukrainian President Petro Poroshenko. “Europe is our civilizational choice.” And Jean-Claude Juncker, president of the European Commission, spoke of the new partnership with the Ukrainian people as “one of our closest and most valued.”

Foreign tourists in Europe often treat it as a theme park, drawn by the cultural and historical attractions. For others outside the EU, however, the allure is a deeper theme, that of civic values such as equality and openness. And they are willing to make big sacrifices to join the Continent’s biggest club.

With this approval, the EU is now in a better position to negotiate with Russia in ending the war in Ukraine. Europe’s soft power of attraction is winning out over Moscow’s hard power.