Many with diabetes are not taking steps to preserve vision.Despite recent advances in prevention and treatment of most vision lossattributed to diabetes, a Johns Hopkins study found that fewer than half ofAmericans with eye damage from diabetes were aware of the link between thedisease and visual impairment, and only six in 10 had their eyes fullyexamined in the year leading up to the study.
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The year 2021 was inauspicious for government-sponsored internet disruptions. In February, one of the first actions the Myanmar military undertook after seizing power in a coup and placing the elected civilian leader, Aung San Suu Kyi, under house arrest, was to cut internet access for the population. In the ensuing months, the military junta enacted a range of internet controls, implementing regular internet blackouts at night, blocking access to different platforms and services during the day, and periodically enacting full-scale national shutdowns.6 By the end of 2021, the junta had imposed more than 12,000 hours of disruptions with some regions still unable to access social media.7
Confronting internet shutdowns should be an integral part of supporting democracy and human rights across borders. To that end, democratic states, together with local and international civil society organizations and technology developers and companies, should pursue a multifaceted strategy to counter shutdown trends. This strategy should focus on advance preparation, such as encouraging citizens to mass download censorship-resistant VPNs ahead of specific windows of risk; prioritize user accessibility to facilitate scaling up (recognizing that the more steps required to install VPNs or circumvention technology, the less likely it is that individuals will actually use the software); employ nontechnological strategies to complement digital solutions; and raise the costs for governments and private companies to continue implementing shutdowns.
While satellite internet and Wi-Fi balloons face high constraints, other tools are available to citizens on the ground without necessitating external intervention. VPNs are protocols that allow users to access many blocked sites by providing internet service based outside of a censored country using a proxy server.60 Proxies allow users to disguise their IP address so they can prevent eavesdropping and interference with communications. Users can download popular free VPNs, such as programs developed by TunnelBear and Psiphon, from app stores, directly from product websites, or through Android application packages (APK files) sent by email or messaging apps like Telegram and Signal.61 These services are most useful during targeted internet shutdowns, when a government blocks specific websites but maintains overall network connectivity. Some countries have attempted to ban VPNs, however, either by outlawing them on paper (as in Russia) or by technically blocking them from being used or downloaded from app stores (as experienced in Iran and China).62 VPN companies have responded by finding new methods to circumvent these tactics.
The most promising strategies to help citizens circumvent internet shutdowns do not involve deploying satellite internet devices or floating balloons. Instead, simpler solutions, such as encouraging citizens to download anticensorship apps or software ahead of time, are much more useful. But they do not work well without advance organizational and logistical preparation. This requires engaging local civil society organizations and holding awareness campaigns to encourage mass adoption before a shutdown initiates. Such efforts are also more likely to succeed if technologies are free, easy to use, and redundant, so that citizens can communicate and access information regardless of context or network restrictions in place. Tech companies also have a role to play in ensuring that citizens can access circumvention solutions that are privacy-preserving and secure. Effective strategies will also incorporate nontechnical adaptations, such as tapping into a diaspora network to import unlocked SIM cards, connecting with sympathetic telecoms officials to circumvent connectivity restrictions, or even using human messengers to smuggle out footage. Finally, enhanced transparency and documentation about shutdowns can also be useful. Telecoms and internet platforms, for example, can institutionalize disclosure and reporting on shutdowns, placing a greater burden on states to justify specific network disruptions. 076b4e4f54