Monday, January 12, 2009

[EQ] Historical Warnings of Future Food Insecurity with Unprecedented Seasonal Heat

Historical Warnings of Future Food Insecurity with Unprecedented Seasonal Heat

 

David. S. Battisti1 and Rosamond L. Naylor2

1 Department of Atmospheric Sciences, University of Washington, USA.

2 Program on Food Security and the Environment, Stanford University, USA

 

Science 9 January 2009:
Vol. 323. no. 5911, pp. 240 – 244 DOI: 10.1126/science.1164363

 

Available online at: http://www.sciencemag.org/cgi/content/full/323/5911/240

“….Higher growing season temperatures can have dramatic impacts on agricultural productivity, farm incomes, and food security. We used observational data and output from 23 global climate models to show a high probability (>90%) that growing season temperatures in the tropics and subtropics by the end of the 21st century will exceed the most extreme seasonal temperatures recorded from 1900 to 2006. In temperate regions, the hottest seasons on record will represent the future norm in many locations. We used historical examples to illustrate the magnitude of damage to food systems caused by extreme seasonal heat and show that these short-run events could become long-term trends without sufficient investments in adaptation……..”.

CLIMATE CHANGE: Higher Temperatures Seen Reducing Global Harvests  

Constance Holden
Science 9 January 2009: 193.
Summary: In a paper appearing on page 240 of this week's issue of Science, researchers apply 23 global climate models used by the Intergovernmental Panel on Climate Change to estimate end-of-century temperatures. Their conclusions with regard to agriculture are sobering.

 

Supporting Online Material

www.sciencemag.org/cgi/content/full/323/5911/240/DC1

 

*      *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

------------------------------------------------------------------------------------
PAHO/WHO website: http://66.101.212.219/equity/
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.  

[EQ] Integrated Health Care for People with Chronic Conditions

Integrated Health Care for People with Chronic Conditions

Oxman AD, Bjørndal A, Flottorp S, Lewin S. Lindahl AK.

Oslo: Norwegian Knowledge Centre for the Health Services, December 2008

 

The report, which is in English, can be downloaded by clicking on the PDF icon at the top of this page, under the title: http://www.kunnskapssenteret.no/Publikasjoner/5114.cms

 

Download: http://www.kunnskapssenteret.no/binary?download=true&id=7746

 

“………health services research. In the same way that clinical research is essential for informing how best to care for patients clinically, health services research is essential to inform decisions about how best to organise, finance and govern our healthcare system.

This policy brief is a good example of both the potential for health services research to inform healthcare policies and management, and an example of the limitations of health services research to inform decisions.

There is a lot of evidence about strategies that are effective or promising, including many of the elements of the Chronic Care Model. There is also lots of uncertainty about the effects of many strategies. Where there is evidence of effects they are mostly small or moderate effects, but important. Where there is lack of evidence, this means that more research is needed. We must, however, also remember that lack of evidence does not mean evidence for the lack of effects….”

“….As part of the development of the Integrated Health Care Reform, this report was prepared to inform deliberations among policymakers and stakeholders regarding how best to reform the Norwegian healthcare system to improve the coordination or integration of health care for people with chronic conditions.

Key messages:

·         Uncoordinated care can affect the quality and efficiency of health care, access to care, participation in and satisfaction with care, and health outcomes for chronically ill patients. However, there is a paucity of data in Norway that provide a basis for estimating the size of the problem or clarifying the underlying reasons for inadequate coordination.

·         The impact of many changes in delivery, financial and governance arrangements that could be made to improve the coordination of care for people with chronic conditions is uncertain; evaluation is critical when such changes are made.

·         Components of the Chronic Care Model and disease management programs, alone or in combination, can improve quality of care, clinical outcomes and health care resource use, but the effects are not consistent and a number of obstacles may hinder their use.

·         The impacts of delivery arrangements that have been shown to be effective (e.g. patient education and motivational counselling, provider education, feedback, reminders, and multidisciplinary team work) are generally modest, but important. There is uncertainty about the impacts of other arrangements (e.g. care pathways, case management, and shared care).

·         Targeted financial incentives with the aim of achieving specific changes in how care is delivered probably influence discrete individual behaviours in the short run, but are less likely to influence sustained changes, and they can have unintended effects, including motivating unintended behaviours, distortions, gaming, cream skimming or cherry-picking, and bureaucratisation. Therefore, they require careful design and monitoring.

·         Similarly, changes in the basic payment methods that are used for both clinicians and institutions in order to offset the inherent limitations of each require careful design and monitoring. A long-term perspective with continual adjustments is more likely to be successful, than dramatic one-off changes.

·         There is not evidence to support any one governance model as being better than others. However, specific structures are likely needed at different levels to improve coordination:

- Clinical governance (healthcare professionals' accountability for quality of care) for both primary and secondary care

- Boards at the local level that conduct detailed oversight and monitoring for both primary and secondary care

- A regional board that coordinates different local networks in the region

- A central governance structure that sets broad standards, which the regional and local boards are responsible to adhere to and implement

·         Consumer and stakeholder involvement in governance arrangements at all levels is a strategy for achieving better coordination of care and other health goals, as well as a goal in itself, but there is little evidence of how to best to achieve this.

·         Because there are multiple barriers to organisational and professional change, simple approaches to implementing change are unlikely to be effective, change is likely to occur incrementally and to require ongoing attention. 

·         There are many tools that may be useful for implementing organisational changes, including analytic models, tools for assessing why change is needed, such as SWOT analysis, and tools for making changes, such as organisational development and project management. However, there is almost no evidence of their effectiveness

 

Table of Contents

Key Messages

Executive Summary

Preface

Definitions and abbreviations

The policy issue

Delivery arrangements

Financial arrangements

Governance arrangements

Implementing change

Reform options

References

Appendice 

 

      *      *     *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

------------------------------------------------------------------------------------
PAHO/WHO website: http://66.101.212.219/equity/
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.  

[EQ] Evidence Informed Health Policy Series

Evidence Informed Health Policy

This series of articles provides support for the use of research evidence in developing health policies


Evidence-informed health policy 4 - Case descriptions of organizations that support the use of research evidence

John N Lavis, Ray Moynihan, Andrew D Oxman, Elizabeth J Paulsen
Implementation Science 2008, 3:56 (17 December 2008)

Available online PDF at: http://www.implementationscience.com/content/pdf/1748-5908-3-56.pdf
 

“….The findings from our case descriptions, the first of their kind, intersect in interesting ways with the messages arising from two systematic reviews of the factors that increase the prospects for research use in policymaking. Strong relationships between researchers and policymakers bodes well given such interactions appear to increase the prospects for research use. The time-consuming nature of an evidence-based approach, on the other hand, suggests the need for more efficient production processes that are ‘quick and clean enough.’ Our case descriptions and accompanying video documentaries provide a rich description of organizations supporting the use of research evidence, which can be drawn upon by those establishing or leading similar organizations, particularly in low- and middle-income countries…”

 

Evidence-informed health policy 3 - Interviews with the directors of organizations that support the use of research evidence

John N Lavis, Andrew D Oxman, Ray Moynihan, Elizabeth J Paulsen
Implementation Science 2008, 3:55 (17 December 2008)
Available online PDF at: http://www.implementationscience.com/content/pdf/1748-5908-3-55.pdf

 

“…..Only a small number of previous efforts to describe the experiences of organizations that produce  clinical practice guidelines (CPGs), undertake health technology assessments (HTAs), or directly  support the use of research evidence in developing health policy (i.e., government support units, or  GSUs) have relied on interviews and then only with HTA agencies. Interviews offer the potential for capturing experiences in great depth, particularly the experiences of organizations that may be underrepresented in surveys…”

 


Evidence-informed health policy 2 - Survey of organizations that support the use of research evidence

John N Lavis, Elizabeth J Paulsen, Andrew D Oxman, Ray Moynihan
Implementation Science 2008, 3:54 (17 December 2008)
Available online PDF at: http://www.implementationscience.com/content/pdf/1748-5908-3-54.pdf

 

“….The findings from our survey, the most broadly based of its kind, both extend or clarify the applicability of the messages arising from previous surveys and related documentary analyses, such as how the ‘principles of evidence-based medicine dominate current  guideline programs’ and the importance of collaborating with other organizations. The survey also provides a description of the history, structure, processes, outputs, and perceived strengths and weaknesses of existing organizations from which those establishing or leading similar organizations can draw….”

 


Evidence-informed health policy 1 - Synthesis of findings from a multi-method study of organizations that support the use of research evidence

John N Lavis, Andrew D Oxman, Ray Moynihan, Elizabeth J Paulsen
Implementation Science 2008, 3:53 (17 December 2008)

Available online PDF at: http://www.implementationscience.com/content/pdf/1748-5908-3-53.pdf  

 

“…..This synthesis of findings from a multi-method study, along with the more detailed findings from each of the three phases of the study (which are reported in the three following articles in the series), provide a strong basis on which researchers, policymakers, international organizations (and networks) like WHO can respond to the growing chorus of voices calling for efforts to support the use of research evidence in developing health policy….”

 

*      *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

------------------------------------------------------------------------------------
PAHO/WHO website: http://66.101.212.219/equity/
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.