Thursday, May 26, 2011

Improving Investments, Policies, and Productivity Is Critical to Combating Hunger and Malnutrition | International Food Policy Research Institute (IFPRI)
Global demand for major grains, such as maize, rice, and wheat, is projected to increase by nearly 48 percent from 2000-2025 and by 70 percent between 2000 and 2050, according to research presented by Mark Rosegrant, who delivered the Ag Economic Forum Keynote during the 2011 Ag Innovation Showcase held in St. Louis from May 23-24. Rosegrant is director of Environment and Production Technology at the International Food Policy Research Institute (IFPRI). Per capita meat consumption will also increase in many developing regions of the world and it will more than double in Sub-Saharan Africa from 2000-2050, leading to a doubling of total meat consumption by 2050, the research shows. At the same time, the growth in production of staple foods is expected to decline significantly in most of the world if business continues as usual.

“Climate change, high and volatile food and energy prices, population and income growth, changing diets, and increased urbanization will put intense pressure on land and water and challenge global food security as never before,” said Rosegrant. “If agricultural production and policymaking continues down its present course, there could be severe consequences for many poor people in developing countries.”

Using state-of-the-art economic modeling based on alternative future scenarios for agricultural supply and demand that take into account the potential harmful impact of climate change, IFPRI projects crop yields, food prices, and child malnutrition through 2050 and beyond. Even without climate change, the prices of rice, maize, and wheat are projected to increase by 25 percent, 48 percent, and 75 percent, respectively, by 2050, in a business-as-usual scenario. Climate change will further slow productivity growth, increasing staple food prices and reducing progress on food security and childhood malnutrition.

“Although the threats to food and nutrition security are very real, these outcomes are by no means inevitable,” said Rosegrant. “The myriad challenges underscore the importance of agricultural research, better policies, new technologies, and social investments to feeding the world’s burgeoning population while protecting critical natural resources.”

According to IFPRI’s sophisticated computer model, developed by Rosegrant, with US$7 billion of additional annual investments in research to improve crop and livestock productivity, nearly 25 million less children in developing countries would be malnourished in 2050 compared to a business-as-usual scenario. If projected business-as-usual investments in agricultural research are increased along with greater spending on irrigation, rural roads, safe drinking water, and girls’ education, for a total additional increase of US$22 billion per year, the number of malnourished children in the developing world—currently projected to be 103 million in 2050—would drop substantially to 45 million.

“Spending in these areas would particularly help farmers to boost their yields, improve their market access, increase their incomes, and improve the health and wellbeing of their families,” added Rosegrant. “Greater crop productivity also means that more of the growing demand for food could be satisfied from existing land, limiting environmental damage and ensuring that progress in the fight against hunger and poverty is sustainable.”

The International Food Policy Research Institute (IFPRI) seeks sustainable solutions for ending hunger and poverty. IFPRI is one of 15 centers supported by the Consultative Group on International Agricultural Research, an alliance of 64 governments, private foundations, and international and regional organizations.
Press Release Dated May 23, 2011

Wednesday, May 25, 2011

Making—or Picking—Winners: Evidence of Internal and External Price Effects in Historic Preservation Policies
Abstract: This article measures the impacts of historic preservation regulations on property values inside and outside of officially designated historic districts. The analysis relies on a model of historic designation to control for the tendency to designate higher-quality properties. An instrumental variables model using rich data on historic significance corrects for this bias. The results for Chicago during the 1990s indicate that price impacts from designation inside a landmark district vary considerably across homes inside the districts. Controlling for extant historic quality, which the market values positively, restrictions apparently have negative price effects on average both within and outside districts.
An April 2009 working paper available at noted that:

OLS results suggest large price premiums (approximately 25%) for homes in preserved districts. (The premium rises to 60% in a totally unconditional model where only DISTRICT is included and all other hedonic attributes are omitted.)
TSLS estimation indicated that the effect of being included in a historic district on sales price is negative 19% (with a 95% confidence interval ranging from -29% to -7%). The large district effect likely reflects several forces. On the one hand, inclusion in a historic district restricts redevelopment options of owners (and buyers), which should lower the value of the property. On the other hand, district designation may offer many benefits, like tax benefits and possibly a kind of certification of (or signal for) the property’s cachet. For attached housing in Chicago, at least, the tax benefits are outweighed by the restrictions on renovation. The cachet effects also appear minimal given the model with excellent controls for historical quality. Buildings with names in the CHRS sell for a 6% premium on top of a 5-8% premium for being in the CHRS. Furthermore, the stability that district designation brings to the neighborhood’s overall character (in terms of the types of land uses and buildings’ external appearance) may be seen as disamenities by buyers in districts. Homes in districts may relatively lack access to modern urban conveniences like shopping, parking, and other mixed uses.
Every 10% of the block group occupied by a district predicts a 2% increase in sale price for all homes in that block group.
The effects of designation on nearby properties are shown to be statistically significant and substantively important.... negative spillovers can be economically important; condo and townhome prices positively
correlate with landmark density.  As a very crude estimate, ... assuming that the sample of sales is representative of Chicago’s housing, removing all landmark buildings would lower home values by $263 on average (winners gain $14,320 on average while losers lose $4,899 on average and greatly outnumber the winners).  Similarly, removing all districts would lower home values by $45 on average (winners gain $59,203 average while losers lose $10,804 on average and again greatly outnumber the winners). Seen in this redistributive light, the historic preservation policy appears to concentrate the harms of designation while spreading the gains widely. The combined effect of landmark buildings and districts shown here has a small net positive effect ($309 is roughly 0.2% of mean home value). This net effect masks how roughly 7% of the units would gain by the absence of landmarks by 13% of their property value, but they are outnumbered by 4:1 by those whose home values would suffer without the landmarks by 4%. Large values are at stake for the 35% of the units that are either winners or losers in Chicago.

The study also reports coefficients for parking, parking spot, waterfront, distance to the Central Business District, distance to Lake Michigan, distance to water, distance to Chicago Transit Authority (CTA) station and distance to a park.

by Douglas S. Noonan 1 and Douglas J. Krupka 2
1. School of Public Policy, Georgia Institute of Technology, Atlanta, GA 30332 or
2. Institute for Research on Labor, Employment and the Economy (IRLEE) and Ford School of Public Policy, University of Michigan, Ann Arbor, MI 48109-1220 and IZA (Institute for the Study of Labor), Bonn, Germany, D-53072. Doug Krupka passed away on June 23, 2010. He will be missed.
Real Estate Economics via Wiley Online Library Volume 39, Issue 2; Summer 2011, article first published online March 1, 2011; Pages 379–407,
American Real Estate and Urban Economics Association
DOI: 10.1111/j.1540-6229.2010.00293.x

Environment: Green and growth go together,3746,en_21571361_44315115_48034436_1_1_1_1,00.html
Governments must look to the green economy to find new sources of growth and jobs. They should put in place policies that tap into the innovation, investment and entrepreneurship driving the shift towards a greener economy.

Green growth makes economic as well as environmental sense. In natural resource sectors alone, commercial opportunities related to investments in environmental sustainability could run into trillions of dollars by 2050.

The OECD Green Growth Strategy, and the new report, Towards Green Growth, provide a practical framework for governments to boost economic growth and protect the environment.
Two broad sets of policies are essential elements in any green growth strategy: the first set mutually reinforces economic growth and the conservation of natural capital, including core fiscal and regulatory settings and innovation policies. The second includes policies that provide incentives to use natural resources efficiently and make pollution more expensive.

Replacing natural capital with physical capital is expensive and the infrastructure needed to clean polluted water can be costly, but the cost of inaction can be higher still. Greening growth now, the report argues, is necessary to prevent further erosion of natural capital, including increased scarcity of water and other resources, more pollution, climate change, and biodiversity loss, all of which can undermine future growth.

In addition to the Synthesis Report, the document Tools for Delivering on Green Growth outlines options available to policy makers for developing green growth strategies. The report Towards Green Growth – Monitoring Progress: OECD Indicators outlines ways to measure progress.

The OECD will continue to support national and global efforts to promote green growth in the run-up to the Rio+20 Conference. Going forward, OECD will integrate green growth into national reviews and in future work on indicators, toolkits, sectoral studies and development co-operation.

Further information on the Green Growth Strategy and related work is available at

Key facts from the report:
  • USD 112 trillion, value of fuel saving between 2020 and 2050 from investment in low-carbon energy systems
  • EUR 153 billion, the economic value in 2005 of insect pollinators (mainly bees) for the main crops that feed  the world
  • USD 2.1 to 6.3 trillion, potential commercial opportunities by 2050 related to environmental sustainability in natural resource sectors alone
  • 1991, the year Sweden introduced a carbon tax.
  • The economy has continued to grow, expanding by 50% since then.
  • 1.7 million, the number of avoidable deaths in the world each year from water pollution, primarily among children under 5 years old
  • 6.4 million, number of avoidable deaths from air pollution
  • Between 1999 and 2008, patented inventions increased annually by: 24%, for renewable energy, 20%, for electric and hybrid vehicles, 11%, for energy efficiency in building and lighting 
  • 25%, share of green technologies in all venture capital investments in the United States in the first half of 2010
  • 26%, share of government energy R&D budgets devoted to energy efficiency and renewable energy, up from 13% in 1990
  • GERMANY: green pioneer. The National Strategy for Sustainable Development (2002) defined targets for 21 different sectors. In 2010 nearly 17% of electricity supply was generated from renewable sources, surpassing the target value of 12.5%.
  • CHINA: renewable energy. China aims to produce 16% of its primary energy from renewable sources by 2020.
  • Ageing water infrastructure is increasingly a problem in developed countries. Some estimates suggest that the United States will have to invest USD 23 billion annually for the next 20 years to maintain water infrastructure at current service levels, while meeting health and environmental standards.
  • The United Kingdom and Japan will need to increase their water spending by 20 to 40% to cope with urgent rehabilitation and upgrading of their water infrastructure.
  • According to the the WHO, in developing countries, USD 18 billion will be needed annually to extend existing infrastructure to achieve the water-related MDGs, roughly doubling current spending. An additional USD 54 billion per year will be needed  just to ensure continued services to the currently served population.
  • Investment in water infrastructure can reduce the strain on government health budgets by reducing external costs from adverse health impacts resulting from poor water and sanitation services. Benefit- to-cost ratios have been reported to be as high as 7 to 1 for basic water and sanitation services in developing countries.
  • 0.012%, the current share of green bonds in the USD 91 trillion global bond market
  • under reasonable assumptions about the adjustment patterns in the labour market, OECD employment would increase by 7.5% over the period 2013-2030, against 6.5% in absence of mitigation actions, and this without any loss of purchasing power for workers.
  • 10% reduction, in global GHG emissions by 2050 from removing fossil fuel subsidies 
  • 2%-4%, the potential real income gains from removing fossil fuel subsidies
The report urged more innovation to favor investments in clean energies such as wind or solar power and a drive to place more value on everything from public health to clean water.

"There is scope for scaled up issuances of green bonds (in the hundreds of billions per year)," the report said. The 34-nation group said the market size of all green bond issuances to date was about $11 billion, "a drop in the ocean" amounting to about 0.012 percent of the capital held in global bond markets estimated at $91 trillion.  But a condition for a more liquid market for green bonds was "transparent policies based on long-term, comprehensive and ambitious political commitments," it said.

The costs of fighting climate change could be halved on average if the world placed a monetary value on longer lifespans caused by a move from high-polluting fossil fuels.

The United States would benefit most, according to the estimates. Gains in life expectancy through reduced air and water pollution "would overcome the monetary cost of climate change mitigation by a significant amount," it said.
The OECD pointed to estimates that it would cost $46 trillion to adapt to and combat climate change in the four decades to 2050 -- about $1 trillion a year.

Organization for Economic Cooperation and Development (OECD)
Press Release dated May 25, 2011
see also

Tuesday, May 24, 2011

Measuring Energy Security: Trends in the Diversification of Oil and Natural Gas Supplies
Summary: We present evidence on one facet of energy security in OECD economies - the extent of diversification in sources of oil and natural gas supplies. Viewed from the perspective of the energy-importing countries as a whole, there has not been much change in diversification in oil supplies over the last decade, but diversification in sources of natural gas supplies has increased steadily. We document the cross-country heterogeneity in the extent of diversification. We also show how the extent of diversification changes if account is taken of the political risk attached to suppliers; the size of the importing country; and transportation risk.

This paper has presented evidence on the measurement and attainment of energy security in OECD  economies, with a focus on two major energy sources—oil and natural gas.  Following the literature, we take diversification in sources of supply to be an important aspect of this security. Our main results are as follows:

  • Viewed from the perspective of the energy-importing countries as a whole, diversification in oil supplies has remained constant over the last decade while diversification in natural gas supplies has steadily increased. Given the increasing importance of natural gas in world energy use, this points to an increase in overall energy security.
  • While there is great heterogeneity at the individual country level, diversification in sources of oil supplies has not increased for most countries since 1990, in contrast to the increase in diversification of natural gas supplies.
  • \An adjustment for the political risk associated with each supplier shows that countries‘ diversification has indeed increased over time, consistent with the popular perception. The large impact of this adjustment points to the importance of using alternate measures of risk; it would also be important to look at whether an energy exporter‘s political risk rating is informative about the risk that it will be the source of an energy supply disruption.
  • An adjustment for the country size of the importing coutnry (following Blyth and Lefevre) lowered measured energy security for the United States but did not impact other countries very much. An adjustment for the distance between energy-consuming and energy-producing countries, intended as a proxy for transportation risk, lowered energy security for countries in the Asia and Pacific regions.
  • An overall diversification index for oil and natural gas combined, using consumption shares of the two fuels as weights, has low values for the U.S. and the U.K, suggesting greater energy security compared with other countries such as Japan.  Within continental Europe there is much heterogeneity, with larger countries such as France and Germany having lower values of the index than smaller countries such as Finland and the Slovak Republic.
In future work, we plan to refine the diversification indices in numerous ways. These include taking into account energy sources other than oil and natural gas; accounting for interfuel substitution; accounting for each supplier‘s reserves rather than just the supplier‘s current production; and including vulnerability measures for infrastructure like import facilities, pipelines, and transmission lines, and refinery capability for petroleum products.

The full report is available free of charge at

By Gail Cohen, Frederick L Joutz, Frederick and Prakash Loungani
International Monetary Fund
Working Paper Number 11/39; Published February 01, 2011; 40 Pages

EPA Announces U.S. Cities with the Most Energy Star Certified Buildings / Third annual list shows dramatic growth, savings of energy efficient buildings
The U.S. Environmental Protection Agency (EPA) released a list of U.S. metropolitan areas with the greatest number of energy-efficient buildings that earned EPA’s Energy Star certification in 2010. The list of 25 cities is headed by Los Angeles; Washington, D.C.; San Francisco; Chicago; New York; Atlanta; Houston; Sacramento; Detroit; and Dallas-Fort Worth. The growth in Energy Star certified buildings across the country has prevented greenhouse gas emissions equal to the emissions from the energy use of nearly 1.3 million homes a year, protecting people’s health, while saving more than $1.9 billion.

'When it's more important than ever to cut energy costs and reduce pollution in our communities, organizations across America are making their buildings more efficient, raising the bar in energy efficiency and lowering the amount of carbon pollution and other emissions in the air we breathe,' said EPA Administrator Lisa P. Jackson. 'Through their partnership with Energy Star, metropolitan areas across the U.S. are saving a combined $1.9 billion in energy costs every year while developing new ways to shrink energy bills and keep our air clean.'

EPA debuted its list of cities with the most Energy Star certified buildings in 2008. Los Angeles remains in first place for the third year; the District of Columbia and San Francisco hold second and third respectively for the second year; and Detroit and Sacramento are new to the top ten. New York City climbed five spots to claim fifth in the rankings and California boasts more cities on EPA’s list than any other state in the country with a total of five.

Surpassing the growth of the past several years, in 2010 more than 6,200 commercial buildings earned the Energy Star, an increase of nearly 60 percent compared to 2009. Since EPA awarded the first Energy Star to a building in 1999, more than 12,600 buildings across America have earned the Energy Star as of the end of 2010.

Energy use in commercial buildings accounts for nearly 20 percent of U.S. greenhouse gas emissions at a cost of more than $100 billion per year. Commercial buildings that earn the Energy Star must perform in the top 25 percent of buildings nationwide compared to similar buildings and be independently verified by a licensed professional engineer or registered architect each year. Energy Star certified buildings use 35 percent less energy and emit 35 percent less carbon dioxide than average buildings. Fourteen types of commercial buildings can earn the Energy Star, including office buildings, K-12 schools, and retail stores.

More information on the top cities in 2010 with Energy Star certified buildings: information on EPA’s real-time registry of all Energy Star certified buildings: information about earning the Energy Star for commercial buildings:


U.S. Environmental Protection Agency (EPA)
Press Release dated March 14, 2001

Monday, May 23, 2011

'Big Meat' and Big Government - Subsidies and regs are the culprits: PERC - The Property and Environment Research Center

Ranchers are a fairly independent bunch. We don’t like overweening authority and prefer to fend for ourselves. We also find few things more objectionable than sitting endlessly indoors. Nevertheless, 2,000 of us did just that a few months ago in the ballroom of Colorado State University. If the setting wasn’t exactly invigorating, the topic was even less so: understanding why the family-scale cattle industry is going broke and why either Big Meat or Big Government is helping it down the drain.

We had dragged ourselves from all over the country to provide testimony to Attorney General Eric Holder and USDA Secretary Tom Vilsack about “Competition Issues Facing Farmers in Today’s Agricultural Marketplaces.”...

The sad facts are indisputable, but how we solve for them is not. It is true that well over 80 percent of the meatpacking industry is now in the hands of four conglomerates. Family cattle operations are disappearing at the rate of one thousand per month and over 40 percent of them have evaporated since 1980. The percentage of the food dollar received by ranchers has dropped over 25 percent since 1970. In my hometown in 1969, a rancher could buy a new pickup with a trailer-load of 15 steers; it now takes a semi-load (44). (Calculated in coordination and with data from the University of Arizona’s agricultural economics department.) ...

But what of it? Do these daunting numbers indicate illegal activity in the meat sector? If a federal probe were to unearth hard evidence that Cargill, Tyson, National, or JBS was engaged in fraud, I would be the first to clamor for a swift legal response. ... Barring such evidence, however, it is my view that the consolidation of the meat industry is really due to a couple of problems unrelated to corporate meat processors. In fact, Big Meat is simply the byproduct of two seemingly “good” government programs: agricultural subsidies and stringent processing regulations.


According to the Cato Institute, upwards of $30 billion taxpayer dollars a year are funneled into cash subsides to farmers and owners of farmland each year. Seventy-two percent of it goes to the ten largest subsidized farms, effectively (but not surprisingly) countering the original New Deal intention of supporting small family farmers.

The extensive federal welfare system for farm businesses is costly to taxpayers and it creates distortions in the economy. Subsidies induce farmers to overproduce, which pushes down prices and creates political demands for further subsidies. Subsidies inflate land prices in rural America. And the flow of subsidies from Washington hinders farmers from innovating, cutting costs, diversifying their land use, and taking the actions needed to prosper in a competitive global economy.

In the meat industry, in case you think we’re exempt, artificially subsidized feeder grain has significantly altered the cow-calf industry. Cheap feed grain encourages concentrated feedlot systems, and these systems naturally tend to conglomerate as the efficiencies scale up beyond imagination (500,000 head of cattle in one feed yard is not unheard of today). It’s difficult to quantify the price effects of subsidized corn on calf prices (economists at the University of Arizona place it at a percentile or a bit more), but it’s safe to assume that the tremendous efficiency and scale of feedlots (the only ones doing any significant buying) lead to lower calf prices at the sale yard. By way of comparison, a locally processed, directly marketed steer can net around $1,500 to the producer who raised it. In the commodity sector, where the rest of the cattle are marketed, the USDA estimates the average per-head return at $15 below production cost! Subsidies contribute in large part to the market manipulations that allow such an incredible discrepancy to exist.

But are there any alternatives to agricultural subsidies? Won’t their removal be a catastrophic blow to an already ailing industry? How can we toy around with food production, arguably the most precious sector of our economy? Luckily, an experiment has already been run for us, and the results are encouraging. Farm subsidies ended in New Zealand in 1984. The effects on New Zealand agriculture have been overwhelmingly positive. According to the Rodale Institute:

New Zealand agriculture is profitable without subsidies, and that means more people staying in the business. Alone among developed countries of the world, New Zealand has virtually the same percentage of its population employed in agriculture today as it did 30 years ago, and the same number of people living in rural areas as it did in 1920.

New Zealand’s farmers and ranchers are significantly better off today than in the heyday of government “assistance.” We should take note.


Overregulation of food processing has done more to hurt ranching families than they even know. The reason for this is that heavy regulation makes it extremely difficult to enter the slaughter and processing sector since the risks are high and the regulatory hurdles immense. It’s easier to build a centralized feedlot/packing house if you are a Cargill with huge capital reserves and an army of technicians than it is to build a USDA certified mom-and-pop packing facility. The reason is simple: reams of paperwork, tests, constantly updated procedures, and risk create an almost insurmountable barrier to entry. The decline in numbers of packinghouses is even more precipitous than the decline in family farms. According to USDA numbers, the number of cattle slaughter plants declined by over a third from 270 in 1996 to 170 in 2006.

The inability to process animals locally has guaranteed that cow-calf producers are locked in to the local auction yards and the attendant cattle-buyers. Alternative marketing opportunities such as direct-marketing finished product are hugely more difficult if the processing facilities don’t exist.

As both a cow-calf producer and owner of a tiny packinghouse myself, I can attest to the forbidding array of regulatory restrictions that hamper creativity and production. For instance, we thought that grassfed hotdogs would be a popular item to sell. It turns out that USDA facilities capable of making them will not accept our state-inspected meat (even though they would be happy to accept non-USDA inspected meat from abroad). Or take jerky: while all-natural grassfed jerky would probably be an excellent and desirable product, inspectors have dismissed the notion out of hand (“Have you seen the regs on Listeria alone? It’s three inches thick!” said one). Managing a packinghouse according to stringent regulation is a crushing burden for anyone, particularly if you are not terribly well connected or financially backed. Government’s genuine concern over safe food has created a megalithic bureaucracy that aims to eliminate all food-borne risk, even if it comes at the cost of local, small-scale food production.
By Paul Schwennesen
PERC - The Property and Environment Research Center The Freeman
February 14, 2011

Better Hand-Washing Through Technology -
Tina Rosenberg writes in The New York Times

Why can’t hospitals get health care workers to wash their hands?

... Virtually all of them have alcohol-rub dispensers, hundreds of them, in the hallways. Using one takes a few seconds. Yet health care workers fail to wash hands a good percentage of the times they should. Doctors are particularly bad.

A health care worker’s hands are the main route infections take to move from one patient to another. One recent study of several intensive care units — where the patients most vulnerable to infection reside — showed that hands were washed on only one quarter of the necessary occasions.

It’s not that hospitals are ignoring the problem — indeed, they are implementing all kinds of strategies to promote hand-washing. Nevertheless, it is rare to find a hospital that has been able to keep the hand-washing rate above 50 percent.
There is a new technological fix available that — when accompanied by other changes — may be key to reducing dangerous infections.

... 2 million patients in America acquire an infection in the hospital every year — about one in 20 patients — and 100,000 people die of them. This is the fourth leading cause of death in America.... Hand-washing rates in other wealthy countries are not much different.

Hospital-acquired infections cost the American health care system between $30 and $40 billion annually. Simple division puts the rough average cost of treating of a hospital-acquired infection at $15,000 to $20,000. One study that gathered data from other studies found the average cost of treating an infection with MRSA, a staph bacteria resistant to many antibiotics, is $47,000.

There are several reasons, however, that hospital hand-washing rates may be about to improve. One reason is that hospitals have a strong financial incentive to reduce infections. In 2008, hospitals were told that Medicare would no longer reimburse them for the cost of treating preventable hospital-acquired conditions it calls “never events,” which includes many kinds of hospital-acquired infections. The new health care reform bill instructs states to do the same with Medicaid. Many insurance companies also now refuse to pay for never events. This tends to concentrate the minds of hospital executives.

Another powerful incentive to prevent infection is the rise of superbugs, like MRSA, that are increasingly resistant to our arsenal of antibiotics. Infections are getting more and more deadly....

Patients are also more knowledgeable about hospital infections and more empowered. Hospitals are increasingly required to report their incidence of hospital-acquired infections, and those results will be posted online. ...
It will be very difficult to improve compliance unless hospitals can tell who is and isn’t cleaning hands, and in what circumstances. Individual doctors and nurses need to know their own hand-washing rates.
Until now, hospitals have had two ways to measure hand-washing. One is by monitoring how often each soap or alcohol gel dispenser needs to be refilled. By tracking how much product a unit uses, you can get a rough idea of how much hand-washing is going on. The limits here are obvious: there is no way to tell who is washing hands and when.

The method currently considered the gold standard is using human observers: nurses or other health care workers who roam halls and patient rooms with a clipboard, recording who does and doesn’t wash hands. Sometimes they’re like secret shoppers and sometimes they’re announced.

This system, too, is woeful. Spending health care workers’ time in observing is expensive. And they can monitor only a small sample of health care workers. A recent study at the University of Iowa to test whether observers should stand still or move around found that moving more was better, but the real news was this: “All observation schedules capture at best 3.5% and at worst 1.2% of all daily opportunities” for handwashing.

When the monitors are announced, it’s bound to inflate compliance, in part because their presence reminds workers to wash hands. ...

In the last year or two, several new ways to promote hand-washing – all things that beep – have made their debut: HyGreen, BioVigil, Patient Care Technology System’s Amelior 360 and Proventix’s nGage are some of them, but there are others. Some are spinoffs of systems widely used to track hospital equipment (this is how hospitals can find a wheelchair when it is needed). All employ new technology that can detect alcohol — which in hospitals is a component not only of rubbing gel but also soap.

They work like this: every health care worker wears an electronic badge. When she washes her hands or uses alcohol rub, a sensor at the sink or dispenser or her own badge smells the alcohol and registers that she has washed her hands. Another sensor near the patient detects when her badge enters a room or the perimeter around a patient that the hospital sets. If that badge shows that her hands were recently washed, it displays a green light or something else the patient can see. If she hasn’t washed, her hands, the badge says so and emits a signal to remind her to do so. The sensor also sends this information to a central data base. Information about the hand-washing practices of a particular unit, shift or individual is instantly available.

Do they work? It is early yet — these systems are largely in the pilot phase or in use in only a handful of hospitals. But several different studies have shown that they greatly improve hand-washing compliance. There is some evidence that the systems are associated with a drop in infections. Proventix claims its nGage system saw a 22 percent drop in infection in the units where it was used in a seven-month trial, while elsewhere in the hospital the drop during that time was only 4 percent.

Miami Children’s Hospital said that during the time it used the HyGreen system in its oncology unit, the unit had a whopping 89 percent drop in infections. Deise Granado-Villar, chief medical officer, said that the gains have been maintained eight months later. ...

The drawback to these systems is that they are much more expensive than other measures hospitals have tried. ... These systems are brand new and their price is likely to drop substantially, but right now they are expensive — Amelior, for example, costs $1,500 to $2,000 per hospital bed to install. Most offer hospitals the option to buy a system or lease it.

Hospital-acquired infections are so expensive, however, that a system that proves effective will pay for itself in the first year. “It paid for itself with the avoidance of one infection,” Granado-Villar said of the HyGreen system. “It cost $50,000 to implement, which can be the cost of one infection today.” An article in the journal Infection Control and Hospital Epidemiology found that if a hospital improved hand-washing rates by 5 percent, it would save $1,000 per bed each year in averted MRSA infections alone – and MRSA infections make up only 8 percent of all hospital-acquired infections.
by Tina Rosenberg
The New York Times
April 25, 2011

Relapse prevention in UK Stop Smoking Services: current practice, systematic reviews of effectiveness and cost-effectiveness analysis
Background: Reducing smoking is a chief priority for governments and health systems like the UK National Health Service (NHS). The UK has implemented a comprehensive tobacco control strategy involving a combination of population tobacco control interventions combined with treatment for dependent smokers through a national network of NHS Stop Smoking Services (NHS SSS).

Objectives: To assess the effectiveness and cost-effectiveness of relapse prevention in NHS SSS. To (1) update current estimates of effectiveness on interventions for preventing relapse to smoking; (2) examine studies that provide findings that are generalisable to NHS SSS, and which test interventions that might be acceptable to introduce within the NHS; and (3) determine the cost-effectiveness of those relapse preventions interventions (RPIs) that could potentially be delivered by the NHS SSS.

Data Sources: A systematic review of the literature and economic evaluation were carried out. In addition to searching the Cochrane Tobacco Addiction Group register of trials (2004 to July 2008), MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, the Science Citation Index and Social Science Citation Index were also searched. REVIEW METHODS: The project was divided into four distinct phases with different methodologies: qualitative research with a convenience sample of NHS SSS managers; a systematic review investigation the efficacy of RPIs; a cost-effectiveness analysis; and a further systematic review to derive the relapse curves for smokers receiving evidence-based treatment of the type delivered by the NHS SSS.

Results: Qualitative research with 16 NHS SSS managers indicated that there was no shared understanding of what relapse prevention meant or of the kinds of interventions that should be used for this. The systematic review included 36 studies that randomised and delivered interventions to abstainers. 'Self-help' behavioural interventions delivered to abstainers who had achieved abstinence unaided were effective for preventing relapse to smoking at long-term follow-up [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.15 to 2.01]. The following pharmacotherapies were also effective as RPIs after their successful use as cessation treatments: bupropion at long-term follow-up (pooled OR 1.49, 95% CI 1.10 to 2.01); nicotine replacement therapy (NRT) at medium- (pooled OR 1.56, 95% CI 1.16 to 2.11) and long-term follow-ups (pooled OR 1.33, 95% CI 1.08 to 1.63) and one trial of varenicline also indicated effectiveness. The health economic analysis found that RPIs are highly cost-effective. Compared with 'no intervention'; using bupropion resulted in an incremental quality-adjusted life-year (QALY) increase of 0.07, with a concurrent NHS cost saving of 68 pounds; for NRT, spending 12 pounds resulted in a 0.04 incremental QALY increase; varenicline resulted in a similar QALY increase as NRT, but at almost seven times the cost. Extensive sensitivity analyses demonstrated that cost-effectiveness ratios were more sensitive to variations in effectiveness than cost and that for bupropion and NRT, cost-effectiveness generally remained. Varenicline also demonstrated cost-effectiveness at a 'willingness-to-pay' threshold of 20,000 pounds per QALY, but exceeded this when inputted values for potential effectiveness were at the lower end of the range explored. For all drugs, there was substantial relapse to smoking after treatment courses had finished. Quit attempts involving NRT appeared to have the highest early relapse rates, when trial participants would be expected to still be on treatment, but for those involving bupropion and varenicline little relapse was apparent during this time.

Limitations: The qualitative research sample was small.

Conclusions: Based on the totality of evidence, RPIs are expected to be effective and cost-effective if incorporated into routine treatment within the NHS SSS. While staff within the NHS SSS were largely favourably inclined towards providing RPIs, guidance would be needed to encourage the adoption of the most effective RPIs, as would incentives that focused on the importance of sustaining quit attempts beyond the currently monitored 4-week targets.

by T. Coleman, S. Agboola, J. Leonardi-Bee, M. Taylor, A. McEwen and A. McNeill
Health Technology Assessment
Volume 14, Number 49; 2010, Pages 1-152

Sunday, May 22, 2011

Study: Tough Vehicle Standards Result in Fewer Asthma Attacks, Heart Attacks, Premature Deaths and Avoid Billions in Costs
State Now Drafting Vehicle Rules That Will Significantly Impact Human Health

A new study from the American Lung Association in California pinpoints the benefits in lives and dollars saved by adopting tough vehicle emission and technology standards, which the California Air Resources Board is now drafting, working closely with the feds to set a stringent national standard.

According to the new report, The Road to Clean Air, California could avoid at least $7.2 billion per year in health and other societal costs and reduce all major air pollution-related health impacts – from asthma attacks, premature deaths and hospitalizations to lost work and school days – by 70% percent if the California fleet of vehicles is converted to the next generation of cleaner, more efficient vehicles by 2025. Greater benefits can be achieved by further accelerating introduction of zero and near-zero emission technologies, like battery electric, plug-in and fuel cell vehicles.

According to the new report, strong state 'Advanced Clean Car' standards beginning in 2017, including smog and particle pollution controls, greenhouse gas emission standards, and an aggressive zero emission vehicle requirement will annually avoid the following illnesses and deaths when fully implemented across the fleet:

400 – 420 premature deaths avoided
8,075 – 8,440 asthma attacks and lower respiratory symptoms avoided
181,000 – 190,000 acute and other respiratory symptoms avoided
390 – 405 heart attacks avoided
420 – 440 respiratory ER visits and cardio/respiratory hospitalizations avoided
28,100 – 29,300 lost work days avoided
8,800 – 9,500 missed school days avoided
$7.2 – $8.1 billion in healthcare, environmental damage and societal damages avoided

'Ninety percent of Californians live in areas with unhealthy air according to the American Lung Association State of the Air report,' said Jane Warner, President and CEO of the American Lung Association in California. 'Pollution from passenger cars and trucks is largely responsible for our dirty air and its huge health toll. Our new study reveals the benefits in lives and dollars saved by adopting tough vehicle emission and technology standards.'

The state currently is drafting the Advanced Clean Car standards, which update and link several existing programs aimed at reducing pollution from vehicles, including the Low-Emission Vehicle program, the Zero-Emission Vehicle program and the greenhouse gas emission reduction program (often called Pavley standards), and plans to release a draft this Fall. All three standards are critical to reduce the level of criteria pollutants and greenhouse gas emissions that new passenger vehicles sold in California will generate through model year 2025.

'There are few needs as urgent as making sure that the air we breathe in California isn't making us sick and contributing to escalating health care costs,' says David T. Cooke, M.D., member of the Lung Association Board and Assistant Professor of Thoracic Surgery at the UC Davis Medical Center in Sacramento. 'California has an opportunity to dramatically reduce the human toll of cars by adopting strong Clean Car standards and accelerating the introduction of zero emission vehicles in the next round of rulemaking.'

The Road to Clean Air finds that under current standards (which apply to passenger vehicles through model year 2016), vehicles on the road in 2025 will generate over 270 tons per day of smog forming pollutants and cause $14.5 billion per year in health and societal costs, including $5 billion per year in public health costs and thousands of cases of illness. Converting the fleet to cleaner, more efficient vehicles would avoid as much as 190 tons per day, or over 70 percent, of these smog forming emissions. Considering that California still has a long way to go in achieving smog levels low enough to meet federal clean air standards, adopting the strongest possible clean car regulations is critical.

On an individual basis, the American Lung Association in California report finds that an average car under current standards will cause more than $4,700 in health, environmental and societal damage over its lifetime – the equivalent to $1.19 in damage per gallon of gasoline, or about $20 per fill-up.

In order to reduce vehicle impacts on human health, the American Lung Association in California finds that the California Air Resources Board must adopt strong Advanced Clean Car Standards for the passenger vehicle fleet for 2017-2025 that will include the following requirements for new cars:

Achieve a 75 percent reduction in smog-forming emissions and place stringent controls on particle pollution from vehicles
Achieve, at minimum, an overall 45 percent (6 percent per year) reduction in greenhouse gas emissions from vehicles
Achieve a new car fleet mix that includes at least 20 percent zero emission vehicles

'Vehicles meeting California's current clean car standards greatly reduce pollutant emissions in California and nationally, but more can be done to clean up our fleet. This report shows that California, by requiring a new generation of clean, efficient vehicles beginning in 2017, can significantly improve the health of children, seniors, and people who live in polluted communities,' says Robert Sawyer, Ph.D., member of the Lung Association Board and past Chairman of the California Air Resources Board.

The state is expected to adopt its new standards in November 2011. To view the full report, go to

Data and Methodology:
The American Lung Association in California commissioned a study to compare the emissions, public health and greenhouse gas benefits that will result from current vehicle emission standards (LEV II for smog-forming emissions and Pavley I for greenhouse gas emissions) to the benefits that can be achieved from the next generation of vehicle standards (LEV III, Pavley II), including strong zero emission vehicle (ZEV) requirements being considered this year. Vehicle emission reductions result from decreases in tailpipe, onboard and upstream emissions.

The American Lung Association in California contracted TIAX, LLC, a nonpartisan engineering consulting firm, to conduct a technical analysis comparing the benefits of moving from existing standards to possible future vehicle standards. This report incorporates the criteria standards into the fleet mixes, calculating the health benefits that result from the mix of tailpipe standards and alternative technologies. For each component of this study, TIAX relied on numerous state and federal regulatory documents, technical models and input from the Lung Association.

Press Release dated May 11, 2011 via PRNewsWire

75% of world's coral reefs under threat, new analysis finds - United Nations Environment Programme (UNEP) - 'Reefs at Risk Revisited' report presents

An analysis released February 23, 2011 finds that 75 percent of the world's coral reefs are currently threatened by local and global pressures. For the first time, the analysis includes threats from climate change, including warming seas and rising ocean acidification. The report shows that local pressures - such as overfishing, coastal development and pollution - pose the most immediate and direct risks, threatening more than 60 percent of coral reefs today.

'Reefs at Risk Revisited,' the most detailed assessment of threats to coral reefs ever undertaken, is being released by the World Resources Institute, along with the Nature Conservancy, the WorldFish Center, the International Coral Reef Action Network, Global Coral Reef Monitoring Network, and the UNEP-World Conservation Monitoring Center, along with a network of more than 25 organizations. Launches also took place in Australia, Caribbean, Indonesia, Malaysia, the United Kingdom, the United States and other locations around the world.

'This report serves as a wake-up call for policy-makers, business leaders, ocean managers, and others about the urgent need for greater protection for coral reefs,' said Dr. Jane Lubchenco, Under Secretary of Commerce for Oceans and Atmosphere and NOAA Administrator. 'As the report makes clear, local and global threats, including climate change, are already having significant impacts on coral reefs, putting the future of these beautiful and valuable ecosystems at risk.'

Local pressures - especially overfishing and destructive fishing - are causing many reefs to be degraded. Global pressures are leading to coral bleaching from rising sea temperatures and increasing ocean acidification from carbon dioxide pollution. According to the new analysis, if left unchecked, more than 90 percent of reefs will be threatened by 2030 and nearly all reefs will be at risk by 2050.

'Coral reefs are valuable resources for millions of people worldwide. Despite the dire situation for many reefs, there is reason for hope,' said Lauretta Burke, senior associate at the World Resources Institute (WRI) and a lead author of the report. 'Reefs are resilient, and by reducing the local pressures we can buy time as we find global solutions to preserve reefs for future generations.'

The report includes multiple recommendations to better protect and manage reefs, including through marine protected areas. The analysis shows that more than one-quarter of reefs are already encompassed in a range of parks and reserves, more than any other marine habitat. However, only six percent of reefs are in protected areas that are effectively managed.

'Well managed marine protected areas are one of the best tools to safeguard reefs,' said Mark Spalding, senior marine scientist at the Nature Conservancy and also a lead author of the report. 'At their core, reefs are about people as well as nature: ensuring stable food supplies, promoting recovery from coral bleaching, and acting as a magnet for tourist dollars. We need to apply the knowledge we have to shore up existing protected areas, as well as to designate new sites where threats are highest, such as the populous hearts of the Caribbean, Southeast Asia, East Africa and the Middle East,' he added.

Reefs offer multiple benefits to people and the economy - providing food, sustaining livelihoods, supporting tourism, protecting coasts, and even helping to prevent disease. According the report, more than 275 million people live in the direct vicinity (30 km/18 miles) of coral reefs. In more than 100 countries and territories, coral reefs protect 150,000 km (over 93,000 miles) of shorelines, helping defend coastal communities and infrastructure against storms and erosion.

For the first time, the report identifies the 27 nations most socially and economically vulnerable to coral reef degradation and loss. Among these, the nine most vulnerable countries are: Haiti, Grenada, Philippines, Comoros, Vanuatu, Tanzania, Kiribati, Fiji, and Indonesia.

'The people at greatest risk are those who depend heavily on threatened reefs, and who have limited capacity to adapt to the loss of the valuable resources and services reefs provide,' said Allison Perry, project scientist at the WorldFish Center and a lead author. 'For highly vulnerable nations - including many island nations - there is a pressing need for development efforts to reduce dependence on reefs and build adaptive capacity, in addition to protecting reefs from threats.'

The report is an update of 'Reefs at Risk,' released by WRI in 1998, which served as an important resource for policymakers to understand and address the threats of reefs. The new report uses the latest data and satellite information to map coral reefs - including a reef map with a resolution 64 times higher than the original report.

'Through new technology and improved data, this study provides valuable tools and information for decision makers from national leaders to local marine managers,' said Katie Reytar, research associate at WRI and a lead author. 'In order to maximize the benefits of these tools, we need policymakers to commit to greater action to address the growing threats to coral reefs.'
Improvement in the collection and treatment of wastewater from coastal settlements benefits both reefs and people through improved water quality and reduced risk of bacterial infections, algal blooms, and toxic fish. Estimates show that for every US$1 invested in sanitation, the net benefit is US$3 to US$34 in economic, environmental, and social improvement for the nearby community.
Both the live reef food fish—that is, fish captured to sell live in markets and restaurants—and the ornamental species trades are high-value industries. The ornamental species trade takes in an estimated $200 million to $330 million per year globally, with the majority of exports leaving Southeast Asian countries and entering the United States and Europe. The overall value of the industry has remained stable within the past decade, though trade statistics are incomplete. The live reef food fish trade is concentrated mainly in Southeast Asia, with the majority of fish exported from the Philippines and Indonesia and imported through Hong Kong to  China. Over time, the trade has expanded its reach, drawing exports from the Indian Ocean and Pacific islands, reflecting depleted stocks in Southeast Asia, rising demand, improvements in transport, and the high value of traded fish. The estimated value of the live reef food fish trade was $810 million in 2002. A live reef food fish sells for approximately four to eight times more than a comparable dead fish, and can fetch up to $180 per kilogram for sought-after species like Napoleon wrasse or barramundi cod, making it a very lucrative industry for fishers and traders alike.
Despite this, the reefs are an important resource. Tourism on the Great Barrier Reef is a critical part of the region’s economy, generating US$5.2 billion in 2006.
Live reef fish imported for food in Hong Kong in 2008 were reportedly worth an average of nearly US$10/kg, while humphead wrasse, the most valuable species, were worth more than US$50/kg.
Estimating the economic value of coral reef-associated tourism typically focuses on its contributions to the economy, through tourist expenditures, adjusted for the operating costs of providing the service. A recent summary of 29 published studies on reef-associated tourism found a very wide range in values, from about US$2/ha/yr to US$1 million/ha/yr. However, most values fall within the narrower range of US$50/ ha/yr to US$1,000/ha/yr. The wide variation of values is strongly related to differences in the accessibility of places, with very low tourism values in remote locations that have limited tourism development and very high values in areas that have intensive tourism. For these reasons, it is not possible to undertake simple extrapolations of specific studies to entire reef tracts where demand and access may be very different.
Although many economic valuation studies have focused on estimating the benefits of coral reef ecosystem services, some studies have also focused on changes in value—that is, what an economy stands to lose if a reef is degraded. For example, the 2004 Reefs at Risk in the Caribbean study estimated that, by 2015, the projected degradation of Caribbean reefs from human activities such as overfishing and pollution could result in annual losses of US$95 million to US$140 million in net revenues from coral reef-associated fisheries, and US$100 million to US$300 million in reduced tourism revenue. In addition, degradation of reefs could lead to annual losses of US$140 million to US$420 million from reduced coastal protection within the next 50 years. Other studies estimate that Australia’s economy could lose US$2.2 billion to US$5.3 billion over the next 19 years due to global climate change degrading the Great Barrier Reef, while Indonesia could lose US$1.9 billion over 20 years due to overfishing.
There are numerous examples of economic analyses successfully informing policy. For example, in the United States, the states of Hawaii and Florida adopted legislation setting amounts for monetary penalties per square meter of damaged coral reef, based on calculations from valuation studies. The Belize government used an economic valuation study of its coral reefs as the premise to sue for damages after the container ship Westerhaven ran aground on its reef in January 2009, resulting in the Belizean Supreme Court ruling that the ship’s owners must pay the government US$6 million in damages. Finally, Bonaire National Marine Park, one of the world’s few self-financed marine parks, used economic valuation to determine appropriate user fees.
Sample Values: Annual Net Benefits from Coral Reef-related Goods and Services (US$, 2010)
Extent of Study                    Tourism                              Fisheries              Shoreline Protection
Global a                                $11.5 billion                         $6.8 billion                  $10.7 billion
Caribbean (Regional) b          $2.7 billion                         $395 million      $944 million to $2.8 billion
Philippines & Indonesia c       $258 million                           $2.2 billion                $782 million
Belize (National) d         $143.1 mill.-$186.5 mill.**   $13.8 mill.-$14.8 mill.** $127.2 to $190.8 mill.
Guam (National) e                $100.3 million**                     $4.2 million**             $8.9 million
Hawaii (Subnational) f           $371.3 million                         $3.0 million              Not evaluated
* All estimates have been converted to US$ 2010.
** Estimates of the value of coral reef-associated fisheries and tourism for Belize and Guam are gross values, while all other numbers in the table are net benefits, which take costs into account.
a. Cesar, H., L. Burke, and L. Pet-Soede.2003. The Economics of Worldwide Coral Reef Degradation. Zeist, Netherlands: Cesar Environmental Economics Consulting (CEEC).
b. Burke, L., and J. Maidens. 2004. Reefs at Risk in the Caribbean. Washington, DC: World Resource Institute.
c. Burke, L., E. Selig, and M. Spalding.2002. Reefs at Risk in Southeast Asia. Washington, DC: World Resources Institute.
d. Cooper, E., L. Burke, and N. Bood. 2008. Coastal Capital: Belize The Economic contribution of Belize’s coral reefs and mangroves. Washington, DC: World Resource Institute.
e. H aider, W. et al. 2007. The economic value of Guam’s coral reefs. Mangilao, Guam: University of Guam Marine Laboratory.
f. Cesar, H. 2002. The biodiversity benefits of coral reef ecosystems: Values and markets. Paris: OECD.

Find out more at:, online resources, including maps, data, regional fact sheets, videos, and more.  The full report is available free of charge at

United Nations Environment Programme (UNEP)
Press Release dated February 23, 2011