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Cambridge, MA, United States

Dulal H.B.,Abt Associates
Local Environment | Year: 2016

Urbanisation is truly a global phenomenon. Starting at 39% in 1980, the urbanisation level rose to 52% in 2011. Ongoing rapid urbanisation has led to increase in urban greenhouse gas (GHG) emissions. Urban climate change risks have also increased with increase in climate-induced extreme weather events and more low-income urban dwellers living in climate sensitive locations. Despite increased emissions, including GHGs and heightened climate change vulnerability, climate mitigation and adaptation actions are rare in the cities of developing countries. Cities are overwhelmed with worsening congestion, air pollution, crime, waste management, and unemployment problems. Lack of resources and capacity constraints are other factors that discourage cities from embarking on climate change mitigation and adaptation pathways. Given the multitude of problems faced, there is simply no appetite for stand-alone urban climate change mitigation and adaptation policies and programmes. Urban mitigation and adaptation goals will have to be achieved as co-benefits of interventions targeted at solving pressing urban problems and challenges. The paper identifies administratively simple urban interventions that can help cities solve some of their pressing service delivery and urban environmental problems, while simultaneously mitigating rising urban GHG emissions and vulnerability to climate change. © 2016 Informa UK Limited, trading as Taylor & Francis Group Source

Hacker K.,Institute for Community Health | Hacker K.,Harvard University | Walker D.K.,Abt Associates
American Journal of Public Health | Year: 2013

Although "population health" is one of the Institute for Healthcare Improvement's Triple Aim goals, its relationship to accountable care organizations (ACOs) remains ill-defined and lacks clarity as to how the clinical delivery system intersects with the public health system. Although defining population health as "panel" management seems to be the default definition, we called for a broader "community health" definition that could improve relationships between clinical delivery and public health systems and health outcomes for communities. We discussed this broader definition and offered recommendations for linking ACOs with the public health system toward improving health for patients and their communities. Copyright © 2012 by the American Public Health Association®. Source

Information on dietary intake is essential for the assessment, planning, monitoring, and evaluation of nutritional interventions. A number of methods are available, each with unique strengths and weaknesses. Dietary intake records, 24-hour recalls, and Food Frequency Questionnaires (FFQs) determine food consumption and nutrient intakes of populations based on individual assessment; few countries have such data at national or regional levels. Food and Agriculture Organization (FAO) Food Balance Sheets (FBS) and food industry data, available in most countries, permit calculations of per capita food consumption but do not provide data on individual consumption. Household Consumption and Expenditures Surveys (HCES) are available for most countries and provide data that can be used to calculate consumption of fortification vehicles and to estimate additional intakes of micronutrients delivered through them to specific population groups. To introduce the reader to the set of papers included in this Supplement reviewing methods and experience with HCES to inform nutrition, and specifically food fortification programs. The Monitoring, Assessment, and Data (MAD) working group and colleagues critically reviewed experiences in estimating dietary intakes,focusing on the use of secondary analysis of HCES. HCES predict coverage of the population that consumes a fortification vehicle and consumed amounts of fortification vehicles. HCES allow comparisons of different population strata and may also approximate micronutrient adequacy, based on nutrient density, at the household level. HCES are useful to inform food fortification and other nutrition programs for planning interventions, but further work is necessary. Currently, combined use of traditional dietary surveys is needed for assessment and for program monitoring and evaluation. Source

The benefits of food fortification depend on the proportion of the population that uses the fortified food (coverage), the amount of the food being consumed, and the additional content of micronutrients in the food. Coverage and amounts consumed can be determined by 24-hour recall or Food Frequency Questionnaires (FFQs). However, these methods are rarely applied. Secondary analysis of data from Household Consumption and Expenditures Surveys (HCES) can be used for these purposes; however, such data analysis has not been validated. To compare the results of HCES and 24-hour recall for estimating the consumption profile of potential fortification vehicles in Uganda. Food intake estimates for 24- to 59-month-old children and 15- to 49-year-old women derived from a one-day 24-hour recall carried out in Uganda (Kampala, North, and Southwest) were compared with data from two HCES (2006, nationwide, and 2008, coupled with the 24-hour recall). The analyzed foods were vegetable oil, sugar, wheat flour, maize flour, and rice. Food consumption estimates calculated from HCES may be less accurate than estimates derived by 24-hour recall. Nevertheless, the HCES results are sensitive enough to differentiate consumption patterns among population strata. In Uganda, HCES predicted proportion of the population that consumes the foods, and approximated intakes of main food vehicles by the "observed" consumers (those who reported using the foods), although estimates for the latter were lower for wheat flour and rice. HCES data offer the basic information needed to provide a rationale for, and help design, food fortification programs. Individual intake surveys are still needed, however, to assess intrahousehold use of foods. Source

Sekabaraga C.,Ministry of Health | Diop F.,Abt Associates | Soucat A.,Human Development
Health Policy and Planning | Year: 2011

Ensuring financial access to health services is a critical challenge for poor countries if they are to reach the health Millennium Development Goals (MDGs). This article examines the case of Rwanda, a country which has championed innovative health care financing policies. Between 2000 and 2007, Rwanda has improved financial access for the poor, increased utilization of health services and reduced out-of-pocket payments for health care. Poor groups' utilization has increased for all health services, sometimes dramatically. Use of assisted deliveries, for example, increased from 12.1 to 42.7 among the poorest quintile; payments at the point of delivery have also been reduced; and catastrophic expenditures have declined. Part of these achievements is likely linked to innovative health financing policies, particularly the expansion of micro-insurance ('mutuelles') and performance-based financing. The paper concludes that the Rwanda experience provides a useful example of effective implementation of policies that reduce the financial barrier to health services, hereby contributing to the health MDGs. Today's main challenge is to build the sustainability of this system. Finally, the paper proposes a simple set of rigorous metrics to assess the impact of health financing policies and calls for implementing rigorous impact evaluation of health care financing policies in low-income countries. © The Author 2011; all rights reserved. Source

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