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Boston, MA, United States

Conditional cash transfer programs are innovative social safetynet programs that aim to relieve poverty. They provide a regular source of income to poor families and are "conditional" in that they require poor families to invest in the health and education of their children through greater use of educational and preventive health services. Brazil's Bolsa Família conditional cash transfer program, created in 2003, is the world's largest program of its kind. During the first five years of the program, it was associated with a significant 9.3 percent reduction in overall infant mortality rates, with greater declines in postneonatal mortality rates than in mortality rates at an earlier age and in municipalities with many users of Brazil's Family Health Program than in those with lower use rates. There were also larger effects in municipalities with higher infant mortality rates at baseline. Programs like Bolsa Família can improve child health and reduce long-standing health inequalities. Policy makers should review the adequacy of basic health services to ensure that the services can respond to the increased demand created by such programs. Programs should also target vulnerable groups at greatest risk and include careful monitoring and evaluation. © 2013 Project HOPE- The People-to-People Health Foundation, Inc.

Grabowski H.G.,Duke University | DiMasi J.A.,Tufts University | Long G.,Analysis Group
Health Affairs | Year: 2015

Patents and other forms of intellectual property protection play essential roles in encouraging innovation in biopharmaceuticals. As part of the "21st Century Cures" initiative, Congress is reviewing the policy mechanisms designed to accelerate the discovery, development, and delivery of new treatments. Debate continues about how best to balance patent and intellectual property incentives to encourage innovation, on the one hand, and generic utilization and price competition, on the other hand.We review the current framework for accomplishing these dual objectives and the important role of patents and regulatory exclusivity (together, the patent-based system), given the lengthy, costly, and risky biopharmaceutical research and development process. We summarize existing targeted incentives, such as for orphan drugs and neglected diseases, and we consider the pros and cons of proposed voluntary or mandatory alternatives to the patent-based system, such as prizes and government research and development contracting. We conclude that patents and regulatory exclusivity provisions are likely to remain the core approach to providing incentives for biopharmaceutical research and development. However, prizes and other voluntary supplements could play a useful role in addressing unmet needs and gaps in specific circumstances. © 2015 Project HOPE-The People-to-People Health Foundation, Inc.

Kessler R.C.,Harvard University | Birnbaum H.,Analysis Group | Bromet E.,State University of New York at Stony Brook | Hwang I.,Harvard University | And 2 more authors.
Psychological Medicine | Year: 2010

Background Although depression appears to decrease in late life, this could be due to misattribution of depressive symptom to physical disorders that increase in late life.Method We studied age differences in major depressive episodes (MDE) in the National Comorbidity Survey Replication, a national survey of the US household population. DSM-IV MDE was defined without organic exclusions or diagnostic hierarchy rules to facilitate analysis of co-morbidity. Physical disorders were assessed with a standard chronic conditions checklist and mental disorders with the WHO Composite International Diagnostic Interview (CIDI) version 3.0.Results Lifetime and recent DSM-IV/CIDI MDE were significantly less prevalent among respondents aged 65 years than among younger adults. Recent episode severity, but not duration, was also lower among the elderly. Despite prevalence of mental disorders decreasing with age, co-morbidity of hierarchy-free MDE with these disorders was either highest among the elderly or unrelated to age. Co-morbidity of MDE with physical disorders, in comparison, generally decreased with age despite prevalence of co-morbid physical disorders usually increasing. Somewhat more than half of respondents with 12-month MDE received past-year treatment, but the percentage in treatment was lowest and most concentrated in the general medical sector among the elderly.Conclusions Given that physical disorders increase with age independent of depression, their lower associations with MDE in old age argue that causal effects of physical disorders on MDE weaken in old age. This result argues against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders. © Copyright Cambridge University Press 2009.

Hanak E.,Public Policy Institute of California | Moreno G.,Analysis Group
Climatic Change | Year: 2012

With over 2,000 miles (3,218 km) of ocean and estuarine coastline, California faces significant coastal management challenges as a result of climate change-induced sea level rise. Under high emission scenarios, recent models predict 1. 4 m or more of sea level rise by 2100, accompanied by increasing storm surges. This article investigates the most important issues facing coastal managers, explores the policy tools available for adapting to the impacts of climate change, assesses institutional constraints to adaptation, and identifies priorities for future research and policy action. We find that adaptation tools exist for dealing with anticipated increases in coastal erosion and flooding, but they involve significant costs and tradeoffs. In particular, coastal armoring, such as seawalls, can protect developed coastal lands, but destroys beaches and habitat. Although California already has policies and institutions that aim to balance the competing objectives for coastal development, management agencies are at the early stages of understanding how to facilitate adaptation. Research priorities to inform coastal adaptation planning include: (i) inventorying coastal resources to provide a firmer basis for balancing decisions on property and habitat protection, (ii) identifying opportunities for coastal habitat migration, (iii) assessing the vulnerabilities of existing and planned coastal infrastructure, and (iv) experimenting with alternatives to armoring as a way of managing the changing coastline. © 2011 Springer Science+Business Media B.V.

The moon's far hemisphere is never directly visible from Earth and while it has been photographed, with the first images appearing in 1959, it has never been explored. China's Chang'e-4 probe—named for the goddess of the moon in Chinese mythology—will be sent to it in 2018, the official Xinhua news agency reported. "The Chang'e-4's lander and rover will make a soft landing on the back side of the moon, and will carry out in-place and patrolling surveys," it cited the country's lunar exploration chief Liu Jizhong as saying on Thursday. Beijing sees its military-run, multi-billion-dollar space programme as a marker of its rising global stature and mounting technical expertise, as well as evidence of the ruling Communist Party's success in transforming the once poverty-stricken nation. But for the most part it has so far replicated activities that the US and Soviet Union pioneered decades ago. "The implementation of the Chang'e-4 mission has helped our country make the leap from following to leading in the field of lunar exploration," Liu added. In 2013, China landed a rover dubbed Yutu on the moon and the following year an unmanned probe completed its first return mission to the earth's only natural satellite. Beijing has plans for a permanent orbiting station by 2020 and eventually to send a human to the moon. Space flight is "an important manifestation of overall national strength", Xinhua cited science official Qian Yan as saying, adding that every success had "greatly stimulated the public's... pride in the achievements of the motherland's development." Clive Neal, chair of the Lunar Exploration Analysis Group affiliated with NASA, confirmed that the Chang'e-4 mission was unprecedented. "There has been no surface exploration of the far side," he told AFP Friday. It is "very different to the near side because of the biggest hole in the solar system—the South Pole-Aitken basin, which may have exposed mantle materials—and the thicker lunar crust". The basin is the largest known impact crater in the solar system, nearly 2,500 kilometres wide and 13 kilometres deep. "I am sure the international lunar science community will be very excited about this mission," he told AFP. "I know I am."

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