Life expectancy has been increasing during the last century within the European Union (EU). To measure progress in population health it is no longer sufficient to focus on the duration of life but quality of life should be considered. Healthy Life Years (HLY) allow estimating the quality of the remaining years that a person is expected to live, in terms of being free of long-standing activity limitation. The Joint Action on Healthy Life Years (JA: EHLEIS) is a joint action of European Member States (MS) and the European Union aiming at analysing trends, patterns and differences in HLY, as well as in other Summary Measures of Population Health (SMPH) indicators, across the European member states.
The JA: EHLEIS consolidates existing information on life and health expectancy by maximising the European comparability; by analysing trends in HLY within the EU; by analysing the evolution of the differences in HLY between Member States; and by identifying both macro-level as micro-level determinants of the inequalities in HLY. The JA: EHLEIS works in collaboration with the USA, Japan and OECD on the development of new SMPHs to be used globally. To strengthen the utility of the HLY for policy-making, annual meetings with policy-makers are planned.
The information system allows the estimation of a set of health indicators (morbidity and disability prevalence, life and health expectancies) for Europe, Member States and shortly their regional levels. An annual country report on HLY in the national languages is available. The JA: EHLEIS is developing statistical attribution and decomposition tools which will be helpful to determine the impact of specific diseases, life styles or other determinants on differences in HLY. Through a set of international workshops the JA: EHLEIS aims to develop a blueprint for an international harmonized Summary Measure of Population Health.
The JA: EHLEIS objectives are to monitor progress towards the headline target of the Europe 2020 strategy of increasing HLY by 2 years by 2020 and to support policy development by identifying the main determinants of active and healthy ageing in Europe.
Health status indicators; Gender; Socioeconomic status; Public health; Health expectancy; Healthy life years; EU
To evaluated the female–male health–survival paradox by estimating the contribution of women’s mortality advantage versus women’s disability disadvantage.
Disability prevalence was measured from the 2006 Survey on Income and Living Conditions in 25 European countries. Disability prevalence was applied to life tables to estimate healthy life years (HLY) at age 15. Gender differences in HLY were split into two parts: that due to gender inequality in mortality and that due to gender inequality in disability. The relationship between women’s mortality advantage or disability disadvantage and the level of population health between countries was analysed using random-effects meta-regression.
Women’s mortality advantage contributes to more HLY in women; women’s higher prevalence of disability reduces the difference in HLY. In populations with high life expectancy women’s advantage in HLY was small or even a men’s advantage was found. In populations with lower life expectancy, the hardship among men is already evident at young ages.
The results suggest that the health–survival paradox is a function of the level of population health, dependent on modifiable factors.
Europe; Gender; Health expectancy; Health inequality; Healthy life years; Health–survival paradox
The aim of this study is to answer the question of whether improvements in the health of the elderly in European countries could compensate for population ageing on the supply side of the labour market. We propose a state-of-health-specific (additive) decomposition of the old-age dependency ratio into an old-age healthy dependency ratio and an old-age unhealthy dependency ratio in order to participate in a discussion of the significance of changes in population health to compensate for the ageing of the labour force. Applying the proposed indicators to the Eurostat’s population projection for the years 2010–2050, and assuming there will be equal improvements in life expectancy and healthy life expectancy at birth, we discuss various scenarios concerning future of the European labour force. While improvements in population health are anticipated during the years 2010–2050, the growth in the number of elderly people in Europe may be expected to lead to a rise in both healthy and unhealthy dependency ratios. The healthy dependency ratio is, however, projected to make up the greater part of the old-age dependency ratio. In the European countries in 2006, the value of the old-age dependency ratio was 25. But in the year 2050, with a positive migration balance over the years 2010–2050, there would be 18 elderly people in poor health plus 34 in good health per 100 people in the current working age range of 15–64. In the scenarios developed in this study, we demonstrate that improvements in health and progress in preventing disability will not, by themselves, compensate for the ageing of the workforce. However, coupled with a positive migration balance, at the level and with the age structure assumed in the Eurostat’s population projections, these developments could ease the effect of population ageing on the supply side of the European labour market.
Population ageing; Old-age dependency ratio; Health indicators; Older workforce
Setting a goal for controlling type 2 diabetes is important for planning health interventions. The purpose of this study was to explore what may be a feasible goal for type 2 diabetes prevention in California.
We used the UCLA Health Forecasting Tool, a microsimulation model that simulates individual life courses in the population, to forecast the prevalence of type 2 diabetes in California's adult population in 2020. The first scenario assumes no further increases in average body mass index (BMI) for cohorts entering adolescence after 2003. The second scenario assumes a gradual BMI decrease for children entering adolescence after 2010. The third scenario builds on the second by extending the same BMI decrease to people aged 12 to 65 years. The fourth scenario builds on the third by eliminating racial/ethnic disparities in physical activity.
We found the predicted diabetes prevalence of the first, second, third, and fourth scenarios in 2020 to be 9.93%, 9.91%, 9.76%, and 9.77%, respectively. We found obesity prevalence for type 2 diabetes patients in 2020 to be 34.2%, 34.0%, 25.7%, and 25.6% for the 4 scenarios. Life expectancy in the third (80.56 y) and fourth (80.94 y) scenarios compared favorably with that of the first (80.32 y) and second (80.32 y) scenarios.
For the next 10 years, behavioral risk factor modifications are more likely to affect obesity prevalence and life expectancy in the general population and obesity prevalence among diabetic patients than to alter type 2 diabetes prevalence in the general population. We suggest setting more specific goals for reducing the prevalence of diabetes, such as reducing obesity-related diabetes complications, which may be more feasible and easier to evaluate than the omnibus goal of lowering overall type 2 diabetes prevalence by 2020.
The Lufwanyama Neonatal Survival Project (“LUNESP”) was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness.
Methods and Findings
We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011–2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as ‘conservative’ and ‘optimistic’ scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation.
Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was ‘highly cost effective’. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.
This study compares gender differences in Healthy Life Years (HLY) and unhealthy life years (ULY) between the original (EU15) and new member states (EU10). Based on the number of deaths, population and prevalence of activity limitations from the Statistics of Living and Income Conditions Survey (SILC) survey, we calculated HLY and ULY for the EU10 and EU15 in 2006 with the Sullivan method. We used decomposition analysis to assess the contributions of mortality and disability and age to gender differences in HLY and ULY. HLY at age 15 for women in the EU10 were 3.1 years more than those for men at the same age, whereas HLY did not differ by gender in the EU15. In both populations ULY at age 15 for women exceeded those for men by 5.5 years. Decomposition showed that EU10 women had more HLY because higher disability in women only partially offset (−0.8 years) the effect of lower mortality (+3.9 years). In the EU15 women’s higher disability prevalence almost completely offset women’s lower mortality. The 5.3 fewer ULY in EU10 men than in EU10 women mainly reflected higher male mortality (4.5 years), while the fewer ULY in EU15 men than in EU15 women reflected both higher male mortality (2.9 years) and higher female disability (2.6 years). The absence of a clear gender gap in HLY in the EU15 thus masked important gender differences in mortality and disability. The similar size of the gender gap in ULY in the EU-10 and EU-15 masked the more unfavourable health situation of EU10 men, in particular the much stronger and younger mortality disadvantage in combination with the virtually absent disability advantage below age 65 in men.
Health expectancy; Life expectancy; Healthy life years; Gender differences
Since 1995, approval for many new medicinal products has been obtained through a centralized procedure in the European Union. In recent years, the use of summary measures of population health has become widespread. We investigated whether efforts to develop innovative medicines are focusing on the most relevant conditions from a global public health perspective.
We reviewed the information on new medicinal products approved by centralized procedure from 1995 to 2009, information that is available to the public in the European Commission Register of medicinal products and the European Public Assessment Reports from the European Medicines Agency. Morbidity and mortality data were included for each disease group, according to the Global Burden of Disease project. We evaluated the association between authorized medicinal products and burden of disease measures based on disability-adjusted life years (DALYs) in the European Union and worldwide.
We considered 520 marketing authorizations for medicinal products and 338 active ingredients. New authorizations were seen to increase over the period analyzed. There was a positive, high correlation between DALYs and new medicinal product development (ρ = 0.619, p = 0.005) in the European Union, and a moderate correlation for middle-low-income countries (ρ = 0.497, p = 0.030) and worldwide (ρ = 0.490, p = 0.033). The most neglected conditions at the European level (based on their attributable health losses) were neuropsychiatric diseases, cardiovascular diseases, respiratory diseases, sense organ conditions, and digestive diseases, while globally, they were perinatal conditions, respiratory infections, sense organ conditions, respiratory diseases, and digestive diseases.
We find that the development of new medicinal products is higher for some diseases than others. Pharmaceutical industry leaders and policymakers are invited to consider the implications of this imbalance by establishing work plans that allow for the setting of future priorities from a public health perspective.
As the need for more experiential sites increases, colleges and schools of pharmacy should consider innovative and strategic approaches to expansion including adding programs that would address the target areas emphasized by Healthy People 2020. Healthy People 2020 encompasses the following areas: adolescent health, early and middle childhood, genomics, global health, health information technology, healthcare-associated infections, hearing and other sensory or communicating disorders (ear, nose, throat-voice, speech and language), weight status, older adults, quality of life and well-being, and social determinants of health. Academic leaders should consider what role exists for pharmacy practice in these areas and focus future program and curriculum development on Healthy People 2020 topic areas.
introductory pharmacy practice experiences; advanced pharmacy practice experiences; experiential education; public health; Healthy People 2020
To conduct a comprehensive analysis of supply of and demand for oncology services through 2020. This study was commissioned by the Board of Directors of ASCO.
New data on physician supply gathered from surveys of practicing oncologists, oncology fellows, and fellowship program directors were analyzed, along with 2005 American Medical Association Masterfile data on practicing medical oncologists, hematologists/oncologists, and gynecologic oncologists, to determine the baseline capacity and to forecast visit capacity through 2020. Demand for visits was calculated by applying age-, sex-, and time-from-diagnosis-visit rate data from the National Cancer Institute's analysis of the 1998 to 2002 Surveillance, Epidemiology and End Results (SEER) database to the National Cancer Institute's cancer incidence and prevalence projections. The cancer incidence and prevalence projections were calculated by applying a 3-year average (2000–2002) of age- and sex-specific cancer rates from SEER to the US Census Bureau population projections released on March 2004. The baseline supply and demand forecasts assume no change in cancer care delivery and physician practice patterns. Alternate scenarios were constructed by changing assumptions in the baseline models.
Demand for oncology services is expected to rise rapidly, driven by the aging and growth of the population and improvements in cancer survival rates, at the same time the oncology workforce is aging and retiring in increasing numbers. Demand is expected to rise 48% between 2005 and 2020. The supply of services provided by oncologists during this time is expected to grow more slowly, approximately 14%, based on the current age distribution and practice patterns of oncologists and the number of oncology fellowship positions. This translates into a shortage of 9.4 to 15.0 million visits, or 2,550 to 4,080 oncologists—roughly one-quarter to one-third of the 2005 supply. The baseline projections do not include any alterations based on changes in practice patterns, service use, or cancer treatments. Various alternate scenarios were also developed to show how supply and demand might change under different assumptions.
ASCO, policy makers, and the public have major challenges ahead of them to forestall likely shortages in the capacity to meet future demand for oncology services. A multifaceted strategy will be needed to ensure that Americans have access to oncology services in 2020, as no single action will fill the likely gap between supply and demand. Among the options to consider are increasing the number of oncology fellowship positions, increasing use of nonphysician clinicians, increasing the role of primary care physicians in the care of patients in remission, and redesigning service delivery.
The global initiative for the elimination of avoidable blindness by the year 2020-(VISION 2020- The Right to Sight), established in 1999, is a partnership of nongovernmental organizations (NGOs), governments, bilateral organizations, corporate bodies and the World Health Organization. The goal is to eliminate the major causes of avoidable blindness by the year 2020. Significant progress has been made in the last decade. For example, the adoption of three major World Health Assembly resolutions (WHA 56.26, 59.25 and 62.1) requesting governments to increase support and funding for the prevention of blindness and eye care. Additionally, the approval of the VISION 2020 declaration, development of plans and establishment of prevention of blindness committees and a designation of a coordinator by most participating countries represent other major achievements. Furthermore there has been increased political and professional commitment to the prevention of visual impairment and an increase in the provision of high-quality, sustainable eye care. Most of these achievements have been attributed to the advocacy efforts of VISION 2020 at the international level. The full success of this global initiative will likely depend on the extent to which the WHA resolutions are implemented in each country. However, most ratifying countries have not moved forward with implementation of these resolutions. To date, only few countries have shown consistent government support and funding for eye care pursuant to the resolutions. One of the main reasons for this may be inadequate and inappropriate advocacy for eye care at the national level. As such it is believed that the success of VISION 2020 in the next decade will depend on intense advocacy campaigns at national levels. This review identified some of the countries and health programs that have had fruitful advocacy efforts, to determine the factors that dictated success. The review highlights the factors of successful advocacy in two countries (Australia and Pakistan) that secured continued government support. The review further explores the achievements of the HIV/AIDs control network advocacy in securing global and national government support. Common factors for successful advocacy at the national level were identified to include generation of evidence data and effective utilization of the data with an appropriate forum and media to develop a credible relationship with prominent decision makers. Aligning eye care programming to the broad health and development agendas was a useful advocacy effort. Also a broad all-encompassing coalition of all stakeholders provides a solid platform for effective and persistent advocacy for government support of eye care.
Advocacy; Eye Care; Vision 2020
This study projected responses of forest net primary productivity (NPP) to three climate change scenarios at a resolution of 5 km × 5 km across the state of Louisiana, USA. In addition, we assessed uncertainties associated with the NPP projection at the grid and state levels. Climate data of the scenarios were derived from Community Climate System Model outputs. Changes in annual NPP between 2000 and 2050 were projected with the forest ecosystem model PnET-II. Results showed that forest productivity would increase under climate change scenarios A1B and A2, but with scenario B1, it would peak during 2011–2020 and then decline. The projected average NPP under B1 over the years from 2000 to 2050 was significantly different from those under A1B and A2. Forest NPP appeared to be primarily a function of temperature, not precipitation. Uncertainties of the NPP projection were due to large spatial resolution of the climate variables. Overall, this study suggested that in order to project effects of climate change on forest ecosystem at regional level, modeling uncertainties could be reduced by increasing the spatial resolution of the climate projections.
Climate change; Subtropical forests; Net primary productivity; Pnet-II; Uncertainty; Community Climate System Model 3.0 (CCSM3.0)
Increasing colorectal cancer screening (CRCS) is important for attaining the Healthy People 2020 goal of reducing CRC-related morbidity and mortality. Evaluating CRCS trends can help identify shifts in CRCS, as well as specific groups that might be targeted for CRCS.
We utilized medical records to describe population-based adherence to average-risk CRCS guidelines from 1997-2008 in Olmsted County, MN. CRCS trends were analyzed overall and by gender, age, and adherence to screening mammography (women only). We also performed an analysis to examine whether CRCS is being initiated at the recommended age of 50.
From 1997-2008, the size of the total eligible sample ranged from 20585 to 21468 people. CRCS increased from 22% to 65% for women and from 17% to 59% for men (p<0.001 for both) between 1997 and 2008. CRCS among women current with mammography screening increased from 26% to 74%, and this group was more likely to be adherent to CRCS than all other subgroups analyzed (p<0.001).The mean ages of screening initiation were stable throughout the study period, with a mean age of 55 years among both men and women in 2008.
While overall CRCS tripled during the study period, there is still room for improvement.
Working to decrease the age at first screening, exploration of gender differences in screening behavior, and targeting women adherent to mammography but not to CRCS appear warranted.
Value-of-life methods are increasingly used in policy analyses of the economic burden of disease. The purpose of this study was to estimate and project the value of life lost from cancer deaths in the United States.
We estimated and projected US age-specific mortality rates for all cancers and for 16 types of cancer in men and 18 cancers in women in the years 2000–2020 and applied them to US population projections to estimate the number of deaths in each year. Cohort life tables were used to calculate the remaining life expectancy in the absence of cancer deaths—the person-years of life lost (PYLL). We used a willingness-to-pay approach in which the value of life lost due to cancer death was calculated by multiplying PYLL by an estimate of the value of 1 year of life ($150 000). We performed sensitivity analyses for female breast, colorectal, lung, and prostate cancers using varying assumptions about future cancer mortality rates through the year 2020.
The value of life lost from all cancer deaths in the year 2000 was $960.6 billion; lung cancer alone represented more than 25% of this value. Projections for the year 2020 with current cancer mortality rates showed a 53% increase in the total value of life lost ($1472.5 billion). Projected annual decreases of cancer mortality rates of 2% reduced the expected value of life lost in the year 2020 from $121.0 billion to $80.7 billion for breast cancer, $140.1 billion to $93.5 billion for colorectal cancer, from $433.4 billion to $289.4 billion for lung cancer, and from $58.4 billion to $39.0 billion for prostate cancer.
Estimated value of life lost due to cancer deaths in the United States is substantial and expected to increase dramatically, even if mortality rates remain constant, because of expected population changes. These estimates and projections may help target investments in cancer control strategies to tumor sites that are likely to result in the greatest burden of disease and to interventions that are the most cost-effective.
In September 2000, world leaders made a commitment to build a more equitable, prosperous and safer world by 2015 and launched the Millennium Development Goals (MDGs). In the previous year, the World Health Organization and the International Agency for the Prevention of Blindness in partnership launched the global initiative to eliminate avoidable blindness by the year 2020–VISION 2020 the Right to Sight. It has focused on the prevention of a disability-blindness and recognized a health issue–sight as a human right. Both global initiatives have made considerable progress with synergy especially on MDG 1–the reduction of poverty and the reduction in numbers of the blind. A review of the MDGs has identified the need to address disparities within and between countries, quality, and disability. Noncommunicable diseases are emerging as a challenge to the MDGs and Vision 2020:0 the Right to Sight. For the future, up to and beyond 2015, there will be need for both initiatives to continue to work in synergy to address present and emerging challenges.
Millennium development goals; eye health; Vision 2020 the Right to Sight
This article provides an empirical assessment of the performance of the member states of the Association of Southeast Asian Nations in terms of science, technology, and innovation. This study is relevant because it employs a larger data set, examines more countries, and covers more years than previous studies. The results indicate that these countries had differing patterns of performance, and the pattern of growth among them was asymmetrical. Additional findings suggest that these countries performed idiosyncratically with respect to the six quantitative dimensions we examined. Our research includes a form of comparative policy evaluation that might assist the monitoring of the implementation of “Vision 2020”. The results simplify how we determine the relative strengths and weaknesses of national innovation systems and are relevant to policy discussions. In relation to transferability, the findings demonstrate similarities to the European Union with regard to performance and governance.
62-07 Data analysis; 01A29 Southeast Asia ASEAN; O38 Government Policy; O33 Technological Change: Choices and Consequences; Diffusion Processes
Chronic respiratory diseases are a major cause of mortality and morbidity, and represent a high chronic disease burden, which is expected to rise between now and 2020. Care for chronic diseases is increasingly located in community settings for reasons of efficiency and patient preference, though what services should be offered and where is contested. Our aim was to identify the key characteristics of a community-based service for chronic respiratory disease to help inform NHS commissioning decisions.
We used the Delphi method of consensus development. We derived components from Wagner’s Chronic Care Model (CCM), an evidence-based, multi-dimensional framework for improving chronic illness care. We used the linked Assessment of Chronic Illness Care to derive standards for each component.
We established a purposeful panel of experts to form the Delphi group. This was multidisciplinary and included national and international experts in the field, as well as local health professionals involved in the delivery of respiratory services. Consensus was defined in terms of medians and means. Participants were able to propose new components in round one.
Twenty-one experts were invited to participate, and 18 agreed to take part (85.7% response). Sixteen responded to the first round (88.9%), 14 to the second round (77.8%) and 13 to the third round (72.2%). The panel rated twelve of the original fifteen components of the CCM to be a high priority for community-based respiratory care model, with varying levels of consensus. Where consensus was achieved, there was agreement that the component should be delivered to an advanced standard. Four additional components were identified, all of which would be categorised as part of delivery system design.
This consensus development process confirmed the validity of the CCM as a basis for a community-based respiratory care service and identified a small number of additional components. Our approach has the potential to be applied to service redesign for other chronic conditions.
Chronic care; Respiratory diseases; Delphi consensus
The Timor-Leste Ministry of Health has recently finalized the National Malaria Control Strategy for 2010-2020. A key component of this roadmap is to provide universal national coverage with long-lasting insecticide-treated nets (LLINs) in support of achieving the primary goal of reducing both morbidity and mortality from malaria by 30% in the first three years, followed by a further reduction of 20% by end of the programme cycle in 2020 . The strategic plan calls for this target to be supported by a comprehensive information, education and communication (IEC) programme; however, there is limited prior research into household and personal usage patterns to assist in the creation of targeted, effective, and socio-culturally specific behaviour change materials.
Nine separate focus group discussions (FGDs) were carried out in Dili, Manatuto, and Covalima districts, Democratic Republic of Timor-Leste, in July 2010.
These focus groups primarily explored themes of perceived malaria risk, causes of malaria, net usage patterns within families, barriers to correct and consistent usage, and the daily experience of users (both male and female) in households with at least one net. Comprehensive qualitative analysis utilized open source analysis software.
The primary determinants of net usage were a widespread perception that nets could or should only be used by pregnant women and young children, and the availability of sufficient sleeping space under a limited number of nets within households. Both nuisance biting and disease prevention were commonly cited as primary motivations for usage, while seasonality was not a significant factor. Long-term net durability and ease of hanging were seen as key attributes in net design preference. Very frequent washing cycles were common, potentially degrading net effectiveness. Finally, extensive re-purposing of nets (fishing, protecting crops) was both reported and observed, and may significantly decrease availability of nighttime sleeping space for all family members if distributed nets do not remain within the household.
Emphasizing that net usage is acceptable and important for all family members regardless of age or gender, and addressing the complex behavioural economics of alternative net usages could have significant impacts on malaria control efforts in Timor-Leste, as the country's programmes make progress towards universal net coverage.
Targets for bioenergy have been set worldwide to mitigate climate change. Although feedstock sources are often ambiguous, pledges in European nations, the United States and Brazil amount to more than 100 Mtoe of biorenewable fuel production by 2020. As a consequence, the biofuel sector is developing rapidly, and it is increasingly important to distinguish bioenergy options that can address energy security and greenhouse gas mitigation from those that cannot. This paper evaluates how bioenergy production affects land-use change (LUC), and to what extent land-use modelling can inform sound decision-making. We identified local and global internalities and externalities of biofuel development scenarios, reviewed relevant data sources and modelling approaches, identified sources of controversy about indirect LUC (iLUC) and then suggested a framework for comprehensive assessments of bioenergy. Ultimately, plant biomass must be managed to produce energy in a way that is consistent with the management of food, feed, fibre, timber and environmental services. Bioenergy production provides opportunities for improved energy security, climate mitigation and rural development, but the environmental and social consequences depend on feedstock choices and geographical location. The most desirable solutions for bioenergy production will include policies that incentivize regionally integrated management of diverse resources with low inputs, high yields, co-products, multiple benefits and minimal risks of iLUC. Many integrated assessment models include energy resources, trade, technological development and regional environmental conditions, but do not account for biodiversity and lack detailed data on the location of degraded and underproductive lands that would be ideal for bioenergy production. Specific practices that would maximize the benefits of bioenergy production regionally need to be identified before a global analysis of bioenergy-related LUC can be accomplished.
indirect land-use change; biofuels; greenhouse gas; ecosystem services; environmental economics; feedstocks
Healthy life expectancy – sometimes called health-adjusted life expectancy (HALE) – is a form of health expectancy indicator that extends measures of life expectancy to account for the distribution of health states in the population. The World Health Organization reports on healthy life expectancy for 192 WHO Member States. This paper describes variation in average levels of population health across these countries and by sex for the year 2002.
Mortality was analysed for 192 countries and disability from 135 causes assessed for 17 regions of the world. Health surveys in 61 countries were analyzed using new methods to improve the comparability of self-report data.
Healthy life expectancy at birth ranged from 40 years for males in Africa to over 70 years for females in developed countries in 2002. The equivalent "lost" healthy years ranged from 15% of total life expectancy at birth in Africa to 8–9% in developed countries.
People living in poor countries not only face lower life expectancies than those in richer countries but also live a higher proportion of their lives in poor health.
The aim of the ‘Uncertain Population of Europe’(UPE) project was to compute long-term stochastic (probabilistic) population forecasts for 18 European countries. We developed a general methodology for constructing predictive distributions for fertility, mortality and migration. The assumptions underlying stochastic population forecasts can be assessed by analysing errors in past forecasts or model-based estimates of forecast errors, or by expert judgement. All three approaches have been used in the project. This article summarizes and discusses the results of the three approaches. It demonstrates how the—sometimes conflicting—results can be synthesized into a consistent set of assumptions about the expected levels and the uncertainty of total fertility rate, life expectancy at birth of men and women, and net migration for 18 European countries.
Probabilistic forecast; Forecast assumptions; Time series; Empirical errors; Expert judgement; Scaled model of error; projection stochastique; hypothèses de projection; séries temporelles; jugement expert; modèle des erreurs d’échelle flexible
If Malaysia is to become a high-income country by 2020, it will have to transform into a knowledge-based, innovation economy. This goal will be achieved by developing an atmosphere conducive to experimentation and entrepreneurship at home; while reaching out to partners across the globe. One of Malaysia’s newest partnerships is with the New York Academy of Sciences. The Academy has expertise in innovation and higher education and a long history of promoting science, education, and science-based solutions through a global network of scientists, industry-leaders, and policy-makers. Malaysia’s Prime Minister, Dato’ Sri Mohd Najib Tun Abdul Razak, leveraged the Academy’s network to convene a science, technology, and innovation advisory council. This council would provide practical guidance to establish Malaysia as an innovation-based economy. Three initial focus areas, namely palm-oil biomass utilisation, establishment of smart communities, and capacity building in science and engineering, were established to meet short-term and long-term targets.
economic development; international cooperation; knowledge; Malaysia; science; technology; United States
There is a widespread awareness that the wealth of preclinical toxicity data that the pharmaceutical industry has generated in recent decades is not exploited as efficiently as it could be. Enhanced data availability for compound comparison (“read-across”), or for data mining to build predictive tools, should lead to a more efficient drug development process and contribute to the reduction of animal use (3Rs principle). In order to achieve these goals, a consortium approach, grouping numbers of relevant partners, is required. The eTOX (“electronic toxicity”) consortium represents such a project and is a public-private partnership within the framework of the European Innovative Medicines Initiative (IMI). The project aims at the development of in silico prediction systems for organ and in vivo toxicity. The backbone of the project will be a database consisting of preclinical toxicity data for drug compounds or candidates extracted from previously unpublished, legacy reports from thirteen European and European operation-based pharmaceutical companies. The database will be enhanced by incorporation of publically available, high quality toxicology data. Seven academic institutes and five small-to-medium size enterprises (SMEs) contribute with their expertise in data gathering, database curation, data mining, chemoinformatics and predictive systems development. The outcome of the project will be a predictive system contributing to early potential hazard identification and risk assessment during the drug development process. The concept and strategy of the eTOX project is described here, together with current achievements and future deliverables.
predictive toxicology; in silico toxicity; in vitro toxicity; in vivo toxicity; Knowledge Management; Expert Systems; Decision Support System; Data Integration; Manual Curation; ontology; histopathology; computational models; QSAR; data sharing
In this short essay, we would like to address a severe divergence observed in Italy between Life Expectancy (LE) and Healthy Life Expectancy (Healthy LE) and a unique trend of worsening in Healthy LE, compared to the other European countries. Both issues emerge in recent data by EUROSTAT Report.
The analysis used by the authors of the EUROSTAT report is based on Sullivan method which combines 2 type of variables: mortality and morbidity data.
While several European countries started to deal with comparable data about LE since 1960, in Italy, analogous data were available for the first time in EUROSTAT Report only in 1985. In Italy, in the period 1985-2008, there was a good progressive increase in L.E., following the best European values. Nevertheless, while until 2004 Italy was among the European best countries in terms of both LE and Healthy LE at birth, four years later in 2008 there was a shocking loss of 10 years of Healthy LE at birth in newborn girls. In the process, they lost their 2-years previous advantage with respect to males (the latter lost only 6 years of Healthy LE, in the same time span). Looking at healthy LE at age 65 in respect to 2004, Italian women in 2008 could expect to live healthy only about 7 years (as much as men) versus the almost 15 years of the European best values (14 years for men).
It is legitimate to wonder why no one official comment has been produced as a reaction after the first year of spectacular decline in Healthy Life Years in Italy: in counter-tendency with European values, from 2004 to 2008 there is a clear evidence of a 10 years drop in Healthy LE among newborn girls. The problem has not been taken into consideration even when the situation clearly appeared to worsen in the following years, dropping 4-6 more years for males and females in 2006 (for newborn babies); two more years of healthy life expectancy have been lost between 2006 and 2007 for each gender. One more year of Healthy Life Expectancy is lost in 2008. And data have not been made available any more, since then, from Italy.
The vision of the European common research programme for 2014–2020, called Horizon 2020, is to create a smarter, more sustainable and more inclusive society. However, this is a global endeavor, which is important for mycologists all over the world because it includes a special role for fungi and fungal products. After ten years of research on industrial scale conversion of biowaste, the conclusion is that the most efficient and gentle way of converting recalcitrant lignocellulosic materials into high value products for industrial purposes, is through the use of fungal enzymes. Moreover, fungi and fungal products are also instrumental in producing fermented foods, to give storage stability and improved health. Climate change will lead to increasingly severe stress on agricultural production and productivity, and here the solution may very well be that fungi will be brought into use as a new generation of agricultural inoculants to provide more robust, more nutrient efficient, and more drought tolerant crop plants. However, much more knowledge is required in order to be able to fully exploit the potentials of fungi, to deliver what is needed and to address the major global challenges through new biological processes, products, and solutions. This knowledge can be obtained by studying the fungal proteome and metabolome; the biology of fungal RNA and epigenetics; protein expression, homologous as well as heterologous; fungal host/substrate relations; physiology, especially of extremophiles; and, not the least, the extent of global fungal biodiversity. We also need much more knowledge and understanding of how fungi degrade biomass in nature.
The projects in our group in Aalborg University are examples of the basic and applied research going on to increase the understanding of the biology of the fungal secretome and to discover new enzymes and new molecular/bioinformatics tools.
However, we need to put Mycology higher up on global agendas, e.g. by positioning Mycology as a candidate for an OECD Excellency Program. This could pave the way for increased funding of international collaboration, increased global visibility, and higher priority among decision makers all over the world.
biodiversity; biomass conversion; fungal enzymes; global challenges; new biological solutions; secretomics; teaching; training
The main goal of this paper is to estimate how the observed and predicted climate changes may affect the development rates and emergence of the codling moth in the southern part of the Wielkopolska region in Poland. In order to simulate the future climate conditions one of the most frequently used A1B SRES scenarios and two different IPCC climate models (HadCM3 and GISS modelE) are considered. A daily weather generator (WGENK) was used to generate temperature values for present and future climate conditions (time horizons 2020–2040 and 2040–2060). Based on the generated data set, the degree-days values were then calculated and the emergence dates of the codling moth at key stages were estimated basing on the defined thresholds. Our analyses showed that the average air surface temperature in the Wielkopolska region may increase from 2.8°C (according to GISS modelE) even up to 3.3°C (HadCM3) in the period of 2040–2060. With the warming climate conditions the cumulated degree-days values may increase at a rate of about 142 DD per decade when the low temperature threshold (Tlow) of 0°C is considered and 91 DD per decade when Tlow = 10°C. The key developmental stages of the codling moth may occur much earlier in the future climate conditions than currently, at a rate of about 3.8–6.8 days per decade, depending on the considered GCM model and the pest developmental stage. The fastest changes may be observed in the emergence dates of 95% of larvae of the second codling moth generation. This could increase the emergence probability of the pest third generation that has not currently occurred in Poland.
Climate change; Degree days; Codling moth (Cydia pomonella L.); Weather generator; WGENK