A POLICY PROPOSAL FOR EXPANSION OF U.S. FEDERAL CLIMATE SERVICES TO ACCELERATE SUBNATIONAL REDUCTION OF GREENHOUSE GAS EMISSIONS

Cities contribute more than 70% of global greenhouse gas (GHG) emissions1 and are essential players in decarbonization. Monitoring sub-national emissions is broadly considered a key first step in identifying where to focus local climate mitigation efforts2. Despite twenty years of incrementally refining standards and tools to build local self-reported GHG inventories, the process remains prohibitively resource-intensive for many jurisdictions. The methods for this policy paper include a review of the academic and gray literature and interviews with experts in the field, with the goal of creating policy recommendations for the development of a Federal GHG Information Service to support local governments in understanding their GHG emissions so they can take strategic actions to reduce them. Recent years have seen a shift in the field of estimating local emissions. One line of thinking is toward a new scientific architecture, with nationwide integrated GHG estimates based on carbon sensors, additional data sources, and atmospheric inversion modeling. The other is about a new social architecture, oriented toward taking immediate action on reducing emissions and centering community input on the path toward carbon neutrality. The current incremental approach, as well as these emerging scientific and social infrastructures all share a common goal: reducing the level of effort for local governments to understand their GHG emissions. With the Biden-Harris Administration engaged on climate with executive actions, legislation, and plans for climate services to infuse science into climate action, the timing is ideal to build out a Federal GHG Information Service so every local jurisdiction has a regularly updated, geographically-detailed estimate of emissions to inform climate planning and emissions reduction. Policy recommendations are: 1) expand climate services to include mitigation, 2) identify high-value data to continuously improve emissions estimates, 3) develop a research agenda to expand the scope of covered emissions for the GHG Information Service, 4) increase the density of carbon sensors nationwide to enable the scaling of detailed estimates, 5) enlist design expertise to bring a human-centered approach to climate services so they meet the decision-making needs of domestic local governments, and 6) identify an inter-agency home for climate services

The relationship between cultural beliefs and treatment-seeking behaviour in Papua New Guinea: implications for the incorporation of traditional medicine into the health system

Health indicators in Papua New Guinea (PNG) are poor by virtually any standards and have declined over the last 2 decades. As in other developing countries that find it impossible to achieve ‘health for all’ through western medical services alone, the idea of developing an integrated health system, one that incorporates traditional medicine, has been proposed as a way of addressing poor health status. The idea of developing an integrated health system in PNG is not new but only recently has it translated into action with tangible results including a draft ‘National Policy on Traditional Medicine for Papua New Guinea’. Over many years researchers have bemoaned the paucity of information on cultural beliefs and treatment practices that could make the incorporation of traditional medicine into the health system, along the lines proposed in the National Policy, better informed. To date this information gap has not been filled.The thesis includes a review of literature on traditional medicine around PNG and the results of a case study conducted by indigenous research assistants among the Nasioi speakers of Central Bougainville. An international perspective is brought to bear through a critique of theoretical models of integration and a review of practical experiences in other countries that have tried to develop various types of integrated health systems. Information from each of these sources is considered in an endeavour to address the urgent need for information to inform the implementation of the National Policy on Traditional Medicine for Papua New Guinea.All available studies on traditional medicine in PNG were included in the literature review. Despite PNG's vast cultural diversity it became evident that some common elements exist between different cultural groups.The case study used a focused ethnographic approach to examine treatment-seeking responses to illness and associated beliefs and decision-making criteria in relation to traditional and modern medicine. It also investigated the organization of traditional health services, attitudes towards an integrated health system and the potential for practitioners to collaborate with one another. The case study made it possible to focus on pertinent issues that had not been covered in earlier studies. The case study suggests that in areas where the organization of and attitudes toward traditional medicine resemble those in the Nasioi area there may be great potential for a health system that incorporates traditional medicine to deliver health benefits to communities. The case study also serves as an example of research that could be replicated or adapted by provinces that need more information about their own situation before embarking on the process of incorporating traditional medicine into the local health system.The process by which integration might proceed in PNG is considered in the context of integration experiences in other countries. Although ideologically attractive, total integration is not realistic for PNG at this stage. The informality and lack of documentation on traditional medicine as well as the lack of resources to support the development of an integrated health system mean that PNG’s own version of an incorporated or collaborative model of integration is more appropriate.It should be noted that in this thesis the term ‘integrated health system’ is used to cover the full range of varying degrees of integration of traditional with modern medicine and should not be taken to imply only a fully integrated system. Similarly, the terms ‘integration’ and ‘incorporation’ are normally used to refer to the process and not the outcome.Even an incorporated health system may not be a viable proposition in all parts of PNG. Where it is feasible, incorporation would need to be progressed in a carefully considered and planned manner with a realistic and long-term approach. The process would require coordination at national level and the flexibility for provinces to participate according to their own prevailing circumstances and capacity. Incorporation should proceed slowly and will require government support including the allocation of resources. It may be possible to pilot and thus fine-tune PNG’s integration model in a few places, such as the Nasioi area, before expanding to multiple provinces.The potential benefits of an incorporated health system include strengthening of primary health care, better access to services, more affordable services, cultural relevance, a holistic approach, preservation of traditional knowledge, increased autonomy and possibly cost savings. An incorporated health system is worth pursuing because, if carefully planned and implemented, it does have the potential to improve health status in a country where health indicators desperately need to be elevated

Toward Competitive Employment for Persons with Intellectual and Developmental Disabilities: What Progress Have We Made and Where Do We Need to Go

Progress toward competitive integrated employment (CIE) for people with intellectual and developmental disabilities (IDD) over the last 40 years has been mixed. Despite evidence showing that supported employment interventions can enable adults with IDD to effectively get and keep jobs, national rates of integrated employment remain below a third of the working-age population. Progress is being made to improve these outcomes. Pathways have been identified that lead to CIE through supported employment, customized employment, internship experiences, and postsecondary education. The recent passage of the Workforce Innovation and Opportunity Act (WIOA) has created fresh momentum and increased the onus on interagency collaboration. This article examines what is known about promoting CIE through these pathways and highlights recommendations for future research and policy change. Recommendations for the future provide direction toward positive change for CIE into the 21st century

Organizing the U.S. Health Care Delivery System for High Performance

Analyzes the fragmentation of the healthcare delivery system and makes policy recommendations -- including payment reform, regulatory changes, and infrastructure -- for creating mechanisms to coordinate care across providers and settings

Single Point of Entry Long-Term Living Resource System Team Report

Pursuant to House File 451 the Single Point of Entry Long-Term Living Resources System Team, involving several state agencies as well as interested associations, submitted a report to the legislature on recommendations to establish a single point of entry system

The Group Employed Model as a Foundation for Health Care Delivery Reform

Outlines group employed models, with salaried primary and specialty care physicians and quality of care- and satisfaction-based incentives as high-quality, low-cost alternatives to fee-for-service; elements of success; and implications beyond Medicare

Encouraging Integrated Care for Dual Eligibles

Outlines examples and elements of integrated care models for those eligible for both Medicare and Medicaid, including multidisciplinary care teams, comprehensive provider networks, and data sharing, that would eliminate inefficiencies and reduce costs