Urban Resilience: From Global Vision to Local Practice - Final Outcome Evaluation of the 100 Resilient Cities Program

Summer hailstorms in Mexico City, weeks-long heat waves in India, hurricane-force winds off the Great Lakes—extreme weather events are becoming commonplace, testing the resilience of local and regional governments across the world. But urban resilience extends beyond weathering climate shocks. It also entails maintaining and improving infrastructure, ecology, economy, and community at the city level.For six years, from 2013 to 2019, the 100 Resilient Cities program sought to boost the capacity of local governments across all facets of urban resilience. Although the program ended earlier than anticipated, its unprecedented breadth of participating cities and scope of intervention provided potential lessons for cities across the world as they prepare for and face an increasingly uncertain future.KEY TAKEAWAYSThe 100 Resilient Cities program included three cohorts of cities from across the globe, each of which experienced three interventions to improve city governance operational and planning capacity for resilience: the creation and selection of a Chief Resilience Officer, the development and publication of a resilience strategy, and the implementation of that strategy, with technical support provided by the program. The Urban Institute monitored and evaluated the core features of the 100 Resilient Cities program for almost seven years, with this final report focusing on the outcomes for city planning and operations attributable to interventions across a 21-city sample. From this program, we believe the following lessons learned can help cities improve their resilience moving forward.Cities must focus on chronic social vulnerability in addition to unexpected shocks. Although cities must be prepared for extreme weather events and civil unrest, both of which can cause extreme devastation, they must also address ongoing issues, such as failing infrastructure and health care accessibility.Chief Resilience Officers and robust networks can facilitate city-to-city learning. As with any program, collaboration and sharing of knowledge can benefit all parties involved. The network of Chief Resilience Officers could advocate for successful resilience strategies from other cities, which could lead to more collaboration in local governments and across regions.Resilient governance requires more voices to be involved in planning and development. Foregrounding inclusion and equity is crucial for building resilience, especially as the COVID-19 pandemic has drawn attention to many underlying systemic inequities in countries across the world.Resilience building takes a long time. Despite the necessary urgency of building resilience, solutions take a long time to implement and need consistent funding and support to fulfill their potential. When the 100 Resilient Cities program ended early, many cities had developed plans and strategies but lost the support that would have helped them enact those solutions. Ongoing political and funder support is critical for long-term resilience

Regulations to Respond to the Potential Benefits and Perils of SelfDriving Cars Analysis and Recommendations for Advancing Equity and Environmental Sustainability

The mobility system in the United States is unsafe, inequitable, and environmentally destructive. Most Americans rely on personally owned, individually occupied, and gas-powered cars—a status quo that leads to tens of thousands of people dying each year in collisions, creates barriers to employment and other opportunities for people of color and people with low incomes, and maintains a resource intensive transportation system that contributes to climate change and spurs sprawling land uses that destroy ecologies. Autonomous vehicles (AVs)—self-driving cars that can travel along publicly accessible streets some or all of the time without human involvement—could help mitigate these problems, if they are implemented in a thoughtful, well-regulated manner. However, if deployed haphazardly with inadequate oversight and regulation, they could produce even worse inequities than those caused by the current system.To evaluate the current landscape for AV deployment and use in the United States, we conducted a study focusing on automobile-sized AVs designed for passenger use as opposed to other types of AVs that could be used for public transit service or freight. Through a scholarship review, a scan of legislation nationwide, and interviews with stakeholders, we examine key potential benefits that AVs could generate, as well as the problems they could exacerbate. Carefully designed regulations could help ensure that these new technologies improve access to mobility and reduce pollution

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Leadership in the Mold of Jesus: Growing the Church and Saving the Nation in Neo-Pentecostal Guatemala City

Reu T. Leadership in the Mold of Jesus: Growing the Church and Saving the Nation in Neo-Pentecostal Guatemala City. JOURNAL OF LATIN AMERICAN AND CARIBBEAN ANTHROPOLOGY. 2019;24(3):746-762.Based on ethnographic fieldwork in one of the largest megachurches in Guatemala, this article describes the cultural impact that the concept of Christian leadership has on the peculiar attitudes toward society that neo-Pentecostal believers develop as members of their religious communities. Evangelical organizations promote liderazgo (leadership) as a remedy for the problems that ail the world. For the residents of Guatemala's capital city, these include extreme levels of violence and crime. At the same time, liderazgo is a principal component of the cell group model, a growth strategy that many neo-Pentecostal churches deploy. This article argues that, in Guatemala, Christian leadership and the cell group model provide a conceptual and pragmatic infrastructure for a specifically evangelical practice of citizenship. By summoning believers to engage with the world beyond their congregations, this practice qualifies the quintessential individualism that scholars typically find in the evangelical faith

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)