Variations in amenable mortality--trends in 16 high-income nations.

BACKGROUND: There has been growing interest in the comparison of health system performance within and between countries, using a range of different indicators. This study examines trends in amenable mortality, as one measure of health system performance, in sixteen high-income countries. METHODS: Amenable mortality was defined as premature death from causes that should not occur in the presence of timely and effective health care. We analysed age-standardised rates of amenable mortality under age 75 in 16 countries for 1997/1998 and 2006/2007. RESULTS: Amenable mortality remains an important contributor to premature mortality in 16 high-income countries, accounting for 24% of deaths under age 75. Between 1997/1998 and 2006/2007, amenable mortality fell by between 20.5% in the US and 42.1% in Ireland (average decline: 31%). In 2007, amenable mortality in the US was almost twice that in France, which had the lowest levels. CONCLUSIONS: Amenable mortality continues to fall across high-income nations although the USA is lagging increasingly behind other high income countries. Despite its many limitations, amenable mortality remains a useful indicator to monitor progress of nations

The DUNE-ALUGrid Module

In this paper we present the new DUNE-ALUGrid module. This module contains a major overhaul of the sources from the ALUgrid library and the binding to the DUNE software framework. The main changes include user defined load balancing, parallel grid construction, and an redesign of the 2d grid which can now also be used for parallel computations. In addition many improvements have been introduced into the code to increase the parallel efficiency and to decrease the memory footprint. The original ALUGrid library is widely used within the DUNE community due to its good parallel performance for problems requiring local adaptivity and dynamic load balancing. Therefore, this new model will benefit a number of DUNE users. In addition we have added features to increase the range of problems for which the grid manager can be used, for example, introducing a 3d tetrahedral grid using a parallel newest vertex bisection algorithm for conforming grid refinement. In this paper we will discuss the new features, extensions to the DUNE interface, and explain for various examples how the code is used in parallel environments.Comment: 25 pages, 11 figure

MODELLING THE EFFECTS OF EU SUGAR MARKET LIBERALIZATION ON AREA ALLOCATION, PRODUCTION AND TRADE

This paper presents a partial equilibrium simulation analysis of EU sugar market reforms with a version of the European Simulation Model (ESIM) addressing three issues: preferential EU imports are a function of the price differential between world market and EU price, EU supply functions are estimated based on FADN data, and the production of bioethanol in the EU and the rest of the world is taken into account as an important component in sugar beet and sugar cane demand. It is found that the current sugar market reform including the restructuring process until the end of 2007 is sufficient to allow the EU to comply with its WTO commitments only very narrowly. EU sugar supply is simulated to decrease from roughly 19 million tons in the base period to 15.5 million tons by 2015 and the EU price remains at a level of about 450 €/t and thus significantly above the reference price. In case of full liberalization production in the EU is projected to decrease to 7.5 million tonnes by 2015.Sugar, Common Agricultural Policy, Sugar Market Reform, Partial Equilibrium Modelling, Everything But Arms, Agricultural and Food Policy, Crop Production/Industries, International Relations/Trade,

Measuring the health of nations: analysis of mortality amenable to health care.

OBJECTIVE: To assess whether and how the rankings of the world's health systems based on disability adjusted life expectancy as done in the 2000 World Health Report change when using the narrower concept of mortality amenable to health care, an outcome more closely linked to health system performance. DESIGN: Analysis of mortality amenable to health care (including and excluding ischaemic heart disease). MAIN OUTCOME MEASURE: Age standardised mortality from causes amenable to health care SETTING: 19 countries belonging to the Organisation for Economic Cooperation and Development. RESULTS: Rankings based on mortality amenable to health care (excluding ischaemic heart disease) differed substantially from rankings of health attainment given in the 2000 World Health Report. No country retained the same position. Rankings for southern European countries and Japan, which had performed well in the report, fell sharply, whereas those of the Nordic countries improved. Some middle ranking countries (United Kingdom, Netherlands) also fell considerably; New Zealand improved its position. Rankings changed when ischaemic heart disease was included as amenable to health care. CONCLUSION: The 2000 World Health Report has been cited widely to support claims for the merits of otherwise different health systems. High levels of health attainment in well performing countries may be a consequence of good fortune in geography, and thus dietary habits, and success in the health effects of policies in other sectors. When assessed in terms of achievements that are more explicitly linked to health care, their performance may not be as good

Labour Market Effects of Large-Scale Agricultural Investment: Conceptual Considerations and Estimated Employment Effects

Large-scale agricultural investments (LSAIs) in general and their socio-economic implications in particular have been heavily debated in recent years. While some claim that LSAIs are an important catalyst for development in neglected rural areas, others caution that they pose a risk to rural communities' livelihoods. The extent to which LSAIs provide benefits for local communities is hence still contested. This paper sets out to conceptually understand what effects the establishment of a large-scale farm has on the rural labor market in low- and middle-income countries. In addition, we empirically address the question of whether large-scale farming as recorded in the Land Matrix creates or destroys employment. We develop a transition matrix to identify several scenarios based on key determinants of the direct employment creation potential of LSAIs, namely the former land use, the crop type and the production model. We empirically assess the actual importance of these scenarios and the employment creation to be expected from this sample of LSAIs based on labor intensities. We further look into the net employment effects for land formerly used by smallholder farmers. Our analysis shows that LSAIs massively crowd out smallholder farmers, which is only partially mitigated through the cultivation of labor intensive crops and the application of contract farming schemes. This holds true for all regions targeted by LSAIs, although regional differences are found in terms of magnitude. The paper concludes that these effects tend to be large on the local scale (i.e., in the immediate surroundings of the investment site) but small in relation to total national employment in agriculture. However, indirect employment creation related to LSAIs, which is discussed but not empirically addressed in this paper, needs to be taken into account to have the full picture

Land investments: a new type of territorial expansion

As foreigners snap up farmland around the world, it is hard to know who is investing in what, and what the effects on local people might be. An international database is throwing light on the murk

Modelling the effects of EU sugar market liberalization on area allocation, production and trade

This paper presents a partial equilibrium simulation analysis of EU sugar market reforms with a version of the European Simulation Model (ESIM) addressing three issues: preferential EU imports are a function of the price differential between world market and EU price, EU supply functions are estimated based on FADN data, and the production of bioethanol in the EU and the rest of the world is taken into account as an important component in sugar beet and sugar cane demand. It is found that the current sugar market reform including the restructuring process until the end of 2007 is sufficient to allow the EU to comply with its WTO commitments only very narrowly. EU sugar supply is simulated to decrease from roughly 19 million tons in the base period to 15.5 million tons by 2015 and the EU price remains at a level of about 450 €/t and thus significantly above the reference price. In case of full liberalization production in the EU is projected to decrease to 7.5 million tonnes by 2015

Diabetes as a tracer condition in international benchmarking of health systems.

OBJECTIVE: To assess the performance of health systems using diabetes as a tracer condition. RESEARCH DESIGN AND METHODS: We generated a measure of "case-fatality" among young people with diabetes using the mortality-to-incidence ratio (M/I ratio) for 29 industrialized countries using published data on diabetes incidence and mortality. Standardized incidence rates for ages 0-14 years were extracted from the World Health Organization DiaMond study for the period 1990-1994; data on death from diabetes for ages 0-39 years were obtained from the World Health Organization mortality database and converted into age-standardized death rates for the period 1994-1998, using the European standard population. RESULTS: The M/I ratio varied >10-fold. These relative differences appear similar to those observed in cohort studies of mortality among young people with type 1 diabetes in five countries. A sensitivity analysis showed that using plausible assumptions about potential overestimation of diabetes as a cause of death and underestimation of incidence rates in the U.S. yields an M/I ratio that would still be twice as high as in the U.K. or Canada. CONCLUSIONS: The M/I ratio for diabetes provides a means of differentiating countries on quality of care for people with diabetes. It is solely an indicator of potential problems, a basis for stimulating more detailed assessments of whether such problems exist, and what can be done to address them