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"What principled business leaders can do to solve America's current financial crisis Broke is a startling wake-up call for America and an honest accounting of what our future holds if we don't take charge and change our country for the better. If the business of America is business, then it's up to our business leaders to solve the mess we're in. Broke offers practical, nonpolitical, and nonpartisan solutions that every business leader can implement today for a better tomorrow. Whether you operate a giant corporation or a local small business, you'll find practical steps to limit future risks, strengthen every business, stabilize the current economy, and help turn the country around. Author John Mumford has spent decades helping business leaders turn around failing companies. Now, he helps them to turn around a failing country. Presents bold initiatives and concrete steps every business leader can use to create a better future-for their businesses and for the country Includes practical, actionable steps for every business leader who wants to build for the future, while preserving the best of his or her existing enterprise. Shows how business leaders can contribute to the solutions for our problems concerning public debt, the environment, and international relations Offers a turnaround plan for the country ideal for use by the U.S. Chamber of Commerce, small business organizations, non-profits and others as the centerpiece of a 2010 campaign for America's turnaround Endorsed by current and former CEO's, top business school leaders, former governors and senators, and leading journalists Desperate times call for creative, effective measures, not desperation. If you're a business leader, here's how you can do your part"--Provided by publisher

Summary Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite noncommunicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Anchovy population dynamics in the Gulf of Cádiz are governed by environmental processes. Sea surface temperature, intense easterly winds, and discharges from the Guadalquivir River have been identified as key factors determining early life stage mortality in this anchovy stock. We have constructed an environment-based recruitment model that simulates the abundance of juveniles under alternative parameters representing plausible biological hypotheses. We are able to evaluate how modelling environment-based recruitment can affect stock assessment and how responding to environmental information can benefit fishery management to allow greater average catch levels through the application of harvest control rules (HCRs) based on environmental conditions. While the environment-based rules generally increase allowable catch levels the variance in catch levels also increases, detracting from the improved value based only on average yield. In addition to changes in revenue, the probability of stock collapse is also reduced by using environmental factors in HCRs. To assess the value of these management systems we simulate a notional insurance scheme, which applies a value to both average yields and uncertainty. The value of the information-driven rules can be determined by comparing the relevant premiums payable for equal levels of insurance cover on revenue within each specific management regime. We demonstrate the net value of incorporating environmental factors in the management of anchovies in the Gulf of Cádiz despite the increased variability in revenue. This could be an effective method to describe outcomes for both commercial fisheries and ecosystem management policies, and as a guide to management of other species whose dynamics are predictable based on in-season observations. ; Gulf of Cadiz and European anchovy; Harvest control rule; insurance; risk

OBJECTIVE: To assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries' population health outcomes and progress toward universal health coverage (UHC). DESIGN: Synthetic control analysis. SETTING AND COUNTRY SELECTION: Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never autocratised from 1989 to 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. MAIN OUTCOME MEASURES: HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. RESULTS: Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 ...

The lack of clarity in the objectives of the Common Fisheries Policy (CFP) must be addressed to create a more efficient balance across diverse ecological, economic and social dimensions. Particularly economic and social objectives present at an overarching level must be made explicit and addressed in lower level management measures, in order to link them to biological objectives and allow policy to build a balance across types of objectives. Selecting clear objectives is essential, particularly for policy impact assessment. The aim of this paper is to demonstrate how more specific high level objectives to managing fisheries can be derived from stakeholders. The paper first reviews the definition of objectives, from a historical and conceptual perspective. Secondly, it discusses the issues of manageability and acceptability, and finally describes an articulation of the high level objectives derived from extensive stakeholder consultations at European and regional level. The results from workshops at the European level to identify objectives were further examined at regional level for the Baltic and North Seas in additional individual consultations. The German case addresses two seas (Baltic and North Seas), has a complex governance structure (due to federalism) and significant roles for the three types of actors (industry, government and environmental NGOs). The analysis suggests that establishing higher level sustainability objectives within the CFP can help diverse interest groups to develop a consensus on management actions to meet complex social goals

The lack of clarity in the objectives of the Common Fisheries Policy (CFP) must be addressed to create a more efficient balance across diverse ecological, economic and social dimensions. Particularly economic and social objectives present at an overarching level must be made explicit and addressed in lower level management measures, in order to link them to biological objectives and allow policy to build a balance across types of objectives. Selecting clear objectives is essential, particularly for policy impact assessment. The aim of this paper is to demonstrate how more specific high level objectives to managing fisheries can be derived from stakeholders. The paper first reviews the definition of objectives, from a historical and conceptual perspective. Secondly, it discusses the issues of manageability and acceptability, and finally describes an articulation of the high level objectives derived from extensive stakeholder consultations at European and regional level. The results from workshops at the European level to identify objectives were further examined at regional level for the Baltic and North Seas in additional individual consultations. The German case addresses two seas (Baltic and North Seas), has a complex governance structure (due to federalism) and significant roles for the three types of actors (industry, government and environmental NGOs). The analysis suggests that establishing higher level sustainability objectives within the CFP can help diverse interest groups to develop a consensus on management actions to meet complex social goals.