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Concept: Sovereign state


 To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide.

Concepts: Policy, Government, Nation, Sovereign state


Dietary choices drive both health and environmental outcomes. Information on diets come from many sources, with nationally recommended diets (NRDs) by governmental or similar advisory bodies the most authoritative. Little or no attention is placed on the environmental impacts within NRDs. Here we quantify the impact of nation-specific NRDs, compared with an average diet in 37 nations, representing 64% of global population. We focus on greenhouse gases (GHGs), eutrophication, and land use because these have impacts reaching or exceeding planetary boundaries. We show that compared with average diets, NRDs in high-income nations are associated with reductions in GHG, eutrophication, and land use from 13.0 to 24.8%, 9.8 to 21.3%, and 5.7 to 17.6%, respectively. In upper-middle-income nations, NRDs are associated with slight decrease in impacts of 0.8-12.2%, 7.7-19.4%, and 7.2-18.6%. In poorer middle-income nations, impacts increase by 12.4-17.0%, 24.5-31.9%, and 8.8-14.8%. The reduced environmental impact in high-income countries is driven by reductions in calories (∼54% of effect) and a change in composition (∼46%). The increased environmental impacts of NRDs in low- and middle-income nations are associated with increased intake in animal products. Uniform adoption of NRDs across these nations would result in reductions of 0.19-0.53 Gt CO2 eq⋅a-1, 4.32-10.6 Gt [Formula: see text] eq⋅a-1, and 1.5-2.8 million km2, while providing the health cobenefits of adopting an NRD. As a small number of dietary guidelines are beginning to incorporate more general environmental concerns, we anticipate that this work will provide a standardized baseline for future work to optimize recommended diets further.

Concepts: Carbon dioxide, Agriculture, Nutrition, Natural gas, Greenhouse gas, Nation, Environmental impact assessment, Sovereign state


The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.

Concepts: Biology, United States, Poverty in the United States, U.S. state, At-large, Hispanic and Latino Americans, Immigration to the United States, Sovereign state


Harmonised, representative data on the state of biological invasions remain inadequate at country and global scales, particularly for taxa that affect biodiversity and ecosystems. Information is not readily available in a form suitable for policy and reporting. The Global Register of Introduced and Invasive Species (GRIIS) provides the first country-wise checklists of introduced (naturalised) and invasive species. GRIIS was conceived to provide a sustainable platform for information delivery to support national governments. We outline the rationale and methods underpinning GRIIS, to facilitate transparent, repeatable analysis and reporting. Twenty country checklists are presented as exemplars; GRIIS Checklists for close to all countries globally will be submitted through the same process shortly. Over 11000 species records are currently in the 20 country exemplars alone, with environmental impact evidence for just over 20% of these. GRIIS provides significant support for countries to identify and prioritise invasive alien species, and establishes national and global baselines. In future this will enable a global system for sustainable monitoring of trends in biological invasions that affect the environment.

Concepts: Biodiversity, Ecology, Natural environment, Ecosystem, Genetic pollution, Invasive species, Introduced species, Sovereign state


One of the challenges of international alcohol research and policy is the variability in and lack of knowledge of how governments in different nations define a standard drink and low-risk drinking. This study gathered such information from governmental agencies in 37 countries.

Concepts: Government, Alcoholic beverage, Drinking culture, Aristotle, Public policy, Nation, Sovereign state, Kefir


 To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group.

Concepts: Sociology, Europe, Sovereign state


Numerous national governments have recently adopted packaging and labeling legislation to curb global tobacco uptake. This coincides with the World Health Organization’s 2011 World No Tobacco Day, which recognized the extraordinary progress of the Framework Convention on Tobacco Control (FCTC). The tobacco industry has presented legal challenges to countries, including Australia, Uruguay, and the United States, for enacting legislation meeting or exceeding FCTC obligations. We argue that national governments attempting to meet the obligations set forth in public health treaties such as the FCTC should be afforded flexibilities and protection in developing tobacco control laws and regulations, because these measures are necessary to protect public health and should be explicitly recognized in international trade and legal agreements. (Am J Public Health. Published online ahead of print February 14, 2013: e1-e5. doi:10.2105/AJPH.2012.301029).

Concepts: Public health, United States, Tobacco, Law, World Health Organization, Political philosophy, Sovereign state, Tobacco control


Global, regional, and country statistics on population and health indicators are important for assessing development and health progress and for guiding resource allocation; however, data are often lacking, especially in low- and middle-income countries. To fill the gaps, statistical modelling is frequently used to produce comparable health statistics across countries that can be combined to produce regional and global statistics. The World Health Organization (WHO), in collaboration with other United Nations agencies and academic experts, regularly updates estimates for key indicators and involves its Member States in the process. Academic institutions also publish estimates independent from the WHO using different methods. The use of sophisticated statistical estimation methods to fill missing values for countries can reduce the pressures on governments and development agencies to improve information systems. Efforts to improve estimates must be accompanied by concerted attempts to address data gaps, common standards for documentation, sharing of data and methods, and regular interaction and collaboration among all groups involved.

Concepts: Statistics, Estimator, Sociology, Data, World Health Organization, United Nations, Expectation-maximization algorithm, Sovereign state


As states weigh whether to expand Medicaid under the Affordable Care Act (ACA) and Medicaid reform remains a priority for some federal lawmakers, fiscal considerations loom large. As part of the ACA’s expansion of eligibility for Medicaid, the federal government paid for 100 percent of the costs for newly eligible Medicaid enrollees for the period 2014-16. In 2017 states will pay some of the costs for new enrollees, with each participating state’s share rising to 10 percent by 2020. States continue to pay their traditional Medicaid share (roughly 25-50 percent, depending on the state) for previously eligible enrollees. We used data for fiscal years 2010-15 from the National Association of State Budget Officers and a difference-in-differences framework to assess the effects of the expansion’s first two fiscal years. We found that the expansion led to an 11.7 percent increase in overall spending on Medicaid, which was accompanied by a 12.2 percent increase in spending from federal funds. There were no significant increases in spending from state funds as a result of the expansion, nor any significant reductions in spending on education or other programs. States' advance budget projections were also reasonably accurate in the aggregate, with no significant differences between the projected levels of federal, state, and Medicaid spending and the actual expenses as measured at the end of the fiscal year.

Concepts: United States, Federal government of the United States, U.S. state, State, Sovereign state, Fiscal year, Federal government


In 2011, the nonprofit Public Health Accreditation Board (PHAB) launched the national, voluntary public health accreditation program for state, tribal, local, and territorial public health departments. As of May 2016, 134 health departments have achieved 5-year accreditation through PHAB and 176 more have begun the formal process of pursuing accreditation. In addition, Florida, a centralized state in which the employees of all 67 local health departments are employees of the state, achieved accreditation for the entire integrated local public health department system in the state. PHAB-accredited health departments range in size from a small Indiana health department that serves approximately 17,000 persons to the much larger California Department of Public Health, which serves approximately 38 million persons. Collectively, approximately half the U.S. population, or nearly 167 million persons, is covered by an accredited health department. Forty-two states and the District of Columbia now have at least one nationally accredited health department. In a survey conducted through a contract with a social science research organization during 2013-2016, >90% of health departments that had been accredited for 1 year reported that accreditation has stimulated quality improvement and performance improvement opportunities, increased accountability and transparency, and improved management processes.

Concepts: United States, Federal government of the United States, Washington, D.C., U.S. state, Quality assurance, State, Sovereign state, Quality infrastructure