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Bills Digest No. 16 1998-99
Wool International Amendment Bill 1998
This Digest was prepared for debate. It reflects the legislation as introduced and does not canvass subsequent amendments. This Digest does not have any official legal status. O ther sources should be consulted to determine the subsequent official status of the Bill.
Wool International Ame ndment Bill 1998
Date Introduced: 11 November 1998
House: House of Representatives
Portfolio: Agriculture, Fisheries and Forestry
The major purposes of the Bill are to:
⢠prohibit Wool International from entering i nto contracts for the sale of stockpile wool between the commencement of the Bill and 30 June 1999; and
⢠require Wool International to assist, including financially, in the privatisation of the organisation.
The official wool stockpile
The offi cial wool stockpile accumulated as a result of purchasing to support the wool reserve price scheme grew from a negligible level at the start of the 1989-90 season to a peak of approximately five million bales in 1990-91. In the subsequent eight years, despite several changes to the stockpile disposal mechanism, a steady reduction in the stockpile was achieved to bring it down to its current level of just over one million bales. For most of this period up until the last year, the disposal program was accompanied by a rising trend in wool prices.
The disposal program came under increasing pressure in 1997-98 with the Asian crisis and weaker European demand pushing down wool prices. The Eastern Market indicator fell from 738 cents/kg clean a year ago to 544 cents at the start of the 1998-99 season and continued falling to the current 481 cents on 30 October.
The current debt on the stockpile is approximately $230 million and the stockpile itself is estimated to have a value of between $450 and $650 million. The Government's decision to freeze sales from the stockpile would, according to the Government, add $8 to $10 million a quarter, to the wool stockpile debt. The current stockpile represents about one quarter of annual production.
Wool international
Wool Inter national is a statutory authority established by the Commonwealth Government under the Wool International Act 1993 . Its mission is to sell the official wool stockpile, subject to certain conditions (outlined below), and to undertake these sales in a manner which maximises the net return to the Australian wool growing industry from sales of new, as well as stockpile, wool.
From 1994 to 1996, Wool International was required to sell wool from the stockpile according to a fixed schedule. A new, more flexible, wool stockpile disposal schedule was introduced with the Wool International Amendment Act 1996 . That Act required Wool International:
⢠to dispose of all of the stockpile wool by 31 December 2000
⢠to impose upper and lower caps on its quarterly sales of st ockpile wool. The current minimum sale is 90 000 bales per quarter and the maximum is 350 000 bales per quarter, and
⢠to retire the debt associated with the stockpile by the end 1998.
In the Second Reading Speech for the Wool International Amendment Act 1996 , the then Minister for Primary Industries and Energy noted the target date set for the final repayment of the debt associated with the stockpile. The Minister said that when repayment of the debt is achieved, the Government's debt guarantee arrangements will also end and that this underlines the Government's view that it needs to continue to withdraw from the industry to allow the industry to determine its own future direction.
Origin of Bill
The current Bill is necessary to provide legislative backing to the Government's decision, announced on 4 August 1998, that it will freeze all sales of wool from the stockpile fo r the remainder of the 1998-99 season.
The Government's intention was that the freeze on wool stockpile sales would take effect immediately. Wool International responded that it could not immediately freeze sales because it had a legislative obligation to sell a minimum of 90 000 bales by 30 September. The Government accepted this and announced that legislation would be introduced into Parliament as soon as possible after the Federal election.
Responses to the stockpile freeze announcement
The responses by industry representatives and by commentators to the Government's announcement to freeze wool stockpile sales have been, for the most part, negative.
The stockpile freeze has been opposed by:
⢠Wool International.(1)
⢠Wool Council of Australia who found t he decision 'basically inexplicable' and that only a vocal minority of growers supported it.(2)
⢠Australian Council of Wool Exporters.(3)
⢠State woolgrower bodies in NSW, Victoria, Tasmania and Queensland and the Pastoralists and Graziers Association in WA.(4)
Support for the stockpile freeze has come from:
⢠Liberal backbenchers, particularly those from WA.(5)
⢠Several Queensland National Party members.(6)
⢠Australian Woolgrowers' Association.(7)
⢠WA Farmers Federation.(8)
⢠SA Farmers Federation.(9)
Media commentators have referred to the decision as being driven by politics rather than economics. Few commentators have accepted the argument that it was an appropriate policy response targeted at arresting the downward slide in wool prices.(10)
It was reported in The Australian of 5 August 1998 that the move to freeze the stockpile was backed by Prime Minister John Howard and other senior ministers, including Ian McLachlan.(11)
On the impact of the decision itself, the Executive Director of the Wool Council of Australia said that it offers no relief to cash-strapped growers, no guarantee of any increase in prices, and creates great uncertainty in the international marketplace, which has become increasingly concerned at the constant government changes to stockpile policy.(12)
Related changes to Government wool policy
The Government made two other important decisions concerning wool marketing in 1998:
⢠On 30 March 1998, the then Primary Industries Minister John Anderson announced that the target date for r epayment of the wool stockpile debt had been extended by up to six months to June 1999, and
⢠On 15 October 1998, John Anderson announced the Government had decided to privatise the stockpile from 1 July 1999. The Minister stated:
Equity in the stockpile is now significantly higher than the wool debt, even at today's depressed prices, so there is no justification for ongoing Government involvement in its management. Wool International will be replaced by a private shareholding company, with shares allocated on the basis of individual equity entitlements in the stockpile. The new company will take over all the assets and liabilities of Wool International.(13)
Main Provisions
Section 3 of the Wool International Act 1993 (the Principal Act) sets out the objects of the Principal Act. The effect of item 1 of Schedule 1 of the Bill is to make it an object of the Principal Act to enable Wool International, as required by the Minister, to assist in the privatisation of the organisation.
Item 5 of Schedule 1 of the Bill inserts a new section 20A, dealing with the freeze on wool stockpile sales, in the Principal Act. The main effect of proposed section 20A is to prohibit Wool International from entering into contracts for the sale of stockpile wool between the commencement of the Bill and 30 June 1999. Proposed section 20A does not affects contracts entered into by Wool International before the commencement of the Bill that require delivery between 1 October 1998 and 30 June 1999.
Item 7 of Schedule 1 of the Bill inserts a new section 22ZG in the Principal Act which requires Wool International, at the written direction of the Minister, to provide certain assistance in the privatisation of the organisation. Such assistance may include technical, informational and financial support.
1. The Australian Financial Review, 6 August 1998, p. 13.
2. The Australian, 5 August 1998, p. 23.
3. Ibid.
4. The Australian Financial Review, 6 August 1998, p. 13.
5. The Australian, 5 August 199 8, p. 1.
6. Ibid.
7. The Age, 6 August 1998, p. 1.
8. The Canberra Times, 6 August 1998, p. B2.
9. Ibid.
10. The Australia, 5 August 1998, p. 12.
11. Ibid., at p. 1.
12. Ibid., at p. 23.
13. Minister for Primary Industries and Energy, Media Release, 15 Oct ober 1998.
Contact Officer
Mike Emmery and Ian Irelend
17 November 1998
Bills Digest Service
Information and Research Services
This paper has been prepared for general distribution to Senators and Members of the Australian Parliament. While great care is taken to ensure that the paper is accurate and balanced, the paper is written using information publicly available at the time of production. The views expressed are those of the author and should not be attributed to the Information and Research Services (IRS). Advice on legislation or legal policy issues contained in this paper is provided for use in parliamentary debate and for related parliamentary purposes. This paper is not professional legal opinion. Readers are reminded that the paper is not an official parliamentary or Australian government document. IRS staff are available to discuss the paper's contents with Senators and Members and their staff but not with members of the public.

subset: commoncrawl


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Father: Daniel Bryant Creager b: 18 MAY 1831 in Hardin County, Kentucky
Mother: Mary Jane Buckles b: 11 NOV 1833 in Kentucky
Marriage 1 Erasimus Mitchell Smith b: 17 JAN 1871 in Muhlenberg County, Kentucky
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Dating back to the thirteenth century and the building of Salisbury's ancient cathedral, the Red Lion Hotel is not only surrounded by history - it is also a part of it. Not far away is Stonehenge, the New Forest, Wilton House, Breamore House, Broadlands, and the Museum of Army Flying. The past is in easy access, yet the Red Lion Hotel offers the most modern of comforts and facilities. The Red Lion is believed to be the oldest purpose built hotel in Britain - and possibly in the world.
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You are going to Watch Demon King Daimao Episode 9 English dubbed online free episodes with HQ / high quality. Stream Anime Demon King Daimao Episode 9 Online English dub Crazy Fuss About Arranged Marriage. Without either of their input, it is decided that an arranged marriage meeting is to be held between Junko and Akuto at Iga Village. Junko, who has feelings for Akuto, is unable to tell him, and so invites him to the village for other reasons. Akuto knows nothing of the marriage interview, but feels responsible for the messes he has caused and decides to go with her. That night, Junko readies herself and visits his room, but another misunderstanding occurs. As Akuto flees, he is confronted by Eiko, who tells him that the god Suhara has decided Kena as a threat, and orders the Teruya Family to eliminate her.


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I thought the "Hills of Andalos" to the north and the "Velvet Hills" to the south are actually two separate things. Hopefully, Lands of Ice and Fire will answer this before 2013.--The Dragon Demands 19:55, June 24, 2012 (UTC)
Is this Hugor of the Hill character from Andal mythology, who was their first king, supposed to be their equivalent to King David in Andalos? Or do the books not say that much about him? --Fenrir51 (talk) 13:53, June 22, 2014 (UTC)


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Nyasha Grayman-Simpson
Assistant Professor of Psychology (2009)
Julia Rogers G17
B.A., Spelman College
M.A., New York University
Ph.D., New York University
Areas of Scholarly Expertise and Interest
Critical Psychologies (Black Psychology, Psychology of Racism, Psychology of Women, Pedagogy for the Privileged, Liberation Psychology, Transformative Learning); Qualitative Research Methods
Sample Syllabi
Cultural Psychology: Black Psychology Syllabus
Psychology of Women: Gender, Culture, and Ethnicity Syllabus
Qualitative Research Methods Lecture Syllabus
Qualitative Research Methods Lab Syllabus
Recent Publications/Presentations/Performances
Doucet, F., Grayman-Simpson, N., & Wertheim, S. S. Steps along the journey: Documenting undergraduate White women's transformative process in a diversity course. (In Press).
Grayman-Simpson, N., & Mattis, J.S. (2013). 'If it wasn't for the church...:' Organizational religiosity and informal community helping among African American adults. Journal of African American Studies, 17(3), 243-252. DOI 10.1007/s12111-012-9213-6.
Grayman-Simpson, N., & Mattis, J.S. (2013). Doing good and feeling good among African Americans: Subjective religiosity, helping, and satisfaction. Journal of Black Psychology, 39(4), 353 - 369. DOI 10.1177/0095798412461809.
Mattis, J.S., & Grayman-Simpson, N. (2013). Faith and the sacred in African American life. In K. Pargament (Ed.), Handbook of religion, spirituality, and psychology (pp. 547 - 564).
Grayman-Simpson, N. (2012). Humor in the horrific: The African American comedic tradition as africultural coping. Psych Discourse, 46(4), 12 - 13.
Grayman-Simpson, N. (2012). Black community involvement and subjective well-being. Journal of Pan African Studies, 5, 26 - 42.
*Gains-Hanks, N., & Grayman-Simpson, N. (2011). Intercultural tensions within international service-learning: Reflections on Barbados. In T. Stewart & N. Webster (Eds.), Exploring cultural dynamics and tensions within service-learning (pp. 323-328). Charlotte, NC: Information Age Publishing.
Chatters, L.M., Mattis, J.S., Taylor, R.J., Woodward, A.T., Neighbors, H.W., & Grayman-Simpson, N. (2011). Uses of ministers for a serious personal problem among African Americans: Findings from the National Survey of American Life. American Journal of Orthopsychiatry, 81, 118-127.
Grayman, N. (2009). "we who are dark...:" The Black community according to Black adults in America: An exploratory content analysis. Journal of Black Psychology, 35, 433 - 455.
*Gaines-Hanks, N., & Grayman, N. (2009). International service-learning in South Africa and personal change: An exploratory content analysis. NASPA Journal, 46, 72 - 93.
Mattis, J.S., Powell Hammond, W., Grayman, N., Bonacci, M., Brennan, W., Cowie, S.E., Ladyzhenskaya, L., & So, S. (2009). The social production of altruism: Motivations for caring action in a low-income urban community. American Journal of Community Psychology, 43, 71 - 84.
Johnson, A. J., Coleman, M. N, Grayman-Simpson, N., & DeLoach, C. (2009). No crystal stairs in the ivory tower: Strategizing for the success of Black women psychologists in the academy. Association of Black Psychologists Annual Convention, Atlanta, GA. (Think Tank).
(* = Equal Contribution by Authors)
Nyasha Grayman-Simpson Goucher College Curriculum Vitae


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I Had a BBL but my Butt is Uneven Due to Long Periods of Sitting and Lying Down.. What Do I Doto Make It Round? (photo)
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What Can I Do to Even out my Butt Cheeks After a BBL? (phoot)
I had a BBL about 8 months ago and I noticed my butt cheeks look uneven. my right cheek has some extra skin that looks weird and makes me... READ MORE
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It'll be six months post my bbl next month and I still feel as though one cheek is bigger than the other. Even my right hip comes out more than the... READ MORE
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Hi I am interested in a brazilian butt lift but have some questions and concerns. I am an average woman (25 years old around 138 pounds)no matter how... READ MORE
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So i understand that u can lose volume...but will the results be uneven or lopsided....how is this prevented? READ MORE
3 weeks post op Brazilian Butt Lift & Fat Transfer, I'm concerned about my fluid pockets. Will lymphatic massage help? (photos)
I had fluid pocket after drainage removed and the doc drain, I am concerned because I have a few more fluid pockets. Should I have them drained again?... READ MORE
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I'm 4 weeks after bbl as of right now my butt looks uneven and is getting smaller , I'm being told that that unevenness is due to swelling and I have... READ MORE
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I got a BBL with transfer to butt and hips. My lipo is uneven. I have a pocket of protruding fat around my belly button, my groin has a dent, my hips... READ MORE
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Hi I feel like butt cheeks are uneven from each other. I have a nice butt already but I would like it to be a little bit bigger. I am a size two. 32... READ MORE
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I want to get rid of these horizontal lines on my butt and round it out at the same time. I have lost almost 100 lbs and that left my body looking... READ MORE
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Had bbl lipo done 3 weeks ago.I wore my garment 24/7 and had 9 massages However my swelling only goes down after the massage then the next day it... READ MORE
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by Staff Writers
Tokyo (AFP) Jan 21, 2012
Anti-whaling activists threw paint and foul smelling acid at a whaling ship in the Antarctic ocean Saturday in a fresh bid to halt the annual hunt, officials said.
Two boats belonging to the US-based environmental group Sea Shepherd approached the Japanese whaling vessel Yushin Maru No. 2 (YS2) and launched 40 bottles containing paint and butyric acid, Japan's Fisheries Agency said.
"YS2 gave warnings, by voice and water cannon, to the obstructive activities," the agency said in a press release, adding that the ship also floated buoys to deter the activists' boats.
None of the YS2 crew was injured but the ship's hull was smeared with the targeted acid and paint.
The agency called Sea Shepherd's actions "extremely dangerous acts which threaten the safety of our country's vessels and the life of its crew".
The Sea Shepherd launched similar attacks against Japanese whaling fleet earlier this month.
Sea Shepherd said three of its members were injured when Japanese crewmen used grappling hooks and bamboo poles to deter them in a high seas clash on Wednesday.
On January 7, three activists from another environmental group Forest Rescue Australia boarded another whaling boat Shonan Maru.
Japan only agreed to hand the men over after intervention from Canberra, and they were returned to Australia later by a border protection vessel.
The Japanese whaling fleet, led by the 720-tonne Yushin Maru, was seen leaving the Japanese port of Shimonoseki on December 6 for the annual hunt, with security measures beefed up after clashes in previous years.
Their mission is officially said to be for "scientific research", with the fleet aiming to catch around 900 minke and fin whales, according to a plan submitted by the government to the International Whaling Commission.
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Three injured as Japan whalers use hooks: activists
Sydney (AFP) Jan 18, 2012
Three anti-whaling demonstrators have been injured after Japanese crew members used grappling hooks and bamboo poles against them in a high seas clash, activist group Sea Shepherd said Wednesday. The Sea Shepherd Conservation Society, which annually shadows and harasses the Japanese whaling fleet, claimed two activists were struck in the shoulder with iron hooks and one was hit twice in the ... read more
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Jorgensen Tabbed New Kentucky Swimming Head Coach
May 28, 2013
LEXINGTON, Ky. – For the first time in 22 years, the University of Kentucky swimming and diving program will be led by someone other than Gary Conelly, who retired in April. That someone new, however, is a familiar face as UK Athletics Director Mitch Barnhart announced Tuesday that associate head coach Lars Jorgensen has been selected to succeed Conelly.
"We are excited that Lars has become our head coach and for the enthusiasm he has for the University of Kentucky," Barnhart said. "During his year here, he has been impressive as associate head coach and as a recruiter and we believe he'll do an outstanding job in his new role. With his success as head coach at Toledo, as an assistant at LSU and as a student-athlete, assistant coach and interim head coach at Tennessee, Lars has the ability, experience and desire to succeed at Kentucky."
"It's a dream of mine to be the head coach at the University of Kentucky," said Jorgensen. "I know we can be very successful here. We have a lot of work to do, but this past year we laid the foundation for future success as we have a really good recruiting class coming in. I think we're going to have a lot better team next year and in the years to come."
Conelly hired Jorgensen prior to the 2012-13 season, giving Jorgensen an opportunity to learn the program and state, build a relationship with the athletes, and form a bond with the athletic department.
"I think, for one, that we have a really great athletic department," said Jorgensen. "I want to thank Mitch Barnhart and (Senior Associate Athletic Director) Jason Schlafer for giving me this opportunity and trusting me with the University of Kentucky swimming and diving program. I think we're in a great location. We have great support being in the SEC. There's no reason why we can't become a more competitive program."
The Southeastern Conference boasts an incredible pool of talent when it comes to swimming and diving. Three men's and women's programs finished in the top 10 nationally at the NCAA Championships in 2013, including the National Champion Georgia women's team. The road will be difficult, but it's a challenge that Jorgensen, a former University of Tennessee swimmer and coach, is quite familiar with and welcomes.
"We want to consistently perform in the SEC and at the NCAA level," said Jorgensen. "We want to lay a foundation built by work ethic and toughness. If we do the little things, then we're going to be competitive, and that's our goal."
While changes to the program are certainly forthcoming, Jorgensen plans to continue to use much of what he learned from Conelly and his 22 years of coaching experience. The 2012-13 season served essentially a transition period as Conelly looked to leave his program in capable hands. Conelly's guidance and wisdom will be prevalent for years to come as Jorgensen settles into his new role.
"Gary was wonderful this past year," said Jorgensen. "I believe in a lot of the same things that Gary taught. It was really nice because I got to know the athletes for a year, so it's an easier step.
"But it's a different role and we have to be accountable in all areas of our program, and my responsibility as a head coach is that our coaches are working hard, our athletes are working hard, and that we're moving the program forward."
Before coming to Kentucky last season, the San Diego, Calif., native and former UT product served as the interim head coach at Tennessee for the 2011-12 season.
During his stint with the Volunteers, Tennessee had a top-12 finish nationally and a third place finish at the SEC Championships while posting a 6-2 (2-1 SEC) record during his first season as an assistant in 2010. He helped coach 12 All-America honorees and they broke three school records during his time there.
Before his time at his alma mater, Jorgensen served as head coach of the Toledo Rockets swimming and diving programs beginning in 2003 and spanning to the 2010 season, where he was twice named the Mid-American Conference Coach of the Year. In his time at Toledo, Jorgensen led the Rockets to new heights, capturing the program's first MAC Championship in 2009-10 and finishing 35th nationally at the NCAA Championships. The Rockets were also fantastic out of the water for Jorgensen, tallying a 3.4 GPA in the classroom, which ranked 17th among NCAA Division I schools that season.
At Kentucky, Jorgensen hopes to continue the Wildcat tradition of academic success while creating a competitive, well-rounded program.
"First, it's creating a culture of excellence across the board -- academically and athletically," said Jorgensen. "Being a great team, that's important and getting our team to believe in itself that we can be competitive. Those are the missions of the program. We will do things the right way. Continue to excel in the classroom because we were pretty good last year, but we have to improve athletically and I think you can do both at a high level."
Prior to his time at Toledo, Jorgensen also spent four seasons with LSU as an assistant coach including his final season with LSU as the Tigers' associate head coach. In all four years at LSU, his teams finished in the top-20 nationally including a 16th-place finish.
As a student-athlete, Jorgensen was a standout swimmer for UT and the United States, representing the USA in the 1,500-meter freestyle at the 1988 Seoul Olympics. He also has six USA National Championships to his name.
Jorgensen also holds the current UT record in the 1000-freestyle, tapping in at 9:05.38 in 1992. In addition, Jorgensen holds the Ironman Triathlon record for fastest swimming time in competition history.
Now, Jorgensen hopes that his success in the pool and his experiences at various stops throughout his career as a coach will translate to a winning culture for the University of Kentucky.
"I'm super excited," said Jorgensen. "I've been involved with swimming my entire life, and to lead a program like Kentucky is something that I've worked very hard for and I can't wait to get started."


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Last Updated Feb 12, 2016 · Written by Rob Schneider
When you're designing your kitchen, the time will come when you have to choose your kitchen tiles. You can take the easy way out and choose white or a plain colour, but you may not be satisfied with the result. You can also make choosing tiles more complicated than it needs to be. The middle road is the best road to take. Here are six tips for choosing the best kitchen tiles that will help take the headache out of choosing tiles.
Where will you be installing your kitchen tiles? If you're installing tiles behind your cooktop, they will will need frequent cleaning. Choose tiles that can stand up to grease and are easy to clean. If you're choosing a plain colour, a glossy tile might be a good choice. If you want decorative tiles, you still want non-porous tiles that you can easily wipe clean.
Is your kitchen a modern or traditional style kitchen? Do you like the minimalist look or do you want splashes of colour? Do you want feature tiles or do you want to stick with one colour? Have a look at our Kitchen Design Ideas pages for inspiration.
You have a variety of tile shapes and sizes to choose from today. You can choose tiny mosaics or large format wall tiles. Tiles are generally square or rectangular, but you're not limited to a "straight lay" with parallel and perpendicular grout lines. Let's say you've decided to stick with white, cream or a neutral colour. Which size and shape will work best in your kitchen. Would subway tiles work better in your kitchen than square tiles?
Many kitchen tiles have a smooth surface, but you can also find textured tiles. A textured tile might be just what you need to add style and interest to your kitchen.
It's easy to get carried away when choosing tiles and forget that they cost money. Some tiles can be very expensive and may be budget-busters. That doesn't mean you have to compromise on style, though. You can find mid-range tiles that will look just as good or choose more expensive feature tiles to give your kitchen splashback a boost. If your choice of tiles is making you compromise on other features of your kitchen, you might want to consider installing an acrylic splashback instead of tiles.
If you take a step-by-step approach to choosing tiles, you can narrow down your selection more easily. Start with the appropriateness of a tile for its location and then think about colour, shape, layout and texture without forgetting about your budget. Finally, stand back and visualise your tiles as they will look against the rest of your kitchen. Do they go well with your benchtop and cupboard doors? Do they enhance the appearance of your kitchen? Don't be afraid to experiment before you buy. You may find a tile that works better for you than the tile you first envisioned.
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Samuji Sina Blouse
Samuji Sina Blouse
Lightweight ecru blouse with billowy sleeves and hidden front-button closure and an oversized fit. Mindfully made in Estonia and crafted from quality materials from both European and Japanese suppliers. Hand wash cold. Olivia is wearing the 34. Olivia is 5'6", 37" bust, 26" waist, 35.5" hips.
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Medications - E
- Econazole Topical
- Eculizumab Injection
- Edoxaban
- Efavirenz
- Efinaconazole Topical
- Eflornithine
- Elbasvir and Grazoprevir
- Eletriptan
- Elotuzumab Injection
- Eltrombopag
- Eluxadoline
- Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir
- Empagliflozin
- Emtricitabine
- Emtricitabine and Tenofovir
- Emtricitabine, Rilpivirine, and Tenofovir
- Enalapril
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Saturday, 30 December, 2000, 13:36 GMT
Tempers flare over frozen planes
The freezing weather has caused angry scenes at Luton and Liverpool airports, leading to the police being called in.
More than 100 EasyJet passengers staged a sit-in at Luton after a series of flights were cancelled because aircraft were iced up.
At Liverpool Airport one person was arrested in a disturbance which broke out after passengers were told the low-cost airline had scrapped services there too.
EasyJet has said it will refund fares for anyone delayed more than four hours and will consider other claims.
A Merseyside Police spokesman said there had been a disturbance at Liverpool involving disgruntled passengers.
He would not say how many people were involved but confirmed that at least one person had been arrested.
Later on Saturday, there were more problems at Luton.
Further delays
Many travellers who had been at the airport throughout the night were hoping to leave on re-scheduled flights during the morning and early in the afternoon.
But the majority of flights were again delayed - several for more than two hours.
Many flights due to arrive at the airport were also delayed.
EasyJet blamed the latest problems on bad weather at various European airports and on delays in checking in.
"Of course we apologise for any inconvenience that our passengers have suffered," he said.
"Basically, we were badly let down by a sub-contractor we employ to de-ice aircraft.
"Because the aircraft were not de-iced we could not fly and therefore had to cancel flights last night.
"But to be fair this could have happened to any other airline, we cannot control the weather.
"I suspect this could have been British Airways or British Midland facing the same problem at another airport."
'Lack of information'
Karen Kemmett, 30, from Brighton, Sussex, was due to fly to Barcelona on Friday but spent the night at Luton. She said the problem was lack of information.
"There was no concern, no-one here to tell us anything, no cups of coffee, no nothing," she said.
"Quite a few people had had enough. It was quite understandable."
Lucy O'Neill, who celebrated her 31st birthday on Friday, said staff and customers had broken down in tears.
"At one stage the police were called and there were a couple of incidents. One guy got very irate with one of the check-in girls. She just walked off in tears.
"Then passengers started arguing amongst themselves. Some were trying to defend the girl and said it wasn't her fault.
"There was no-one around at all to answer any questions or offer any help."
Flooding danger
Weather experts warn the cold weather which has caused transport chaos across the UK will last until late on 1 January.
Temperatures have plummeted and to add to people's misery there is a danger of flooding when the snow eventually thaws.
The Meteorological Office has issued an early warning of blizzards and drifting snow on New Year's Eve.
Cumbria, north-east England and Scotland are currently facing the worst weather.
See also:
30 Dec 00 | UK
Big freeze hits holiday sport
29 Dec 00 | Scotland
Hogmanay freeze warning
28 Dec 00 | Wales
Aircraft skids on icy runway
30 Dec 00 | UK
Picture gallery: Snowed under
30 Dec 00 | UK
UK weather and travel round-up
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text:
Carl Hoffman
Class of
My hometown is
Midland, MI
My major(s):
IPHS and Biology, double major
After I graduate I plan to
Pursue a medical degree, MD, in Sports Medicine.
My favorite place on campus is
McIntrye Mall
Some of my favorite professors include
IPHS Professors (Dr. L is extra funny), Dr. Palmer, Dr. Hill, and Professor Karbowiak
My greatest accomplishment at Alma is
Helped raise over $31,000 for Relay for Life Committee
I'd advise an Alma freshman to
Get involved on campus at Alma, thru sports, organization, and clubs , it will make your fours years more of an experience. Also, get to know your professor's they are cooler than you think!
I'd tell a student considering coming to Alma
#Plaid twerks!


text:
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text:
This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (
There is a broad consensus that climate change will increase the costs arising from diseases such as malaria and diarrhea and, furthermore, that the largest increases will be in developing countries. One of the problems is the lack of studies measuring these costs systematically and in detail. This paper critically reviews a number of studies about the costs of planned adaptation in the health context, and compares current health expenditures with MDGs which are felt to be inadequate when considering climate change impacts. The analysis serves also as a critical investigation of the methodologies used and aims at identifying research weaknesses and gaps.
Climate change is expected to have considerable impacts on human health. The most important include increased vector-, water- and food-borne diseases; injuries and deaths caused by extreme hydro-geological events; heat-related diseases and deaths caused by heat waves (thermal stresses); and negative impacts on malnutrition [
In order to reduce these negative health impacts, various programs or measures, known in the climate literature as adaptation measures, are being put in place or are being planned. Adaptation is defined by IPCC (Intergovernmental Panel on Climate Change) as the "adjustment in natural or human systems in response to actual or expected climatic stimuli or their effects, which moderates harm or exploits beneficial opportunities" [
For informed decision-making, national governments need therefore to know what financial resources are needed for adaptation, what is the financial gap in funding, what damages could be avoided through adaptation, and what is the cost-effectiveness of the proposed programs. This would allow them to set priorities and to choose the most appropriate combination of measures to reduce the negative health impacts.
This paper critically reviews a number of studies on the costs of health interventions. It analyses the methodological approaches used and identifies critical gaps and research priorities in this area. The goals are three-fold. First, we wish to explore the economic impact of climate change in developing countries in terms of planned adaptation costs, based on the empirical evidence from the existing literature. Quantification of the health costs of adaptation requires an extensive analysis of long-term data including the increase in the number of cases and deaths caused by climate change, as well as economic variables such as unit costs of specific health measures. Such an analysis is more complex in developing countries, due to the lack of consistent long-term datasets. Given these difficulties and the limited number of studies in the context of health adaptation, the analysis is completed by selecting a number of relevant studies coming from the public health literature for climate-related disease control programs. Second, we use the estimated total costs resulting from the literature to perform a simple cost-effectiveness analysis of different health interventions for different diseases, in order to identify the alternatives with the lowest cost to achieve the desired result. Preventive and reactive measures for different health endpoints are compared, the first aiming at avoiding deaths or episodes of illness, while the second are intended to treat the disease when already occurred and minimize the damage. Third, this analysis serves also as a critical investigation of the methodologies used for cost assessment with the purpose of identifying the research gaps and the conditions that need to be satisfied to assure reliable estimates.
Section 2 presents a brief overview of the main health impacts caused by climate change with a specific focus on developing countries. Section 3 presents a classification of adaptation measures, identifies the main cost categories and reports on the methodological approach used for cost assessment. The methodological issues that arise in judging whether a measure is justified from an economic point of view are discussed in Section 4, reporting on two main approaches, cost effectiveness analysis and cost-benefit analysis. Section 5 details the existing studies on the costs of health interventions to reduce climate-related diseases, comparing results among macro-geographical regions. In Section 6 different health interventions are discussed in term of their cost-effectiveness. Finally Section 7 discusses the existing research gaps, the main methodological issues in the cost assessment and how to improve knowledge.
Climate change will have a wide range of implications to human health. These include thermal-related morbidity and mortality due to extreme temperatures, effects associated with air pollution, impacts of extreme weather events, malnutrition, water-borne (e.g. diarrhea, cholera, typhoid), food-borne (e.g.
The increase in the frequency and intensity of extreme temperatures will have both direct and indirect effects on health. Direct effects include thermal stresses (cardio-vascular and respiratory diseases, heat exhaustion, heat cramps and dehydration), while indirect effects are related to the impact of heat extremes on urban air pollution and humidity (which can aggravate pre-existing morbidity).
The risk of heat-related morbidity and mortality would increase mainly in the elderly, children, those with pre-existing cardio-vascular and respiratory diseases, and among the urban poor. The greatest impact is expected for mid- to high-latitude cities, especially in poor countries, characterized by poorly adapted buildings and without air conditioning. Lack of datasets and long-term statistics in developing countries makes it difficult to provide quantitative estimates of health effects in these countries. Nevertheless some studies exist which project large impacts in the temperate and tropical regions in Asiaand India [
The negative impact of heat waves might be partially compensated by a decrease in cold-related deaths during the winter season. According to some studies, the decrease in winter mortality in temperate regions might be greater than the increase in heat-related mortality expected in summer [
Extreme temperatures may also increase the exposure to urban air pollution, with the potential to aggravate pre-existing respiratory and cardio-vascular diseases. In the recent years, extreme weather events, such as floods and landslides, storms, cyclones and droughts, have caused considerable damage and loss of life in China, Venezuela, Bangladesh and Mozambique. Direct impacts of extreme weather events include increased incidence of deaths, physical injuries and psychological stresses, while indirect impacts are related to increased risk of exposure to water-borne diseases due to water contamination, and impacts on malnutrition due to loss in agricultural production. Unsafe water and sanitation conditions and decrease water accessibility would further increase the transmission of infectious diseases. It is estimated that by 2050, one billion people in Asia could have limited access to drinking water [
Other indirect impacts of changes in weather patterns include variation in the geographical and seasonal distribution of vector-borne diseases (malaria, dengue, leishmaniasis, lyme disease, tick-borne encephalitis), in some cases by expanding transmission to higher altitudes and latitudes. There is, however, considerable uncertainty as to the magnitude of the impacts. Some mathematical models project a net increase in the amount of population exposed to malaria and dengue transmission as a result of climate change [
Finally, higher temperatures can lead to increased exposure to food-borne diseases due to contamination of food, which can cause various gastrointestinal diseases. Notwithstanding the existing scientific uncertainties, most researchers project that in the next decades these health impacts are likely to increase considerably in developing countries, which are more vulnerable to climate change impacts and less capable to adapt to such changes, having poor health care systems, poor health status, and few financial, social and technological resources to adapt. Hence climate change is threatening the capacity of these countries to attain the United Nations Millennium Development Goals by 2015 (UN 2015). It is therefore crucial to understand how climate change is likely to impact development priorities in poor countries, and to respond with appropriate and cost-effective measures for adaptation.
In order to cope with the adverse health effects of climate change, adaptation measures, plans and programs are put in place. Adaptation is defined in terms of "policies, practices, and projects with the effect of moderating damages and/or realizing opportunities associated with climate change" [
Another important classification distinguishes between anticipatory (or proactive) or reactive adaptation. The first implies preventive actions which take place before the impact occurs in order to avoid of reduce the risk of disease and death. This type of adaptation involves long-term decision making and reduces long-term impacts, risk and vulnerability caused by climate change. For this reason, anticipatory adaptation is more effective and involves generally planned interventions. On the other side, reactive adaptation provides an immediate response to climate change. The actions take place after the impact with detection and subsequent treatment of the disease. In the public health sector, adaption actions are usually classified into three categories according to the timing: primary, secondary and tertiary [
Other criteria distinguish between short term and long term adaptation, localized and widespread adaptation [
Legislative measures consist of laws, guidelines and regulations put in place by the parliament and government to prevent negative impacts of climate change. Technical measures can be anticipatory or reactive, they can be implemented by various government departments depending on the type of measure (e.g. vaccination programs issued by the public health care sector), by the municipality (e.g. green islands in the city centre) or by the industrial sector (e.g. thermal building insulation). Education measures can be implemented by the central government with the cooperation of various departments (e.g. public health). Finally, the behavioral measures are put in place by individuals and they are defined as autonomous adaptation.
Examples of possible health adaptation actions are reported in
The cost of health adaptation programs includes the cost of building, operating and maintaining health provision service structures, setting up and running emergency response systems,
From an economic point of view, we should estimate the social costs of adaptation programs. These include external costs incurred by the society (opportunity costs), besides the private costs of production. The studies analyzed in this paper focus on the first two categories of costs mentioned above, namely direct and institutional costs, excluding transition and opportunity costs.
The costs of health adaptation are estimated using market-based data and information in order to perform a cost assessment based on unit values multiplied by the target population living in the vulnerable areas and by the incidence of diseases. Health adaptation costs include treatment costs of additional cases (reactive adaptation) and costs for preventive measures to reduce the incidence of disease (proactive adaptation). The cost of health adaptation will depend on the health outcome, the intervention type (e.g. treatment or prevention), the expected reduction in the incidence of mortality and morbidity and finally on the geographical region where the impact is expected.
As important as estimating the costs of adaptation programs for health protection, is to have some way of judging whether these costs are reasonable and whether the program is justified. For this purpose economists use two tools: Cost-Benefit Analysis (CBA) and Cost-Effectiveness Analysis (CEA). The main difference between CBA and CEA is that in CBA both the costs and benefits of a proposed program are estimated in monetary terms, and then compared with the costs and benefits of alternative programs, in order to identify the program with the highest net benefits. By contrast, CEA estimates only the costs of attaining certain health goals, which are measured in physical units (number of lives saved, number of cases of illness avoided, and quality adjusted life years - QALY).
Cost-effectiveness analysis (CEA) is a technique used to identify the least cost intervention to reach a desired result. It enables us to define priorities among different alternative interventions by identifying the least cost option able to reach the underlying objectives. CEA is sometimes used as a second-best option when a full-blown CBA would be desirable, but many benefits cannot easily be monetized [
The cost-effectiveness ratio of a program is computed by dividing the annualized costs of the program by the physical benefits, measured in terms of lives saved (or life years saved), and cases of illness avoided. Results are expressed as unit costs, in terms of costs to be supported to save one life (or one year life) and to avoid one episode of illness. If all else is the same, the program deemed more cost-effective would be the one with the lowest cost per life saved or avoided case. For example a government might decide that any project where the cost per life year saved is in excess of €1,000 cannot be funded. It could arrive at this conclusion, given information on the range of possible interventions, the cost per life year associated with them and the budgetary resources available. Each project then would have to report a cost per life year saved and a necessary condition for adopting it would be that this cost is less than €1,000. This approach is attractive because: (a) it is generally feasible (although not always easy) to calculate the cost per life year saved or case avoided from health related interventions and (b) the criteria are simple and transparent. Traditionally, CEA has been used widely in medical decision-making and in public health although in practice the selection of health interventions does not rely exclusively on this criterion [
Estimation of the costs of a program within a CEA is similar to that in a CBA. The advantage of the first is that the benefits are computed in physical terms and not in monetary terms as in a CBA, which results in a less complex calculation. Analysts engaging in a CEA, however, still have to deal with complex issues such as the choice of the discount rate when the costs of the program are incurred over several periods. Further problems arise when a program impacts on more than one indicator (e.g. it results in savings in life years as well as a reduction in the experience of unpleasant symptoms). In such cases other criteria have to be used or one has to be chosen at the expense of the other This is particularly relevant as a program could reduce both mortality and morbidity impacts, and in this case the use of one indicator (cost per case avoided) instead of the other (cost per life saved) could have misleading results if the two measures differ widely. In these cases another physical indicator known as the Quality Adjusted Life Year (QALY) is routinely used in medical decision-making and public health. This measure is based on the individual preferences over quality of life and longevity, which are assumed to depend on the health consequences (it is assumed that a year of healthy life expectancy is worth 1, while a year of unhealthy file expectancy is worth less than 1, being this value lower the worse the quality of life). This indicator has the advantage of incorporating both mortality and morbidity effects, instead of favoring one of the two. The main problem with this approach is that older individuals would have fewer QALYs than younger individuals, which would lead to higher cost per case avoided or per life saved for the elderly. Furthermore this approach does not account for individual risk perception. For these reasons, in our computations we use the indicator cost per case and/or death avoided.
In the context of climate change CEA is a useful tool to provide a measure of the costs of a program in terms that are comparable across programs. Studies on the costs of adaptation programs are indeed difficult to compare in a way that provides some guidance on whether they are justifiable or not. Although imperfect, measures such as the cost per case avoided or cost per life year saved are at least feasible and the numbers obtained useful for policy purposes.
This technique has been used to analyze many public policies, including transportation, urban regeneration, agriculture, public health, education, and the environment. It is also used for valuing for adaptation to climate change impacts. By monetizing the benefits of a program, CBA makes it possible to evaluate many different types of government programs and to compare them with the costs of the programs. When different programs are examined, economists suggest choosing the one with the largest net benefits (equal to total benefits minus total costs of the policy). Note that, unlike CEA, cost-benefit analysis also allows one to determine the socially optimal size of the program, i.e., the one that maximizes net benefits.
In order to determine the net effect of a proposed program, we must first identify who will gain (beneficiaries) and who will lose from its implementation, and then estimate the gains or losses for each of the partners. In spite of that equity considerations are not sufficiently reflected in CBAs (the argument that projects or policies with the best benefit-cost-ratio are socially desirable rests on the assumptions that the gainers can – in principle – compensate the losers of a project/policy and still be better off. Since such compensation is not generally paid, most projects or policies have distributional implications that need to be taken into account). CBA is complicated further by the fact that, while it is quite easy to identify the costs, it is more difficult to estimate the benefits, as these are generally non-market goods, for which no market prices exist.
Another problem with CBA is that it must compare costs and benefits that are experienced at different times in a single measure. The choice of the rate at which future costs and benefits should be discounted is particularly relevant for climate projects because costs of adaptation measures will be incurred in the near future while the benefits will be spread over a much longer time period. The debate on discounting for climate change is not resolved but many economists argue that very long term impacts of the kind associated with climate change require very low discount rates – of the order of one percent or less. In practice normal public sector projects involve discount rates of around 5–6 percent [
One other feature of the use of CBA to evaluate health adaptation programs is worth mentioning. This is the problem of valuing benefits that take the form of reductions in mortality – implying savings in life years, which in turn requires a value to be attached to a life year or a life saved. In the past this has produced serious debate and disagreement. Methods have been developed for making such estimates, but the studies are mainly from developed countries. In the context of climate change the use of different values for a life year according to the country in which the person lives has raised serious problems (this issue created a political crisis at the time of the 2nd IPCC Report when a recommendation to take a lower value of life in developing countries compared to industrialized was strongly objected by representatives from developing countries). Studies in the climate change field have wrestled with this problem and resolved it with broadly two uneasy compromises. Some have taken different values for different countries, more or less in proportion to real per capita GDP [
The analysis reviews a number of valuable studies about the costs of health interventions (planned actions) to reduce the disease incidence and related mortality, with a specific focus on developing countries, expected to face most of the health impacts of climate change. The studies selected focus on similar targets in terms of health impacts reduction, which allows comparison among interventions types and countries. The health outcomes considered in the analysis are vector-borne and water-borne diseases, malnutrition, pneumonia and newborn causes of death in children. It must be recognized that quantification of costs is much more difficult in developing countries, due to the lack of data and long-term analysis, high variation of data among countries, inefficiencies in disease detection and reporting. Nevertheless we have selected some relevant studies in order to analyze the methodology and to draw some quantitative estimates of the cost of health adaptation.
There are two main groups of studies considered in this analysis. The first relate to health care costs associated with the additional health impacts arising as a result of climate change. These costs include disease treatment measures (reactive adaptation) as well as preventive measures to reduce the incidence of climate related diseases (anticipatory adaptation). Despite the important role of adaptation in reducing the health costs of climate change (known as the 'costs of inaction'), there is very little information available from the literature on the costs of health adaptation in different climate change scenarios. For this reason we have reported on a second group of studies focusing on the costs of health interventions programmed to achieve a reduction in the burden of climate-related diseases, in accordance with internationally agreed objectives and targets, like the MDGs. These costs are estimated outside the climate change context, but they focus on climate-related diseases (e.g. malaria, diarrhea, pneumonia). As the types of measures used for disease treatment and prevention are, in principle, the same in both contexts, the second group of studies can be reasonably used to provide some indications of how much adaptation measures would cost.
The methodological approach for estimating health adaptation costs requires to estimate the disease incidence due to climate change, to project future population under different scenarios, and to estimate the number of people at risk in the future (multiplying future population with the incidence ratio). The costs of adaptation are assessed by multiplying the number of people at risk in the future with the cost per capita of health interventions.
Perhaps the most important study in this category is that of Ebi [
Total costs under various categories for the year 2030 are summarized in
For the sake of comparison among different countries, additional annual costs have been calculated for major geographical macro-regions in developing and developed countries. Detailed estimates for these macro-regions are reported in
As regards diarrhoeal diseases, South East Asia and Africa are expected to face the highest costs in all scenarios, accounting for respectively 42% and 27% of total annual costs for health interventions in developing world, followed by Western Pacific with 16%. As for malaria, the majority of the costs are expected in Africa (82%), followed Eastern Mediterranean countries (14%).
In terms of gains from reducing GHGs in developing countries,
The second study in this context is from Van Rensburg and Blignaut [
The above mentioned figures can be compared with the total expected costs of malaria if no intervention was implemented [
In this section we analyse and discuss the results of some studies estimating the costs of health interventions outside the climate change context but focusing on climate-related diseases and therefore relevant to the climate change health discussion. The diseases looked at are malaria, diarrhoea, malnutrition, pneumonia and other newborn diseases. The studies included in the analysis report estimates for macro-geographical regions and for a combined set of intervention programs.
The first study analysed is Kiszewski
The study integrates cost valuation methodologies with epidemiological estimates about the proportion of people exposed to malaria (using climatic modelling and clinical evidence of incidence) and projections of population growth rates (unit costs have been calculated in each country for the baseline year. For preventive measures, unit costs are multiplied by the total population living in areas at risk. For reactive measures, unit costs are multiplied by the incidence of disease in those areas. Future changes in demand and production have not been considered in this analysis, nor have the associated effects on future prices).
Results show that the total financial resources needed from 2006 to 2015 to implement the recommended measures (in Africa, Asia, Middle East and South America) amount to US$ 38 to US$ 46 billion (on average US$ 3.8 to 4.6 billion per year). Among the different cost categories, the vector control costs are estimated to be the highest. The average annual costs (2006–2015) are expected to be around US$ 1.7–2.2 billion for Africa, around US$ 1.9–4.6 billion for South East Asia, Western Pacific and Eastern Mediterranean, and finally US$ 212–235 million for Central and South America (
These figures are similar to the costs for health adaptation estimated by Ebi [
If we compare total costs of these interventions with the national resources available for malaria control we find that only 4.6 percent of the estimated annual financial resources required can be covered by national resources in the African countries, and only 9.2 percent in the countries of Asia, Oceania and Americas, showing a financial gap between domestic funding and funding needs on annual basis of 90–95 percent. This suggests that governments are unable to fund programs at a level high enough to meet the malaria targets or to treat the additional cases resulting from climate change.
The results of Kiszewski
Another relevant study for malaria is that of Morel
Various prevention and treatment measures and combinations of them on a 10 year timeframe are evaluated under different assumption of population coverage. Preventive interventions include vector control programs like insecticide treatment of bed nets, indoor residual spraying and intermittent treatment of pregnant women (aiming at reducing neonatal mortality). Treatment measures include distribution of several drugs, and combination treatments, while hospital admissions are not considered. Interventions have been evaluated at 50%, 80% and 95% coverage. Population at risk is calculated taking into account the proportion of person living in malaria endemic areas. Results show that, for 95% population coverage, annual costs are equal to US$ 468 million for Western Africa and US$ 442 million for Southern and Eastern Africa (based on year 2000 estimation), for a combination of measures including indoor residual spraying, impregnated bed nets, case management based combination therapy and intermittent presumptive treatment in pregnancy. These figures are 45 to 70 percent lower than those provided by Epstein and Mills [
A more extensive study estimating health care programs costs is Stenberg
Hutton and Haller [
Total annual costs of these interventions (in developing and developed countries) range from US$ 1,782 million in the first scenario to a huge US$ 136,514 million in the fifth scenario. The first scenario involves improvement in water accessibility only, while the second scenario involves both water and sanitation accessibility improvement, requiring therefore much larger financial resources (equal to US$ 11,303 million). Investments on sanitation are indeed considerably more expensive. In scenario three it is expected that the entire population has access to water and sanitation services, which doubles the costs of implementation (equal to US$ 22,612 million). Scenario four requires only a low increase in financial resources as it includes the availability of disinfected water at the point of use (US$ 24,648 million).
The high costs for the fifth scenario (US$ 136,414 million) is explained by the substantial investments and corresponding maintenance costs necessary to guarantee access for all, in order to regulated piped water supply and sewage connection in the houses. These figures are much higher than the corresponding annual costs for non-structural interventions for disease control and prevention in public health but the water and sanitation programs do attain a number of other objectives as well. In terms of health they attain a 60–70 percent reduction in the incidence of disease.
The last study analyzed in this group is the one of Meddings
In this section we use the cost estimates from the above-mentioned studies to compute a simple index of cost-effectiveness for different intervention programs and health endpoints. We use two indicators, the cost per death or per case avoided, depending on the available data and the intervention targets and objectives. Only health benefits are incorporated in the index, while potential non-health benefits are excluded from the analysis.
Results are reported in the fourth column of
The cost per case avoided in water and sanitation programs has been based on the data of Hutton and Haler [
Finally, we include the cost per death avoided estimated by Meddings
The analysis is completed with a critical review of the existing studies about the cost-effectiveness of single health interventions in developing countries (
Results vary according to the intervention type and the country of origin. Cost effectiveness for immunization programs of diarrhea varies from US$ 226 to 887 (US$ 1999) per death avoided, while breastfeeding promotion ranges from US$ 115 to 919 per death avoided. These results confirm that non structural health interventions are less cost-effective compared to structural environmental health interventions like water and sanitation programs [
As regards prevention of malaria, cost per death avoided is around US$ 305 (US$ 1999) for vaccination, it ranges from US$ 227 to 858 for bed net impregnation measures, from US$ 73 to 414 for vitamin A supplementation and from US$ 81 to 950 for prevention in pregnancy. Treatment measures of malaria show a cost per death avoided of US$ 271–1,355 for early diagnosis and prompt treatment.
These results are comparable with the cost per death avoided we estimated using data from Kiszewsky [
In this paper we have looked at the costs of adapting to climate change from a health perspective and we have computed a simple cost-effectiveness index for alternative programs based on the estimated total costs resulting from the literature. The analysis is completed with a critical review of the existing studies about the cost-effectiveness of different health interventions.
There is a broad consensus that climate change will increase the costs arising from diseases such as malaria and diarrhea and, furthermore, that the increases will be largest in the developing world. Estimates of the costs of adaptation measure the additional cases and the costs of treating those additional cases. They may also include some estimates of more preventive actions. One of the problems in this area is a lack of any studies that measure these costs systematically and report the data in detail. The detailed study of Ebi [
Although these estimates refer to 2025 and 2030, which may seem a long time away, the additional cases are already evident and climate change is increasing the relative risk of these and other diseases right now. The implications are quite serious in terms of the goals of reducing deaths from malaria and other causes of infant and child mortality (Goals 4, 5 and 6). Estimates of expenditures made in respect of attaining these goals indicate expenditures for malaria alone of 2 billion US$ per annum in Africa (based Kiszewski
The case for making these expenditures is strong, on economic as well as on moral grounds. One of the studies cited estimates the costs to people who contract malaria and who are not treated at US$ 90–270 billion in sub-Saharan Africa in 1999 [
The paper provides finally a critical analysis of the reported studies coming from the public health literature showing a number of relevant points, which should be considered in future research. The magnitude of the costs of health interventions for reducing climate-sensitive diseases (not related to climate change) is comparable to the costs of health adaptation under climate change but the latter have a much wider range. Hence more work is needed to narrow the estimates of the costs of adaptation.
The studies make it difficult to identify which interventions are the most cost effective in targeting diseases related to climate change. A more consistent approach to further work in reporting cost effectiveness indicators would help us make more informed judgments. One problem is the use of different metrics (cost per case or per death avoided). Another is how to consider programs with multiple benefits. As regards malaria, for example, the measures relate to disease prevention and treatment and they provide mainly health benefits. For diarrhoea, instead, structural intervention can be implemented which provide also considerable non-health benefits. These should be also taken into account when computing the cost-effectiveness ratio.
In spite of this we note that the costs per life saved in the case of diarrhoea are considerably lower than those in the case of malaria. That would suggest at least starting out targeting diarrhoea cases. Furthermore, within that group the costs of improved water and sanitation, while requiring huge investments to meet the MDGs, result in costs per case avoided that are fairly low. Given that these same interventions have multiple benefits, not all of which have been accounted for would suggests that non-health structural interventions may be more cost effective but further research is needed to confirm this.
WHO Regions.
|Member States
|Developing countries with high mortality
|Algeria, Angola, Benin, Burkina Faso, Cameroon, Cape Verde, Chad, Comoros, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Madagascar, Mali, Mauritania, Mauritius, Niger, Nigeria, San Tome and Principe, Senegal, Seychelles, Sierra Leone, Togo Botswana, Burundi, Central African Republic, Congo, Cote d'Ivoire, Democratic Republic of the Congo, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia, Zimbabwe
|North America
|Developed countries with very low mortality
|Canada, Cuba, United States of America
|Central and South America
|Developing countries with low mortality
|Antigua and Barbuda, Argentina, Bahamas, Barbados, Belize, Brazil, Chile, Colombia, Costa Rica, Dominica, Dominican Republic, El Salvador, Grenada, Guyana, Honduras, Jamaica, Mexico, Panama, Paraguay, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, Uruguay, Venezuela (Bolivarian Republic of)
|South East Asia
|Developing countries with low mortality
|Indonesia, Sri Lanka, Thailand
|Developed countries with very low mortality
|Andorra, Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Slovenia, Spain, Sweden, Switzerland, United Kingdom
|Eastern Mediterranean
|Developing countries with low mortality
|Bahrain, Iran (Islamic Republic of), Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Tunisia, United Arab Emirates
|Western Pacific (A)
|Developed countries with very low mortality
|Australia, Brunei Darussalam, Japan, New Zealand, Singapore
|Western Pacific (B)
|Developing countries with low mortality
|Cambodia, China, Cook Islands, Fiji, Kiribati, Lao People s Democratic Republic, Malaysia, Marshall Islands, Micronesia (Federated States of), Mongolia, Nauru, Niue, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu, Viet Nam
Source: adapted from WHO 2002 [
Health Impacts of Climate Change: Classification.
|Health impacts
|Climate impacts
|Temperature extremes (heat or cold waves).
|Heat- and cold- related stresses
|- Respiratory and cardio-vascular diseases due to the combined effect of exposure to high temperature and air pollutants
|Extreme weather events
|Floods, landslides, storms, cyclones
|Deaths and injuries
|- Water-borne diseases caused by water contamination and poor sanitation conditions
|- Malnutrition and under-nutrition, due to loss of agricultural production
|Increased temperature
|- Vector-borne diseases due to higher risk of transmission and changes in the geographical and seasonal distribution
Health Impacts of Climate Change in Developed and Developing Countries.
|Health Impacts
|Adaptive Capacity
|- Changing in spatial and temporal distribution of malaria, dengue, diarrhea, cholera, meningitis,
|Low adaptive capacity due to lack of financial and technological resources, low GDP per capita, poverty, limited infrastructure, weak primary health care, high infant mortality, low education levels, limited access to capital, armed conflicts.
|-Thermal stresses due to heat waves in East Asia
|Adaptive capacity varies among countries and is often constrained due to poor financial and technological resources, income inequalities and weak health care system.
|Latin America
|-Thermal stresses due to heat waves in big cities
|Limited adaptive capacity due to high infant mortality, income inequalities, weak health care system.
|Small Island developing states
|-Thermal stresses due to heat waves
|Low adaptive capacity, due to poor resources, weak health care system and high frequency of natural hazards
|-Thermal stresses due to heat waves
|Adaptive capacity higher than in developing countries.
|North America
|-Thermal stresses due to heat waves, mainly in Nord-east and Mid-west
|Adaptive capacity higher than in developing countries.
|Australia and New Zealand
|-Thermal stresses due to heat waves
|Adaptive capacity higher than in developing countries.
Source: adapted from UNFCCC 2007 [
Health Adaptation Measures to Climate Change.
|Adaptation measures
|Health impacts
|Thermal stresses
|Extreme weather events
|Vector-borne diseases
|Water-borne diseases
|Food-borne diseases
|Legislative and regulatory
|- Building guidelines
|- Building guidelines
|- Watershed protection laws
|- Food sanitation and hygiene regulation
|- Urban planning (green islands, fountains, greenroofs)
|- Urban planning (flood-resistant)
|- Vector control
|- Water treatment and distribution
|- Refrigeration
|- Financial and domiciliary assistance services, "telecare" systems, accompaniment and transport to emergency medical services
|- Pre-disaster recovery plans
|- Hospital and primary care
|- Hospital and primary care
|- Food-borne disease surveillance
|Education and advisory
|- Heat watch warning systems
|- Real-time forecasting
|- Education campaign
|- Health educational campaigns
|- Food safety education
|Cultural and behaviour
|Clothing, drinking, visiting places with air conditioning and green areas
|- Use of storm shelters
|- Water storage practices
|- Washing hands and hygiene
|- Avoid high risky food (such as runny eggs and raw shellfish)
Sources: adapted from [
Annual Costs of Health Adaptation to Climate Change. Worldwide 2000–2030 (US$Million, 2000).
|Stabilization at 750ppm
|Stabilization at 550ppm
|3,100 to 8,800
|1,900 to 5,600
|1,600 to 4,500
|2,731 to 9,010
|1,983 to 6,814
|1,706 to 6,024
|62 to 166
|81 to 216
|54 to 150
|All Costs
|5,900 to 18,000
|4,000 to 12,600
|3,300 to 10,700
Additional Annual Costs of Health Adaptation in Alternative Climate Change Scenarios per Geographical World Region 2000–2030 (Million US$, 2000).
|Climate Scenario
|Americas (Central/South)
|Eastern Mediterranean
|South East Asia
|Western Pacific (A)
|North America
|Western Pacific (B)
Source: based on cost estimates from Ebi [
Annual Costs of Health Interventions to Reduce Malaria 2006–2015 (Million US$, 2006).
|Annual Costs
|Americas (Central/South)
|South East Asia, Western Pacific and Eastern Mediterranean
Source: based on cost estimates from Kiszewski
They refer to a 50% reduction by 2010 and a 75% reduction by 2015.
Annual Costs for Water and Sanitation Programs 2000–2015 and Expected Cases Avoided (Million US$, 2000).
|Annual Costs by Intervention
|Halving proportion people without access to improved water
|Halving proportion of people without access to improved water and sanitation
|Access for all to improved water and sanitation
|Access for all to improved water and sanitation, with water disinfected
|Access for all to regulated piped water and sewage connection at home
|Developing countries
|South East Asia
|Western Pacific (A)
|Developed countries
|North America
|Western Pacific (B)
Source: based on cost estimates from Hutton and Haller [
Studies about the Costs of Health Intervention Programs Relevant to Climate Change.
|Annual costs of health interventions in developing countries (Million US$)
|Cost per Case or Per Death Avoided (US$)
|Costs of health adaptation to climate change
|Ebi (2008) [
|Malaria, diarrhea, malnutrition.
|Intervention program from 2000 to 2030. Prevention and treatment measures. Different scenarios for climate investigated. Worldwide.
|Van Rensburg and Blignaut (2002) [
|Intervention program from 2000 to 2025. Prevention and treatment measures to achieve 95% coverage. Different malaria risk scenarios. South Africa.
|Costs of climate-related disease control programs in the public health context
|Kiszewski et al (2007) [
|257–296 per case avoided (US$ 2006) Estimate is based on S. America data only.
|Intervention program 2006–2015 to achieve 80% coverage and 75% reduction in cases by 2015. Treatment/prevention and support activities programs. Africa, Asia and Middle East, South America.
|Epstein and Mills (2005) [
|Interventions in Sub Saharan Africa to achieve the Millennium Development Goals (MDGs): 40% coverage for prevention and 50% for treatment by 2010. 70% coverage for treatment and prevention by 2015.
|Morel et al (2005) [
|468 (US$ 2000) (Western Africa)
|Intervention program for 10 years. Combined therapy of preventive and treatment measures. Sub-Saharan Africa.
|Malnutrition, diarrhea, malaria, pneumonia and newborn diseases.
|314–630 per death avoided (US$ 2006)
|Intervention program 2006–2015 to reduce child mortality and morbidity by 2/3 by 2015 (MDGs). Prevention and treatment. All costs included. 75 developing countries.
|Hutton and Haler (2004) [
|Diarrhea (cholera, salmonellosis, shigellosis, other intestinal infections).
|11.5–36.7 per case avoided (US$ 2000).
|Structural intervention program for water and sanitation 2000–2015. Different scenarios of increased access. Worldwide.
|Meddings et al (2004) [
|1,804–4,086 per child death avoided (US$ 1999)
|Structural interventions: latrine construction and rehabilitation program in Kabul (Afganistan).
Annual Cost per Case of Diarrhea Avoided with Water and Sanitation Programs 2000–2015 (US$, 2000).
|Annual Cost per Case Avoided by Intervention Scenario (US$, 2000)
|Halving proportion people without access to improved water
|Halving proportion of people without access to improved water and sanitation
|Access for all to improved water and sanitation
|Access for all to improved water and sanitation, with water disinfected
|Access for all to regulated piped water and sewage connection at home
Source: based on cost estimates from Hutton and Haller [
Studies about the Cost-Effectiveness of Health intervention Programs in Developing Countries.
|Cost per Death (DA) or Case Avoided (CA) (US$)
|Immunization program. Indonesia and Ghana
|Shepard (1986) [
|Immunization program. Côte d'Ivoire.
|USAID Micronutrient program (2004) [
|Standard child health intervention. Vitamin A supplementation. Ghana, Nepal, Zambia.
|Horton (1996) [
|Breastfeeding promotion. Brazil, Honduras, Mexico.
|Routine cholera immunization.
|Malaria prevention: vaccination and insecticide impregnation of bed nets.
|Malaria prevention: insecticide impregnation of bed nets and chemoprophylaxis. Gambia.
|Malaria prevention: bed net impregnation. Gambia.
|Loevinsohn (1997) [
|Malaria prevention: vitamin A supplementation. Philippine.
|Fiedler (2000) [
|Malaria prevention: vitamin A supplementation. Nepal.
|Malaria prevention in pregnancy: antenatal treatment and chemoprophylaxis. Malawi.
|Malaria treatment: early diagnosis and prompt treatment. Brazil.


text:
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Associated Press
Sunday, April 10, 2011 | 2:05 a.m.
Related Content
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SAN DIEGO — Good luck telling Nick Diaz and Gilbert Melendez that mixed martial arts isn't a team sport.
Melendez and Diaz are long-time training partners at Cesar Gracie Jiu-Jitsu in San Francisco who ushered in a new era of Strikeforce together Saturday night at Valley View Casino Center.
In the first major Strikeforce event under the ownership of Zuffa, the parent company of the UFC, Diaz and Melendez fed off of each others' presence and defended their respective championship belts.
"I started from scratch with these guys," Melendez said. "I'm a Nick Diaz fan, I'm a Nate Diaz fan, I'm a Jake Shields fan. It runs deep for us. It gets emotional out there."
Melendez mauled Tatsuya Kawajiri via TKO at 3:14 of the first round to keep his 155-pound Strikeforce strap. Diaz got his own TKO over Paul Daley at 4:57 of the first round after a welterweight striking war.
Melendez and Diaz have served as two of the most visible faces of Strikeforce in recent years. It's only appropriate that they'll together deal with the first wave of speculation and demand regarding potential mega fights with UFC champions going up against Strikeforce's top fighters.
Those questions already reared themselves minutes after Saturday's fight card.
"We haven't even had that conversation of when it would happen," said Strikeforce CEO Scott Coker. "But I think when the fans demand it, those fights will happen. And personally, myself as a fan, I would love to see it."
Melendez is already lobbying for the chance. He improved his record to 19-2 and won his fifth straight in the victory over Kawajiri.
As far as Melendez is concerned, now is the time to unify the two titles. He wants the winner of the lightweight championship fight between Frankie Edgar and Gray Maynard at UFC 130 in May.
"I'm not the UFC champion, but I've been around this sport a lot longer than Frankie Edgar and Gray Maynard," Melendez said. "If you look at the stats and what I've accomplished, I think I've accomplished more."
If Melendez needed to prove his mettle Saturday to show he was ready, consider it accomplished. The fight with Kawajiri (27-7-2) looked nothing like the contest between the two five years ago in PRIDE when Melendez eked out a unanimous decision.
Melendez rushed Kawajiri and dropped him within the opening minute using a knee and vicious right hand. Kawajiri got up only to experience more pain.
Melendez continued his assault until he found himself on the ground in top position. Once there, Melendez fed Kawajiri enough elbows that the referee had no other choice but to pull him off.
"Kawajiri is no joke," Melendez said. "The pressure was there. I'm happy I performed for Strikeforce."
Diaz is much more silent about fighting the UFC welterweight champion, but the reasons are obvious. Another one of his Cesar Gracie Jiu-Jitsu teammates, Jake Shields, faces Georges St. Pierre for the belt at UFC 129 in Toronto at the end of the month.
Diaz naturally predicts Shields will win. But those two are adamant they would never even consider facing each other. If St. Pierre does emerge victorious and stay in the 170-pound division, however, expect to hear Diaz campaigning for a shot at him.
"We'll see what's up," Diaz said. "I need to get paid."
Diaz (25-7) will command a heavy purse if he keeps putting on performances like the one against Daley (27-9-2). It was a five-minute war of momentum-shifting, face-swelling action.
Diaz left himself open early in the fight and taunted Daley by yelling profanities and challenging him to engage. Daley, a renowned striker, wailed away and appeared to have Diaz in serious trouble after sending him to the mat on two occasions.
Usually knocking down an opponent twice is a dominant round, but not in this contest, because Diaz did the same. He connected a multitude of shots to both Daley's head and body.
Diaz won the key exchange of the night with less than 20 seconds remaining in the round. Diaz looked dazed as he backed away with 10 seconds left, but that was better than Daley who stumbled to the ground.
Diaz chased after him, turning a near slip-up into a resounding victory.
"I didn't feel like I was in danger," Diaz said.
Diaz credits his calm to experiences in training camp with the likes of his brother Nate and Melendez.
There's no denying their team has already risen to the top of Strikeforce. Before long, they'll have their chance in the UFC.
"It gets real discouraging in camp when I spar with Nick, Jake and Nate," Melendez said. "I'm like, 'I'm not ready for a fight.' I think I'm going to get my butt kicked. Then I go fight and I'm like, 'These guys are 10 times easier than my teammates.' It makes me feel how good our team is."
Case Keefer can be reached at 948-2790 or [email protected]. Follow Case on Twitter at twitter.com/casekeefer.


text:
Prue Leith, 72, was born in South Africa. In the early 1960s, she moved to London where she set up a catering firm; she went on to open Leith's Restaurant and Leith's School of Food And Wine, and to write 12 cookbooks. In 1995 she began writing fiction and has published five novels, the latest being A Serving Of Scandal. Her new memoir is called Relish: My Life On A Plate. She is a judge on BBC2's Great British Menu.
When were you happiest?
In my 40s: I had two children young enough to think their parents wonderful, my business was booming, I was happily married and living in the Cotswolds with a veg garden and ponies in the paddock. Who could not be happy?
What is your greatest fear?
Senility – my mother and grandmother both went off with the fairies in their old age.
What is your earliest memory?
My brother James's birth. I was six and having an operation for an infected ear on the dining room table while mama had him in the bedroom.
Which living person do you most admire, and why?
Desmond Tutu. If there is a God, He must find his Cape Town archbishop a big relief from the humourlessness of pontificating prelates.
What is your most treasured possession?
My garden.
What would your super power be?
To be able to run and jump and do cartwheels as I did when young.
What would be your fancy dress costume of choice?
A catsuit with whiskers and mask, as in Cats. But can I hire the figure, too?
What is your guiltiest pleasure?
A deep, eco-unfriendly, hot bath. Preferably with a glass of champagne and someone sitting on the loo seat gossiping.
What do you owe your parents?
Thanks for an extraordinarily happy childhood.
To whom would you most like to say sorry, and why?
My dad, who died too soon to see me "come good". He suffered at my addiction to boys and horses.
What or who is the greatest love of your life?
Rayne Kruger, my husband. Novelist, historian, partner in my business. He never said, "I told you so" when I disregarded his advice and things went wrong.
What does love feel like?
It feels the same at 60 or 70 as at 16. Feeling sick, longing for the phone to ring, renewed interest in poetry. All the clichés.
What was the best kiss of your life?
Nothing beats that sloppy kiss of a six-month-old grandchild.
Which living person do you most despise, and why?
Robert Mugabe: he inherited a premier's dream – and he blew it.
What is the worst job you've done?
Clearing out 42 bin bags of putrid kitchen waste from the basement of the Queen Elizabeth II Conference Centre. I was wearing strappy black sandals and ended up squelching barefoot through the maggots.
What has been your biggest disappointment?
Public catering in the parks, where we lost a tonne of money. Now the public will buy excellent simple, fresh food. All they wanted in the 80s were slimy burgers, Mr Whippy and Coke.
How often do you have sex?
Not often enough. And what a question to ask an old lady!
What single thing would improve the quality of your life?
New knees.
Where would you most like to be right now?
In bed. It's past midnight.
• Follow Rosanna on Twitter at twitter.com/celebQandA.


text:
publication since 1991, Wrangler News is distributed
free every other Saturday to more than 18,000 homes in
the Kyrene Corridor area of South Tempe and West
Chandler, and is supported by local and regional
February 18, 2006
Editor's note: Residents of the Kyrene
Corridor can experience the vicarious
thrill of Mardi Gras at one of the
area's notable dining spots. Here's what
Matt Stone learned during an interview
with the owner of Voodoo Daddy's.
Anyone who has ever been down south to
culture-rich New Orleans will tell you
there's nothing like it.
Richard Kerchenko, owner of Voodoo
Daddy's Magic Kitchen & Bar, says the
same about his restaurant.
purchased the Cajun/Creole-themed
restaurant five years ago and has made
significant changes to amp up the
atmosphere and quality. What originally
attracted him was the theme of the
restaurant, Kerchenko said.
"(I love) the experience," said
Kerchenko. "The total experience people
can enjoy." "I thought it was
underserved in the metro market."
After acquiring the restaurants, one in
Phoenix and one in Tempe, Kerchenko set
out to implement a new system of
orientation and training. He also
expanded the menu, adding a wine
selection, barbecue and steak while
preserving the southern theme.
Kerchenko also boasts that the food is
unparalleled in accuracy.
"Our menu is the most authentic Cajun
(food), period," Kerchenko said.
To fit the concept, the menu includes
specials such as "catfish madness," "all
you can eat crawfish boil," "back Gulf
shrimp stuffed with crab meat" and "a
dozen Gulf oysters."
Staying truthful to New Orleans style,
half of the restaurant represents a
Bourbon Street feel, while the other
half strives for the look of a bayou.
With any Bourbon Street, there has to be
a celebration of Fat Tuesday and Mardi
The annual holiday marks the day of
Mardi Gras (which means "Fat Tuesday" in
French) and will fall on Feb. 28 this
Kerchenko has planned a sizeable party,
one he holds at Voodoo Daddy's every
year. With the accompaniment of live
music, outside dining, giveaways and, of
course, colorful Mardi Gras beads, the
celebration is hugely popular, Kerchenko
"We have people lining up to get into
the restaurant," Kerchenko said. "(It's)
our busiest day of the year."
Although cognizant of the disastrous
effects of Hurricane Katrina, Kerchenko
says proceeds from this year's "Fat
Tuesday" event won't be funneled into
disaster relief–not from his own lack of
interest but
because an earlier fund-raising effort
fell flat.
Katrina is not forgotten to Kerchenko,
however: The restaurant's most popular
drink, Hurricane, serves as a constant
reminder of the tragedy and is offered
in three types--category one, three and
depending on potency.
In the restaurant business for 30 years,
Kerchenko knows how to accommodate his
patrons. While he said most of the
clientele on weekdays consists of
business people, the restaurant also
serves many families. To adjust to the
normally less-developed taste buds of a
child, Kerchenko has an extensive kids
menu that includes classic favorites
that are a little less Cajun-esque.
The hardest people to please at such a
themed-restaurant are visitors from the
area it is based on. Here, however, it's
not a problem, said Kerchenko.
"They love it..." said Kerchenko. "I
hear that all the time. They're very
passionate about coming in."
Voodoo Daddy's Magic Kitchen & Bar is
located at 1706 E. Warner Road, Tempe.
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