Monday, April 27, 2020

THIRD WORLD USA

Segregation and local funding gaps drive disparities in drinking water

Ongoing legacies raise risk that many US community water systems can't cope with future drought

DUKE UNIVERSITY

DURHAM, N.C. -- As droughts become more frequent and intense, the fragmentation of water service in the U.S. among tens of thousands of community systems, most of which are small and rely on local funding, leaves many households vulnerable to water contamination or loss of service, a new Duke University analysis finds.

These vulnerabilities aren't distributed equally, the study shows. Households in low-income or predominantly minority neighborhoods are likely to face the highest risks.

Resolving this disparity and making sure the taps in these homes don't run dry will require a fundamental re-evaluation of how the nation's patchwork of community water systems (CWSs) is managed and funded.

"Small water systems already are at a disadvantage when it comes to protecting water security during drought, because of the financial constraints they face," said Megan Mullin, associate professor of environmental politics at Duke's Nicholas School of the Environment, who wrote the analysis. "Underlying patterns of segregation can amplify these weaknesses along economic and racial lines."

Mullin published her peer-reviewed article April 17 in a special drought edition of Science.

Disparities in drinking water insecurity are rooted in segregation and the local political economy of public services, she explained. Because CWSs rely on user fees for their funding, they historically have extended service to neighborhoods or adjacent municipalities where residents are more able to pay. The result is that some communities get high-quality water service, while others - often rural communities or places where poverty is concentrated - get lower-quality service. Repairs or upgrades to pipes and other infrastructure are made less frequently, allowing leaks and increasing the potential risks of contamination. When drought arrives, these systems can't cope.

"Drought aggravates vulnerabilities for small, under-resourced water systems. The user fee finance model then limits options for drought response, because policies that conserve dwindling water resources reduce revenue for water systems and make it harder for residents to pay their water bills," Mullin said.

"Until now, people have tried to resolve these disparities through piecemeal approaches. We need to think more fundamentally about our reliance on user fees as a financial model for the delivery of such an essential service. States should consider equalizing resources across water systems to counter the legacy of racism and segregation, as we have done in public school funding," she said.

To do this, policymakers need to have a clearer understanding about the nature and extent of demographic disparities between water systems, she said. Recent efforts to develop maps of water system service areas in several states show promise, she said, and should be replicated nationwide and integrated with data on drinking water finance, infrastructure, and water supply and use.

Over the last year, Mullin has been leading a team of Duke students to produce such a map of North Carolina water systems, through a partnership with the state's Division of Water Resources.

"Of the 50,000+ community water systems delivering water year-round in the United States, more than 80% serve fewer than 3,300 people," Mullin said. "Systems this small face tremendous challenges in delivering safe drinking water even under normal conditions, and as droughts become more frequent and intense, the challenges are going to mount."

For these systems to become more resilient, they need to encourage and enforce water conservation. The strongest tools at their disposal for doing that are tiered pricing and mandatory use restrictions, but these reduce the water-use fees the systems depend on for funding and create an economic burden for low-income customers that could result in failure to pay and subsequent service shutoff.

Equalizing resources across water systems, as states already do for public schools, would circumvent many of these trade-offs and improve water security to millions of American homes.

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Research supporting the new review paper was funded by a Research Collaboratory grant from Duke University.

CITATION: "The Effects of Drinking Water Service Fragmentation on Drought-Related Water Security," Megan Mullin. April 17, 2020, Science. DOI: 10.1126/science.aba7353

Stanford study reveals a holistic way to measure the economic fallout from earthquakes
Stanford researchers have developed a way to quantify the economic toll that a major earthquake is likely to exact, and their analysis shows that such a disaster will likely hit hardest at the poor

STANFORD SCHOOL OF ENGINEERING

CHART A: (DED IN GRAPHIC). CRECAPTION EMBEDDIT: FARRIN ABBOT
When an earthquake or other natural disaster strikes, government relief agencies, insurers and other responders converge to take stock of fatalities and injuries, and to assess the extent and cost of damage to public infrastructure and personal property.

But until now, such post-disaster assessment procedures have focused on the dollar value of damages to property while failing to account for something that is equally important but harder to quantify; namely, that the poorer someone or their family is, the harder it is for them to recover and regain their former standard of living.

Now, civil engineers at Stanford, working with economists from the World Bank, have devised the first disaster assessment model that combines the well-understood property damage estimates with a way to calculate two previously nebulous variables - the community-wide economic impacts caused by disruptions to industry and jobs, and the social costs to individuals and families.

Although such an analysis might seem obvious, no one had ever put brick-and-mortar losses together with pain and suffering consequences until the Stanford civil engineers teamed up with World Bank economists Stephane Hallegatte and Brian Walsh to create this holistic damage assessment model.

A hypothetical scenario

In a study published March 30 in Nature Sustainability, the researchers test their model using a hypothetical 7.2 magnitude earthquake on the Hayward fault near San Francisco. "We've developed a financial model that builds upon previous property damage procedures in a way that allows us to quantify the pain and suffering people feel after a quake depending on their socioeconomic status," said study co-author Jack Baker, a professor of civil and environmental engineering at Stanford.

Although the researchers tailored their approach specifically for earthquakes, they hope experts in hurricanes, tornados, floods and other disasters will also adopt the new economic and sociological measures in order to give policymakers new tools to plan for disasters.

Study first author Maryia Markhvida, a former graduate student of Baker's, said the researchers started with traditional models of property damage assessment, and added on top of these a second layer of analysis to quantify a concept called "well-being," which they borrowed from economists and sociologists. The model calculates the incomes and consumption levels of people in different socioeconomic strata to assign a numerical value to well-being, which can be thought of as how people feel about daily life as they recover from a disaster.

The researchers combined the physical damage tools with economic and well-being assessments to create a more holistic model of disaster effects. For example, should the property damage part of their system show that a particular building is likely to collapse, the second layer of analysis would kick in to extrapolate how such structural damage would affect where people work and how it would affect a variety of industries in ways that would trickle down to impact people's incomes and spending power, thus diminishing their sense of well-being.

Policy implications

Much of the income, expense and spending data for the analysis was derived from Census data, which enabled the researchers to tie their well-being calculations to the relative poverty or prosperity of people living in different neighborhoods.

When they estimated the relative loss of well-being for people in each of four income brackets, they found that those at the bottom felt a roughly 60 percent loss of well-being as a fraction of the Bay Area's average annual income, relative to something closer to 25 percent for those at the top (see Chart A available via image download).

The researchers also compared three types of losses for 10 cities in the San Francisco Bay Area (see Chart B available via image download). These calculations factored in the vulnerability of each city's building stock (the number and types of homes, offices and other structures), its proximity to the hypothesized earthquake and other factors such what sort of savings and insurance people had as safety cushions. The chart shows that, even when property damages are roughly equal, well-being losses are larger in cities that have lower-income population and lower household savings.

"It makes sense that the people who have less in the first place feel that life becomes that much harder when they lose some of what little they had," Markhvida said.

The researchers envision that policymakers will use the model to consider in advance how to mitigate the impacts of a quake and speed the region's recovery afterward. They might, for instance, run "what if" exercises to weigh the relative benefits of measures such as tightening building codes, providing incentives to do retrofits or get earthquake insurance, or make contingency plans to extend or expand unemployment benefits.

"This model could help government officials decide which policies provide the best bang for the buck, and also see how they might affect not just potential property damages, but losses to people's sense of well-being," Baker said.

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Children face three times more air pollution during the school run

UNIVERSITY OF SURREY

Children face a worrying threefold increase in air pollution during the daily school runs, causing air quality experts to call for restrictions on the use of cars during those periods.

In a study published by the journal Science of the Total Environment, experts from the University of Surrey's world-renowned Global Centre for Clean Air Research (GCARE) partnered with a local school and the local community in Guildford to investigate the impact cars have on air quality in and around schools during drop-off and pick-up times.

In a school of around 420 pupils, the research team installed air quality sensor kits in five key areas around the school - including drop-off points where cars often sit idling in queues, the playground which is located near a main road, and a classroom. The team investigated the concentration of fine (PM2.5) and coarse particulate matter, as well as carbon dioxide in the morning (7:30am until 9:30am) and the evenings (2pm until 4pm).

The study discovered that dangerous PM2.5 from vehicles lining up to drop off children were the main source of air pollution around the school. The team also found that PM2.5 levels were nearly three times higher during morning drop-off periods than the afternoon pick-up or active school periods. This is due to the fact that pick-ups were conducted from off-site parking areas and a large number of pupils took part in after school activities.

The team also found that PM2.5 levels rose slightly within the classrooms closest to the road during drop-off and pick-up times. Researchers speculated that this could be because of the classroom's dependence on natural ventilation (open windows) which brings in unfiltered air.

The study also found that the playground's close proximity to the main road, a characteristic similar to many of the country's schools, resulted in the playground having consistently high PM2.5 levels at key times in the school day.

The researchers from GCARE have recommended that schools provide safe and accessible off-site parking drop-off points to help reduce levels of air pollution. The team has also recommended the use of green hedges as physical barriers to prevent air pollutants reaching children from cars at drop-off points and the main road.

Professor Prashant Kumar, Director of GCARE at the University of Surrey, said: "This is work of global significance, but we are also proud to collaborate with our local community on this work - employing smart sensing technology and a citizen science approach. The findings will be of great concern to parents locally and further afield. It goes without saying that our children's health and wellbeing is of the highest priority in society and that is why we must protect them from the dangers of air pollution, including where the school run can now be seen to be directly impacting the school environment.

"Every school is different. However, many have characteristics that will mean that children are exposed to hotspots of air pollution in school premises. We have found that the use of cars during the school run is increasing the number of dangerous particles our children breath in, even during playtime long after they have been dropped off."

Mr Neil Lewin, the Headteacher of St Thomas of Canterbury Catholic Primary School in Guildford, said: "Minimising air pollution exposure in and around the school has to be at the top of our agenda and we need to find practical but effective ways to reduce this exposure to air pollution in our school environment. This co-designed study has been an excellent experience for our children (especially our eco-warriors) giving them hands-on real science experience, and I hope will be very influential in compelling our parents to think again about their journeys to and from school to ensure the safest environment for their children."

Mr Andrew Strawson, the Chairman of Merrow Residents' Association in Guildford, said: "This is a rare and welcome opportunity for direct community involvement in the co-creation and co-design of a scientific study aimed at addressing important local and national issues. We thank Professor Kumar and his team for their continuing involvement with this community programme. His team promotes excellent guidance on green infrastructure initiatives. He has now taken this further and enabled this joint project which provides key data and strategies for use in helping to protect our children from air pollution at school."

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This work was supported by the H2020 iSCAPE project (Grant Agreement #689954) and builds upon previous GCARE research into citizen science as a part of Guildford Living Lab.

Reference

Kumar, P., Omidvarborna, H., Pilla, F. and Lewin, N., 2020. A primary school driven initiative to influence commuting style for dropping-off and picking-up of pupils. Science of the Total Environment. Free online link: https://doi.org/10.1016/j.scitotenv.2020.138360

New report: Inclusive food systems needed to boost development, resilience

Inclusive food systems play a critical role in meeting global goals to end poverty, hunger, and malnutrition; the report offers recommendations for making food systems more inclusive for marginalized groups

INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE

CREDIT: IFPRI

Washington, D.C. - The rapid spread of COVID-19 and efforts to contain it are generating growing concerns that food insecurity, malnutrition, and poverty may escalate, particularly among marginalized people in the developing world. To build more resilient, climate-smart, and healthy food systems that help people withstand these types of shocks policymakers must prioritize making them inclusive, according to the 2020 Global Food Policy Report, released earlier this month by the International Food Policy Research Institute (IFPRI).

"Food systems provide opportunities to improve food and nutrition security, generate income, and drive inclusive economic growth, but even in prosperous times too many people are excluded from fully participating in them and securing these benefits," said Johan Swinnen, director general of IFPRI. "In times of crisis like today, inclusion is an even greater imperative for protecting the most vulnerable."

The report highlights the central role that inclusive food systems play in meeting global goals to end poverty, hunger, and malnutrition, and offers recommendations for making food systems more inclusive for four marginalized groups - smallholders, women, youth, and conflict-affected people - as well as analysis on transforming national food system.

More than 60% of people in low income countries are employed in agriculture and smallholders comprise more than 70% of farm units in Africa south of the Sahara and 85% of farms in South Asia. The rapid expansion of food markets across Africa and Asia offers tremendous potential for many of these smallholders to benefit if they can increase farm production or engage themselves in food distribution, processing and other parts of the supply chain where ample well-paying employment opportunities will emerge.

Currently, many smallholders lack the means and kind of support to gain from growing food demand. "Initiating and sustaining a process of inclusive transformation requires supporting smallholders' market access by investing in basic infrastructure, creating market incentives, and promoting inclusive agribusiness models. But it is as important to invest in the 'hidden middle' of supply chains where millions of small- and medium-scale enterprises already operate in food processing, storage, logistics and distribution. Getting this right will be essential to lift smallholders from poverty and food insecurity," said Rob Vos director of IFPRI's Markets, Trade and Institutions Division.

Women are already making significant contributions throughout food systems, but these contributions are often not formally recognized, and women often face constraints that prevent them from engaging on equitable terms. Increasing women's decision-making power and control over resources and assets such as credit, land, and training helps empower them to contribute to food systems in ways that benefit both men and women. "Women's empowerment can spur a wide range of improvements that often reverberate throughout households and societies - from agricultural productivity, to household food security and dietary quality, to maternal and child nutrition," said Hazel Malapit, senior research coordinator at IFPRI.

In African south of the Sahara, youth are expected to play a growing role in food systems but their role in driving growth is often misunderstood. Projections show Africa south of the Sahara will add 30 million people to its working age population each year by 2050, and that much of this growth will be in rural areas. "Africa's rural areas will need to play a major role in providing employment opportunities for young people, but focusing on broad-based rural growth to create thriving economic environments for food system business will likely do more to support these growing youth populations than policies narrowly focused on youth," said James Thurlow, senior research fellow at IFPRI.

Political instability and conflict have been fundamental drivers to the recent surge in global hunger numbers, with more than half of all undernourished people living in conflict-affected countries. "Integrating conflict-affected people into food systems - either in their places of origin or the locales to which they have fled - can substantially help them rebuild their lives," said Vos. Providing long-term refugees with access to land and means to build secure livelihoods can support their own food security while also contributing to local economies. Rebuilding local agriculture and food value chains for conflict-affected people will bolster resilience thereby reducing the risk of further conflict and sowing the seeds for last peace.

Across the developing world national food systems are already transforming rapidly, creating challenges and opportunities to make them more inclusive to all these groups. Case studies of these transformations in Bangladesh, Ethiopia, Nigeria, and Viet Nam provide useful examples of the drivers and components of change, as well as the promising entry points for actions that can increase inclusion. "Approaches to food system transformation must be country specific, as each country's food system is unique," said John McDermott, director of the CGIAR Research Program on Agriculture for Nutrition and Health.

Governments can foster these inclusive food systems by enacting laws, policies, and regulations that provide basic infrastructure, create the right market incentives, promote inclusive agribusiness models and leverage the potential of digital technology. Additionally, investments in human capital in areas such as secure land tenure rights, improved access to information, and stronger social protections can lower the barriers to participation that man marginalized groups face.

"The spread of COVID-19 has highlighted how vulnerable we all can be to global shocks," said Swinnen. "Greater inclusivity in food systems is not a panacea for this or any other crisis, but it is a critical part of strengthening our resilience. Times of crises also offer opportunities for change and it is essential that we act now so that everyone, especially the most vulnerable, can recover from the COVID-19 shock and be prepared to withstand future shocks."

The report also features chapters analyzing developments in agri-food systems in Africa south of the Sahara, the Middle East and North Africa, Central Asia, South Asia, East and Southeast Asia, and Latin America and the Caribbean.

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For more information, download the report, click here.

The International Food Policy Research Institute (IFPRI) provides research-based policy solutions to sustainably reduce poverty and end hunger and malnutrition in developing countries. IFPRI was established in 1975 to identify and analyze alternative national and international strategies and policies for meeting the food needs of the developing world, with particular emphasis on low-income countries and on the poorer groups in those countries. It is a research center of CGIAR, a worldwide partnership engaged in agricultural research for development. Visit http://www.ifpri.org

Delivery drones instead of postal vans? Study reveals drones still consume too much energy

MARTIN-LUTHER-UNIVERSITÄT HALLE-WITTENBERG

When delivering parcels, drones often have a poorer energy balance than traditional delivery vans, as shown by a new study conducted at Martin Luther University Halle-Wittenberg. In densely populated areas, drones consume comparatively high amounts of energy and their range is strongly influenced by wind conditions. In rural areas, however, they may be able to compete with diesel-powered delivery vans. The study has been published in the journal Transportation Research Part D: Transport and Environment.

During the Corona pandemic many people are increasingly ordering online instead of going into shops. More and more parcels are being shipped, pushing many delivery services to the limits of their capacity. One possible solution are drones that can automatedly deliver parcels to customers from a delivery depot. What sounds like science fiction could soon become reality: "Google, DHL and Amazon have been experimenting with this concept for several years and launched the first commercial pilot projects in the USA and Australia in 2019," says Dr Thomas Kirschstein from MLU's department of Production and Logistics. He has calculated whether current drone models are ready to compete with vans in terms of energy consumption. "When evaluating the hypothetical use of delivery drones, attention has frequently only been on whether drones could deliver parcels faster and cheaper. Sustainability aspects, on the other hand, played less of a role," explains the economist.

In his new study, Kirschstein compared the energy consumption of drones with that of the diesel-powered delivery vans and electric transport vehicles currently used by parcel carriers. In a simulation, he hoped to discover which vehicle had, under which circumstances, the best energy balance. Basing his calculations on the greater Berlin area, he played through several scenarios. "Among other things, we investigated how the number of parcels per stop and the traffic situation impacted energy consumption," the researcher explains. He expanded his calculations to include the emissions produced through the generation of electricity or the consumption of diesel.

Initially, a trend became evident across all scenarios: electric vans were significantly more economical than diesel vans, consuming up to 50 per cent less energy. "This is not surprising for an urban setting: In cities, vans have to drive slowly and stop and start a lot. Here, electric vehicles consume significantly less energy," says Kirschstein.

These factors are not relevant, of course, for drones. Instead, wind conditions play a crucial role in how they perform. If there is a crosswind, for example, more energy must be expended to keep the drone on course. On the other hand, headwinds or tailwinds can even have a slightly positive effect on energy consumption. "Drones consume a relatively large amount of energy when they have to hover in one place in the air, for example when they want to deliver a parcel and have to wait outside the door of the recipient's home," explains the economist.

On average, the drones in the simulation consumed up to ten times more energy than electric delivery vans in such a densely populated city like Berlin. "Parcel carriers, for example, can stop and deliver several parcels on foot if multiple customers are receiving deliveries in one street. This is not possible for drones, as they can only deliver one package at a time. This increases their energy consumption, sometimes drastically," says Kirschstein. But his simulations also reveal a scenario in which the flying couriers are more energy-efficient than delivery vans: in more rural areas that are sparsely populated. However, higher energy consumption does not necessarily mean a poorer environmental balance: "Even if drones require more energy, they could represent an alternative to diesel vehicles, provided the electricity they need is generated by environmentally friendly means," explains the researcher.

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Novel research on African bats pilots new ways in sharing and linking published data

PENSOFT PUBLISHERS

ONE OF THE POSSIBLY THREE NEW TO SCIENCE BAT SPECIES, PREVIOUSLY REFERRED TO AS HIPPOSIDEROS CAFFER OR SUNDEVALL'S LEAF-NOSED BAT. view more CREDIT: B. D. PATTERSON / FIELD MUSEUM

Newly published findings about the phylogenetics and systematics of some previously known, but also other yet to be identified species of Old World Leaf-nosed bats, provide the first contribution to a recently launched collection of research articles, whose task is to help scientists from across disciplines to better understand potential hosts and vectors of zoonotic diseases, such as the Coronavirus. Bats and pangolins are among the animals already identified to be particularly potent vehicles of life-threatening viruses, including the infamous SARS-CoV-2.

The article, publicly available in the peer-reviewed scholarly journal ZooKeys, also pilots a new generation of Linked Open Data (LOD) publishing practices, invented and implemented to facilitate ongoing scientific collaborations in times of urgency like those we experience today with the COVID-19 pandemic currently ravaging across over 230 countries around the globe.

In their study, an international team of scientists, led by Dr Bruce Patterson, Field Museum's MacArthur curator of mammals, point to the existence of numerous, yet to be described species of leaf-nosed bats inhabiting the biodiversity hotspots of East Africa and Southeast Asia. In order to expedite future discoveries about the identity, biology and ecology of those bats, they provide key insights into the genetics and relations within their higher groupings, as well as further information about their geographic distribution.

"Leaf-nosed bats carry coronaviruses--not the strain that's affecting humans right now, but this is certainly not the last time a virus will be transmitted from a wild mammal to humans," says Dr Terrence Demos, a post-doctoral researcher in Patterson's lab and a principal author of the paper. "If we have better knowledge of what these bats are, we'll be better prepared if that happens," he adds.

"With COVID-19, we have a virus that's running amok in the human population. It originated in a horseshoe bat in China. There are 25 or 30 species of horseshoe bats in China, and no one can determine which one was involved. We owe it to ourselves to learn more about them and their relatives," comments Patterson.

In order to ensure that scientists from across disciplines, including biologists, but also virologists and epidemiologists, in addition to health and policy officials and decision-makers have the scientific data and evidence at hand, Patterson and his team supplemented their research publication with a particularly valuable appendix table. There, in a conveniently organized table format, everyone can access fundamental raw genetic data about each studied specimen, as well as its precise identification, origin and the natural history collection it is preserved. However, what makes those data particularly useful for researchers looking to make ground-breaking and potentially life-saving discoveries is that all that information is linked to other types of data stored at various databases and repositories contributed by scientists from anywhere in the world.

Furthermore, in this case, those linked and publicly available data or Linked Open Data (LOD) are published in specific code languages, so that they are "understandable" for computers. Thus, when a researcher seeks to access data associated with a particular specimen he/she finds in the table, he/she can immediately access additional data stored at external data repositories by means of a single algorithm. Alternatively, another researcher might want to retrieve all pathogens extracted from tissues from specimens of a specific animal species or from particular populations inhabiting a certain geographical range and so on.

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The data publication and dissemination approach piloted in this new study was elaborated by the science publisher and technology provider Pensoft and the digitisation company Plazi for the purposes of a special collection of research papers reporting on novel findings concerning the biology of bats and pangolins in the scholarly journal ZooKeys. By targeting the two most likely 'culprits' at the roots of the Coronavirus outbreak in 2020: bats and pangolins, the article collection aligns with the agenda of the COVID-19 Joint Task Force, a recent call for contributions made by the Consortium of European Taxonomic Facilities (CETAF), the Distributed System for Scientific Collections (DiSSCo) and the Integrated Digitized Biocollections (iDigBio).

Original source:

Patterson BD, Webala PW, Lavery TH, Agwanda BR, Goodman SM, Kerbis Peterhans JC, Demos TC (2020) Evolutionary relationships and population genetics of the Afrotropical leaf-nosed bats (Chiroptera, Hipposideridae). ZooKeys 929: 117-161. https://doi.org/10.3897/zookeys.929.50240

Contacts:

Dr Bruce D. Patterson, Field Museum
Email: bpatterson@fieldmuseum.org

Prof Lyubomir Penev, founder of ZooKeys and founder and CEO at Pensoft
Email: penev@pensoft.net

Portland State study finds bike lanes provide positive economic impact

PORTLAND STATE UNIVERSITY

Despite longstanding popular belief, bicycle lanes can actually improve business. At worst, the negative impact on sales and employment is minimal, according to a new study from Portland State's Transportation Research and Education Center (TREC).

The report is part of a larger National Street Improvements Study, conducted by Portland State University, with support from consulting firm Bennett Midland and the cycling-advocacy nonprofit PeopleForBikes. The study was funded by The Summit Foundation and the National Institute for Transportation and Communities.

Researchers studied 14 corridors in 6 cities -- Portland, Seattle, San Francisco, Memphis, Minneapolis and Indianapolis -- and found such improvements had either positive or non-significant impacts on sales and employment. Essentially, adding improvements like bike lanes largely boosted business and employment in the retail and food service sectors.

"I think that it is very significant that we found that positive business outcomes to the food service and retail industries on these corridors are persistent, even when we looked at different data metrics on employment or sales or when different analytical methods are utilized," said Jenny Liu, associate professor in the Toulan School of Urban Studies & Planning.

Past studies examined the effects of street improvement corridors within specific cities, but this study is among the first to apply consistent and robust analytical approaches across multiple corridors and multiple cities.

The findings also provide policymakers and planners with an analytical framework and further evidence to support investment in non-motorized transportation infrastructure.

"The Street Improvement Study supports with data what we have seen in many communities: adding bicycle infrastructure boosts a neighborhood's economic vitality," said Zoe Kircos, director of grants and partnerships at PeopleForBikes. "Our collaboration with Portland State University and Bennett Midland on this research gives us more resources to share with cities across the U.S. that are eager to make bicycling safer and easier for everyone."

Liu added that the partnership between PSU, PeopleForBikes and Bennett Midland contributed significantly to the end products that are directly targeted to planners and policymakers. The study produced in-depth reports for Portland, Seattle, San Francisco, Memphis, Minneapolis and Indianapolis.

Nationally, the study found the food service industry benefits most often from the addition of transportation infrastructure.

Even in cases where a motor vehicle travel lane or parking was removed to make room for a bike lane, food sales and employment tended to go up, according to the report.

"There is tremendous potential to expand on what we learned in this research project to additional cities and corridors, and to provide policymakers with the opportunity to evaluate street improvement projects before implementation or to collect additional economic/business metrics before and after implementation," Liu said.

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Many cancer survivors experience challenges related to employment, including limitations in ability to work.¹ Given that most health insurance coverage for working-age individuals in the US is employer-based, a challenge is the inability to freely leave a job given limitations on health insurance portability, also called job lock.² Job lock can negatively affect career trajectory and quality of life.³ Likewise, spouse/partner job lock can also affect family well-being.⁴ We examined job lock prevalence among cancer survivors and their spouses/partners and associated factors in the US.

Methods

This study identified cancer survivors who responded to questions about job lock (ever having stayed at a job out of concern for losing health insurance) from the 2011, 2016, and 2017 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Separate multivariable logistic regression models examined the association of job lock in survivors and spouses/partners with self-reported survivor characteristics, including current age, sex, educational attainment, race/ethnicity, years since last cancer treatment, current marital status, comorbidities, and household income as a percentage of the federal poverty level (FPL). The study was determined to be exempt from institutional review by the National Cancer Institute. Weighted logistic regression modeling was used. P-values were determined to be significant at 0.05 (two-tailed test). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines were used. Analyses were conducted using SAS version 9.4 (SAS Institute) and SAS-callable SUDAAN version 11.0.0 (RTI International).

Results

Of 1340 survivors, 526 (42.2%) were men and 814 (57.8%) were women. There were 365 respondents (26.1%) between the ages of 18 and 54 years, 387 (29.6%) between 55 and 64 years, 389 (30.1%) between 65 and 74 years, and 199 (14.4%) older than 75 years. Of 1340 surveyed cancer survivors overall, 266 (19.6%) (95% CI, 17.1%-22.3%) reported job lock. Of 1593 partners of survivors, 677 (44.4%) were men and 916 (55.6%) were women. There were 320 (18.9%) respondents between the ages of 18 and 54 years, 372 (24.0%) between 55 and 64 years, 475 (31.2%) between 65 and 74 years, and 426 (25.9%) older than 75 years. Of 1593 spouses/partners surveyed, 171 (10.7%) (95% CI, 8.4%-11.9%) reported job lock. Of 1094 respondents, 374 (32.3%) (95% CI, 29.1%-35.6%) reported any job lock for either themselves or their spouse/partner. Of 628 women, 235 (35.9%) (95% CI, 31.7%-40.3%, 235/628) reported any job lock and of 466 men, 139 (27.9%) (95% CI, 23.5%-32.8%) reported any job lock (Figure).

Characteristics significantly associated with survivor job lock included younger age and earning income between 138% and 400% of the FPL (Table). Spouse/partner job lock was more common among survivors who were women vs men (12% vs 8%), married vs unmarried (11% vs 7%), and nonwhite vs non-Hispanic white (16% vs 9%). Survivors with 3 or more vs no comorbidities were more likely to report spouse/partner job lock (14% vs 6%). Younger survivors (under 75 years) were more likely to report spouse/partner job lock, as were those earning between 138% and 400% of the FPL.

Discussion

In this study, approximately 1 in 3 cancer survivors in the US reported job lock for themselves or their spouses/partners, suggesting that job lock is common and has implications for the well-being and careers of both survivors and their families. Given higher prevalence of job lock among younger survivors and those with incomes near the poverty level, it is important to note that those earning between 138% and 400% of the FPL are ineligible for Medicaid and may have fewer employment alternatives with comprehensive health benefits. Clinicians, social workers, and navigators have opportunities to identify job lock and other employment concerns throughout treatment/survivorship care and connect survivors with employment and health insurance counseling.⁵

One long-term study of childhood cancer survivors from 2018⁶ found that 23% of survivors reported job lock. The present study demonstrates consistent findings in a nationally representative population of adult cancer survivors and also provides data on the prevalence of spousal/partner job lock. The Patient Protection and Affordable Care Act eliminated preexisting condition exclusions and created Marketplace exchanges for purchasing insurance coverage outside of work; whether these provisions will reduce job lock over time is unknown.

Study limitations include the cross-sectional design, lack of a control group, self-report of measures, and lack of information on cancer stage or course of treatment. Response rates ranged from 44% to 55%, comparable with other national household surveys. Sample weights help address nonresponse. Study strengths include it being a large, nationally representative sample and assessment of job lock experiences.

The present study found that 32% of cancer survivors reported job lock in either themselves or their spouses/partners. Additional research, particularly prospective, longitudinal, and qualitative studies, can help elucidate downstream consequences that may vary by sex and develop interventions to increase availability of insurance coverage regardless of employment.

Article Information

Accepted for Publication: February 27, 2020.

Corresponding Author: Erin E. Kent, PhD, MS, Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1102-B McGavran-Greenberg Hall, CB # 7411, Chapel Hill, NC 27599-7411 (erin.kent@unc.edu).

Published Online: April 23, 2020. doi:10.1001/jamaoncol.2020.0742

Author Contributions: Dr Kent had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kent, deMoor, Zhao, Ekwueme, Yabroff.

Acquisition, analysis, or interpretation of data: Kent, deMoor, Ekwueme, Han, Yabroff.

Drafting of the manuscript: Kent, deMoor, Ekwueme, Yabroff.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Kent, Ekwueme, Yabroff.

Administrative, technical, or material support: Kent, Zhao.

Supervision: Kent.

Conflict of Interest Disclosures: None reported.

Funding/Support: Drs Han and Zhao received funding from AstraZeneca unrelated to this study.

Role of the Funder/Sponsor: AztraZeneca had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The findings and conclusions in this article represent those of the authors and do not necessarily represent the official position of the National Cancer Institute, National Institutes of Health, the US Centers for Disease Control & Prevention, or the American Cancer Society.

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COVID-19 coronavirus could cost the US billions in medical expenses

Study shows hospitalizations, ventilators, and other health resources that patients would require could cost $654 billion if a majority of the population gets infected
CUNY GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY

ESTIMATED COVID-19 CORONAVIRUS HEALTH CARE COSTS BASED ON PERCENT OF US POPULATION INFECTED view more CREDIT: CUNY SPH
One of the major concerns about the COVID-19 coronavirus pandemic has been the burden that cases will place on the health care system. A new study published April 23 in the journal Health Affairs found that the spread of the virus could cost hundreds of billions of dollars in direct medical expenses alone and require resources such as hospital beds and ventilators that may exceed what is currently available. The findings demonstrate how these costs and resources can be cut substantially if the spread of COVID-19 coronavirus can be reduced to different degrees.

The study was led by the Public Health Informatics, Computational, and Operations Research (PHICOR) team at the City University of New York (CUNY) Graduate School of Public Health and Health Policy (CUNY SPH) along with the Infectious Disease Clinical Outcomes Research Unit (ID-CORE) at the Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center and Torrance Memorial Medical Center. The team developed a computer simulation model of the entire U.S. that could then simulate what would happen if different proportions of the population end up getting infected with the COVID-19 coronavirus. In the model, each infected person would develop different symptoms over time and, depending upon the severity of those symptoms, visit clinics, emergency departments, or hospitals. The resources each patient would require such as health care personnel time, medication, hospital beds, and ventilators would then be based on the health status of each patient. The model then tracks the resources invovled, the associated costs, and the outcomes for each patient.

For example, if 20 percent of the U.S. population were to become infected with the COVID-19 coronavirus, there would be an average of 11.2 million hospitalizations and 1.6 million ventilators used, costing an average of $163.4 billion in direct medical costs during the course of the infection. The study shows the factors that could push this amount up to 13.4 million hospitalizations and 2.3 million ventilators used, costing an average of $214.5 billion. If 50 percent of the U.S. population were to get infected with the COVID-19 coronavirus, there would be 27.9 million hospitalizations, 4.1 million ventilators used and 156.2 million hospital bed days accrued, costing an average of $408.8 billion in direct medical costs during the course of the infection. This increases to 44.6 million hospitalizations, 6.5 million ventilators used and 249.5 million hospital bed days (general ward plus ICU bed days) incurred, costing an average of $654 billion during the course of the infection if 80 percent of the U.S. population were to get infected. The significant difference in medical costs when various proportions of the population get infected show the value of any strategies that could reduce infections and, conversely, the potential cost of simply letting the virus run its course.

"Some have suggested herd immunity strategies for this pandemic," explained Sarah Bartsch, project director at PHICOR and the study's lead author. "These strategies consist of allowing people to get infected until herd immunity thresholds are reached and the virus can no longer spread. However, our study shows that such strategies could come at a tremendous cost."

"This also shows what may occur if social distancing measures were relaxed and the country were to be 're-opened' too early," said CUNY SPH Professor Bruce Y. Lee, executive director of PHICOR and the study's senior author. "If the virus is still circulating and the infection rates surge as a result, we have to consider the resulting health care costs. Such costs will affect the economy as well because someone will have to pay for them. Any economic argument for re-opening the country needs to factor in health care costs."

The study shows how costly the COVID-19 coronavirus is compared to other common infectious diseases. For example, a single symptomatic COVID-19 coronavirus infection costs an average of $3,045 in direct medical costs during the course of the infection alone. This is four times higher than a symptomatic influenza case and 5.5 times higher than a symptomatic pertussis case. Factoring in the costs from longer lasting effects of the infection such as lung damage and other organ damage increased the average cost to $3,994.

"This is more evidence that the COVID-19 coronavirus is very different from the flu," said Bartsch. "The burden on the health care system and the resources needed are very different."

"Factoring in the costs incurred after the infection is over also adds to the costs. It is important to remember that for a proportion of the people who get infected, health care costs don't end when the active infection ends," Lee warned. "This pandemic will have its lasting effects and taking care of those who will suffer contuing problems is one of them."

A continuing concern is that the U.S. health care system will become overloaded with the surge of COVID-19 coronavirus cases and will subsequently not have enough person-power, ventilators, and hospital beds to accommodate the influx of patients. This study shows that even when only 20 percent of the population gets infected, the current number of available ventilators and ICU beds will not be suffient. According to the Society of Critical Care Medicine, there are approximately 96,596 ICU beds and 62,000 full-featured mechanical ventilators in U.S., substantially lower than what would be needed when only 20 percent of the population gets infected.

"Of course, the actual capacity used will depend on the timing of when patients need them," said Bartsch. "But showing that there are orders of magnitude differences between what is currently available and what may be needed is concerning."

While health care professionals and public health officials have expressed concerns about ventilator and hospital bed shortages, the model can quantify in a more detailed manner what specifically will be required at different phases of the pandemic and what to expect when more people are infected.

"The Potential Health Care Costs and Resource Use Associated with COVID-19 Coronavirus in the United States" was written by Sarah M. Bartsch, Marie C. Ferguson, James A. McKinnell, Kelly J. O'Shea, Patrick T. Wedlock, Sheryl S. Siegmund and Bruce Y. Lee.

This work was supported in part by CUNY SPH, the Agency for Health care Research and Quality (AHRQ) via grant R01HS023317, United States Agency for International Development (USAID) under agreement number AID-OAA-A-15-00064, Global Obesity Prevention Center (GOPC) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Office of the Director, National Institutes of Health (OD) under award number U54HD070725. It was also supported by NICHD via grant U01HD086861 and 5R01HD086013-02 and by National Institute of General Medical Sciences (NIGMS) via the Models of Infectious Disease Agent Study (MIDAS) network under grant 1 R01 GM127512-01A1. The funders did not have any role in the study design, collection, analysis and interpretation of data, writing the report, and the decision to submit the report for publication. The authors of this manuscript are responsible for its content, including data analysis. Statements in the manuscript do not necessarily represent the official views of, or imply endorsement by, National Institute of Health, AHRQ or HHS.

About CUNY SPH

The CUNY Graduate School of Public Health and Health Policy is committed to teaching, research, and service that creates a healthier New York City and helps promote equitable, efficient, and evidence-based solutions to pressing health problems facing cities around the world.

About PHICOR

Since 2007, PHICOR has been developing computational methods, models, and tools to help decision makers better understand and address complex systems in health and public health. Follow @PHICORTeam for updates.

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