HIA of transport projects for Plaine Commune

Download the report

An English summary of the Plaine Commune HIA of transport projects has been developed. It describes an HIA of three related transport projects in the Saint-Denis area of Paris.

You can download the report here.

Health Care Cost Inflation Returns

True, that....

Call it the return to the old normal.

With the slow recovery of the U.S. economy, the advent of some blockbuster drugs and the entry of more than 8 million newly-insured persons, healthcare cost inflation is ticking back up. Writing in Health Affairs, CMS' actuaries are projecting a 5.8% year-over-year rate of inflation that reminds them of the years prior to the Great Recession. This rate is projected to grow faster than the Gross Domestic Product (GDP), which means that by 2024, the U.S. will be devoting 19.6% of its economy to healthcare.

Some eye-catching observations:

1) If it weren't for consumer cost-sharing, the inflation rate would be even higher;

2) Drug treatment for a single disease - Hepatitis C -  is driving prescription drug costs "sharply higher" and adding to the overall 5.8% rate;

3) No mention of the impact of the administration's innovations, like accountable care organizations;

4) Substantial uncertainty.

The Population Health Blog's take:

In a highly competitive global economy, even single point increases in healthcare costs underlying the manufacture of items that make up the GDP, automobiles or washing machines, is bad news.  If the projections are true, business leaders could reconsider the merits of overseas outsourcing or start dropping employer-based health insurance.

Costs in 2015 and 2016 will be lower than the 5.8% rate, which means it won't hurt enough to make healthcare a big factor in the 2016 elections.  While the Affordable Care Act remains a rhetorically rich target environment, the PHB expects politicians on both sides of the partisan divide to find better red meat elsewhere, like building thousand-mile walls or buying hundreds of millions of solar panels.  So, if you're an investor in healthcare stocks, continue to go long.

Any good news in other sectors of the economy could paradoxically make healthcare costs look comparatively worse. As energy and housing costs creep along at a lower rate, consumers are going to see a greater percent of their income going toward healthcare - either in the form of health insurance premiums or out-of-pocket cost-sharing.  If (and that's a big if) the U.S. economy can return to its efficient cost-cutting ways, expect the healthcare debate to heat up and for calls for a government-sponsored option to increase. 

The mean increase of 5.8% is an average.  Some segments of the insured population will see higher costs and others will see lower costs "around" the mathematical mean.  Which voter block "loses" by paying more than the 5.8% could drive the coming debate as it shifts from insurance coverage to affordability and access.  Case in point: the PHB's spouse is registered to vote and she's not happy with the guesswork behind our pricey monthly insurance premium.

While Americans have reasons to be reluctant to travel overseas for cheaper surgery, they'll be far less so for access to a course of just-as-good medications that are under foreign price control.  Call it medication tourism.

And finally.... uncertain abounds.  No one saw that Hepatitis C would have such a near-term impact.  Who knows what else is out there?  A new epidemic?  Another cure?

Stay tuned!

My Journey through Menopause

My journey through menopause is more of an update since my "Mad at Menopause" article written a year ago.  Head on over and read that before diving in here to get the full story of my symptoms, frustrations and actions to resolve them.

Instead of being mad at menopause, I am now calling it a journey through menopause.  The drastic symptoms have softened thanks to research, talking with my doctors, and making treatment decisions that best fit my body.  As women we will all experience menopause and the havoc placed upon our bodies during this transition.  Menopause is part of life and health and not a subject to be hushed and brushed under the carpet.  There is no shame or embarrassment discussing anything that relates to health and fitness.  We have lived too long with our heads tucked between our tails and still thinking how dare we use the term "vagina" in public.  Come on now, we are all grown women and men for that matter and this is a `need to take care of issue` for women and the men who support them.

One year ago I was plagued with unbelievable hot flashes that tormented my days and nights, fatigue, irritability, foggy thinking, inability to sleep, vaginal dryness, numerous urinary tract infections, decreased libido, and complete frustration that consumed me. This is a brief description of what can be read in the above referenced article fully outlined in ugly detail.  I think menopause was at the forefront of every conversation I had with my husband back then and "thank you God" for such a supportive man.  It did not matter how physically fit I looked on the outside because my inside was so out of balance I did not feel confident sexually or as a woman.  This weighed on me heavily and I was desperate to fight menopause with all I had.

One year later and I am feeling fabulous.  I no longer take OTC herbal blends and decided to give bio-identical hormone therapy a try. I have been on the bio-identicals for 10-months now and the improvement in menopause symptoms is remarkable. In addition,  I have continued the low dose estrogen vaginal insert pill and very happy with the `plumped up` results.  I also use natural coconut oil and vitamin E suppositories regularly for internal vaginal moisturizing.  My hot flashes went away within 2-weeks of bio-identical therapy and as the months have gone by, I feel like my old self again.  Emotionally and physically my body feels like it has been brought back into hormonal balance and I am functioning at what I would call a normal level.

My confidence is renewed, my thinking is clear, and sex is great.  I am taking an additional herb that I will not disclose right now until I can provide fair feedback.  I will share that it has to do with increased vascular functioning.  My lifestyle of eating healthy and exercising regularly continues to help residual menopause symptoms.  The only thing remaining is irregular bleeding which is normal on or off bio-identical hormones.  I may go 3 months with no cycle and get that surprise period which can be light or heavy.

I do not know how long I will require trans dermal bio-identical hormone therapy but am happy that I made the decision to go this route for my body.  It has changed my frustrations into stress free days of going through the transition and I look forward to no longer having periods...sweet freedom. Sharing my journey through menopause is not only informative but to support you are not alone in the process.  However, we are all individuals needing to be our own health care advocates.  It is important to make the best choices for ourselves through research and doctor discussions.  If anything, be motivated there is hope to feeling better going through menopause and always be pro-active when it comes to your health.

Check out my article "Menopause: Fight Back with Food" on the About.com network for more great info on the subject.

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Dedicated to my Beautiful Husband

Stay Healthy!

Darla

Refined Sugar Worsens Blood Lipid Markers of Cardiovascular Disease

Blood lipids such as LDL and HDL cholesterol are markers of the biological processes that impact cardiovascular disease, and they are commonly measured to assess cardiovascular risk.  When we think about the impact of food on blood lipids, dietary fat typically comes to mind.  Yet a new study shows that dietary carbohydrate, specifically high-fructose corn syrup, can have a large impact on blood lipid markers of cardiovascular disease risk.

Introduction

Dietary fats have well-established impacts on blood lipids.  For example, in short-term feeding trials, saturated fat tends to increase total cholesterol, increase LDL ("bad") cholesterol, and increase HDL ("good") cholesterol, while the omega-6 polyunsaturated fat linoleic acid decreases total cholesterol and decreases LDL cholesterol.  For this reason, dietary advice to reduce cardiovascular risk tends to focus on dietary fat.

The hypothesis that refined dietary sugar is harmful to the cardiovascular system isn't new.  In 1972, British physiologist and nutrition researcher John Yudkin published a classic book called Pure, White, and Deadly, which argued, among other things, that refined sugar is harmful to the cardiovascular system.  Yet at the time, the supporting data were weak, and the hypothesis was never taken very seriously by the scientific community.

Peter Havel and his group at UC Davis have begun to breathe new life into this hypothesis with their rigorous work on the cardiovascular effects of dietary sugars.

Read more »

A Primer on Population Health

If you need to help a colleague who is clueless about cost-saving potential  of population health, the Population Health Blog recommends you refer him or her to this efficiently written primer from The Health Care Transformation Task Force's High Cost Patient Work Group.

Basically, if the small number of patients who are destined to be high cost can be prospectively a) identified and b) helped, a lot of money could be saved.  By focusing resources on a small fraction of insured people, the costs for the entire risk pool can be decreased.

In the meantime the majority-remainder of the population can be aided with other lower-cost resources that include, but are not limited to wellness and prevention.

Who are the small numbers of people?

1) patients with a) advanced illness who are nearing end of life who may benefit from b) hospice.

2) patients with a) high spending patterns who may benefit from b) coordination of care by a dedicated health provider (such as a nurse or a lay community care worker).

This population does not include:

3) high cost patients with a) any illness who b) are destined to get better all by themselves or c) unlikely to derive any benefit.

Algorithms to spot that small number of patients use diagnosis codes, treatment codes and medication utilization data from the electronic record or insurance claims databases.  Other useful insights can be gained from patient surveys (and a number are available), using public data to ascertain socioeconomic status (zip codes are destiny), asking physicians to refer patients who are at risk and the design of insurance benefit (patients may not be aware that certain services are covered).

The science behind the use of these inputs is imperfect but getting better, and the more inputs, the better.  Don't let the perfect be the enemy of the good, however, because simple algorithms based on readily available data will get you started.

One of the advantages of this approach is that the cost of coordination of care is variable.  It can start small and be flexed up as expertise grows and opportunities arise

The Population Health Blog couldn't have said it better.

Are Primary Care Physicians (PCPs) Important to ACO Success? Payment Arrangements Say Otherwise

Long ago, the Population Health Blog learned that when it comes to health insurance, capitation or bundled payments brakes, while fee-for service payments are gas. Too many physician office visits?  Use "capitation" brakes. Want to increase physician visits?  Apply a payment for each encounter with some FFS gas. 

Health care organizations can pass this arrangement onto their physicians. They can pay them with a salary (a form of capitation), or a variable "productivity" compensation (seeing more patients is compensated with a form of FFS) or with a combination of both.
 
Simple, right?  To figure out this ying-yang of utilization management, just follow the money.

That's why the PHB was interested in this just-published Annals of Family Medicine paper on how primary care physicians are being paid by Accountable Care Organizations (ACOs). If you believe more primary care visits translate to savings in other parts of the ACO, then you'd want to apply gas. If you believe primary care visits are a cost that doesn't necessarily save money, you'd want to apply the brakes.

The authors used data from the 2012-2013 "National Survey of Physician Organizations" to compare primary care physician (PCP) compensation in ACOs with non-ACOs. 1,398 organizations were in the original database; after excluding solo practitioners and specialist physician organizations, 632 were left. 

Three groups were compared:

1) Medicare ACOs (21.1%) with exposure to some financial risk related to total health care utilization;

2) Non-ACOs (2.8%) with contracted financial risk for primary care costs (2.8%);

3) No ACO and no risk (76.1%).

Results?  PCPs in.....
Medicare ACOs got 49% of their income from a flat salary and 46% tied to productivity. 3.4% was tied to quality;
Non-ACOs at primary care risk got 66% of their compensation from salary, 32% tied to productivity and .8% from quality;

No ACO arrangements with no risk had compensation that was similar to the Medicare ACOs.

The PHB's take-aways?

Based on the non-ACOs, health care organizations are prepared to use salary to influence physician behavior.  If you believe PCP visits are a cost and you are at financial risk for utilization, apply more brakes than gas.  The model is still out there.

But......

The leaders running Medicare ACOs don't know what the right balance of FFS and capitation for PCPs, and are mirroring a status quo that is indistinguishable from business as usual.  Despite the fanfare about the critical role of primary care in health reform, the Medicare ACOs have decided otherwise. If they ultimately succeed or fail, it won't be because of any special innovation involving their PCPs' compensation.

Image from Wikipedia

Taking Control of Right Now

Right now is what I have to work with.  I have learned from past mistakes and hurts,  overcome injuries through hard work, and this has taught me to make the most of my "nows".  It has also shown me how to celebrate every moment in this life.

The road has been tough and sometimes still can be, but each day is about taking control of right now and becoming my best me.  Procrastination is a waste of life, body and soul and really a slap in our own faces when we don't take care of business.  Right now we have a choice to eat healthy, exercise and stop complaining about all the things wrong in our lives.  So many are caught up in all the negative stuff and can't see the forest through the trees. Instead of celebrating a pound lost, the happy event quickly becomes downgraded to "just a pound" and this has just ruined my day.

We are the products of our daily choices.  It is important to take control of "right now" and not allow another day to pass without making some great changes. Whether you are struggling with poor nutrition, sedentary lifestyle, stress, or a bad attitude there is no time like the present to take positive action.   Our lives become so habitual that change feels alien and impossible, but I say it is POSSIBLE.

Get out a piece of paper and journal changes you would like to see happen in your life.  Do you want to look better, feel better, and improve the quality of your life?  Create a plan to make that happen and that may mean going to a qualified counselor, personal trainer, or registered dietitian. Whatever needs to happen, only you can make it so.  Dependence on others to somehow create this magic transformation for you is a fairytale.  We are all responsible for our physical, spiritual and emotional health and any slacking manifests itself as illness, unhappiness and low self-esteem.

Time to take control of RIGHT NOW and Stay Healthy!

Read my latest article on the sportsnutrition.about.com network titled "Five Food Strategies You Can Do Right Now to Reach Your Fitness Goals" for some great ideas.

Thanks for stopping by my Blog and I look forward to responding to your comments.  Don't forget to subscribe below and never miss a FREE update.

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I believe in Right Now

The Latest Health Wonk Review is Up!

Hank Stern of the InsureBlog has posted the latest version of the Health Wonk Review.  Titled Hot Summer Nights, Cool Summer Drinks, this compendium of posts is sure to quench any thirst for health policy braininess.

Enjoy!

APHA summer webinar series about racism's impact on health and disparities in the USA

The recent events in Charleston, South Caroline, Baltimore, Maryland, and Ferguson, Missouri, remind us that stigma, inequalities and civil rights injustices remain in our society today. Unfortunately, skin color plays a large part in how people are viewed, valued and treated. We know that racism, both intentional and unintentional, affects the health and well-being of individuals and communities and stifles the opportunity of many to contribute fully to the future and growth of this nation.

Join the leadership of the American Public Health Association in a summer webinar series about racism's impact on health and disparities. This a four part webinar series.


Register by clicking here.

Naming and Addressing Racism: A Primer

July 21, 2015 | 2 p.m. EDT

Use timeanddate.com to find the time in your timezone.

Shiriki Kumanyika, PhD, MPH, and Camara P. Jones, MD, MPH, PhD 

This kick-off webinar featuring APHA’s executive director, president and president-elect will take a look at some of the nation’s leading health inequities.

APHA President Shiriki Kumanyika will discuss how racism is one of the most challenging tools of social stratification we face when trying to improve the health of the public. She also will reflect on the evidence and research needs related to how racism limits our ability to make America the healthiest nation.

APHA President-Elect Camara Jones will tell the Gardener's Tale and present a framework for understanding racism on three levels. This framework is useful for understanding the basis for race-associated differences in health, designing effective interventions to eliminate those differences and engaging in a national conversation.

Upcoming webinars in this series:

Community Violence Well-Being
August 4, 2015, 2 p.m. EDT

Unequal Treatment: Disparities in Access, Quality and Care
August 18, 2015, 2 p.m. EDT

Racism: The Silent Partner in High School Dropout and Health Disparities
September 1, 2015, 2 p.m. EDT

Eat Like a Fitness Expert to Achieve YOUR Best Body

I recently posted this motivation on my Stay Healthy Instagram and Facebook:

My Goal is to be my BEST ME, Fit Over 50

" I do take the time to read your feedback and comments left on motivation that I post and excited that you are striving to adopt a healthy lifestyle. Showing images of those who are dedicated to fitness to include myself are to encourage and inspire. I have also read feedback of a negative vain and I want to address that. I am going to get very personal with you and you can read more about me in my Blog if you choose. I am over 50, a fitness professional and freelance writer that works extremely long hours. My day does not end when I step out of my studio. I look the way I do because of the lifestyle I walk daily. I do not spend hours in the gym and in fact limit my workouts to one hour 5 days a week. I indulge on treats on occasion and eat incredible tasting healthy food. I am a woman of God and my faith helps me with inner strength and getting through each day. I am passionate about helping people get healthy and would love to hug everyone making this choice. I believe life is a gift and I am not here to be anyone else or look like anyone else. I am also not here to shame others for not looking like a fitness model. My goal is always to be my best me each day and in that I may fail but pick up and keep trying. My image is to show that it is not too late, no circumstance too hard, and even injury so severe to not be able to do something. You are working on being your best you and to use articles and images as inspiration or motivation. Getting angry and discouraged because you are not personally making the choices to change your body does nothing but fuel resentment and may even cause you to walk away from trying. I pray that your thoughts and feelings would be changed for the positive and your focus to become a better you starts with today. Fitness is a journey and we are all works in progress reaching for our best and never perfection. Embrace the now, love who you are now and start working on better tomorrow's. But today is what we have and narrowing that down more, this moment is the concern. What you are thinking, doing and how you are acting right now...is it creating a better, healthier you? Have a blessed Sunday and Stay Healthy!"

The responses to this post were incredible, touching, inspiring and some definitely put a knot in my throat. I am a woman of my word and answering the call to several requests of what I eat on a weekly basis and my workout routine. I will be begin with nutrition because I have found this to be the biggest struggle for people throughout my years of teaching health and fitness. 

I like to teach nutrition simply and focus on health.  There is nothing secret or costly about how to eat to obtain a fit body and too much complication has been placed on this topic.  It really is frustrating that so many suffer with food fears due to untruths floating around the media, in commercials and even TV shows. Getting back to the basics, taking a deep breathe, and releasing the stress surrounding food is the first item of business.  Once food is looked upon as our friend and not the enemy and cause of making us fat, can we embrace all the good things that food does for our body.

I am glad that I motivate and inspire you, but please understand that in this share, you are learning how to eat for your best body.  We are all works in progress, and I am far from perfect, but what I do is apply the best principles of healthy nutrition and fitness each day. That does not mean I am free from indulgence once in awhile.  If any fitness professional tells you indulgence never occurs that is a bold face lie and I will answer to that statement.  I have been in the fitness industry over 30 years and have had my share of burgers, fries, pizza and brownies.  I live a life of moderation and use a 90/10 percent eating strategy and sometimes 80/20 depending on the situation.  Eating healthy is also about balance and allowing for the occasional treat meal.

Moving on to what I eat typically during my work week.  I am a walk the talk trainer and adhere to what I teach my clients.  Results come when consistent healthy food intake and exercise are happening.  I eat a wide variety of healthy food from good carbohydrates, lean proteins, healthy fats and lots of water.  I can be a creature of habit and find myself eating the same meals everyday, except for dinner which is typically changed each night.  I believe in cooking at home being in control of what I put in my face and body.  I eat simply, never count calories, and if I am hungry I have gone too long without eating.  I space my meals every 2 1/2 to 3 hours and that works for me.  I use my palm as a guide for portion size and keep measuring cups handy for wet ingredients.

My typical daily nutritional intake looks like this:

Meal 1: Ozery Bakery Morning round with Coffee 

Meal 1: Option 2, Powered Up Oats with Coffee

1/2 cup steel cut oats
1/4 sliced banana
handful blueberries
handful walnuts









Meal 2: Open face peppered turkey and hummus

I enjoy this with a green smoothie
1 cup fresh pineapple chunks
large handful of power greens
(chard, kale, spinach), blend in water

Alpine Valley Organic Bread toasted
smear with organic hummus
top with peppered turkey











Meal 3: Sliced fruit with flax meal and yogurt

1 large nectarine or fruit of choice
I also like to use 1/2 cup blueberries
1/4 cup ground flax meal
1/2 cup Fage plain Greek yogurt
I like to top with a handful of raw unsalted mixed nuts
Stir and eat




Meal 3: Option 2, boiled eggs with sweet potatoes

1 full organic egg, 1 egg white mixed with mustard, sprinkle with paprika if desired
1/2 large sweet potato, cooked and cut in wedges

I like to dip my sweet potato in organic ketchup ... call me weird, but I have always been a ketchup kinda girl 





Meal 4: Grilled salmon and roasted veggies

Brussel sprouts, cauliflower, and red bell peppers drizzled in olive oil, and tossed with basil pesto and minced garlic. Roast in open pan at 450 for 30 to 35 minutes

season and grill salmon outdoors for 25 minutes






Other Meal 4 Options I enjoy:

Roasted Veggies and Egg

Healthy Grilled Pizza

Brussels and Baked Stuffed Pork

I enjoy a small snack before bed and that really varies between my mood.  I enjoy hummus or peanut butter on toast or if I have baked a healthy treat, I will have that.

For more meal ideas from my kitchen, visit my recipe page and also see my Sports Nutrition site on the About.com network.  I hope this information is helpful and provides a great foundation to simple and healthy meal ideas.

Enjoy my latest article on the About network ,"Natural Body Building: Eating for Goals" and guest written by Frank Gigante, Natural Competitive Bodybuilder and Lifestyle Coach.



Thanks for stopping by my Blog and I look forward to your comments. Subscribe below to never miss a free update!

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Darla Leal, Fit Over 50!

Stay Healthy!

Darla

United Nations Development Program (UNDP) Global Roster of Environmental, Social and Health Expert Consultants

UNDP is establishing a global roster of expert consultants to support implementation of our Social and Environmental Standards (SES), deadline for applications is Friday, August 7:

http://jobs.undp.org/cj_view_job.cfm?cur_job_id=58123


Background

UNDP’s Social and Environmental Standards (SES) underpin our commitment to mainstream social and environmental sustainability in our Programmes and Projects to support sustainable development.

The objectives of the standards are to:
Strengthen the social and environmental outcomes of Programmes and Projects;
Avoid adverse impacts to people and the environment;
Minimize, mitigate, and manage adverse impacts where avoidance is not possible;
Strengthen UNDP and partner capacities for managing social and environmental risks;
Ensure full and effective stakeholder engagement, including through a mechanism to respond to complaints from project-affected people.

The SES are comprised of an Overarching Policy and Principles, Project-Level Standards, and a Policy Delivery Process. The overarching policy and principles at the core of the SES are: (i) human rights-based approach to development programming; (ii) gender equality; and (iii) environmental sustainability.

A key mechanism to ensure these standards are applied is through UNDP’s project-level Social and Environmental Screening Procedure (SESP) which is a requirement for all proposed projects with a budget of $500,000 or more. The objectives of the SESP are to: (a) Integrate the SES Overarching Principles (human rights, gender equality and environmental sustainability); (b) Identify potential social and environmental risks and their significance; (c) Determine the Project's risk category (Low, Moderate, High); and (d) Determine the level of social and environmental assessment and management required to address potential risks and impacts.

UNDP’s SES and SESP came into effect January 1, 2015. The challenge now is to ensure successful implementation and strengthened capacities of staff to apply the standards.

Duties and Responsibilities (if selected to be on the roster and then selected for an assignment

To support implementation of the SES a Roster of Social and Environmental Standards Experts will be established. Experts will need to demonstrate extensive experience in at least one (preferably multiple) of the thematic areas listed below:

• Human Rights (including human rights based approach and human rights impact assessment);
• Gender Equality and Women’s Empowerment (including gender mainstreaming and gender analysis);
• Biodiversity Conservation and Sustainable Natural Resource Management (including mitigation and use of offsets, protected areas, forests, water);
• Climate Change and Disaster Risk Reduction (including climate risk analysis, disaster risk, greenhouse gas emissions);
• Community Health and Safety (including infrastructure safety, health impacts, emergency preparedness);
• Labour Standards (including familiarity with ILO standards, decent work);
• Cultural Heritage (including chance find procedures, physical and intangible cultural resources);
• Displacement and Resettlement (including Resettlement Action Plan, livelihoods);
• Indigenous Peoples (including Free, Prior and Informed Consent, Indigenous Peoples Plans);
• Pollution Prevention and Resource Efficiency (including pollution prevention plans, waste management, hazardous materials);
• Social and Environmental Screening and Assessment (including Environmental and Social Impact Assessment, Strategic Environmental and Social Assessment, Environmental and Social Management Plans).

Relevant experience includes demonstrated familiarity with the relevant UN international legal and normative framework, the application of relevant standards, stakeholder engagement, analytical tools, methods, impact assessment and risk management measures during the planning and implementation of development projects.

The duties and responsibilities detailed below are a representative, but not exhaustive, list of potential activities.

Specific Terms of Reference will dictate the scope of work and the selection of experts from the vetted roster for each of the assignments. Key areas of support and activities will include:

Development of guidance and tools

• Provide inputs in area(s) of expertise to the development of guidance and tools to support implementation of the SES;
• Support the elaboration of case studies;

Capacity development and trainings for staff

• Support the development and delivery of trainings for staff, including webinars, the development of online training content, and support to face-to-face trainings;
• Support the development of learning materials, including case studies and documentation of lessons learned.
• Technical and advisory support related to implementation of the SES
• Review draft SESP reports and related assessments and management plans and provide advice on how to further strengthen the quality.
• Support the conduct of assessments and development of management plans.
• Support implementation and monitoring of management and mitigation activities.
• Institutional arrangements will be agreed if a contract is formalized. The hired consultants will report to, seek approval/acceptance of outputs as specified in the contract.

Duration of the Work: (If selected for roster and then selected for a specific project)

One year initial with possibility of extension up to two additional years subject to satisfactory performance. 

Competencies

• Specific technical expertise in at least one of the SES thematic areas listed above;
• Highly organized with strong analytical and research skills;
• Excellent analytical, writing, advocacy, presentation, and communications skills;
• Ability to prepare succinct, analytical publications and reports;
• Focuses on impact and result for the client and responds positively to critical feedback;
• Demonstrated ability to work in an independent manner.

Required Skills and Experience

Education:

• Masters degree in field related to international development, with specific academic background related to social and environmental sustainability.

Experience:

• At least 10 years of experience related to social and environmental standards and impact assessment in an international development context;
• Experience developing and conducting training related to social and environmental standards;
• Experience or strong familiarity with the work of UNDP and/or other multilateral, bilateral and civil society development partners.
• Familiarity with the UN System, in particular UNDP.

Three Downsides to Commercial Health Insurer Consolidation

Writing in The Wall Street Journal, Scott Gottlieb argues that the Aetna-Humana and the Anthem-Cigna combinations are evidence of waning insurer competition that is the direct result of Obamacare.  Not only are ACOs not a panacea, but the Affordable Care Act's insurance mandate to limit administrative costs is forcing Aetna et al to spread their costs over a larger base.  Dr. Gottlieb fears that the oligopolies won't be able to deliver on innovation and will limit consumer choice   

Too bad The WSJ didn't give him more print space.  If they did, Dr. Gottlieb may have also pointed to three other potential downsides to commercial insurer consolidation:

1) The concentration of risk: While having a small regional health insurer go bust is a big problem for hundreds of thousands of insurance enrollees, having a for-profit national insurer with tens of millions of enrollees go bust would be a national catastrophe. Think Lehman Brothers, Black Swans and Too Big To Fail.

2) Cronyism: Politicians and C-Suite executives no longer blush at the prevalence of the revolving door between government and all industry.  Health insurance will likewise be too regulated and complicated to leave to anyone other than insiders, who will naturally be unable to discern the line that separates their interests from the patients'.
 
3) Political Power: Will Washington DC and 50 states really be able to stand up to a handful of companies that dominate a fifth of the national economy?  Years ago, the commercial insurers remained silent while they were called "Fat Cats." The Population Health Blog bets that the next time a While House blames the insurers for rising costs, they won't remain so deferential.

Image from Wikipedia

How I Boost My Workouts

Are YOU Shocked?

I use a stimulant to boost my workout!  Are you shocked with that share?  If that was the only thing stated in this post, you may form an ugly opinion of me, and you still might but I will cough up the goods.  This substance is not found in supplement stores, is fairly inexpensive, and provides very effective metabolism boosting results.  Studies have given it rave reviews for not only helping with more efficient fat burning, but also reducing exercise induced muscle pain, improved mental focus, and reduced risk of disease.

Five Reasons to Drink Coffee for a Fit Body

Drum roll ... COFFEE!  I drink one and sometimes two cups of coffee per day prior to my workouts.  Two-cup days typically mean I feel sluggish and will need more of a boost to get me through the physical demands of my workout.  I must admit to enjoying my morning cup of Joe and it has become something that I look forward to mentally as well as physically.  I can feel my body and brain waking up within 30 minutes of drinking it and ready to start my day.  I understand the habit forming properties of caffeine which is why I do not partake in all-day binges of coffee. I will use it to push through a workout however and I do not drink anymore post training.

I am very caffeine sensitive and it does not take much for me to feel the edge which is why I have cut down to a half-calf coffee mix intake.  This seems to work best for me and after a hard workout it seems to eliminate any stimulant feeling that may come from my cup of Java. During my workouts, I do enjoy the caffeine rush that enhances my athletic performance.   I do not have health issues like hypertension or diagnosed heart problems where coffee would be contraindicated so I do partake in moderation.  The other health benefits from antioxidants within coffee are an added bonus.

Drinking coffee, minus all the cream and sugar is one of my secret weapons for maintaining a fit body.  Studies show that the fat burning effects last up to 3 hours after having caffeine so I create that window for my workout.  I would not venture into unsafe stimulant territory and do not support unhealthy ways to maintain my body.  Coffee on the other hand is probably the best natural and effective stimulant making it my pre-workout drink of choice.

Check out my latest article "Five Reasons to Drink Coffee for a Fit Body" on About.com for more great information on the subject.

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Stay Healthy!

Darla

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Introduction

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Is there evidence that walking groups have health benefits? A systematic review and meta-analysis

Is there evidence that walking groups have health benefits? A systematic review and meta-analysis

Sarah Hanson, Andy Jones

9 November 2014

Regular physical activity positively impacts health potentially offering similar effects to some drug interventions in terms of mortality benefits. Indeed, it has been suggested as an alternative or adjunct to conventional drug therapy. Walking at a pace of 3–5 m/h (5–8 km/h) expends sufficient energy to be classified as moderate intensity2 and is an easy and accessible way of meeting physical activity recommendations.

Systematic reviews and meta-analyses have shown walking to have various health benefits including:

• positive effects on fitness
• fatness and resting blood pressure
• blood pressure control
• weight loss
• depression
• cardiovascular disease risk prevention.

ABSTRACT

Objective

To assess the health benefits of outdoor walking groups.

Design

Systematic review and meta-analysis of walking group interventions examining differences in commonly used physiological, psychological and well-being outcomes between baseline and intervention end.

Data sources

Seven electronic databases, clinical trial registers, grey literature and reference lists in English language up to November 2013.

Eligibility criteria

Adults, group walking outdoors with outcomes directly attributable to the walking intervention.

Results

Forty-two studies were identified involving 1843 participants. There is evidence that walking groups have wide-ranging health benefits. Meta-analysis showed statistically significant reductions in mean difference for systolic blood pressure −3.72 mm Hg (−5.28 to −2.17) and diastolic blood pressure −3.14 mm Hg (−4.15 to −2.13); resting heart rate −2.88 bpm (−4.13 to −1.64); body fat −1.31% (−2.10 to −0.52), body mass index −0.71 kg/m2 (−1.19 to −0.23), total cholesterol −0.11 mmol/L (−0.22 to −0.01) and statistically significant mean increases in VO2max of 2.66 mL/kg/min (1.67 3.65), the SF-36 (physical functioning) score 6.02 (0.51 to 11.53) and a 6 min walk time of 79.6 m (53.37–105.84).

A standardised mean difference showed a reduction in depression scores with an effect size of −0.67 (−0.97 to −0.38). The evidence was less clear for other

outcomes such as waist circumference fasting glucose, SF-36 (mental health) and serum lipids such as highdensity lipids. There were no notable adverse side effects reported in any of the studies.

Conclusions

Walking groups are effective and safe with good adherence and wide-ranging health benefits. They could be a promising intervention as an adjunct to other healthcare or as a proactive health-promoting activity.

Open Access

Original Source BJSM