for the Lancet NCDI Poverty Commission Study Group Executive summary"As we embark on this great collective journey, we pledge that no one will be left behind. Recognizing that the dignity of the human person is fundamental, we wish to see the goals and targets met for all nations and peoples and for all segments of society. And we will endeavour to reach the furthest behind first."Transforming our world: the 2030 agenda for sustainable development 1

Bukhman (2019) A comparison of all-cause and causespecific mortality by household socioeconomic status across seven INDEPTH network health and demographic surveillance systems in sub

Background The health of populations living in extreme poverty has been a long-standing focus of global development efforts, and continues to be a priority during the Sustainable Development Goal era. However, there has not been a systematic attempt to quantify the magnitude and causes of the burden in this specific population for almost two decades. We estimated disease rates by cause for the world’s poorest billion and compared these rates to those in high-income populations. Methods We defined the population in extreme poverty using a multidimensional poverty index. We used national-level disease burden estimates from the 2017 Global Burden of Disease Study and adjusted these to account for within-country variation in rates. To adjust for within-country variation, we looked to the relationship between rates of extreme poverty and disease rates across countries. In our main modeling approach, we used these relationships when there was consistency with expert opinion from a survey we conducted of disease experts regarding the associations between household poverty and the incidence and fatality of conditions. Otherwise, no within-country variation was assumed. We compared results across multiple approaches for estimating the burden in the poorest billion, including aggregating national-level burden from the countries with the highest poverty rates. We examined the composition of the estimated disease burden among the poorest billion and made comparisons with estimates for high-income countries. Results The composition of disease burden among the poorest billion, as measured by disability-adjusted life years (DALYs), was 65% communicable, maternal, neonatal, and nutritional (CMNN) diseases, 29% non-communicable diseases (NCDs), and 6% injuries. Age-standardized DALY rates from NCDs were 44% higher in the poorest billion (23,583 DALYs per 100,000) compared to high-income regions (16,344 DALYs per 100,000). Age-standardized DALY rates were 2,147% higher for CMNN conditions (32,334 DALYs per 100,000) and 86% higher for injuries (4,182 DALYs per 100,000) in the poorest billion, compared to high-income regions. Conclusion The disease burden among the poorest people globally compared to that in high income countries is highly influenced by demographics as well as large disparities in burden from many conditions. The comparisons show that the largest disparities remain in communicable, maternal, neonatal, and nutritional diseases, though NCDs and injuries are an important part of the “unfinished agenda” of poor health among those living in extreme poverty.

Considerable interest has been given to forming an international collaboration to develop a virtual moderate spatial resolution land observation constellation through aggregation of data sets from comparable national observatories such as the US Landsat, the Indian ResourceSat and related systems. This study explores the complementarity of India's ResourceSat-1 Advanced Wide Field Sensor (AWiFS) with the Landsat 5 Thematic Mapper (TM) and Landsat 7 Enhanced Thematic Mapper Plus (ETM+). The analysis focuses on the comparative radiometry, geometry, and spectral properties of the two sensors. Two applied assessments of these data are also explored to examine the strengths and limitations of these alternate sources of moderate resolution land imagery with specific application domains. There are significant technical differences in these imaging systems including spectral band response, pixel dimensions, swath width, and radiometric resolution which produce differences in observation data sets. None of these differences was found to strongly limit comparable analyses in agricultural and forestry applications. Overall, we found that the AWiFS and Landsat TM/ETM+ imagery are comparable and in some ways complementary, particularly with respect to temporal repeat frequency. We have found that there are limits to our understanding of the AWiFS performance, for example, multi-camera design and stability of radiometric calibration over time, that leave some uncertainty that has been better addressed for Landsat through the Image Assessment System and related cross-sensor calibration studies. Such work still needs to be undertaken for AWiFS and similar observatories that may play roles in the Global Earth Observation System of Systems Land Surface Imaging Constellation.

BackgroundFinancial risk protection (FRP) is a key objective of national health systems and a core pillar of universal health coverage (UHC). Yet, little is known about the disease-specific distribution of catastrophic health expenditure (CHE) at the national level.MethodsUsing the World Health Surveys (WHS) from 39 countries, we quantified CHE, or household health spending that surpasses 40% of capacity-to-pay by key disease areas. We restricted our analysis to households in which the respondent used health care in the last 30 days and categorized CHE into disease areas included as WHS response options: maternal and child health (MCH); high fever, severe diarrhea, or cough; heart disease; asthma; injury; surgery; and other. We compared disease-specific CHE estimates by income, pooled funding as a share of total health expenditure, share of the population affected by the different diseases, and poverty status.ResultsAcross countries, an average of 45.1% of CHE cases could not be tied to a specific cause; 37.6% (95% UI 35.4–39.9%) of CHE cases were associated with high fever, severe cough, or diarrhea; 3.9% (3.0–4.9%) with MCH; and 4.1% (3.3–4.9%) with heart disease. Injuries constituted 5.2% (4.2–6.4%) of CHE cases. The distribution of CHE varied substantially by national income. A 10% increase in heart disease prevalence was associated with a 1.9% (1.3–2.4%) increase in heart disease CHE, an association stronger than any other disease area.ConclusionsOur approach is comparable, comprehensive, and empirically based and highlights how financial risk protection may not be aligned with disease burden. Disease-specific CHE estimates can illuminate how health systems can target reform to best protect households from financial risk.Electronic supplementary materialThe online version of this article (10.1186/s12916-019-1266-0) contains supplementary material, which is available to authorized users.

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Urban outdoor water conservation and efficiency offer high potential for demand-side management, but irrigation, greenness, and climate interlinks must be better understood to design optimal policies. To identify paired transitions during drought, we matched parcel-level water use data from smart, dedicated irrigation meters with high-spatial resolution, multispectral aerial imagery. We examined changes across 72 non-residential parcels using potable or recycled water for large landscape irrigation over four biennial summers (2010, 2012, 2014, and 2016) that encompassed a historic drought in California. We found that despite little change in irrigation levels during the first few years of the drought, parcel greenness deteriorated. Between summers 2010 and 2014, average parcel greenness decreased −61% for potable water irrigators and −56% for recycled water irrigators, providing evidence that vegetation could not reach its vigor from wetter, cooler years as the drought intensified with abnormally high temperatures. Between summers 2014-2016 as drought severity lessened, irrigation rates decreased significantly in line with high drought saliency, but greenness rebounded ubiquitously, on average +110% for potable water irrigators and +62% for recycled water irrigators, demonstrating climate-driven vegetation recovery as evaporation and plant evapotranspiration rates decreased. Transitions were similar for customers with both potable and recycled water; vegetation changes were dominated by the overarching climatic regime. As irrigation cannot always overcome drought conditions, which will become more severe under climate change, to maintain vegetation health, utilities and urban planners should consider the tradeoffs between providing green spaces and water scarcity. This includes evaluating the roles of climate-appropriate landscaping and adaptive reallocation of potable and recycled water resources to enhance water security. By addressing emerging themes in urban water management through analysis of data from forthcoming water metering and aerial imagery technologies, this research provides a unique perspective on water use, greenness, and drought linkages.

Background: Global efforts to address NCDs focus primarily on 4-by-4 interventions-interventions to prevent and treat four groups of conditions affecting mainly older adults (some cardiovascular disease and cancers, type 2 diabetes, chronic respiratory disease) and four associated risk factors (alcohol, tobacco, poor diets, and physical inactivity). However, the NCD burden in Sub-Saharan Africa (SSA) is composed of a more diverse set of conditions, driven by a more complex group of risks, and impacting all segments of the population. Objective: To document the NCD priorities identified by NCD strategic plans, to characterize the proposed policy response, and to assess the alignment between the two. Methods: Using a two-part conceptual framework, we undertook a descriptive study to characterize the framing and overall policy response of strategic plans from 24 low-and lower-middle-income countries across SSA. Results: The national situation assessments that ground strategic plans emphasize a diversity of conditions that range in terms of severity and frequency. These assessments also highlight a wide diversity of factors that shape this burden. Most include discussions of a broad range of behavioral, structural, genetic, and infectious risk factors. Plans endorse a more narrow response to this diverse burden, with a focus on primary and secondary prevention that is generally convergent with the objectives established in global policy documents. Conclusions: Broadly, we observe that plans developed by countries in SSA recognize the heterogeneity of the NCD burden in this region. However, they emphasize interventions that are consistent with global strategies focused on preventing a narrower set of cardiometabolic risk factors and their associated diseases. In comparison, relatively few countries detail plans to prevent, treat, and palliate the full scope of the needs they identify. There is a need for increased support for bottom-up planning efforts to address local priorities.