SummaryBackgroundDetailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016.MethodsWe have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15–60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations in...

SummaryBackgroundNational levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.MethodsWe mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.FindingsBetween 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among...

Abstract:The interest to reduce food losses and wastes has grown considerably in order to guarantee adequate food for the fast growing population. A systematic review was used to show the potential of Value Stream Mapping (VSM) not only to identify and reduce food losses and wastes, but also as a way to establish links with nutrient retention in supply chains. The review compiled literature from 24 studies that applied VSM in the agri-food industry.Primary production, processing, storage, food service and/or consumption were identified as susceptible hotspots for losses and wastes. Results further revealed discarding and nutrient loss, most especially at the processing level, as the main forms of loss/waste in food, which were adapted to four out of seven lean manufacturing wastes (i.e. defect, unnecessary inventory, overproduction and inappropriate processing). This paper presents the state of the art of applying lean manufacturing practices in the agri-food industry by identifying lead time as the most applicable performance indicator. VSM was also found to be compatible with other lean tools such as Just-In-Time and 5S which are continuous improvement strategies, as well as simulation modelling that enhances adoption. In order to ensure successful application of lean practices aimed at minimizing food or nutrient losses and wastes, multistakeholder collaboration along the entire food supply chain is indispensable.

There are numerous studies on food loss on the demand side examining consumer behavior towards food choice and food waste generation at the household level. In this paper, we target food loss on the supply side, with a focus on the industrial food processing environment. More specifically, we map food loss in each processing stage, that is sustainable operations. Primary data were conducted through a survey (complemented with observations and documentary analysis) in 47 food processing companies in Belgium to identify hotspots and quantify food loss. The findings show that processing is by far the most important food loss hotspot. While transportation, changeover, interrupted production, human errors and product effects at this stage often lead to substantial or excessive losses, causes of food loss during packaging and before or after production have a smaller impact. At subsector level, however, there are substantial differences with respect to the most important causes. The originality of this research can be evaluated in three ways: one, identifying hotspots of food loss in the industrial processing environment; two, measuring the magnitude of losses across different product categories and causes and three, how sustainable operations plays a significant role in food loss prevention.

New food technologies, such as genetic modification, food fortification, and processing technologies, are of growing interest for future food security and safety. For ensuring successful implementation of such technologies, consumers and other food supply chain actors should embrace them. We present a systematic review to identify and compare key factors of supply chain actors’ evaluation of new food technologies. Evaluation encompasses indicators such as likelihood or intention to perform a behavior, perceived benefits/risks, willingness to pay, acceptance/adoption, and attitudes. Results from 183 studies showed several imbalances in research. Although studies mainly focused on (1) genetically modified foods, (2) by consumers, (3) in developed countries, only very few studies have targeted other food technologies, other supply chain actors such as farmers (13 studies) or processors (two studies), or developing countries (43 studies). With respect to consumers’ evaluation, key determinants were trust in institutions, information assessment, perceived risks and benefits, attitudes toward the product or technology, perceived behavioral control, quality perception of the product, and impact on health. Farmers’ evaluation of new food technologies was explained by the factors of perceived risk and benefits and of actual source of information. For the few processor evaluation studies, no convergence of factors could be reached. This systematic review contributes to a better understanding of consumers’ and farmers’ evaluation behavior and opens up avenues for future research on supply chain actors’ food technology evaluations. The differences in the conceptualization and measurement of extracted factors demonstrate the need for standardized approaches in future studies.

Following the growing evidence on biofortification as a cost-effective micronutrient strategy, various researchers have elicited consumers' willingness to pay (WTP) for biofortified crops in an effort to justify and determine their adoption. This review presents a meta-analysis of WTP studies on biofortified foods, either developed through conventional breeding or using genetic modification technology. On the basis of 122 estimates from 23 studies (9507 respondents), consumers are generally willing to pay 21.3% more for biofortified crops. Because WTP estimates are often determined through different valuation methods and procedures, a meta-regression was carried out to examine the role of potential determinants. Aside from contextual factors, such as type of food crop, target nutrient, and region (but not breeding technique), various methodological factors significantly influence premiums, including the type of respondent, nature of the study, study environment, participation fee, and provided information. The findings allow researchers to better anticipate potential methodological biases when examining WTP for (biofortified) foods, while it gives policy makers a broad understanding of the potential demand for different biofortified crops in various settings.

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This study investigates the determining factors that drive sustainable performance through the application of management lean methods in the primary production segment of the horticultural supply chain for apples and pears. The determining factors, identified through a systematic review of the available literature, are thematically synthesized, conceptually framed and utilized for the development of a case study. The single case study approach is utilized to develop a detailed and nuanced understanding of the context, evaluating the practices of 4 cooperative primary producers operating within a forward integrated supply chain. The study posits that the combination of climatic and biophysical dynamism inherent in the primary producer environment, in combination with the inflexibility of seasonal batch production, imposes itself as a key barrier to the imposition of pull and flow in the chain, the fundamental tenets of a lean system. A case is outlined where cold infrastructure is employed to break the inflexibility of supply whilst a process of forward contracting establishes fruit orders up to 1-year in advance, beyond the forthcoming annual cycle, functionally transforming fruit cultivation within the group from a "push" to a "pull" system of production. It is further highlighted that functional partitioning of the organizational-chain structure is necessary to isolate and mitigate the effects of contextual dynamism, whereby downstream chain structures purposed for agility and responsiveness serve as a protective buffer to lean focused grower operations. The findings reaffirm the positive relationship between the size of the grower operation, the capacitation of the workforce and the ability of the operation to attain superior lean driven performance outcomes. However, it is severally highlighted that horizontal cooperation between primary producers may help overcome the resource limitations of smaller growers. Data based decision controls are marked as being centrally important sustainable performance determinant, both at the level of the grower, in terms of orchard management and harvest process control, as well as at the level of the cooperative serving the needs of crop programming and practice benchmarking processes. This exposition of determining factors driving lean sustainable performance in horticultural primary production represents a new contribution to the body of literature linking lean and sustainable organizational performance. The study should support further development of lean management research and practiced lean methods within the agri-food context.