If we want a whole Earth, Nature Needs Half: a response to Büscher et al. Büscher et al.'s () recent article 'Half-Earth or Whole Earth? Radical ideas for conservation, and their implications' raises some important issues for conservation, but it paints a misleading picture of the Nature Needs Half movement. Nature Needs Half expresses three main tenets: () habitat loss and degradation are the leading causes of biodiversity loss, () current protected areas are not extensive enough to stem further loss of biodiversity, and () it is morally wrong for our species to drive other species to extinction (Wilson, ). Conservation biologists agree that to maintain viable populations of most of Earth's remaining species, we will need to protect c. % of landscapes and seascapes from intensive human economic use (Noss & Cooperrider, ; Locke, ). This bold goal is necessary if we hope to bring our societies' massive displacement of other species to an end. Necessary, but not sufficient. Büscher et al. correctly note that setting aside more habitat for other species will not preserve them if we continue to misbehave in more developed areas: over-consuming and generating excessive pollution, for example. It is all one Earth, after all, and protected areas are often degraded by external actions. We also agree with Büscher et al. that any significant changes in land use, including Nature Needs Half, must be made with due consideration for the rights and interests of the world's poor and indigenous peoples (Kopnina, ). This accords with a consensus among conservationists that local communities should be actively involved in conservation efforts. However, intraspecies justice-justice for peopleshould not come at the expense of interspecies justice: the very existence of other species. Nature Needs Half proponents envision a world where all species can flourish (Goodall, ). This will require setting aside sufficient habitat for other species while living justly and prudently on the remainder. Supporters of Nature Needs Half agree with Büscher et al. on the need to challenge the neoliberal growth economy (Crist, ); our proposal does precisely that, by protecting many more areas from its ravenous demands for natural resources. Creating such a mutually flourishing world will also require limiting human numbers, another sharp challenge to the endless growth economy (and a subject ignored by Büscher et al.). The scientific consensus is clear: humanity is on a trajectory to cause a mass extinction unrivalled in the last million years of life on Earth (Secretariat of the Convention on Biological Diversity, ). This calamity can be avoided only by setting aside far more of Earth's land and seas for conservation, and by developing ecologically sustainable societies. We believe doing so is a moral imperative (Cafaro & Primack, ). We owe it to the many magnificent and unique forms of life that remain, who we have no right to exterminate, and we owe it to future human generations, who will be grateful to...
It is possible to use a simple census form in both health and social services agencies. The completion rates were good in both services. The levels of reliability were good, and concurrent validity was established with specific types of care in the community.
BackgroundCase management, particularly in intensive form, has been widely introduced for the treatment of severe mental illness. However, the optimal intensity of case management has not been determined.AimsWe aimed to assess whether intensive case management (small case load) reduces hospitalisation and costs compared with standard case management.MethodDevelopment and rationale of a large randomised controlled trial comparing intensive case management (case load per worker? 15 patients) with standard case management (case load 30–35 patients)ResultsTwo-year outcome data will be obtained on patients representative of the seriously mentally ill in inner-city mental health services.ConclusionsThe study planned with 700 patients should be sufficient to detect small differences in the readmission of patients to hospital (10%), the number of days spent in hospital over a two-year period (10 days) and the average weekly cost of care per patient. The sample is large enough to compare the cost-effectiveness of intensive and standard case management in mild and severe disability and in people of African–Caribbean origin and White Caucasians.
The most likely explanation for the change in service provision is the separate operation of different professional groups acting as gatekeepers for their own resources.
Delivery of the 10 year strategy for health set out in the white paper will depend to an important degree on the effectiveness of the new primary care groups in delivering local health improvement programmes, in partnership with health authorities. From April 1999, 500 new primary care groups, typically serving populations of 100 000, will replace nearly 4000 existing commissioning organisations, including general practice fundholders. They will be resourced out of current fundholding allowances. Primary care groups will involve all local general practitioners, along with community nurses. The white paper outlines four progressive forms of primary care group: giving advice to health authorities on commissioning; managing devolved budgets; independent primary care trusts responsible for some devolved commissioning; and primary care trusts responsible for commissioning all primary and secondary care services with a fully integrated budget. It is not yet clear how primary care groups will relate to optometrists, pharmacists, or dentists. For the first time, primary care budgets will be fully cash limited, but groups will be able to move money between different parts of the service to balance their books. Although national standards will be set to ensure fair access to services and uniform quality, the planning, commissioning, and delivery of services will be local responsibilities. The fully developed model looks much like an extension of total purchasing, with the addition of fully integrated primary and secondary care budgets-not unlike an American health maintenance organisation. Primary care groups with trust status will be managed by a board consisting of general practitioners, community nurses, managers, social services representatives, and lay members. Will the new system work, and will it represent an improvement on what it replaces? The success of primary care groups will depend largely on two issues: engaging the support of people in primary care, and demonstrating local accountability and control of decision making.
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