A multinational Delphi consensus to end the COVID-19 public health threat.

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

Accurate market price formation model with both supply-demand and trend-following for global food prices providing policy recommendations.

Recent increases in basic food prices are severely affecting vulnerable populations worldwide. Proposed causes such as shortages of grain due to adverse weather, increasing meat consumption in China and India, conversion of corn to ethanol in the United States, and investor speculation on commodity markets lead to widely differing implications for policy. A lack of clarity about which factors are responsible reinforces policy inaction. Here, for the first time to our knowledge, we construct a dynamic model that quantitatively agrees with food prices. The results show that the dominant causes of price increases are investor speculation and ethanol conversion. Models that just treat supply and demand are not consistent with the actual price dynamics. The two sharp peaks in 2007/2008 and 2010/2011 are specifically due to investor speculation, whereas an underlying upward trend is due to increasing demand from ethanol conversion. The model includes investor trend following as well as shifting between commodities, equities, and bonds to take advantage of increased expected returns. Claims that speculators cannot influence grain prices are shown to be invalid by direct analysis of price-setting practices of granaries. Both causes of price increase, speculative investment and ethanol conversion, are promoted by recent regulatory changes-deregulation of the commodity markets, and policies promoting the conversion of corn to ethanol. Rapid action is needed to reduce the impacts of the price increases on global hunger.

Anticipating Economic Market Crises Using Measures of Collective Panic.

Predicting panic is of critical importance in many areas of human and animal behavior, notably in the context of economics. The recent financial crisis is a case in point. Panic may be due to a specific external threat or self-generated nervousness. Here we show that the recent economic crisis and earlier large single-day panics were preceded by extended periods of high levels of market mimicry--direct evidence of uncertainty and nervousness, and of the comparatively weak influence of external news. High levels of mimicry can be a quite general indicator of the potential for self-organized crises.

Good fences: the importance of setting boundaries for peaceful coexistence.

We consider the conditions of peace and violence among ethnic groups, testing a theory designed to predict the locations of violence and interventions that can promote peace. Characterizing the model's success in predicting peace requires examples where peace prevails despite diversity. Switzerland is recognized as a country of peace, stability and prosperity. This is surprising because of its linguistic and religious diversity that in other parts of the world lead to conflict and violence. Here we analyze how peaceful stability is maintained. Our analysis shows that peace does not depend on integrated coexistence, but rather on well defined topographical and political boundaries separating groups, allowing for partial autonomy within a single country. In Switzerland, mountains and lakes are an important part of the boundaries between sharply defined linguistic areas. Political canton and circle (sub-canton) boundaries often separate religious groups. Where such boundaries do not appear to be sufficient, we find that specific aspects of the population distribution guarantee either sufficient separation or sufficient mixing to inhibit intergroup violence according to the quantitative theory of conflict. In exactly one region, a porous mountain range does not adequately separate linguistic groups and that region has experienced significant violent conflict, leading to the recent creation of the canton of Jura. Our analysis supports the hypothesis that violence between groups can be inhibited by physical and political boundaries. A similar analysis of the area of the former Yugoslavia shows that during widespread ethnic violence existing political boundaries did not coincide with the boundaries of distinct groups, but peace prevailed in specific areas where they did coincide. The success of peace in Switzerland may serve as a model to resolve conflict in other ethnically diverse countries and regions of the world.

Developing a mobile produce distribution system for low-income urban residents in food deserts.

Low-income households in the contemporary city often lack adequate access to healthy foods, like fresh produce, due to a variety of social and spatial barriers that result in neighborhoods being underserved by full-service supermarkets. Because of this, residents commonly resort to purchasing food at fast food restaurants or convenience stores with poor selections of produce. Research has shown that maintaining a healthy diet contributes to disease prevention and overall quality of life. This research seeks to increase low-income residents' access to healthy foods by addressing spatial constraints through the characterization of a mobile market distribution system model that serves in-need neighborhoods. The model optimally locates mobile markets based on the geographic distribution of these residents. Using data from the medium-sized city of Buffalo, New York, results show that, with relatively few resources, the model increases these residents' access to healthy foods, helping to create a healthier city.

Dynamic urban food environments a temporal analysis of access to healthy foods.

BACKGROUND: Low-income, urban populations' limited access to healthy foods is often pointed to as a key barrier to improving nutrition. Although much has been written on identifying urban "food deserts," little has been done to examine how the food environment changes over the course of 1 year. PURPOSE: This study was designed to dynamically describe the urban food environment as a means to identify when at-risk neighborhoods are without access to healthy food. METHODS: Demographic and road data of Buffalo NY from the 2000 U.S. Census, a 2010 listing of city supermarkets, and 2011 government records of the time and location of urban farmers' markets are mapped. Road network distances from block groups to supermarkets and farmers' markets are calculated. A computer simulation, written in 2011, examines the market closest to each block group for 52 weeks. RESULTS: The average distance to markets with produce from block groups with poverty levels in the top 10th percentile is greater than that across all block groups during winter and spring months. However, during the farmers' market season, the same impoverished block groups are on average closer to markets when compared to all block groups. CONCLUSIONS: Including the temporal dimension in an analysis of healthy food access generates a more complex picture of urban food-desert locations. The implications are that spatiotemporal factors should be used to inform appropriate interventions for creating an equitable food environment.

Global pattern formation and ethnic/cultural violence.

We identify a process of global pattern formation that causes regions to differentiate by culture. Violence arises at boundaries between regions that are not sufficiently well defined. We model cultural differentiation as a separation of groups whose members prefer similar neighbors, with a characteristic group size at which violence occurs. Application of this model to the area of the former Yugoslavia and to India accurately predicts the locations of reported conflict. This model also points to imposed mixing or boundary clarification as mechanisms for promoting peace.

Improving the effectiveness of health care and public health: a multiscale complex systems analysis.

The US health care system is struggling with a mismatch between the large, simple (low-information) financial flow and the complex (high-information) treatment of individual patients. Efforts to implement cost controls and industrial efficiency that are appropriate for repetitive tasks but not high-complexity tasks lead to poor quality of care. Multiscale complex systems analysis suggests that an important step toward relieving this structural problem is a separation of responsibility for 2 distinct types of tasks: medical care of individual patients and prevention/population health. These distinct tasks require qualitatively different organizational structures. The current use of care providers and organizations for both purposes leads to compromises in organizational process that adversely affect the ability of health care organizations to provide either individual or prevention/population services. Thus, the overall system can be dramatically improved by establishing 2 separate but linked systems with distinct organizational forms: (a) a high-efficiency system performing large-scale repetitive tasks such as screening tests, inoculations, and generic health care, and (b) a high-complexity system treating complex medical problems of individual patients.