The Emissions Prediction and Policy Analysis (EPPA) model is the part of the MIT Integrated Global Systems Model (IGSM) that represents the human systems EPPA is a recursive-dynamic multi-regional general equilibrium model of the world economy, which is built on the GTAP dataset and additional data for the greenhouse gas and urban gas emissions It is designed to develop projections of economic growth and anthropogenic emissions of greenhouse related gases and aerosols The main purpose of this report is to provide documentation of a new version of EPPA, EPPA version 4 In comparison with EPPA3, it includes greater regional and sectoral detail, a wider range of advanced energy supply technologies, improved capability to represent a variety of different and more realistic climate policies, and enhanced treatment of physical stocks and flows of energy, emissions, and land use to facilitate linkage with the earth system components of the IGSM Reconsideration of important parameters and assumptions led to some revisions in reference projections of GDP and greenhouse gas emissions In EPPA4 the global economy grows by 125 times from 2000 to 2100 (25%/yr) compared with an increase of 107 times (24%/yr) in EPPA3 This is one of the important revisions that led to an increase in CO2 emissions to 257 GtC in 2100, up from 23 GtC in 2100 projected by EPPA3 There is considerable uncertainty in such projections because of uncertainty in various driving forces To illustrate this uncertainty we consider scenarios where the global GDP grows 05% faster (slower) than the reference rate, and these scenarios result in CO2 emissions in 2100 of 34 (17) GtC A sample greenhouse gas policy scenario that puts the world economy on a path toward stabilization of atmospheric CO2 at 550 ppmv is also simulated to illustrate the response of EPPA4 to a policy constraint

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The MIT Emissions Prediction and Policy Analysis (EPPA) Model: Version 4

Collaborations of physicians and researchers with industry can provide valuable benefits to society, particularly in the translation of basic scientific discoveries to new therapies and products. Recent reports and news stories have, however, documented disturbing examples of relationships and practices that put at risk the integrity of medical research, the objectivity of professional education, the quality of patient care, the soundness of clinical practice guidelines, and the public's trust in medicine. Conflict of Interest in Medical Research, Education, and Practice provides a comprehensive look at conflict of interest in medicine. It offers principles to inform the design of policies to identify, limit, and manage conflicts of interest without damaging constructive collaboration with industry. It calls for both short-term actions and long-term commitments by institutions and individuals, including leaders of academic medical centers, professional societies, patient advocacy groups, government agencies, and drug, device, and pharmaceutical companies. Failure of the medical community to take convincing action on conflicts of interest invites additional legislative or regulatory measures that may be overly broad or unduly burdensome. Conflict of Interest in Medical Research, Education, and Practice makes several recommendations for strengthening conflict of interest policies and curbing relationships that create risks with little benefit. The book will serve as an invaluable resource for individuals and organizations committed to high ethical standards in all realms of medicine.

Conflict of Interest in Medical Research, Education, and Practice

Background
There is little information about the global burden of non-traumatic low back pain (LBP) attributable to the effects of physical and psychosocial occupational stressors.

Methods
Based on a review of the epidemiological evidence, occupation-specific relative risks were used to compute attributable proportions by age, gender, and geographical sub-region for the economically active population aged 15 and older. The reference group was professional/administrative workers; other risk categories were Low, clerical and sales; Moderate, operators (production workers) and service; and High, farmers.

Results
Worldwide, 37% of LBP was attributed to occupation, with twofold variation across regions. The attributable proportion was higher for men than women, because of higher participation in the labor force and in occupations with heavy lifting or whole-body vibration. Work-related LBP was estimated to cause 818,000 disability-adjusted life years lost annually.

Conclusions
Occupational exposures to ergonomic stressors represent a substantial source of preventable back pain. Specific research on children is needed to quantify the global burden of disease due to child labor. Am. J. Ind. Med. 48:459–469, 2005. © 2005 Wiley-Liss, Inc.

Estimating the global burden of low back pain attributable to combined occupational exposures.

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Redefining Health Care: Creating Value-Based Competition on Results

The future of food demand: understanding differences in global economic models

Background The failure to recognize occupational health as an economic phenomenon limits the effectiveness of interventions ostensibly designed to prevent disease and injury. Hence, consideration of economic efficiency is essential in the evaluations of interventions to reduce hazardous working conditions. In this paper, we present an analysis of the cost effectiveness of alternative means of preventing silicosis. Method To evaluate the cost-effectiveness of specific interventions for the prevention of occupationally induced silicosis, we have used the simulation models based on the generalized cost effectiveness analysis (GCEA) developed by the WHO-CHOICE initiative for two representative subregions – namely AMROA (Canada, United States of America), and WPROB1(China, Korea, Mongolia). Results In both of the two subregions, engineering controls are the most cost-effective with ratios varying from $105.89 per healthy year or disability adjusted life year saved in AMROA to approximately $109 in WPROB1. In the two subregions, the incremental cost-effectiveness ratio of Engineering Controls (EC) looks most attractive. Although Dust Masks (DM) looks attractive in terms of cost, the total efficacy is extremely limited. Conclusion To the extent that this analysis can be generalized across other subregions, it suggests that engineering control programs would be cost-effective in both developed and developing countries for reducing silica

The cost effectiveness of occupational health interventions: prevention of silicosis.

Background

Occupational back pain exacts a toll on society with concomitant economic losses; it is imperative to evaluate the cost-effectiveness of interventions to reduce the relevant ergonomic stressors at work. This study estimates and evaluates the average and incremental cost-effectiveness ratios (CERs) of specific interventions for the prevention of occupationally induced back pain for the World Health Organization (WHO) defined subregions of the world.



Methods

Four back-pain interventions were selected from the literature: training (T), engineering controls (EC), engineering controls and training (EC&T), and a comprehensive full ergonomics program (EP) for evaluation. A simulation model for a 100-year time horizon, developed by the WHO CHOICE initiative project was used to estimate the effectiveness of the interventions in healthy year equivalents. The intervention costs were adjusted for all WHO subregions.



Results

In all of the subregions, training was the most cost-effective with CERs varying from $74 per healthy life years gained in the subregion comprising of Egypt, Iraq, Morocco, Yemen (EMROD) to approximately $567 in the subregion covering Canada and the United States (AMROA). Training is considered to be very cost-effective and would be the first choice option where resources are scarce. However, the overall effectiveness of training is low. Although other interventions such as engineering controls and total ergonomic interventions are relatively more expensive, the addition to health outcome through these interventions is much higher. The difference in the CERs for training and other engineering controls and full ergonomic interventions is relatively small for most of the industrialized regions of the world. It is clear from the ranked CERs and incremental CERs over the different subregions that in most of the industrialized regions of the world additional resources, if they become available, should go straight to the full ergonomics program.



Conclusions

The model results based on CERs show that worker training is a low cost, feasible first step toward reducing back pain/injury incidence. However, all of the average CERs for the different interventions, for each of the regions, fall well within their GDP per capita estimates [World Bank, 2001]. According to the WHO Commission on Macroeconomics and Health any intervention that costs less than three times GDP per capita for saving a healthy year equivalent should be considered worthwhile and good value for money [WHO, 2002]. Given this criterion, the engineering controls interventions as well as the full ergonomics program look very cost effective for all of the WHO subregions. Am. J. Ind. Med. 48:515–529, 2005. © 2005 Wiley-Liss, Inc.

The cost effectiveness of occupational health interventions: preventing occupational back pain.

https://www.who.int/occupational_health/topics/lahiri.pdf

Net-cost model for workplace interventions.

Objective: To identify insurance related, structural, and workplace cultural barriers to the implementation of effective preventive and upstream clinical interventions in the working age adult population. Methods: Analysis of avoided costs from perspective of health economics theory and from empiric observations from large studies; presentation of data from our own cost-plus model on integrating health promotion and ergonomics. Results: We identify key avoided costs issues as a misalignment of interests between employers, insurers, service institutions, and government. Conceptual limitations of neoclassical economics are attributable to work culture and supply-driven nature of health care. Discussion: Effective valuation of avoided costs is a necessary condition for redirecting allocations and incentives. Key content for valuation models is discussed. T his economic evaluation of disease prevention and upstream interventions administered at the workplace is intended to facilitate broader implementation of preventive initiatives and to encourage favorable health outcomes through the valuation of intervention effectiveness. The underlying premise is that modifications of chronic diseases are a function of individual behavior, amenable to interventions in the forum of the workplace but are also sociobiological consequences of work organization, work demand, compensation, and job security and mobility. Emphasizing the interplay of work life, home life, and individual risk reflects our own affiliation with the Center for Promoting Health in the New England Workplace, one of three National Work life Centers funded by the National Institute for Occupational Safety and Health. This work life concept considers biological, socioeconomic, and psychosocial pathways of disease in combination. The content includes ergonomics and aging-associated musculoskeletal diseases, work organization and cardiovascular diseases, and workfamily interactions and mental health. The accent on prevention and early chronic disease management (CDM) diverges from customary articulation of the working life concept in Northern Europe, where the emphasis has been on working conditions, protection of leave, and salary replacement for disease or pregnancy. 1 Considerable evidence supports the effectiveness of prevention directed to working cohorts, 2 but the divorce of workforce oriented preventive initiatives from conventional group health insurance and financing attenuates available resources. There are nationally idiosyncratic problems of valuing and sustaining investment in preventive programs for working adults in the United States because of the bifurcation of the worker’s compensation and group health systems. Insurance companies and the government, the main third party payers, often mediate between and monitor different stakeholders: patients, employers, individual physicians, large group practices, and hospitals. Third party payers have commanding roles in the misaligned incentives identified by critics of American health care. 3 Accordingly, resource allocation and depletion among adults in their workplaces is a special case of more general health care financing problems. The challenge is to create a viable systems-based incentives approach with an emphasis on the consolidating role of the workplace. Such an approach would use principles from traditional neoclassical and behavioral economics to facilitate participation and successful adoption of health interventions. This redirection of insurance reimbursement procedures includes public policies such as government tax credits and subsidies for prevention and Workplace Health Promotion (WHP) and broader facilitation of workplace organizational change to promote positive effects on health outcomes. Three types of barriers to more effective and sustainable workplace interventions are as follows. 1. Misplaced allocations and incentives. 2. Organizational and cultural barriers to implementing efficient interventions. 3. Systemic flaws: supply-driven medical care versus demanddriven health.

Barriers to implementation of workplace health interventions: an economic perspective.

Background
Occupational low back pain (OLBP) is widespread in industrialized societies. We present a model to estimate the net economic costs of investments in ergonomic interventions at the company level to reduce work-related low back pain.

Methods
Costs of interventions are defined by incorporating not only the costs of investment of equipment and labor, but also by taking into account the avoided costs of lost work time, medical care costs, and productivity improvements. In the net-cost model, all costs are annualized and are calculated at the level of an individual organization. Three case studies have been performed based on data from three companies in the manufacturing sector of the United States using the above approach.

Results
The net-cost estimates for the three case studies consistently show that ergonomic interventions applied appropriately can result in substantial cost savings for the companies.

Conclusions
Although generalizing on the basis of three case studies is not ideal, our analyses show that it might be in the economic interest of management to play a more active role to prevent back pain. Gathering useful retrospective cost data, even on interventions deemed effective by corporate innovators, proved to be extremely difficult. We conclude that it is essential to incorporate a protocol for collecting cost and effectiveness data in the standard operating procedures of ergonomists and companies introducing such innovation. We intend to validate the net-cost model for the monitoring and reporting of such data through prospective studies in a variety of industrial settings and in countries at various stages of economic development. Am. J. Ind. Med. 48:530–541, 2005. © 2005 Wiley-Liss, Inc.

Supriya Lahiri

Papers

The cost effectiveness of occupational health interventions: prevention of silicosis.

The cost effectiveness of occupational health interventions: preventing occupational back pain.

Net-cost model for workplace interventions.

Barriers to implementation of workplace health interventions: an economic perspective.

Estimation of net-costs for prevention of occupational low back pain: Three case studies from the US†‡§