bookmark_borderAntimicrobial Resistance — a Serious Threat to Health

WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health

New WHO report provides the most comprehensive picture of antibiotic resistance to date, with data from 114 countries

 

A new report by the World Health Organization (WHO) –its first to look at antimicrobial resistance, including antibiotic resistance, globally–reveals that this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance–when bacteria change so antibiotics no longer work in people who need them to treat infections–is now a major threat to public health.

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” says Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security. “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

Key findings of the report

The report, “Antimicrobial resistance: global report on surveillance”, notes that resistance is occurring across many different infectious agents but the report focuses on antibiotic resistance in seven different bacteria responsible for common, serious diseases such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea. The results are cause for high concern, documenting resistance to antibiotics, especially “last resort” antibiotics, in all regions of the world.

Key findings from the report include:

  • Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumoniae–carbapenem antibiotics–has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections.
  • Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli–fluoroquinolones–is very widespread. In the 1980s, when these drugs were first introduced, resistance was virtually zero. Today, there are countries in many parts of the world where this treatment is now ineffective in more than half of patients.
  • Treatment failure to the last resort of treatment for gonorrhoea–third generation cephalosporins–has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhoea around the world every day.
  • Antibiotic resistance causes people to be sick for longer and increases the risk of death. For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection. Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required.

Ways to fight antibiotic resistance

The report reveals that key tools to tackle antibiotic resistance–such as basic systems to track and monitor the problem–show gaps or do not exist in many countries. While some countries have taken important steps in addressing the problem, every country and individual needs to do more.

Other important actions include preventing infections from happening in the first place–through better hygiene, access to clean water, infection control in health-care facilities, and vaccination–to reduce the need for antibiotics. WHO is also calling attention to the need to develop new diagnostics, antibiotics and other tools to allow healthcare professionals to stay ahead of emerging resistance.

This report is kick-starting a global effort led by WHO to address drug resistance. This will involve the development of tools and standards and improved collaboration around the world to track drug resistance, measure its health and economic impacts, and design targeted solutions.

How to tackle resistance

People can help tackle resistance by:

  • using antibiotics only when prescribed by a doctor;
  • completing the full prescription, even if they feel better;
  • never sharing antibiotics with others or using leftover prescriptions.

Health workers and pharmacists can help tackle resistance by:

  • enhancing infection prevention and control;
  • only prescribing and dispensing antibiotics when they are truly needed;
  • prescribing and dispensing the right antibiotic(s) to treat the illness.

Policymakers can help tackle resistance by:

  • strengthening resistance tracking and laboratory capacity;
  • regulating and promoting appropriate use of medicines.

Policymakers and industry can help tackle resistance by:

  • fostering innovation and research and development of new tools;
  • promoting cooperation and information sharing among all stakeholders.

The report–which also includes information on resistance to medicines for treating other infections such as HIV, malaria, tuberculosis and influenza–provides the most comprehensive picture of drug resistance to date, incorporating data from 114 countries.

bookmark_borderVegetarians Are Less Healthy

A new study had concluded that vegetarians are less healthy than omnivores:

Nutrition and Health – The Association between Eating Behavior and Various Health Parameters: A Matched Sample Study

Nathalie T. Burkert*, Johanna Muckenhuber, Franziska Großschadl, Eva Rasky, Wolfgang Freidl

Institute of Social Medicine and Epidemiology, Medical University Graz, Graz, Austria

Abstract

Population-based studies have consistently shown that our diet has an influence on health. Therefore, the aim of our study was to analyze differences between different dietary habit groups in terms of health-related variables. The sample used for this cross-sectional study was taken from the Austrian Health Interview Survey AT-HIS 2006/07. In a first step, subjects were matched according to their age, sex, and socioeconomic status (SES). After matching, the total number of subjects included in the analysis was 1320 (N = 330 for each form of diet – vegetarian, carnivorous diet rich in fruits and vegetables, carnivorous diet less rich in meat, and carnivorous diet rich in meat). Analyses of variance were conducted controlling for lifestyle factors in the following domains: health (self-assessed health, impairment, number of chronic conditions, vascular risk), health care (medical treatment, vaccinations, preventive check-ups), and quality of life. In addition, differences concerning the presence of 18 chronic conditions were analyzed by means of Chi-square tests. Overall, 76.4% of all subjects were female. 40.0% of the individuals were younger than 30 years, 35.4% between 30 and 49 years, and 24.0% older than 50 years. 30.3% of the subjects had a low SES, 48.8% a middle one, and 20.9% had a high SES. Our results revealed that a vegetarian diet is related to a lower BMI and less frequent alcohol consumption. Moreover, our results showed that a vegetarian diet is associated with poorer health (higher incidences of cancer, allergies, and mental health disorders), a higher need for health care, and poorer quality of life. Therefore, public health programs are needed in order to reduce the health risk due to nutritional factors.

Citation: Burkert NT, Muckenhuber J, Großschadl¨ F, Rasky´ ´
E, Freidl W (2014) Nutrition and Health – The Association between Eating Behavior and Various Health
Parameters: A Matched Sample Study. PLoS ONE 9(2): e88278. doi:10.1371/journal.pone.0088278

Editor: Olga Y. Gorlova, Geisel School of Medicine at Dartmouth College, United States of America

Received May 17, 2013; Accepted January 9, 2014; Published February 7, 2014

Copyright: 2014 Burkert et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors have no support or funding to report.

Competing Interests: The authors have declared that no competing interests exist. * E-mail: nathalie.burkert@medunigraz.at

Introduction

Our diet has an impact on our well-being and on our health. Studies have shown a vegetarian diet to be associated with a lower incidence of hypertension, cholesterol problems, some chronic degenerative diseases, coronary artery disease, type II diabetes, gallstones, stroke, and certain cancers [1–7]. A vegetarian diet is characterized by a low consumption of saturated fat and cholesterol, due to a higher intake of fruits, vegetables and whole-grain products [3,4,8]. Overall, vegetarians have a lower body mass index [1,4,5,7,9–12], a higher socioeconomic status [13], and better health behavior, i.e. they are more physically active, drink less alcohol, and smoke less [9,13,14]. On the other hand, the mental health effects of a vegetarian diet or a Mediterranean diet rich in fruits, vegetables, whole-grain products and fish are divergent [9,15]. For example, Michalak et al. [16] report that a vegetarian diet is associated with an elevated prevalence of mental disorders. A poor meat intake has been shown to be associated with lower mortality rates and higher life expectancy [17], and a diet which allows small amounts of red meat, fish and dairy products seems to be associated with a reduced risk of coronary heart disease as well as type 2 diabetes [18]. Additionally, evidence concerning lower rates of cancer,

colon diseases including colon cancer, abdominal complaints, and all-cause mortality is, however, inconsistent [5–7,19–22].

Not only is the intake of certain nutrients, like red meat, associated with an increased health risk [18,23–26],high-caloric intake also plays a crucial role [23,27]. Moreover, there seems to be proof that lifestyle factors like physical activity may be more crucial in lowering disease rates than individual dietary habits [20,28–29]. While, generally speaking, diets based on plants, like vegetarian diets, seem to be associated with a certain health benefit, a lower risk to contract certain chronic diseases [30], and the ability to improve health [31–32], restrictive and monotonous vegetarian diets include the risk of nutritional deficits [2,18,19,30,33]. Baines et al. [9] report that vegetarians take more medication than non-vegetarians.

To summarize, a number of studies have shown vegetarian diets and diets with poor meat intake to be associated with lower mortality rates for certain diseases. Research about the dietary habits in Austria is, however, rather sparse and mainly focused on genetic factors [33–36]. Therefore, the aim of this study was to investigate health differences between different dietary habit groups among Austrian adults.

Methods

Study Design and Study Population

The sample for this cross-sectional study was taken from the Austrian Health Interview Survey (AT-HIS) which ran from March 2006 to February 2007 [37]. The AT-HIS is a standardized survey which is conducted at regular intervals in Austria (currently every eight years). The subjects included in the survey form a representative sample of the Austrian population. They were chosen from the central population register and are distributed across the different geographic regions of Austria. The AT-HIS is part of the European Health Interview Survey (E-HIS; http://www.euhsid.org), an important high-quality survey. The interviews were conducted by free-lancers engaged by the Austrian Statistic Agency. To ensure that all interviews were conducted in the same way, interviewers had to participate in a training day where they were instructed on how to conduct the survey. Time measurement, non-response analyses, and analyses of error dialogs were performed in order to ensure consistency between interview- ers. Additionally, all interviewers were supervised by field supervisors. Overall, 15474 individuals, aged 15 years and older, were questioned in computer-assisted personal interviews (CAPI; 54.7% female; response rate: 63.1%).

While 0.2% of the interviewees were pure vegetarians (57.7% female), 0.8% reported to be vegetarians consuming milk and eggs (77.3% female), and 1.2% to be vegetarians consuming fish and/ or eggs and milk (76.7% female). 23.6% reported to combine a carnivorous diet with lots of fruits and vegetables (67.2% female), 48.5% to eat a carnivorous diet less rich in meat (60.8% female), and 25.7% a carnivorous diet rich in meat (30.1% female). Since the three vegetarian diet groups included a rather small number of persons (N = 343), they were analyzed as one dietary habit group. Moreover, since the vegetarian group was the smallest, we decided to match each of the vegetarians (1) with an individual of each other dietary habit group (carnivorous diet rich in fruits and vegetables (2), carnivorous diet less rich in meat (3) and a carnivorous rich in meat (4)).

Matching Process

In a first step, subjects consuming a vegetarian diet were identified (N = 343). All vegetarians were categorized according to their sex, age (in age-groups spanning 5 years, e.g. 20- to 24-year- olds), and socioeconomic status (SES). Each such vegetarian was then matched with one subject consuming a carnivorous diet rich in fruits and vegetables, one individual eating a carnivorous diet less rich in meat, and one subject consuming a carnivorous diet rich in meat. Only 96.2% of the vegetarians were included in the analyses, since not all of them corresponded to a subject of the same sex, age, and SES from a different dietary habit group. Therefore, the total number of analyzed subjects was 1320 (comprising 330 vegetarians, 330 subjects consuming a carnivo- rous diet rich in fruits and vegetables, 330 individuals eating a carnivorous diet less rich in meat, and 330 subjects consuming a carnivorous diet rich in meat). Each dietary habit group was set-up according to the demographic characteristics shown in Table 1.

Ethical Approval

The study was carried out in compliance with the principles laid down in the Helsinki Declaration. No minors or children were included in the study. Verbal informed consent was obtained from all subjects, witnessed, and formally recorded. The Ethics Committee of the Medical University of Graz approved the consent procedure as well as the conductance of this study (EK- number: 24–288 ex11/12).

The Association between Nutrition and Health

Table 1. Data definition and structure for each of the four dietary habit groups.

Age Sex TOTAL
men women
SES N N N %
15–19 Low 3 22 25 7.6%
Middle 9 19 28 8.5%
High 0 1 1 0.3%
20–29 Low 4 11 15 4.5%
Middle 10 35 45 13.6%
High 5 13 18 5.4%
30–39 Low 3 10 13 3.9%
Middle 6 23 29 8.8%
High 6 11 17 5.2%
40–49 Low 4 6 10 3.0%
Middle 4 20 24 7.3%
High 8 16 24 7.3%
50–59 Low 3 7 10 3.0%
Middle 3 11 14 4.2%
High 1 6 7 2.1%
60–69 Low 3 7 10 3.0%
Middle 1 14 15 4.5%
High 0 2 2 0.6%
70–79 Low 4 8 12 3.6%
Middle 1 2 3 0.9%
High 0 0 0 0.0%
80+ Low 0 5 5 1.5%
Middle 0 3 3 0.9%
High 0 0 0 0.0%
TOTAL Low 24 76 100 30.3%
Middle 34 127 161 48.8%
High 20 49 69 20.9%
TOTAL 78 252 330 100.0%

Note. Data source: Austrian Health Interview Survey (AT-HIS) 2006/07.

N = number of subjects. Analyses were calculated with subjects matched according to their age, sex, and socio-economic status. Each dietary habit group consisted of 330 subjects with the above shown demographic characteristics (330 vegetarians, 330 subjects consuming a carnivorous diet rich in fruits and vegetables, 330 individuals eating a carnivorous diet less rich in meat, and 330 subjects consuming a carnivorous diet rich in meat; N = 1320). SES: A low SES corresponds a SES score between $3 and #6, a middle SES between .6 and # 10, and a high SES a score between .10 and #15. doi:10.1371/journal.pone.0088278.t001

Variables and Measurements

Face-to-face interviews were conducted by questioning the subjects about their socio-demographic characteristics, health- related behavior, diseases, medical treatments, and also psycho- logical aspects.

The independent variable in this study was the dietary habit of individuals. Concerning eating behavior, the respondents were given a list of six different dietary habits and asked which one describes their eating behavior best (1 = vegan, 2 = vegetarian eating milk/eggs, 3 = vegetarian eating fish and/or milk/eggs, 4 = carnivorous diet rich in fruits and vegetables, 5 = carnivorous diet less rich in meat, 6 = carnivorous diet rich in meat).

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Participants described their dietary habit, without interviewers giving a clear definition of the various eating categories. Since, overall, only 2.2% of all participants consumed a vegetarian diet, these individuals were analyzed as one dietary habit group. We created a scale that would reflect the animal fat intake for each dietary habit (1 = vegetarian diet, 2 = carnivorous diet rich in fruits and vegetables, 3 = carnivorous diet less rich in meat, 4 = carniv- orous diet rich in meat).

Since age, sex, and the socioeconomic background of subjects all have an influence on health [38–41], we matched the subjects according to these variables in order to control for their influence. The SES of the subjects (ranging between 3 and 15) was calculated using the following variables: net equivalent income, level of education, and occupation. Net equivalent income was calculated based on an equivalence scale provided by the OECD [42], and divided by quintiles. Level of education was measured by an ordinal variable, distinguishing between (1) basic education (up to 15 years of age), (2) apprenticeship/vocational school, (3) secondary education without diploma, (4) secondary education with diploma, and (5) university education. The occupation of the subjects was differentiated into the following five levels: (1) unskilled worker, (2) apprentice/skilled worker, (3) self-em- ployed/middle job, (4) qualified job/academic, (5) executive position. To verify the combination of variables that served to calculate the SES, correlations with the different variables were calculated. They ranged between r = .70 and r = .80.

The body mass index (BMI) and lifestyle factors (physical activity, smoking, and alcohol consumption) were included as covariates in all analyses. The BMI was calculated by dividing the weight of a person in kilograms by the square of their height in meters (kg/m2) [43]. Physical exercise was measured using the short version of the International Physical Activity Questionnaire (IPAQ), a self-reported instrument, which asks for an estimate of the total weekly physical activity (walking, moderate- and vigorous-intensity activity) performed during the last week. The short version of the IPAQ does not discriminate between leisure- time and non-leisure time physical activity. The total MET score was calculated by weighting the reported minutes per week within each activity by a MET energy expenditure estimate that was assigned to each category [44]. Smoking behavior was measured as the number of cigarettes smoked per day. Alcohol consumption was surveyed as the number of days on which alcohol was consumed during the last 28 days.

The dependent variables focusing on ill-health included self- perceived health, ranging from 1 (very good) to 5 (very bad), and impairment to health, ranging from 1 (very impaired) to 3 (not impaired). We further assessed the presence of 18 specific chronic conditions (asthma, allergies, diabetes, cataract, tinnitus, hyper- tension, cardiac infarction, apoplectic stroke, bronchitis, arthritis, sacrospinal complaints, osteoporosis, urinary incontinence, gastric or intestinal ulcer, cancer, migraine, mental illness (anxiety disorder or depression), and any other chronic condition). Each condition was coded as present (1) or absent (0). We calculated a total frequency score by summing up the chronic conditions present (0–18, sum index). Additionally, a vascular risk score was calculated by summing up the variables ‘‘hypertension’’, ‘‘en- hanced blood cholesterol level’’, ‘‘diabetes’’, and ‘‘smoking’’ (0–4, sum index). Each variable was coded as present (1) or absent (0).

A dependent variable concerning health care was created as the sum index of the number of doctors consulted in the last 12 months (0–8, sum index). Each of the 8 medical treatments (general practitioner, gynecologist, urologist, dermatologist, oph- thalmologist, internist, orthopedist, and ENT physician) was coded as ‘‘consulted’’ (1) or ‘‘not consulted’’ (0). The number of

The Association between Nutrition and Health

andsex,age,socio-economic 28lastthedays) (N = 1320).
meatin p-value .000 .000 .002 .000 .150 .000 .003 .005 .033
3 4 4 4 4 3 4 4 4
carnivorous diet rich SD 0.87 0.61 1.60 0.73 1.22 2.13 1.05 withsubjects matched according to their which alcohol was consumed during
N= 330 M 1.57 2.73 1.03 1.98 1.60 3.61 1.26
habitdietarydifferentthebetweengroups. carnivorousdiet rich in fruits carnivorous diet less vegetablesand330=NvegetarianN = 330 rich in meat N = 330 MSDM SD M SD 1.500.941.78 0.90 1.46 0.87 2.710.662.62 0.62 2.72 0.59 1.001.601.29 1.64 0.92 1.29 1.960.742.02 0.75 2.01 0.71 1.681.331.69 1.27 1.43 1.02 3.652.283.22 2.15 3.59 2.02 1.391.071.25 1.07 1.29 1.07 Ndeviation,standard=SDmean,=M2006/07.= number of subjects, p = probability.
results,better day),percigarettesof(numberbehaviorsmokingand alcohol consumption (number of days on
calculatedcomparison.univariateresultAnalyseswereof
4
multivariate test result,
3
carehealthandhealthinDifferences2.Table Measure Health generallyhealthreported-Self Impairment conditionsChronic riskVascular careHealth doctor)thetovisitsof(numbertreatmentsMedical vaccinationsofNumber healthpreventiveofNumber usedofferscare HIS)-(ATSurveyInterviewHealthAustriansource:DataNote. 1 score),MET(totalactivityphysicalBMI,forcontrollingstatus doi:10.1371/journal.pone.0088278.t002
1 means
a higher score
2
1 results,
2 worse
1 2 means
2 1 score
a higher
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The Association between Nutrition and Health

Table 3. Differences in suffering from various chronic conditions between the different dietary habit groups.

Carnivorous diet rich in Carnivorous diet less Carnivorous diet
Chronic condition Vegetarian fruits and vegetables rich in meat rich in meat p-value (x2)
Asthma 4.8% 3.3% 3.9% 4.5% .772
Allergies 30.6% 18.2% 20.3% 16.7% .000
Diabetes 2.7% 4.2% 2.4% 2.4% .455
Cataract 4.2% 3.0% 3.3% 1.8% .348
Tinnitus 4.8% 4.8% 4.8% 3.6% .840
Hypertension 11.5% 10.6% 12.4% 15.5% .260
Cardiac infarction 1.5% 1.5% 0.9% 0.6% .610
Apoplectic stroke 1.2% 1.8% 1.5% 1.8% .610
Bronchitis 3.9% 3.6% 2.4% 3.0% .701
Arthritis 8.5% 7.6% 8.8% 10.3% .662
Sacrospinal complaints 26.7% 24.8% 18.2% 23.9% .060
Osteoporosis 6.4% 4.8% 3.6% 5.8% .415
Urinary incontinence 2.1% 3.9% 2.7% 6.4% .023
Gastric or intestinal ulcer 4.2% 4.2% 1.5% 3.6% .169
Cancer 4.8% 3.3% 1.2% 1.8% .022
Migraine 15.8% 11.8% 9.1% 12.1% .074
Mental illness (anxiety 9.4% 4.8% 5.8% 4.5% .036
disorder or depression)
Any other chronic conditions 8.8% 5.5% 5.8% 6.7% .308

Note. Data source: Austrian Health Interview Survey (AT-HIS) 2006/07. Percentage of subjects suffering from the different chronic conditions. p (x2): probability value of Chi-Square-Test. Analyses were calculated with subjects matched according to their age, sex, and socio-economic status (N = 1320). doi:10.1371/journal.pone.0088278.t003

vaccinations was analyzed by calculating a sum index combining 8 different vaccinations (influenza, tetanus, diphtheria, polio, FSME, pneumococci, hepatitis A and B; 0–8, sum index). Each vaccination was coded as present (1) or absent (0). In addition, preventive health care was analyzed by calculating a sum index of the variables ‘‘preventive check-ups’’, ‘‘mammography’’, ‘‘prostate gland check-up’’, and ‘‘Papanicolaou test’’ (0–4, sum index). Each variable was coded as present (1) or absent (0).

The dependent variable concerning quality of life was measured using the short version of the WHOQOL (WHOQOL-BREF) [45]. Four domain scores (physical health, psychological health, social relationships, and environment) were calculated. These domain scores ranged between 4 and 20.

Statistical Analysis

In a first step subjects with different dietary habits (vegetarian, carnivorous diet rich in fruits and vegetables, carnivorous diet less rich in meat, carnivorous diet rich in meat) were matched according to their sex, age, and SES. Differences in lifestyle factors (BMI, total MET score, number of cigarettes smoked per day, and alcohol consumption in the last four weeks) between the different dietary habit groups were calculated by multivariate analysis of variance.

In order to analyze the differences between the dietary habit groups, multivariate analyses of variance were calculated for the three domains: (1) health (self-reported health, impairment due to health problems, number of chronic conditions, vascular risk), (2) health care (number of visits to the doctor, number of vaccinations, number of used preventive care offers), and (3) quality of life (physical and psychological health, social relation- ships, and environment). To address the bias of lifestyle factors impacting health, analyses of variance were calculated, controlling

for the aforementioned lifestyle variables (BMI, physical activity, smoking behavior, and alcohol consumption).

In the domain of ‘‘health’’, the two variables ‘‘self-reported health’’ and ‘‘impairment due to health problems’’ were originally assessed using an ordinal scale. Therefore, we controlled the results using non-parametric tests (Kruskal Wallis Test). Since the results were the same, only results of the analyses of variance are reported.

In addition, Chi-square tests were calculated for the aforemen- tioned 18 chronic conditions in order to establish which one occurs significantly more often, depending on the form of nutrition. p- values ,.050 were considered as statistically significant. All analyses were calculated using IBM SPSS software (version 20.0) for Windows.

Results

Participant Characteristics and Lifestyle Differences between the Dietary Habit Groups

In total, we analyzed the data of 1320 individuals (330 in each dietary habit group). Each dietary habit group was set-up according to the demographic characteristics shown in Table 1. Overall, 23.6% of all subjects were male and 76.4% female. 40.0% of the individuals were younger than 30 years, 17.8% between 30 and 39 years, 17.6% between 40 and 49 years, 9.4% between 50 and 59 years, 8.4% between 60 and 69 years, 4.4% between 70 and 79 years, and 2.4% than 80 years or older. 30.3% of the subjects had a low SES (they had an SES score of #6), 48.8% a middle one (SES between .6 and #10), and 20.9% had a high SES (SES.10).

Our multivariate analysis regarding lifestyle showed a significant main effect for the dietary habit of individuals (p = .000), showing

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that the different dietary habit groups differ in their overall health behavior. However, results of the univariate analyses showed that the dietary habit groups only differ concerning their BMI and their alcohol consumption.

Concerning BMI: vegetarians have the lowest mean BMI (M = 22.9), followed by subjects eating a carnivorous diet less rich in meat (M = 23.4), rich in fruits and vegetables (M = 23.5), and rich in meat (M = 24.9). Heavy meat eaters differ significantly from all other groups in terms of their BMI (p = .000).

Concerning physical exercise: no significant difference was found in the total MET score between the various dietary habit groups (p = .631).

Concerning smoking behavior: the number of cigarettes smoked per day did not differ between the various dietary habit groups (p = .302).

Concerning alcohol consumption: Subjects following a vegetar- ian diet (M = 2.6 days in the last 28 days) or a carnivorous diet rich in fruits and vegetables (M = 3.0 days) consume alcohol signifi- cantly less frequently than those eating a carnivorous diet less rich in meat (M = 4.4 days) or rich in meat (M = 4.8 days; p = .000).

Health Differences between the Dietary Habit Groups

In the domain of health, the multivariate analysis of variance showed a significant main effect for the dietary habit of individuals (p = .000). Overall, vegetarians are in a poorer state of health compared to the other dietary habit groups. Concerning self- reported health, vegetarians differ significantly from each of the other groups, toward poorer health (p = 000). Moreover, these subjects report higher levels of impairment from disorders (p = .002). Vegetarians additionally report more chronic diseases than those eating a carnivorous diet less rich in meat (p = .000; Table 2). Significantly more vegetarians suffer from allergies, cancer, and mental health ailments (anxiety, or depression) than the other dietary habit groups (Table 3). Subjects who eat a carnivorous diet rich in meat more often report urinary incontinence (p = .023). No differences between individuals consuming different forms of diet were found regarding their vascular risk (p = .150; Table 2).

Differences in Health Care between the Dietary Habit Groups

Our multivariate analysis regarding health care has shown a significant main effect for dietary habits (p = .000) and confirmed that, overall, subjects with a lower animal fat intake demonstrate worse health care practices. Vegetarians and subjects eating a carnivorous diet rich in fruits and vegetables consult doctors more often than those eating a carnivorous diet less rich in meat (p = .003). Moreover, vegetarians are vaccinated less often than all other dietary habit groups (p = .005) and make use of preventive check-ups less frequently than subjects eating a carnivorous diet rich in fruits and vegetables (p = .033; Table 2).

Differences in Quality of Life between the Dietary Habit Groups

Regarding quality of life, the main effect of the multivariate analysis of variance showed no significant difference between the dietary habit groups (p = .291). The results obtained in the univariate analyses of variance, however, revealed that vegetarians have a lower quality of life in the domains of ‘‘physical health’’ (p = .026) and ‘‘environment’’ (p = .037) than subjects consuming a carnivorous diet less rich in meat. Moreover, vegetarians have a lower quality of life regarding ‘‘social relationships’’ than individuals eating a carnivorous diet rich in fruits and vegetables,

The Association between Nutrition and Health

value-p .291 .026 .116 .043 .037 BMI,forphysical
2 3 3 3 3
carnivorous diet rich in meat SD 2.86 2.24 16.88 2.63 16.45 2.08 sex, and socio-economic status controlling
N= 330 M 17.40 16.66 last 28 days) (N = 1320).
carnivorous diet less rich in M SD 2.90 2.33 16.96 2.38 16.56 1.98 subjects matched according to their age, alcohol was consumed during the
meat N = 330 17.68 16.88 p = probability.
dietarydifferentthebetweenlife habit groups. carnivorous diet rich in fruits 330=Nvegetarianand vegetables N = 330 SDM M SD 3.2617.16 17.52 2.95 2.7416.50 16.75 2.42 2.8216.59 16.99 2.49 2.2616.16 16.44 2.11
mean.=M2006/07.HIS)-(ATSurveySD = standard deviation. N = numbersubjects.of result,testmultivariate andday),percigarettesof(numberalcohol consumption (number of dayswhichon
result ofcomparison.univariatecalculatedAnalyseswerewith
3
qualityinDifferences4.Tableof Measure lifeofQuality healthphysicalWHOQOL healthpsychologicalWHOQOL relationshipssocialWHOQOL environmentWHOQOL InterviewHealthAustriansource:DataNote. 1 behaviorsmokingscore),MET(totalactivity doi:10.1371/journal.pone.0088278.t004
2
1 1 results,
1 1 better
a higher score means
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or those with a carnivorous diet less rich in meat (p = .043). All results are shown in Table 4.

Discussion

Overall, our findings reveal that vegetarians report poorer health, follow medical treatment more frequently, have worse preventive health care practices, and have a lower quality of life. Concerning the variable ‘‘eating behavior’’, we tried to generate a variable that would reflect the animal fat intake (1 = vegetarian, 2 = carnivorous diet rich in fruits and vegetables, 3 = carnivorous diet less rich in meat, 4 = carnivorous diet rich in meat). The mean BMI of subjects is coupled in nearly linear progression with the amount of animal fat intake. This is in line with previous studies showing vegetarians to have a lower body mass index [1,4,5,7,9– 12].

Our results have shown that vegetarians report chronic conditions and poorer subjective health more frequently. This might indicate that the vegetarians in our study consume this form of diet as a consequence of their disorders, since a vegetarian diet is often recommended as a method to manage weight [10] and health [46]. Unfortunately, food intake was not measured in more detail, e.g. caloric intake was not covered. Hence, further studies will be necessary to analyze health and its relationship with different forms of dietary habits in more detail.

When analyzing the frequency of chronic diseases, we found significantly higher cancer incidence rates in vegetarians than in subjects with other dietary habits. This is in line with previous findings, reporting that evidence about cancer rates, abdominal complaints, and all-cause mortality in vegetarians is rather inconsistent [5–7,19–22]. The higher cancer incidence in vege- tarians in our study might be a coincidence, and is possibly related to factors other than the general amount of animal fat intake, such as health-conscious behavior, since no differences were found regarding smoking behavior and physical activity in Austrian adults as reported in other studies for other countries [9,13,14]. Therefore, further studies will be required in Austria in order to analyze the incidence of different types of cancer and their association with nutritional factors in more depth.

Several studies have shown the mental health effects of a vegetarian diet to be divergent [9,15,16]. Vegetarians in our study suffer significantly more often from anxiety disorder and/or depression. Additionally, they have a poorer quality of life in terms of physical health, social relationships, and environmental factors.

Moreover, the use of health care differs significantly between the dietary habit groups in our study. Vegetarians need more medical treatment than subjects following another form of diet. However, this might be due to the number of chronic conditions, which is higher in subjects with a vegetarian diet.

Among the strengths of our study are: the large sample size, the matching according to age, sex, and socioeconomic background, and

References

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The Association between Nutrition and Health

the standardized measurement of all variables. Other strengths of our study include considering the influence of weight and lifestyle factors on health, e.g. physical exercise and smoking behavior.

Potential limitations of our results are due to the fact that the survey was based on cross-sectional data. Therefore, no statements can be made whether the poorer health in vegetarians in our study is caused by their dietary habit or if they consume this form of diet due to their poorer health status. We cannot state whether a causal relationship exists, but describe ascertained associations. More- over, we cannot give any information regarding the long-term consequences of consuming a special diet nor concerning mortality rates. Thus, further longitudinal studies will be required to substantiate our results. Further limitations include the measure- ment of dietary habits as a self-reported variable and the fact that subjects were asked how they would describe their eating behavior, without giving them a clear definition of the various dietary habit groups. However, a significant association between the dietary habit of individuals and their weight and drinking behavior is indicative for the validity of the variable. Another limitation concerns the lack of detailed information regarding nutritional components (e.g. the amount of carbohydrates, cholesterol, or fatty acids consumed). Therefore, more in-depth studies about nutri- tional habits and their effects on health are required among Austrian adults. Further studies should e.g. investigate the influence of the various dietary habits on the incidence of different cancer types. To our knowledge this is the first study ever in Austria to analyze differences in terms of dietary habits and their impact on health. We admit that the large number of participants made it necessary to keep the questions simple, in order to cover the large sample. Overall, we feel that our results are of specific interest and contribute to extant scientific knowledge, notwith- standing some limitations regarding causes and effects.

Conclusions

Our study has shown that Austrian adults who consume a vegetarian diet are less healthy (in terms of cancer, allergies, and mental health disorders), have a lower quality of life, and also require more medical treatment. Therefore, a continued strong public health program for Austria is required in order to reduce the health risk due to nutritional factors. Moreover, our results emphasize the necessity of further studies in Austria, for a more in- depth analysis of the health effects of different dietary habits.

Author Contributions

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46.Leitzmann C (2005) Vegetarian diets: what are the advantages? Forum Nutr 57: 147–56.

bookmark_borderPost-mortem Brains

National Institute of Mental Health — To expedite research on brain disorders, the National Institutes of Health is shifting from a limited funding role to coordinating a Web-based resource for sharing post-mortem brain tissue. Under a NIH NeuroBioBank initiative, five brain banks will begin collaborating in a tissue sharing network for the neuroscience community.

“Instead of having to seek out brain tissue needed for a study from scattered repositories, researchers will have one-stop access to the specimens they need,” explained Thomas Insel, M.D., director of NIH’s National Institute of Mental Health (NIMH), one of three NIH institutes underwriting the project. “Such efficiency has become even more important with recent breakthrough technologies, such as CLARITY and resources such as BrainSpan that involve the use of human tissue.”

NIMH, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Institute of Neurological Disorders and Stroke (NINDS) announced funding of the federated network of five brain tissue repositories.

Historically, NIH institutes have awarded investigator-initiated grants to support disease-specific brain bank activities. The NIH NeuroBioBank instead employs contracts, which affords the agency a more interactive role.

Contracts totaling about $4.7 million for the 2013 fiscal year were awarded to brain banks at the Mount Sinai School of Medicine, New York City; Harvard University in Cambridge, Mass., the University of Miami; Sepulveda Research Corporation, Los Angeles; and the University of Pittsburgh.

These brain and tissue repositories seek out and accept brain donations, store the tissue, and distribute it to qualified researchers seeking to understand the causes of – and identify treatments and cures for – brain disorders, such as schizophrenia, multiple sclerosis , depression, epilepsy , Down syndrome , and autism. In addition to serving the research community, the NeuroBioBank website provides the public with information about the donation process and about how post-mortem tissue research advances knowledge about the disorders.

“While making a gift of a loved one’s brain to science may seem unsettling to many of us, brain tissue is a precious resource that enables progress in understanding and treating neurologic and psychiatric disorders,” said NINDS director Story Landis, Ph.D. “Donors are making an important contribution in advancing knowledge about the structure and function of our most complex organ.”

The project seeks brain tissue from people with brain disorders and from non-affected individuals whose brains serve as controls in studies. Anyone age 18 years or older can register as potential donor, but next-of-kin can also give permission for donation of tissue from children and those who have not registered. The preferences and privacy of donors or their next-of-kin are respected in the process of sample collection.

“”The NIH NeuroBioBank will offer economies of scale, increase availability of biospecimens, establish a standardized system, and raise public awareness of the importance of human brain research,” said NICHD director Alan Guttmacher, M.D.

Other brain banks are encouraged to partner with the NeuroBioBank, by making their inventories available via the centralized website, he added.

bookmark_borderForaging For Food in the Winter

Winter foraging can be one of the toughest challenges; however, if you do a little preparation in the fall, the buried treasures will yield healthy results.

Find out more from the Guide To Edible Plants’ Foraging for Food in the Winter.

Chives, Garlic Greens, Mint, Carrot Greens, Parsley

bookmark_borderMusic Is Food for the Brain

New studies have shown that listening to music, or better yet playing a musical instrument, helps keep the brain from aging. The Alzheimer’s association suggests doing both activities. The latest study shows playing an instrument can add 5 years to anti-aging of the brain.

Wikipedia says:
Instruments are often implemented in Music Therapy (MT) for Alzheimer’s patients that have musical backgrounds, because in many cases procedural musical memory is still preserved. As a result, some patients with AD retain the ability to play instruments, such as the piano. Some studies suggest for people with minimal guitar experience to implement MT that involves playing easy instruments. A study utilized the Autoharp and Omni, which are simple instruments that Alzheimer’s patients without musical background can use as a music therapy to stimulate and soothe

bookmark_borderThe BRAIN Initiative

Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative

What is the NIH BRAIN Initiative?

The NIH Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative is part of a new Presidential focus aimed at revolutionizing our understanding of the human brain. By accelerating the development and application of innovative technologies, researchers will be able to produce a revolutionary new dynamic picture of the brain that, for the first time, shows how individual cells and complex neural circuits interact in both time and space. Long desired by researchers seeking new ways to treat, cure, and even prevent brain disorders, this picture will fill major gaps in our current knowledge and provide unprecedented opportunities for exploring exactly how the brain enables the human body to record, process, utilize, store, and retrieve vast quantities of information, all at the speed of thought.

A map of overall task-fMRI brain coverage from the seven tasks used in the Human Connectome Project.

A map of overall task-fMRI brain coverage from the seven tasks used in the Human Connectome Project. Yellow and red represent regions that become more active in most participants during one or more tasks in the MR scanner; blue represents regions that become less active. Source: D.M. Barch for the WU-Minn HCP Consortium.

bookmark_borderThe President’s Climate Change Action Plan

President Obama released his action plan to deal with global warming. Coal company stocks were hammered on the news.

PRESIDENT OBAMA’S CLIMATE ACTION PLAN
“We, the people, still believe that our obligations as Americans are not just to ourselves, but to
all posterity. We will respond to the threat of climate change, knowing that the failure to do so
would betray our children and future generations. Some may still deny the overwhelming
judgment of science, but none can avoid the devastating impact of raging fires and crippling
drought and more powerful storms.

The path towards sustainable energy sources will be long and sometimes difficult. But America
cannot resist this transition, we must lead it. We cannot cede to other nations the technology that
will power new jobs and new industries, we must claim its promise. That’s how we will maintain
our economic vitality and our national treasure — our forests and waterways, our croplands and
snow-capped peaks. That is how we will preserve our planet, commanded to our care by God.
That’s what will lend meaning to the creed our fathers once declared.”
— President Obama, Second Inaugural Address, January 2013

THE CASE FOR ACTION
While no single step can reverse the effects of climate change, we have a moral obligation to
future generations to leave them a planet that is not polluted and damaged. Through steady,
responsible action to cut carbon pollution, we can protect our children’s health and begin to slow
the effects of climate change so that we leave behind a cleaner, more stable environment.

In 2009, President Obama made a pledge that by 2020, America would reduce its greenhouse gas
emissions in the range of 17 percent below 2005 levels if all other major economies agreed to
limit their emissions as well. Today, the President remains firmly committed to that goal and to
building on the progress of his first term to help put us and the world on a sustainable long-term
trajectory. Thanks in part to the Administration’s success in doubling America’s use of wind,
solar, and geothermal energy and in establishing the toughest fuel economy standards in our
history, we are creating new jobs, building new industries, and reducing dangerous carbon
pollution which contributes to climate change. In fact, last year, carbon emissions from the
energy sector fell to the lowest level in two decades. At the same time, while there is more work
to do, we are more energy secure than at any time in recent history. In 2012, America’s net oil
imports fell to the lowest level in 20 years and we have become the world’s leading producer of
natural gas – the cleanest-burning fossil fuel.

While this progress is encouraging, climate change is no longer a distant threat – we are already
feeling its impacts across the country and the world. Last year was the warmest year ever in the
contiguous United States and about one-third of all Americans experienced 10 days or more of
100-degree heat. The 12 hottest years on record have all come in the last 15 years. Asthma rates
have doubled in the past 30 years and our children will suffer more asthma attacks as air
pollution gets worse. And increasing floods, heat waves, and droughts have put farmers out of
business, which is already raising food prices dramatically.

These changes come with far-reaching consequences and real economic costs. Last year alone,
there were 11 different weather and climate disaster events with estimated losses exceeding $1
billion each across the United States. Taken together, these 11 events resulted in over $110
billion in estimated damages, which would make it the second-costliest year on record.

In short, America stands at a critical juncture. Today, President Obama is putting forward a
broad-based plan to cut the carbon pollution that causes climate change and affects public health.
Cutting carbon pollution will help spark business innovation to modernize our power plants,
resulting in cleaner forms of American-made energy that will create good jobs and cut our
dependence on foreign oil. Combined with the Administration’s other actions to increase the
efficiency of our cars and household appliances, the President’s plan will reduce the amount of
energy consumed by American families, cutting down on their gas and utility bills. The plan,
which consists of a wide variety of executive actions, has three key pillars:
1) Cut Carbon Pollution in America: In 2012, U.S. carbon emissions fell to the lowest level
in two decades even as the economy continued to grow. To build on this progress, the Obama
Administration is putting in place tough new rules to cut carbon pollution – just like we have
for other toxins like mercury and arsenic – so we protect the health of our children and move
our economy toward American-made clean energy sources that will create good jobs and
lower home energy bills.
2) Prepare the United States for the Impacts of Climate Change: Even as we take new steps
to reduce carbon pollution, we must also prepare for the impacts of a changing climate that
are already being felt across the country. Moving forward, the Obama Administration will
help state and local governments strengthen our roads, bridges, and shorelines so we can
better protect people’s homes, businesses and way of life from severe weather.
3) Lead International Efforts to Combat Global Climate Change and Prepare for its
Impacts: Just as no country is immune from the impacts of climate change, no country can
meet this challenge alone. That is why it is imperative for the United States to couple action
at home with leadership internationally. America must help forge a truly global solution to
this global challenge by galvanizing international action to significantly reduce emissions
(particularly among the major emitting countries), prepare for climate impacts, and drive
progress through the international negotiations.

Climate change represents one of our greatest challenges of our time, but it is a challenge
uniquely suited to America’s strengths. Our scientists will design new fuels, and our farmers will
grow them. Our engineers to devise new sources of energy, our workers will build them, and our
businesses will sell them. All of us will need to do our part. If we embrace this challenge, we will
not just create new jobs and new industries and keep America on the cutting edge; we will save
lives, protect and preserve our treasured natural resources, cities, and coastlines for future
generations.

What follows is a blueprint for steady, responsible national and international action to slow the
effects of climate change so we leave a cleaner, more stable environment for future generations.
It highlights progress already set in motion by the Obama Administration to advance these goals
and sets forth new steps to achieve them.

CUT CARBON POLLUTION IN AMERICA
In 2009, President Obama made a commitment to reduce U.S. greenhouse gas emissions in the
range of 17 percent below 2005 levels by 2020. The President remains firmly committed to
achieving that goal. While there is more work to do, the Obama Administration has already made
significant progress by doubling generation of electricity from wind, solar, and geothermal, and
by establishing historic new fuel economy standards. Building on these achievements, this
document outlines additional steps the Administration will take – in partnership with states, local
communities, and the private sector – to continue on a path to meeting the President’s 2020
goal.

I.
Deploying Clean Energy
Cutting Carbon Pollution from Power Plants: Power plants are the largest concentrated source
of emissions in the United States, together accounting for roughly one-third of all domestic
greenhouse gas emissions. We have already set limits for arsenic, mercury, and lead, but there is
no federal rule to prevent power plants from releasing as much carbon pollution as they want.
Many states, local governments, and companies have taken steps to move to cleaner electricity
sources. More than 35 states have renewable energy targets in place, and more than 25 have set
energy efficiency targets.

Despite this progress at the state level, there are no federal standards in place to reduce carbon
pollution from power plants. In April 2012, as part of a continued effort to modernize our electric
power sector, the Obama Administration proposed a carbon pollution standard for new power
plants. The Environmental Protection Agency’s proposal reflects and reinforces the ongoing
trend towards cleaner technologies, with natural gas increasing its share of electricity generation
in recent years, principally through market forces and renewables deployment growing rapidly to
account for roughly half of new generation capacity installed in 2012.

With abundant clean energy solutions available, and building on the leadership of states and
local governments, we can make continued progress in reducing power plant pollution to
improve public health and the environment while supplying the reliable, affordable power
needed for economic growth. By doing so, we will continue to drive American leadership in
clean energy technologies, such as efficient natural gas, nuclear, renewables, and clean coal
technology.

To accomplish these goals, President Obama is issuing a Presidential Memorandum directing the
Environmental Protection Agency to work expeditiously to complete carbon pollution standards
for both new and existing power plants. This work will build on the successful first-term effort to
develop greenhouse gas and fuel economy standards for cars and trucks. In developing the
standards, the President has asked the Environmental Protection Agency to build on state
leadership, provide flexibility, and take advantage of a wide range of energy sources and
technologies including many actions in this plan.

Promoting American Leadership in Renewable Energy: During the President’s first term, the
United States more than doubled generation of electricity from wind, solar, and geothermal
sources. To ensure America’s continued leadership position in clean energy, President Obama
has set a goal to double renewable electricity generation once again by 2020. In order to meet
this ambitious target, the Administration is announcing a number of new efforts in the following
key areas:
• Accelerating Clean Energy Permitting: In 2012 the President set a goal to issue permits
for 10 gigawatts of renewables on public lands by the end of the year. The Department of
the Interior achieved this goal ahead of schedule and the President has directed it to
permit an additional 10 gigawatts by 2020. Since 2009, the Department of Interior has
approved 25 utility-scale solar facilities, nine wind farms, and 11 geothermal plants,
which will provide enough electricity to power 4.4 million homes and support an
estimated 17,000 jobs. The Administration is also taking steps to encourage the
development of hydroelectric power at existing dams. To develop and demonstrate
improved permitting procedures for such projects, the Administration will designate the
Red Rock Hydroelectric Plant on the Des Moines River in Iowa to participate in its
Infrastructure Permitting Dashboard for high-priority projects. Also, the Department of
Defense – the single largest consumer of energy in the United States – is committed to
deploying 3 gigawatts of renewable energy on military installations, including solar,
wind, biomass, and geothermal, by 2025. In addition, federal agencies are setting a new
goal of reaching 100 megawatts of installed renewable capacity across the federally
subsidized housing stock by 2020. This effort will include conducting a survey of current
projects in order to track progress and facilitate the sharing of best practices.

• Expanding and Modernizing the Electric Grid: Upgrading the country’s electric grid
is critical to our efforts to make electricity more reliable, save consumers money on their
energy bills, and promote clean energy sources. To advance these important goals,
President Obama signed a Presidential Memorandum this month that directs federal
agencies to streamline the siting, permitting and review process for transmission projects
across federal, state, and tribal governments.

Unlocking Long-Term Investment in Clean Energy Innovation: The Fiscal Year 2014
Budget continues the President’s commitment to keeping the United States at the forefront of
clean energy research, development, and deployment by increasing funding for clean energy
technology across all agencies by 30 percent, to approximately $7.9 billion. This includes
investment in a range of energy technologies, from advanced biofuels and emerging nuclear
technologies – including small modular reactors – to clean coal. To continue America’s
leadership in clean energy innovation, the Administration will also take the following steps:

• Spurring Investment in Advanced Fossil Energy Projects: In the coming weeks, the
Department of Energy will issue a Federal Register Notice announcing a draft of a
solicitation that would make up to $8 billion in (self-pay) loan guarantee authority available
for a wide array of advanced fossil energy projects under its Section 1703 loan guarantee
program. This solicitation is designed to support investments in innovative technologies that
can cost-effectively meet financial and policy goals, including the avoidance, reduction, or
sequestration of anthropogenic emissions of greenhouse gases. The proposed solicitation will
cover a broad range of advanced fossil energy projects. Reflecting the Department’s
commitment to continuous improvement in program management, it will take comment on
the draft solicitation, with a plan to issue a final solicitation by the fall of 2013.

• Instituting a Federal Quadrennial Energy Review: Innovation and new sources of
domestic energy supply are transforming the nation’s energy marketplace, creating economic
opportunities at the same time they raise environmental challenges. To ensure that federal
energy policy meets our economic, environmental, and security goals in this changing
landscape, the Administration will conduct a Quadrennial Energy Review which will be led
by the White House Domestic Policy Council and Office of Science and Technology Policy,
supported by a Secretariat established at the Department of Energy, and involving the robust
engagement of federal agencies and outside stakeholders. This first-ever review will focus on
infrastructure challenges, and will identify the threats, risks, and opportunities for U.S.
energy and climate security, enabling the federal government to translate policy goals into a
set of analytically based, clearly articulated, sequenced and integrated actions, and proposed
investments over a four-year planning horizon.

II.
Building a 21st-Century Transportation Sector
Increasing Fuel Economy Standards: Heavy-duty vehicles are currently the second largest
source of greenhouse gas emissions within the transportation sector. In 2011, the Obama
Administration finalized the first-ever fuel economy standards for Model Year 2014-2018 for
heavy-duty trucks, buses, and vans. These standards will reduce greenhouse gas emissions by
approximately 270 million metric tons and save 530 million barrels of oil. During the President’s
second term, the Administration will once again partner with industry leaders and other key
stakeholders to develop post-2018 fuel economy standards for heavy-duty vehicles to further
reduce fuel consumption through the application of advanced cost-effective technologies and
continue efforts to improve the efficiency of moving goods across the United States.
The Obama Administration has already established the toughest fuel economy standards for
passenger vehicles in U.S. history. These standards require an average performance equivalent of
54.5 miles per gallon by 2025, which will save the average driver more than $8,000 in fuel costs
over the lifetime of the vehicle and eliminate six billion metric tons of carbon pollution – more
than the United States emits in an entire year.

Developing and Deploying Advanced Transportation Technologies: Biofuels have an
important role to play in increasing our energy security, fostering rural economic development,
and reducing greenhouse gas emissions from the transportation sector. That is why the
Administration supports the Renewable Fuels Standard, and is investing in research and
development to help bring next-generation biofuels on line. For example, the United States Navy
and Departments of Energy and Agriculture are working with the private sector to accelerate the
development of cost-competitive advanced biofuels for use by the military and commercial
sectors. More broadly, the Administration will continue to leverage partnerships between the
private and public sectors to deploy cleaner fuels, including advanced batteries and fuel cell
technologies, in every transportation mode. The Department of Energy’s eGallon informs drivers
about electric car operating costs in their state – the national average is only $1.14 per gallon of
gasoline equivalent, showing the promise for consumer pocketbooks of electric-powered
vehicles. In addition, in the coming months, the Department of Transportation will work with
other agencies to further explore strategies for integrating alternative fuel vessels into the U.S.
flag fleet. Further, the Administration will continue to work with states, cities and towns through
the Department of Transportation, the Department of Housing and Urban Development, and the
Environmental Protection Agency to improve transportation options, and lower transportation
costs while protecting the environment in communities nationwide.

III.
Cutting Energy Waste in Homes, Businesses, and Factories
Reducing Energy Bills for American Families and Businesses: Energy efficiency is one of the
clearest and most cost-effective opportunities to save families money, make our businesses more
competitive, and reduce greenhouse gas emissions. In the President’s first term, the Department
of Energy and the Department of Housing and Urban Development completed efficiency
upgrades in more than one million homes, saving many families more than $400 on their heating
and cooling bills in the first year alone. The Administration will take a range of new steps geared
towards achieving President Obama’s goal of doubling energy productivity by 2030 relative to
2010 levels:

• Establishing a New Goal for Energy Efficiency Standards: In President Obama’s first
term, the Department of Energy established new minimum efficiency standards for
dishwashers, refrigerators, and many other products. Through 2030, these standards will
cut consumers’ electricity bills by hundreds of billions of dollars and save enough
electricity to power more than 85 million homes for two years. To build on this success,
the Administration is setting a new goal: Efficiency standards for appliances and federal
buildings set in the first and second terms combined will reduce carbon pollution by at
least 3 billion metric tons cumulatively by 2030 – equivalent to nearly one-half of the
carbon pollution from the entire U.S. energy sector for one year – while continuing to cut
families’ energy bills.

• Reducing Barriers to Investment in Energy Efficiency: Energy efficiency upgrades
bring significant cost savings, but upfront costs act as a barrier to more widespread
investment. In response, the Administration is committing to a number of new executive
actions. As soon as this fall, the Department of Agriculture’s Rural Utilities Service will
finalize a proposed update to its Energy Efficiency and Conservation Loan Program to
provide up to $250 million for rural utilities to finance efficiency investments by
businesses and homeowners across rural America. The Department is also streamlining
its Rural Energy for America program to provide grants and loan guarantees directly to
agricultural producers and rural small businesses for energy efficiency and renewable
energy systems.

In addition, the Department of Housing and Urban Development’s efforts include a $23
million Multifamily Energy Innovation Fund designed to enable affordable housing
providers, technology firms, academic institutions, and philanthropic organizations to test
new approaches to deliver cost-effective residential energy. In order to advance ongoing
efforts and bring stakeholders together, the Federal Housing Administration will convene
representatives of the lending community and other key stakeholders for a mortgage
roundtable in July to identify options for factoring energy efficiency into the mortgage
underwriting and appraisal process upon sale or refinancing of new or existing homes.

• Expanding the President’s Better Buildings Challenge: The Better Buildings
Challenge, focused on helping American commercial and industrial buildings become at
least 20 percent more energy efficient by 2020, is already showing results. More than 120
diverse organizations, representing over 2 billion square feet are on track to meet the
2020 goal: cutting energy use by an average 2.5 percent annually, equivalent to about $58
million in energy savings per year. To continue this success, the Administration will
expand the program to multifamily housing – partnering both with private and affordable
building owners and public housing agencies to cut energy waste. In addition, the
Administration is launching the Better Buildings Accelerators, a new track that will
support and encourage adoption of State and local policies to cut energy waste, building
on the momentum of ongoing efforts at that level.

IV.
Reducing Other Greenhouse Gas Emissions
Curbing Emissions of Hydrofluorocarbons: Hydrofluorocarbons (HFCs), which are primarily
used for refrigeration and air conditioning, are potent greenhouse gases. In the United States,
emissions of HFCs are expected to nearly triple by 2030, and double from current levels of 1.5
percent of greenhouse gas emissions to 3 percent by 2020.

To reduce emissions of HFCs, the United States can and will lead both through international
diplomacy as well as domestic actions. In fact, the Administration has already acted by including
a flexible and powerful incentive in the fuel economy and carbon pollution standards for cars and
trucks to encourage automakers to reduce HFC leakage and transition away from the most potent
HFCs in vehicle air conditioning systems. Moving forward, the Environmental Protection
Agency will use its authority through the Significant New Alternatives Policy Program to
encourage private sector investment in low-emissions technology by identifying and approving
climate-friendly chemicals while prohibiting certain uses of the most harmful chemical
alternatives. In addition, the President has directed his Administration to purchase cleaner
alternatives to HFCs whenever feasible and transition over time to equipment that uses safer and
more sustainable alternatives.

Reducing Methane Emissions: Curbing emissions of methane is critical to our overall effort to
address global climate change. Methane currently accounts for roughly 9 percent of domestic
greenhouse gas emissions and has a global warming potential that is more than 20 times greater
than carbon dioxide. Notably, since 1990, methane emissions in the United States have decreased
by 8 percent. This has occurred in part through partnerships with industry, both at home and
abroad, in which we have demonstrated that we have the technology to deliver emissions
reductions that benefit both our economy and the environment. To achieve additional progress,
the Administration will:

• Developing an Interagency Methane Strategy: The Environmental Protection Agency
and the Departments of Agriculture, Energy, Interior, Labor, and Transportation will
develop a comprehensive, interagency methane strategy. The group will focus on
assessing current emissions data, addressing data gaps, identifying technologies and best
practices for reducing emissions, and identifying existing authorities and incentive-based
opportunities to reduce methane emissions.

• Pursuing a Collaborative Approach to Reducing Emissions: Across the economy,
there are multiple sectors in which methane emissions can be reduced, from coal mines
and landfills to agriculture and oil and gas development. For example, in the agricultural
sector, over the last three years, the Environmental Protection Agency and the
Department of Agriculture have worked with the dairy industry to increase the adoption
of methane digesters through loans, incentives, and other assistance. In addition, when it
comes to the oil and gas sector, investments to build and upgrade gas pipelines will not
only put more Americans to work, but also reduce emissions and enhance economic
productivity. For example, as part of the Administration’s effort to improve federal
permitting for infrastructure projects, the interagency Bakken Federal Executive Group is
working with industry, as well as state and tribal agencies, to advance the production of
oil and gas in the Bakken while helping to reduce venting and flaring. Moving forward,
as part of the effort to develop an interagency methane strategy, the Obama
Administration will work collaboratively with state governments, as well as the private
sector, to reduce emissions across multiple sectors, improve air quality, and achieve
public health and economic benefits.

Preserving the Role of Forests in Mitigating Climate Change: America’s forests play a
critical role in addressing carbon pollution, removing nearly 12 percent of total U.S. greenhouse
gas emissions each year. In the face of a changing climate and increased risk of wildfire,
drought, and pests, the capacity of our forests to absorb carbon is diminishing. Pressures to
develop forest lands for urban or agricultural uses also contribute to the decline of forest carbon
sequestration. Conservation and sustainable management can help to ensure our forests continue
to remove carbon from the atmosphere while also improving soil and water quality, reducing
wildfire risk, and otherwise managing forests to be more resilient in the fact of climate change.
The Administration is working to identify new approaches to protect and restore our forests, as
well as other critical landscapes including grasslands and wetlands, in the face of a changing
climate.

V.
Leading at the Federal Level
Leading in Clean Energy: President Obama believes that the federal government must be a
leader in clean energy and energy efficiency. Under the Obama Administration, federal agencies
have reduced greenhouse gas emissions by more than 15 percent – the equivalent of permanently
taking 1.5 million cars off the road. To build on this record, the Administration is establishing a
new goal: The federal government will consume 20 percent of its electricity from renewable
sources by 2020 – more than double the current goal of 7.5 percent. In addition, the federal
government will continue to pursue greater energy efficiency that reduces greenhouse gas
emissions and saves taxpayer dollars.

Federal Government Leadership in Energy Efficiency: On December 2, 2011, President
Obama signed a memorandum entitled “Implementation of Energy Savings Projects and
Performance-Based Contracting for Energy Savings,” challenging federal agencies, in support of
the Better Buildings Challenge, to enter into $2 billion worth of performance-based contracts
within two years. Performance contracts drive economic development, utilize private sector
innovation, and increase efficiency at minimum costs to the taxpayer, while also providing long-
term savings in energy costs. Federal agencies have committed to a pipeline of nearly $2.3
billion from over 300 reported projects. In coming months, the Administration will take a
number of actions to strengthen efforts to promote energy efficiency, including through
performance contracting. For example, in order to increase access to capital markets for
investments in energy efficiency, the Administration will initiate a partnership with the private
sector to work towards a standardized contract to finance federal investments in energy
efficiency. Going forward, agencies will also work together to synchronize building codes –
leveraging those policies to improve the efficiency of federally owned and supported building
stock. Finally, the Administration will leverage the “Green Button” standard – which aggregates
energy data in a secure, easy to use format – within federal facilities to increase their ability to
manage energy consumption, reduce greenhouse gas emissions, and meet sustainability goals.

PREPARE THE UNITED STATES FOR THE IMPACTS OF CLIMATE CHANGE
As we act to curb the greenhouse gas pollution that is driving climate change, we must also
prepare for the impacts that are too late to avoid. Across America, states, cities, and communities
are taking steps to protect themselves by updating building codes, adjusting the way they manage
natural resources, investing in more resilient infrastructure, and planning for rapid recovery from
damages that nonetheless occur. The federal government has an important role to play in
supporting community-based preparedness and resilience efforts, establishing policies that
promote preparedness, protecting critical infrastructure and public resources, supporting science
and research germane to preparedness and resilience, and ensuring that federal operations and
facilities continue to protect and serve citizens in a changing climate.

The Obama Administration has been working to strengthen America’s climate resilience since its
earliest days. Shortly after coming into office, President Obama established an Interagency
Climate Change Adaptation Task Force and, in October 2009, the President signed an Executive
Order directing it to recommend ways federal policies and programs can better prepare the
Nation for change. In May 2010, the Task Force hosted the first National Climate Adaptation
Summit, convening local and regional stakeholders and decision-makers to identify challenges
and opportunities for collaborative action.

In February 2013, federal agencies released Climate Change Adaptation Plans for the first time,
outlining strategies to protect their operations, missions, and programs from the effects of
climate change. The Department of Transportation, for example, is developing guidance for
incorporating climate change and extreme weather event considerations into coastal highway
projects, and the Department of Homeland Security is evaluating the challenges of changing
conditions in the Arctic and along our Nation’s borders. Agencies have also partnered with
communities through targeted grant and technical-assistance programs—for example, the
Environmental Protection Agency is working with low-lying communities in North Carolina to
assess the vulnerability of infrastructure investments to sea level rise and identify solutions to
reduce risks. And the Administration has continued, through the U.S. Global Change Research
Program, to support science and monitoring to expand our understanding of climate change and
its impacts.

Going forward, the Administration will expand these efforts into three major, interrelated
initiatives to better prepare America for the impacts of climate change:
I.
Building Stronger and Safer Communities and Infrastructure
By necessity, many states, cities, and communities are already planning and preparing for the
impacts of climate change. Hospitals must build capacity to serve patients during more frequent
heat waves, and urban planners must plan for the severe storms that infrastructure will need to
withstand. Promoting on-the-ground planning and resilient infrastructure will be at the core of
our work to strengthen America’s communities. Specific actions will include:
Directing Agencies to Support Climate-Resilient Investment: The President will direct
federal agencies to identify and remove barriers to making climate-resilient investments; identify
and remove counterproductive policies that increase vulnerabilities; and encourage and support
smarter, more resilient investments, including through agency grants, technical assistance, and
other programs, in sectors from transportation and water management to conservation and
disaster relief. Agencies will also be directed to ensure that climate risk-management
considerations are fully integrated into federal infrastructure and natural resource management
planning. To begin meeting this challenge, the Environmental Protection Agency is committing
to integrate considerations of climate change impacts and adaptive measures into major
programs, including its Clean Water and Drinking Water State Revolving Funds and grants for
brownfields cleanup, and the Department of Housing and Urban Development is already
requiring grant recipients in the Hurricane Sandy–affected region to take sea-level rise into
account.

Establishing a State, Local, and Tribal Leaders Task Force on Climate Preparedness: To
help agencies meet the above directive and to enhance local efforts to protect communities, the
President will establish a short-term task force of state, local, and tribal officials to advise on key
actions the federal government can take to better support local preparedness and resilience-
building efforts. The task force will provide recommendations on removing barriers to resilient
investments, modernizing grant and loan programs to better support local efforts, and developing
information and tools to better serve communities.

Supporting Communities as they Prepare for Climate Impacts: Federal agencies will
continue to provide targeted support and assistance to help communities prepare for climate-
change impacts. For example, throughout 2013, the Department of Transportation’s Federal
Highway Administration is working with 19 state and regional partners and other federal
agencies to test approaches for assessing local transportation infrastructure vulnerability to
climate change and extreme weather and for improving resilience. The Administration will
continue to assist tribal communities on preparedness through the Bureau of Indian Affairs,
including through pilot projects and by supporting participation in federal initiatives that assess
climate change vulnerabilities and develop regional solutions. Through annual federal agency
“Environmental Justice Progress Reports,” the Administration will continue to identify
innovative ways to help our most vulnerable communities prepare for and recover from the
impacts of climate change. The importance of critical infrastructure independence was brought
home in the Sandy response. The Federal Emergency Management Agency and the Department
of Energy are working with the private sector to address simultaneous restoration of electricity
and fuels supply.

Boosting the Resilience of Buildings and Infrastructure: The National Institute of Standards
and Technology will convene a panel on disaster-resilience standards to develop a
comprehensive, community-based resilience framework and provide guidelines for consistently
safe buildings and infrastructure – products that can inform the development of private-sector
standards and codes. In addition, building on federal agencies’ “Climate Change Adaptation
Plans,” the Administration will continue efforts to increase the resilience of federal facilities and
infrastructure. The Department of Defense, for example, is assessing the relative vulnerability of
its coastal facilities to climate change. In addition, the President’s FY 2014 Budget proposes
$200 million through the Transportation Leadership Awards program for Climate Ready
Infrastructure in communities that build enhanced preparedness into their planning efforts, and
that have proposed or are ready to break ground on infrastructure projects, including transit and
rail, to improve resilience.

Rebuilding and Learning from Hurricane Sandy: In August 2013, President Obama’s
Hurricane Sandy Rebuilding Task Force will deliver to the President a rebuilding strategy to be
implemented in Sandy-affected regions and establishing precedents that can be followed
elsewhere. The Task Force and federal agencies are also piloting new ways to support resilience
in the Sandy-affected region; the Task Force, for example, is hosting a regional “Rebuilding by
Design” competition to generate innovative solutions to enhance resilience. In the transportation
sector, the Department of Transportation’s Federal Transit Administration (FTA) is dedicating
$5.7 billion to four of the area’s most impacted transit agencies, of which $1.3 billion will be
allocated to locally prioritized projects to make transit systems more resilient to future disasters.
FTA will also develop a competitive process for additional funding to identify and support
larger, stand-alone resilience projects in the impacted region. To build coastal resilience, the
Department of the Interior will launch a $100 million competitive grant program to foster
partnerships and promote resilient natural systems while enhancing green spaces and wildlife
habitat near urban populations. An additional $250 million will be allocated to support projects
for coastal restoration and resilience across the region. Finally, with partners, the U.S. Army
Corps of Engineers is conducting a $20 million study to identify strategies to reduce the
vulnerability of Sandy-affected coastal communities to future large-scale flood and storm events,
and the National Oceanic and Atmospheric Administration will strengthen long-term coastal
observations and provide technical assistance to coastal communities.

II.
Protecting our Economy and Natural Resources
Climate change is affecting nearly every aspect of our society, from agriculture and tourism to
the health and safety of our citizens and natural resources. To help protect critical sectors, while
also targeting hazards that cut across sectors and regions, the Administration will mount a set of
sector- and hazard-specific efforts to protect our country’s vital assets, to include:
Identifying Vulnerabilities of Key Sectors to Climate Change: The Department of Energy
will soon release an assessment of climate-change impacts on the energy sector, including
power-plant disruptions due to drought and the disruption of fuel supplies during severe storms,
as well as potential opportunities to make our energy infrastructure more resilient to these risks.
In 2013, the Department of Agriculture and Department of the Interior released several studies
outlining the challenges a changing climate poses for America’s agricultural enterprise, forests,
water supply, wildlife, and public lands. This year and next, federal agencies will report on the
impacts of climate change on other key sectors and strategies to address them, with priority
efforts focusing on health, transportation, food supplies, oceans, and coastal communities.
Promoting Resilience in the Health Sector: The Department of Health and Human Services
will launch an effort to create sustainable and resilient hospitals in the face of climate change.

Through a public-private partnership with the healthcare industry, it will identify best practices
and provide guidance on affordable measures to ensure that our medical system is resilient to
climate impacts. It will also collaborate with partner agencies to share best practices among
federal health facilities. And, building on lessons from pilot projects underway in 16 states, it
will help train public-health professionals and community leaders to prepare their communities
for the health consequences of climate change, including through effective communication of
health risks and resilience measures.

Promoting Insurance Leadership for Climate Safety: Recognizing the critical role that the
private sector plays in insuring assets and enabling rapid recovery after disasters, the
Administration will convene representatives from the insurance industry and other stakeholders
to explore best practices for private and public insurers to manage their own processes and
investments to account for climate change risks and incentivize policy holders to take steps to
reduce their exposure to these risks.

Conserving Land and Water Resources: America’s ecosystems are critical to our nation’s
economy and the lives and health of our citizens. These natural resources can also help
ameliorate the impacts of climate change, if they are properly protected. The Administration has
invested significantly in conserving relevant ecosystems, including working with Gulf State
partners after the Deepwater Horizon spill to enhance barrier islands and marshes that protect
communities from severe storms. The Administration is also implementing climate-adaptation
strategies that promote resilience in fish and wildlife populations, forests and other plant
communities, freshwater resources, and the ocean. Building on these efforts, the President is also
directing federal agencies to identify and evaluate additional approaches to improve our natural
defenses against extreme weather, protect biodiversity and conserve natural resources in the face
of a changing climate, and manage our public lands and natural systems to store more carbon.
Maintaining Agricultural Sustainability: Building on the existing network of federal climate-
science research and action centers, the Department of Agriculture is creating seven new
Regional Climate Hubs to deliver tailored, science-based knowledge to farmers, ranchers, and
forest landowners. These hubs will work with universities and other partners, including the
Department of the Interior and the National Oceanic and Atmospheric Administration, to support
climate resilience. Its Natural Resources Conservation Service and the Department of the
Interior’s Bureau of Reclamation are also providing grants and technical support to agricultural
water users for more water-efficient practices in the face of drought and long-term climate
change.

Managing Drought: Leveraging the work of the National Disaster Recovery Framework for
drought, the Administration will launch a cross-agency National Drought Resilience Partnership
as a “front door” for communities seeking help to prepare for future droughts and reduce drought
impacts. By linking information (monitoring, forecasts, outlooks, and early warnings) with
drought preparedness and longer-term resilience strategies in critical sectors, this effort will help
communities manage drought-related risks.

Reducing Wildfire Risks: With tribes, states, and local governments as partners, the
Administration has worked to make landscapes more resistant to wildfires, which are
exacerbated by heat and drought conditions resulting from climate change. Federal agencies will
expand and prioritize forest and rangeland restoration efforts in order to make natural areas and
communities less vulnerable to catastrophic fire. The Department of the Interior and Department
of Agriculture, for example, are launching a Western Watershed Enhancement Partnership – a
pilot effort in five western states to reduce wildfire risk by removing extra brush and other
flammable vegetation around critical areas such as water reservoirs.
Preparing for Future Floods: To ensure that projects funded with taxpayer dollars last as long
as intended, federal agencies will update their flood-risk reduction standards for federally funded
projects to reflect a consistent approach that accounts for sea-level rise and other factors
affecting flood risks. This effort will incorporate the most recent science on expected rates of
sea-level rise (which vary by region) and build on work done by the Hurricane Sandy Rebuilding
Task Force, which announced in April 2013 that all federally funded Sandy-related rebuilding
projects must meet a consistent flood risk reduction standard that takes into account increased
risk from extreme weather events, sea-level rise, and other impacts of climate change.

III.
Using Sound Science to Manage Climate Impacts
Scientific data and insights are essential to help government officials, communities, and
businesses better understand and manage the risks associated with climate change. The
Administration will continue to lead in advancing the science of climate measurement and
adaptation and the development of tools for climate-relevant decision-making by focusing on
increasing the availability, accessibility, and utility of relevant scientific tools and information.
Specific actions will include:

Developing Actionable Climate Science: The President’s Fiscal Year 2014 Budget provides
more than $2.7 billion, largely through the 13-agency U.S. Global Change Research Program, to
increase understanding of climate-change impacts, establish a public-private partnership to
explore risk and catastrophe modeling, and develop the information and tools needed by
decision-makers to respond to both long-term climate change impacts and near-term effects of
extreme weather.

Assessing Climate-Change Impacts in the United States: In the spring of 2014, the Obama
Administration will release the third U.S. National Climate Assessment, highlighting new
advances in our understanding of climate-change impacts across all regions of the United States
and on critical sectors of the economy, including transportation, energy, agriculture, and
ecosystems and biodiversity. For the first time, the National Climate Assessment will focus not
only on dissemination of scientific information but also on translating scientific insights into
practical, useable knowledge that can help decision-makers anticipate and prepare for specific
climate-change impacts.

Launching a Climate Data Initiative: Consistent with the President’s May 2013 Executive
Order on Open Data – and recognizing that freely available open government data can fuel
entrepreneurship, innovation, scientific discovery, and public benefits – the Administration is
launching a Climate Data Initiative to leverage extensive federal climate-relevant data to
stimulate innovation and private-sector entrepreneurship in support of national climate-change
preparedness.

Providing a Toolkit for Climate Resilience: Federal agencies will create a virtual climate-
resilience toolkit that centralizes access to data-driven resilience tools, services, and best
practices, including those developed through the Climate Data Initiative. The toolkit will provide
easy access to existing resources as well as new tools, including: interactive sea-level rise maps
and a sea-level-rise calculator to aid post-Sandy rebuilding in New York and New Jersey, new
NOAA storm surge models and interactive maps from the National Oceanic and Atmospheric
Administration that provide risk information by combining tidal data, projected sea levels and
storm wave heights, a web-based tool that will allow developers to integrate NASA climate
imagery into websites and mobile apps, access to the U.S. Geological Survey’s “visualization
tool” to assess the amount of carbon absorbed by landscapes, and a Stormwater Calculator and
Climate Assessment Tool developed to help local governments assess stormwater-control
measures under different precipitation and temperature scenarios.

LEAD INTERNATIONAL EFFORTS TO ADDRESS GLOBAL CLIMATE CHANGE
The Obama Administration is working to build on the actions that it is taking domestically to
achieve significant global greenhouse gas emission reductions and enhance climate preparedness
through major international initiatives focused on spurring concrete action, including bilateral
initiatives with China, India, and other major emitting countries. These initiatives not only serve
to support the efforts of the United States and others to achieve our goals for 2020, but also will
help us move beyond those and bend the post-2020 global emissions trajectory further. As a key
part of this effort, we are also working intensively to forge global responses to climate change
through a number of important international negotiations, including the United Nations
Framework Convention on Climate Change.

I.
Working with Other Countries to Take Action to Address Climate Change
Enhancing Multilateral Engagement with Major Economies: In 2009, President Obama
launched the Major Economies Forum on Energy and Climate, a high-level forum that brings
together 17 countries that account for approximately 75 percent of global greenhouse gas
emissions, in order to support the international climate negotiations and spur cooperative action
to combat climate change. The Forum has been successful on both fronts – having contributed
significantly to progress in the broader negotiations while also launching the Clean Energy
Ministerial to catalyze the development and deployment of clean energy and efficiency solutions.
We are proposing that the Forum build on these efforts by launching a major initiative this year
focused on further accelerating efficiency gains in the buildings sector, which accounts for
approximately one-third of global carbon pollutions from the energy sector.
Expanding Bilateral Cooperation with Major Emerging Economies:

From the outset, the Obama Administration has sought to intensify bilateral climate cooperation
with key major emerging economies, through initiatives like the U.S.-China Clean Energy
Research Center, the U.S.-India Partnership to Advance Clean Energy, and the Strategic Energy
Dialogue with Brazil.

We will be building on these successes and finding new areas for cooperation in the second term,
and we are already making progress: Just this month, President Obama and President Xi Jinping
of China reached an historic agreement at their first summit to work to use the expertise and
institutions of the Montreal Protocol to phase down the consumption and production of HFCs, a
highly potent greenhouse gas. The impact of phasing out HFCs by 2050 would be equivalent to
the elimination of two years’ worth of greenhouse gas emissions from all sources.
Combatting Short-Lived Climate Pollutants: Pollutants such as methane, black carbon, and
many HFCs are relatively short-lived in the atmosphere, but have more potent greenhouse effects
than carbon dioxide. In February 2012, the United States launched the Climate and Clean Air
Coalition to Reduce Short-Lived Climate Pollution, which has grown to include more than 30
country partners and other key partners such as the World Bank and the U.N. Environment
Programme. Major efforts include reducing methane and black carbon from waste and landfills.
We are also leading through the Global Methane Initiative, which works with 42 partner
countries and an extensive network of over 1,100 private sector participants to reduce methane
emissions.

Reducing Emissions from Deforestation and Forest Degradation: Greenhouse gas emissions
from deforestation, agriculture, and other land use constitute approximately one-third of global
emissions. In some developing countries, as much as 80 percent of these emissions come from
the land sector. To meet this challenge, the Obama Administration is working with partner
countries to put in place the systems and institutions necessary to significantly reduce global
land-use-related emissions, creating new models for rural development that generate climate
benefits, while conserving biodiversity, protecting watersheds, and improving livelihoods.
In 2012 alone, the U.S. Agency for International Development’s bilateral and regional forestry
programs contributed to reducing more than 140 million tons of carbon dioxide emissions,
including through support for multilateral initiatives such as the Forest Investment Program and
the Forest Carbon Partnership Facility. In Indonesia, the Millennium Challenge Corporation is
funding a five-year “Green Prosperity” program that supports environmentally sustainable, low
carbon economic development in select districts.

The Obama Administration is also working to address agriculture-driven deforestation through
initiatives such as the Tropical Forest Alliance 2020, which brings together governments, the
private sector, and civil society to reduce tropical deforestation related to key agricultural
commodities, which we will build upon.

Expanding Clean Energy Use and Cut Energy Waste: Roughly 84 percent of current carbon
dioxide emissions are energy-related and about 65 percent of all greenhouse gas emissions can
be attributed to energy supply and energy use. The Obama Administration has promoted the
expansion of renewable, clean, and efficient energy sources and technologies worldwide
through:

• Financing and regulatory support for renewable and clean energy projects
• Actions to promote fuel switching from oil and coal to natural gas or renewables
• Support for the safe and secure use of nuclear power
• Cooperation on clean coal technologies
• Programs to improve and disseminate energy efficient technologies

In the past three years we have reached agreements with more than 20 countries around the
world, including Mexico, South Africa, and Indonesia, to support low emission development
strategies that help countries to identify the best ways to reduce greenhouse gas emissions while
growing their economies. Among the many initiatives that we have launched are:

• The U.S. Africa Clean Energy Finance Initiative, which aligns grant-based assistance
with project planning expertise from the U.S. Trade and Development Agency and
financing and risk mitigation tools from the U.S. Overseas Private Investment
Corporation to unlock up to $1 billion in clean energy financing.
• The U.S.-Asia Pacific Comprehensive Energy Partnership, which has identified $6 billion
in U.S. export credit and government financing to promote clean energy development in
the Asia-Pacific region.

Looking ahead, we will target these and other resources towards greater penetration of
renewables in the global energy mix on both a small and large scale, including through our
participation in the Sustainable Energy for All Initiative and accelerating the commercialization
of renewable mini-grids. These efforts include:
• Natural Gas. Burning natural gas is about one-half as carbon-intensive as coal, which
can make it a critical “bridge fuel” for many countries as the world transitions to even
cleaner sources of energy. Toward that end, the Obama Administration is partnering with
states and private companies to exchange lessons learned with our international partners
on responsible development of natural gas resources. We have launched the
Unconventional Gas Technical Engagement Program to share best practices on issues
such as water management, methane emissions, air quality, permitting, contracting, and
pricing to help increase global gas supplies and facilitate development of the associated
infrastructure that brings them to market. Going forward, we will promote fuel-switching
from coal to gas for electricity production and encourage the development of a global
market for gas. Since heavy-duty vehicles are expected to account for 40 percent of
increased oil use through 2030, we will encourage the adoption of heavy duty natural gas
vehicles as well.
• Nuclear Power. The United States will continue to promote the safe and secure use of
nuclear power worldwide through a variety of bilateral and multilateral engagements. For
example, the U.S. Nuclear Regulatory Commission advises international partners on
safety and regulatory best practices, and the Department of Energy works with
international partners on research and development, nuclear waste and storage, training,
regulations, quality control, and comprehensive fuel leasing options. Going forward, we
will expand these efforts to promote nuclear energy generation consistent with
maximizing safety and nonproliferation goals.
• Clean Coal. The United States works with China, India, and other countries that
currently rely heavily on coal for power generation to advance the development and
deployment of clean coal technologies. In addition, the U.S. leads the Carbon
Sequestration Leadership Forum, which engages 23 other countries and economies on
carbon capture and sequestration technologies. Going forward, we will continue to use
these bilateral and multilateral efforts to promote clean coal technologies.
• Energy Efficiency. The Obama Administration has aggressively promoted energy
efficiency through the Clean Energy Ministerial and key bilateral programs. The cost-
effective opportunities are enormous: The Ministerial’ s Super-Efficient Equipment and
Appliance Deployment Initiative and its Global Superior Energy Performance
Partnership are helping to accelerate the global adoption of standards and practices that
would cut energy waste equivalent to more than 650 mid-size power plants by 2030. We
will work to expand these efforts focusing on several critical areas, including: improving
building efficiency, reducing energy consumption at water and wastewater treatment
facilities, and expanding global appliance standards.

Negotiating Global Free Trade in Environmental Goods and Services: The U.S. will work
with trading partners to launch negotiations at the World Trade Organization towards global free
trade in environmental goods, including clean energy technologies such as solar, wind, hydro and
geothermal. The U.S. will build on the consensus it recently forged among the 21 Asia-Pacific
Economic Cooperation (APEC) economies in this area. In 2011, APEC economies agreed to
reduce tariffs to 5 percent or less by 2015 on a negotiated list of 54 environmental goods. The
APEC list will serve as a foundation for a global agreement in the WTO, with participating
countries expanding the scope by adding products of interest. Over the next year, we will work
towards securing participation of countries which account for 90 percent of global trade in
environmental goods, representing roughly $481 billion in annual environmental goods trade.
We will also work in the Trade in Services Agreement negotiations towards achieving free trade
in environmental services.

Phasing Out Subsidies that Encourage Wasteful Consumption of Fossil Fuels: The
International Energy Agency estimates that the phase-out of fossil fuel subsidies – which amount
to more than $500 billion annually – would lead to a 10 percent reduction in greenhouse gas
emissions below business as usual by 2050. At the 2009 G-20 meeting in Pittsburgh, the United
States successfully advocated for a commitment to phase out these subsidies, and we have since
won similar commitments in other fora such as APEC. President Obama is calling for the
elimination of U.S. fossil fuel tax subsidies in his Fiscal Year (FY) 2014 budget, and we will
continue to collaborate with partners around the world toward this goal.

Leading Global Sector Public Financing Towards Cleaner Energy: Under this
Administration, the United States has successfully mobilized billions of dollars for clean energy
investments in developing countries, helping to accelerate their transition to a green, low-carbon
economy. Building on these successes, the President calls for an end to U.S. government support
for public financing of new coal plants overseas, except for (a) the most efficient coal technology
available in the world’s poorest countries in cases where no other economically feasible
alternative exists, or (b) facilities deploying carbon capture and sequestration technologies. As
part of this new commitment, we will work actively to secure the agreement of other countries
and the multilateral development banks to adopt similar policies as soon as possible.
Strengthening Global Resilience to Climate Change: Failing to prepare adequately for the
impacts of climate change that can no longer be avoided will put millions of people at risk,
jeopardizing important development gains, and increasing the security risks that stem from
climate change. That is why the Obama Administration has made historic investments in
bolstering the capacity of countries to respond to climate-change risks. Going forward, we will
continue to:

• Strengthen government and local community planning and response capacities, such as
by increasing water storage and water use efficiency to cope with the increased
variability in water supply
• Develop innovative financial risk management tools such as index insurance to help
smallholder farmers and pastoralists manage risk associated with changing rainfall
patterns and drought
• Distribute drought-resistant seeds and promote management practices that increase
farmers’ ability to cope with climate impacts.
Mobilizing Climate Finance: International climate finance is an important tool in our efforts to
promote low-emissions, climate-resilient development. We have fulfilled our joint developed
country commitment from the Copenhagen Accord to provide approximately $30 billion of
climate assistance to developing countries over FY 2010-FY 2012. The United States contributed
approximately $7.5 billion to this effort over the three year period. Going forward, we will seek
to build on this progress as well as focus our efforts on combining our public resources with
smart policies to mobilize much larger flows of private investment in low-emissions and climate
resilient infrastructure.

II.
Leading Efforts to Address Climate Change through International Negotiations
The United States has made historic progress in the international climate negotiations during the
past four years. At the Copenhagen Conference of the United Nations Framework Convention on
Climate Change (UNFCCC) in 2009, President Obama and other world leaders agreed for the
first time that all major countries, whether developed or developing, would implement targets or
actions to limit greenhouse emissions, and do so under a new regime of international
transparency. And in 2011, at the year-end climate meeting in Durban, we achieved another
breakthrough: Countries agreed to negotiate a new agreement by the end of 2015 that would
have equal legal force and be applicable to all countries in the period after 2020. This was an
important step beyond the previous legal agreement, the Kyoto Protocol, whose core obligations
applied to developed countries, not to China, India, Brazil or other emerging countries.

The 2015 climate conference is slated to play a critical role in defining a post-2020 trajectory.
We will be seeking an agreement that is ambitious, inclusive and flexible. It needs to be
ambitious to meet the scale of the challenge facing us. It needs to be inclusive because there is
no way to meet that challenge unless all countries step up and play their part. And it needs to be
flexible because there are many differently situated parties with their own needs and imperatives,
and those differences will have to be accommodated in smart, practical ways.
At the same time as we work toward this outcome in the UNFCCC context, we are making
progress in a variety of other important negotiations as well. At the Montreal Protocol, we are
leading efforts in support of an amendment that would phase down HFCs; at the International
Maritime Organization, we have agreed to and are now implementing the first-ever sector-wide,
internationally applicable energy efficiency standards; and at the International Civil Aviation
Organization, we have ambitious aspirational emissions and energy efficiency targets and are
working towards agreement to develop a comprehensive global approach.

bookmark_borderNoise Pollution

We’re so use to it that a lot of us hardly notice the noise that surrounds us everyday, but our hearts may be picking up the buzz.

Researchers in Germany had more than 100 people record their heart activity over several 6-hour spans. They also recorded surrounding noise levels.

The sounds were classified as either above or below a threshold of 65 decibels, which is the level of a normal conversation. The corresponding heart activity was then analyzed.

According to the results, the heart’s ability to adapt to acute events was affected by as little as a 5 decibel increase in exposure no matter what level the noise started at.

The researchers say their findings show that noise at low levels may be just as harmful to your health as noise at high levels.

Since the average age of the participants was 61, there is interest in repeating the study with younger people to see if the results are the same.

I’m Dr. Cindy Haines of HealthDay TV, with the news doctors are reading health news that matters to you.

Health And Wellness Guide
Industrial Noize Pollution: Music Good For Your Heart

bookmark_borderSound Thinking

A conversation on FaceBook about the Universal Hum / Om:

 

A Faulty Formula
A Faulty Formula

i’ve been trying to figure out how it fits into e=mc². i think i’m getting warmer…

Like · ·

Also of interest:
When an opera singer shatters glass — standing wave
* resonant vibration *
“A standing wave is formed when energy moves in two directions at once.”

bookmark_borderBrain Music: Improving Emergency Response Through Music

Every brain has a soundtrack. Its tempo and tone will vary, depending on mood, frame of mind, and other features of the brain itself. When recorded and played back to an emergency responder, say a firefighter, it may sharpen their reflexes during a crisis, and calm their nerves afterward.

Over the past decade, the influence of music on cognitive development, learning, and emotional well-being has emerged as a hot field of scientific study. To explore music’s potential relevance to emergency response, the Science & Technology Directorate (S&T) has begun a study into a form of neurotraining called “Brain Music” that uses music created in advance from listeners’ own brain waves to help them deal with common ailments like insomnia, fatigue, and headaches stemming from stressful environments.

“Because of the strains that come with an emergency response job, we are interested in finding ways to help these workers remain at the top of their game when working and get quality rest when they go off a shift,” said Department of Homeland Security (DHS) Program Manager Robert Burns. “Our goal is to find new ways to help first responders perform at the highest level possible, without increasing tasks, training, or stress levels.”

If the brain “composes” the music, the first job of scientists is to take down the notes. Each recording is converted into two unique musical compositions designed to trigger the body’s natural responses, for example, by improving productivity while at work, or helping adjust to constantly changing work hours. The compositions are clinically shown to promote one of two mental states in each individual: relaxation – for reduced stress and improved sleep; and alertness – for improved concentration and decision-making.

Each 2–6 minute track is a composition performed on a single instrument, usually a piano. The relaxation track may sound like a “melodic, subdued Chopin sonata,” while the alertness track may have “more of a Mozart sound,” according to Burns. (It seems there’s a classical genius—or maybe two genii—in all of us.) Listen to an example of an instrumental alert track.

After their brain waves are set to music, each person is given a specific listening schedule, such as once an hour for four hours each day, personalized to their work environment and needs. After an extended length of time, people may be able to listen to the music more sporadically. If used properly, the music can boost productivity and energy levels, or trigger a body’s natural responses to stress. A selected group of firefighters will be the first emergency responders taking part in the project.

The music is created by Human Bionics LLC, with the project conducted through the TechSolutions Program, in conjunction with the Human Factors Behavior Sciences Division. It is being tested as part of the Readiness Optimization Program (ROP), a wellness program that combines nutrition education and neurotraining to evaluate a cross population of first responders, including federal agents, police, and firefighters.

Since the ROP is supposed to help them sleep more soundly and eat healthier, the benefits should extend beyond the work environment and ultimately improve one’s entire life.

The nutrition component of the ROP has grown out of numerous clinical studies on nutrition and brain development, sleep, and aging, as well as from the fields of military and sports medicine. The Brain Music component is derived from patented technology developed at Moscow University to use brain waves as a feedback mechanism to correct physiological conditions.

The concept of Brain Music is to use the frequency, amplitude, and duration of musical sounds to move the brain from an anxious state to a more relaxed state. In British philosopher John Locke’s terms, Brain Music brings new meaning to his famous phrase: “A sound mind in a sound body, is a short, but full description of a happy state in this World.”

To request more information about this story, please e-mail st.snapshots@hq.dhs.gov.