Southern Regional JournalNo. 1

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Southern Regional Journal

Editor-in-ChiefPolicy Coordinator

Policy Editors

Daphne ZhangJoe SwansonMehak GuptaHannah ReissLouis Varriano

No. 1

We are pleased to share the !rst edition of the Roosevelt Institute | Campus Networks Southern Regional Journal series a series created to showcase a sample of the incred-ible policy work students are undertaking on college campuses across the south.

"is journal o#ers a compilation of ideas aimed at solving a variety of structural issues through changes in policy. "e chosen policies, which address issues ranging from food insecurity to water conservation, tend to focus on local, southern issues at the state and community level. "e journal also features students engaging in national and interna-tional policy. Nevertheless, each policy was carefully considered for its innovativeness and actionability.

Together, these proposals refute narratives that portray Millennials as uninformed, disengaged, and lethargic in the face of social issues. Moreover, the Southern Regional Journal stands as a denouncement of the Southern reputation for being complacent about matters of injustice. Whether its through the !eld of healthcare, economic devel-opment, education, equal justice, or sustainability, this journal seeks to accurately re$ect the reality that Southern institutions are increasingly the home of students contributing innovative solutions that aim to advance every level of society.

Independently, each idea is but a single solution. Collectively, however, these solutions construct a narrative, one that characterizes southern Millennials as advocates engaged in the creation of a more just world.

We hope you will join us in seeing these ideas realized.

Joe SwansonSouthern Regional Policy CoordinatorRoosevelt Institute | Campus Network

Daphne Zhang Editor-in-Chief Southern Regional Journal

Welcome!

Table of ContentsCooperative Housing: Fighting Homelessness and Poverty Corey Puckett | University of Tennesee, Knoxville

Curbing Evergreen Pharmaceutical Patent Protections Alexius Marcano | Emory University

Conserving Water in the Flint River Giovanni Righi | University of Georgie

Establishing an Arkansan State Bank Chirag Lala | Hendrix College

Food for the FutureAlex Puckett, Katie Lovejoy, Valerie Tucker, and Colton Houseman | Univer-sity of Georgia

Helping the Food-Insecure Purchase Nutritional Food at Farmers Markets Jason Walker, Joe Swanson, Sinthu Ramalingam, Pam Clough, Richard Caban-Cubero & Jared Sossin | Wake Forest University

Increasing Nutrition through Genetically Modi!ed Foods Erin Hollander | University of Georgia

Increasing Voter Turnout with Tax IncentivesJill Nguyen | Hendrix College

Mental Health First Aid in Pennsylvania Public SchoolsMuad Hrezi & Emily Cerciello | University of North Carolina, Chapel Hill

Reducing Vitamin D De!ciency in Georgia Sheela Sheth | University of Georgia

Revitalization of Historic Downtown Hot Springs Robert Taylor | Hendrix College

Shifting the Focus on Preschool Expansion Madelyn Schorr & Chisolm Allenlundy | University of Georgia

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1 Utah has reduced its chronic homelessness by 74 percent since 2005.1 Utah saves an average of $5,670 per person placed in permanent supportive hous-

ing, based on its original estimates prior to the programs initiation.3 By 2008, Housing First programs had helped reduce chronic homelessness by 30

percent.2

KEY FACTS

Cooperative Housing: Fighting Homelessness and PovertyCorey Puckett | University of Tennessee, Knoxville

To address chronic homelessness, Tennessee should create a Housing First Cooperative Initia-tive by adopting the Housing First Model, augmented with worker cooperative incubation.

The Idea

In 2005, Utah played host to 1,932 displaced persons qualifying as chronically homeless. In the same year, Utah began a ten-year plan to end chronic homelessness using a novel concept: they gave the homeless homes. Despite its intuitive appearance, many approaches to combating homelessness have focused on temporary placement and supportive programs intended to move the homeless eventually into permanent housing. Utahs plan follows the Housing First Model, a plan which envisions permanent supportive housing (PSH) with minimum requirements on placement.1 As a result of the models implementation, chronic homelessness has diminished in Utah by 74 percent.1 Following the 2008 recession, it has become even more imperative for other cities, states, and regions to follow suit.

History

The Housing First Model is successful because it neither places limiting restrictions on placements, nor does it provide only temporary shelter. The programs policy is to identify the people with the greatest need (those who suffer from physical or mentally illness, fami-lies, children, etc.) and works to place them in a PSH as quickly as possible. Once shelter has been provided, Housing First works to create a network of support for each individual to deal with the problems which may have restricted their eligibility in non-Housing First programs.1

The primary concern is the choice between reducing the financial burden of the homeless on the state versus the cost of the network of support and the cost of renovation or con-struction of the PSH. In 2005, Utah estimated that the average annual cost of providing an apartment and a social worker was $11,000 per person; alternatively, it was found that the average annual cost of E.R. visits and jailing per individual was $16,670. Obviously, the data should be formed for each state; however, Utahs findings are promising. These findings underscore the philosophy behind Housing First, because the lack of housing is not only the main concern in dealing with the homeless, but it is also the root cause of many of the afflictions that harm the individuals and place a strain on the states pocketbook.

Analysis

2Tennessee, and other states in the Southeast, should emulate Utahs initiative, and work to improve on it. For instance,worker cooperatives (WC), businesses owned and managed by its workers, in Cleveland have committed to provide suitable employment options for those who are being assisted by the Housing First program in order to support cooperative incubation to support workplace democracy and sustainable growth. To further support cooperative incubation, the state, or perhaps the federal government, could provide tax incentives to WCs that hire those who have utilized the PSH system. If these programs were combined, the transformation from a person living on the streets to a worker-owner would be remarkable.

Next Steps

1. Wrathall, Jonathan et al. 2013. Comprehensive Report on Homelessness. Salt Lake City: Utah Housing and Community Development. http://jobs.utah.gov/housing/

2. Swarns, Rachel L. 2008. U.S. Reports Drop in Homeless Population. The New York Times. July 30. Accessed March 1, 2014. http://www.nytimes.com/2008/07/30/us/30homeless.html?_r=0.

3. Shank, Jenny. 2013. Utah Is on Track to End Homelessness by 2015 With This One Simple Idea. December 19. Accessed February 22, 2014. http://www.nationswell.com/one-state-track-become-first-end-homelessness-2015/.

4. Schwartz, Judith D. 2009. In Cleveland, Worker Co-Ops Look to a Spanish Model. TIME.com. December 22. Accessed December 10, 2013. http://content.time.com/time/business/arti-cle/0,8599,1947313,00.html.

References

Non-Housing First programs are too restrictive and fail address the root issues that plague the homeless population.

The Housing First Model is financially efficient and effective in reducing chronic homelessness.

TALKING POINTS

3 The health of the riparian ecosystem supports agriculture, municipalities, and the species living in the river, and the water available to this ecosystem has become more strained in the last forty years.

Droughts cost the agricultural community hundreds of millions of dollars, so there needs to be a structure that allows for overall reduction in irrigation along with financing for drought irrigation reduction.

Current efforts by the Appalachicola-Chattahoochee-Flint Stakeholders will help to understand appropriate target water levels.

KEY FACTS

Conserving Water in the Flint RiverGiovanni Righi | University of Georgia

!e Georgia Environmental Protection Division should develop a volumetric water pricing system to conserve water on the Flint River and dedicate it to a fund that reduces water usage during droughts.

The Idea

Since the arrival of center-pivot irrigation in the 1970s, Georgias number of acres under irriga-tion has nearly doubled. !is has been the largest contributor to low "ows in the Flint River Basin, where streams have begun to run dry. Meanwhile, data suggest that Georgia will face more frequent droughts, exacerbating the water limitation.

!e Flint River Drought Protection Act (2000) directed the Environmental Protection Divi-sion (EPD) to develop an auction process that would provide incentives for farmers to reduce water usage in the Flint River Basin (FRB) during years when the Director of the EPD declares drought conditions. However, the auctions were deemed ine#ective at reducing drought, and there are no more funds available for auctions. As a result, the EPD lacked policy tools to cope with the drought of 2012.

Under Georgia statutes, any person who needs to withdraw more than 100,000 gallons per day of water must obtain ground water or surface water use permits from the EPD. Since July 30, 2012, there has been a moratorium on new withdrawal permits in the Lower FRB. !e agency is at an impasse unless it can pass the legislation necessary for the continuation of an aquifer water storage project, which is not certain to succeed and does nothing to address the underlying problem of drought.

History

!e root of the problem lies in the rules of the game by which farmers on the Flint River must make decisions regarding their livelihood. Water is very cheap; the only costs for farmers are the cost of pumping energy and payments on capital such as irrigation systems. !us the fact that water is scarce does not a#ect farmers decisions about whether to irrigate and how much water to use. Crop prices for water intensive crops, on the other hand, are high enough that farm-ers are able to make substantial pro$ts. Furthermore, there is currently no public goal for water levels. So while Flint River farmers may fear surpassing reasonable use or sustainable yield, the prevailing economic conditions may force them to do so.

Analysis

4!e Georgia General Assembly should authorize the EPD to collect and disburse funds. !e cost of water will have to be identi$ed with respect to variables such as crop prices and farm revenues. Certainly, EPD will need to consider whether larger farms are able to accept higher taxes than smaller farms. !e EPD can then develop a model relating water cost with water projections. !e EPD will also need to set a water target for ground and surface water usage, and develop a program to return the funds to the community in the event of drought. Local meetings on the Lower Flint River should be developed to encourage communication with stakeholders.

Next Steps

1. United States Geological Survey, Georgia Irrigation, 1979-80, A Decade of Growth, by Robert Pierce, Nancy Barber, and Harold Stiles. WRI 83-4177. Doraville, Georgia, 1984.

2. Edward Cook, et al., Drought reconstructions for the continental United States, Journal of Climate 12 (1999): 11451162.

3. Georgia Department of Natural Resources, Suspension of Consideration of Agricultural Withdrawal Permits in portion of the Lower Flint and Chattahoochee River Basins [Public Announcement], Judson Turner. 30 July 2012, http://www.gaepd.org/Files_PDF/news/20120730113433.pdf.

4. Yassert Gonzalez-Alvarez, Andrew Keeler, and Jeffrey Mullen, Farm-level irrigation and the marginal cost of water use: Evidence from Georgia, Journal of Environmental Management 80 (2006): 311-317.

5. Pam Knox, Agricultural Impacts of Drought on the Southeast US, (Presentation to the USDM Forum, April 2013), http://drought.unl.edu/Portals/0/docs/workshops/USDM%20Forum%202013/Wednes-day/Knox.pdf.

References

The amount of water available to users on the Flint River is becoming increasingly precarious as surface waters in the basin are beginning to dry during droughts.

Past strategies for managing the Flint River, including irrigation reduction auc-tions and a new water plan, have not taken effective steps to forestall the effects of droughts.

A volumetric pricing or user-fee program implemented by the Georgia EPD would provide the flexibility and costs needed to reduce water usage to target levels, particularly in drought years.

TALKING POINTS

A user-fee water pricing scheme can make farmers account for the cost of water, which would change in response to crop prices and climate. To reduce risk, publishing pricing information at the beginning of a growing season would ensure that the price is taken into account even if costs are paid at the end of the growing season. !is would both reduce water usage to a necessary base target rate and give the EPD su%cient authority to in"uence the outcome of droughts. Col-lected funds would a fund for further water planning or irrigation reduction auctions.

Agriculture makes up the largest portion of consumptive water use on the lower Flint River Basin, so the majority of interaction will need to occur between these communities and the Environmental Protection Division.

5 Healthcare expenses accounted for 62.1% of all individual bankruptcies in 2009, with illness and medical bills contributing to an increasing share of US bankruptcies.12

Lack of market competition for certain drugs artificially inflates healthcare costs while reducing incentives to innovate.13

Lower cost generic prescription drugs have saved the US healthcare system approximately $1.07 trillion over the past decade.14

KEY FACTS

Curbing Evergreen Pharmaceutical Patent Protectionsby Alexius Marcano | Emory University

Limit market protection duration granted to pharmaceutical patents to their initial lifetime by ending the evergreen loophole and issuing compulsory licenses allowing for the production of generic drugs.

The Idea

Upon the invention of any new useful creation, a patent is frequently sought to grant the inventing party exclusive rights for a limited time in exchange for public disclosure. !is legal protection grants intel-lectual monopoly over an invention which gives patentees sole discretion to produce, use, or sell their product.1 In the pharmaceutical industry, the pro$tability of a new drug provides incentives to invest in research and development for new treatments. Once the companys time frame for the exclusivity of a drug expires, other manufacturers start competing typically by producing a low-cost generic drug.

Using certain business and legal strategies, however, drug companies can prolong their patent protec-tions, which can already last up to 20 years.2 !rough the synthesis of drugs with similar chemical struc-tures or the combination of analogous formulas, it becomes possible to make small patentable changes to existing drugs before their patents expire.3 Pharmaceutical industries employ this process known as ev-ergreening to keep their exclusive market share and continue collecting pro$ts.4 !is practice e#ectively avoids the patent cli# where a product would face a decline in revenues as a result of competition.

History

To address the practice of evergreening and its costly consequences for patients, the patent process must be modi$ed by legislation to prevent minor and often insigni$cant chemical modi$cations of preexist-ing drugs from extending patents thus e#ectively barring introduction of generic versions to markets. Patented products should only be granted market exclusivity for the protections initial lifetime. !is would not change any existing intellectual property agreements, but would address the loophole which grants monopolistic protection to pharmaceutical companies as a result of minor changes to a product.5 Generic drugs could then be introduced to markets and o#er more a#ordable alternatives to the public, stimulating healthy competition over the markets shares in various pharmaceutical and health care are-nas.6 Generic drug $rms would respond to consumer demands for specialized drugs by developing super generics whose niche qualities can o#er advantages over the original product.7

Name-brand prescription drug makers have used evergreening as a means of shutting out potential competitors. While monopolistic exclusivity provides incentives for the development of breakthrough medications, the patent system is being exploited to make these protections inde$nite. Closing the evergreening market failure would promote e%cient competition among drug manufacturers while maximizing the consumer surplus by lowering prices. It is $nally time for the US to take a step towards economic equity by enforcing the spirit of patents rewarding innovation to bene$t the public.

Analysis

6Next Steps

1. Patents United States Patent and Trademark Office. Department of Commerce. http://www.uspto.gov/inventors/patents.jsp2. 2701 Patent Term [R-11.2013] United States Patent and Trademark Office. Department of Commerce. http://www.uspto.gov/web/of-

fices/pac/mpep/s2701.html3. Vernaz, Nathalie, Guy Haller, and Francois Girardin. Patented Drug Extension Strategies on Healthcare Spending: A Cost-Evaluation

Analysis. PLOS Medicine. June 4, 2013. 4. Hemphill, C. Scott and Sampat, Bhaven N., Evergreening, Patent Challenges, and Effective Market Life in Pharmaceuticals 2011.

Journal of Health Economics, Vol. 31, 2012; Columbia Law and Economics Working Paper No. 399. 5. Evergreening Drugs: An attack on access to medicines Access Campaign. http://www.msfaccess.org/content/evergreening-drugs-attack-

access-medicines 6. Schluter, Timothy. Weighing Two Drivers for Pharmaceutical Stocks. MarketMinder. Fisher Investments. July 22, 2011. http://www.

marketminder.com/s/fisher-investments-weighing-two-drivers-for-pharmaceutical-stocks/13ad7ca9-a3b7-404e-b2f4-fbf484f39321.aspx 7. Dey, Esha and Shinghal, Monika. Small generic drug firms need niches to survive looming price war. Reuters. July 20, 2012. http://

www.reuters.com/article/2012/07/20/us-genericdrugs-specialization-idUSBRE86J0ZI201207208. Morgan, Steve and Kennedy, Jae. Prescription Drug Accessibility and Affordability in the United States and Abroad. 2010. Issues in

International Health Policy. The Commonwealth Fund. 1408, Vol 88. 9. IP Law & Policy: Rulemaking. United States Patent and Trademark Office. http://www.uspto.gov/ip/rules/index.jsp.10. Compulsory Licensing of Pharmaceuticals and TRIPS. WTO. September 2006. http://www.wto.org/english/tratop_e/trips_e/pub-

lic_health_faq_e.htm.11. Bhat, Pratima. Drug Patent Evergreening: An Overview. July 26, 2012. http://blog.mmsholdings.com/blog/bid/86991/Drug-Patent-

Evergreening-An-Overview.12. Himmelstein, David U., MD, Deborah Thorne, PhD, Elizabeth Warren, JD, and Steffie Woolhandler, MD, MPH. Medical Bankruptcy in

the United States, 2007: Results of a National Study. The American Journal of Medicine. Physicians for a National Health Program. 2009.13. Kesselheim, Aaron S. Rising Health Care Costs and Life-Cycle Management in the Pharmaceutical Market. 2013. PLOS Medicine. Vol.

10, Iss. 6. 14. Savings: $1 Trillion Over 10 Years - Generic Drug Savings in the US. Generic Pharmaceutical Association4. 2012 http://www.gphaon-

line.org/media/cms/IMSStudyAug2012WEB.pdf.15. Moody, Glyn. Indian Supreme Court Rejects Trivial Evergreening Of Pharma Patents. Techdirt. April 1, 2013. https://www.techdirt.

com/articles/20130401/09233022536/indian-supreme-court-rejects-evergreening-pharma-patents.shtml.16. H.C. Drug Patents- A Fools Game. The Economist. April 01, 2013. http://www.economist.com/blogs/schumpeter/2013/04/drug-

patents

References

While evergreening is a major issue due to the sheer amount of people who are a#ected by the lack of access to a#ordable medications, it does have several solutions.8 !e US Patent and Trademark O%ce (PTO) has a fair amount of latitude on the issuance of protection from market competition.9 As such, the PTO should be directed to only provide market exclusivity for the patents initial lifetime, after which new pharmaceutical manufacturers can enter the market. In a case where the original patent-holder wishes to extend its intellectual property protections due to the alteration of an existing drug, it may still do so provided that they can demonstrate a signi$cant enough change in the function or formulation of the drug. !e partial extension of patent protection would remain contingent on the ability for new phar-maceutical developers to approach the original patentee for an operating license in exchange for $xed-term royalties.

To address existing instances of patent abuse, the US should use its existing compulsory license system which allows the grantee to produce the product without the patent owners consent.10 Compulsory licenses allow generic drug manufacturers to domestically produce low-cost versions of a drug while maintaining the patent owners property rights. Patent owners keep their right to be paid for authorized copies and wield arbitration power through exclusive partnerships with generic drug companies, defensive pricing strategies, and contin-ued product manufacturing.11

Renewing monopolies exploits the patents implicit bargain where a companys product will receive a government-backed monopoly in exchange for the public good brought from the invention upon the patents expiration.15

There is international precedent in the limiting of patent exclusivity in Australian law, which penalizes evergreening activities, and a historic ruling by Indias Supreme Court denying patents for incremental improvements.16

TALKING POINTS

7The following are projects that could potentially have costs reduced by the state bank: Arkansas schools require an estimated $4.5 billion in infrastructure funds while

the annual outlay for schools was only $1.5 billion between 2005 and 2008. Arkansas needs an additional $5.3 billion to improve drinking water infrastructure

in the next 20 years. In Arkansas, 2,929 bridges are structurally deficient or functionally obsolete.

KEY FACTS

Establishing an Arkansan State Bankby Chirag Lala | Hendrix College

Arkansas should establish a public state bank, modeled on the Bank of North Dakota, to sustainably $nance small businesses, local banks, and critical development projects.

The Idea

!e model for state banks is the Bank of North Dakota (BND). Founded in 1919, the BND lends primarily to community banks to increase their lending capacity and partially absorb risk from their in-vestments. As a result, North Dakota has a local lending per capita rate four times the national average, and the BND maintains a return on equity of 25 to 26 percent . By expanding lending to small busi-nesses and local development projects, the BND returned $300 million to the state general fund in the past decade. Additionally, North Dakota has the lowest unemployment rate in the nation at 2.6 percent. Based on this model, sixteen states have proposed bills to study or create banks.

!e National Highway System Designation Act (NHS Act) of 1995 established a pilot program of State Infrastructure Banks (SIBs). Utilizing Federal capitalization grants, the SIBs use various lending measures including revolving funds to fund infrastructure in a more targeted manner than traditional Federal reimbursement grants. Arkansas established a joint-SIB with Tennessee in 1997 but Arkansas loan agreement only totaled $31,000.

History

!e primary advantage of a state bank is o#ering recyclable and pro$table investments to local businesses and projects without the need for immediate pro$t maximization, thereby reducing interest rates and the need for repeated state expenditures. !e states economy would bene$t from increased lending by community banks with access to cheap loans and clearing services from a state bank. During a recession, the banks lending could counteract the decrease in private lend-ing and provide much needed stimulus to the states economy while reducing pressure on state aid.

!e bank would hold public funds and o#er low-interest loans, so borrowing costs for municipali-ties would decrease, while interest income could go directly to the state or to future investment. Federal funds and public-private partnerships would lessen the chances of pro$t loss and the state could withdraw funding if necessary.

Commercial banks with main o%ces in Arkansas, collectively holding over $50 billion in assets, represent prime sources of capital to be tapped and would bene$t immensely from the services a state bank could provide. Small businesses, contractors, and developers in Arkansas would directly bene$t from any renewed or expanded lending from invigorated local banks. !e BND

Analysis

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8!e State Bank of Arkansas (SBA) should be chartered directly via legislation and regulated by the exist-ing State Bank Department. Along with an initial capitalization of $250 million to $750 million from state revenue or bond issues, all state funds should be deposited in the SBA. !e same option should be o#ered to local banks and municipalities. !e SBA should also incentivize individuals and businesses to deposit their money in local banks. Arkansas should guarantee all deposits. !ese steps would enable Arkansas to build up a capital base for the bank as the years go by. Initially, projects would have their costs paid down, but as the banks capital base would expand, so to would the amount available for investment.

In addition, the state should subsequently direct smaller portions of its tax revenues, pro$t from the bank, and Federal aid back into the bank to increase its funds further each $scal year. !ese funds should be loaned to projects on a meritocratic basis with interest rates based on potential risk and contingency measures prepared for delays or failure.

Next Steps

Long term projects that are not immediately profitable such as school repair, wa-ter works, or infrastructure investment would finally receive additional funds.

An Arkansan state bank would provide community banks and local businesses with a cheaper source of credit and investment than Wall Street firms.

By holding public funds and providing low cost loans, the bank would reduce state and local borrowing costs and provide the state with profits and interest income for reinvestment into new projects.

TALKING POINTS

demonstrates that public banks do not compete with local banks since less than two percent of BND deposits come from consumers. Instead, local businesses and banks give the BND strong political support.

1. What You Should Know About Arkansas Infrastructure. American Society of Civil Engineers. 2013. http://www.infrastructurereportcard.org/a/documents/Arkansas.pdf.

2. Ibid.3. Ibid.4. Bank of North Dakota. Institute for Local Self-Reliance. May 5, 2011. http://www.ilsr.org/rule/bank-of-north-dako-

ta-2/.5. Ibid.6. Advantages. Public Banking Institute. Accessed December 1, 2013, http://publicbankinginstitute.org/advantages.htm.7. Ibid.8. Unemployment Rates for States. Bureau of Labor Statistics. Modi$ed December 20, 2013. http://www.bls.gov/web/

laus/laumstrk.htm.9. Rapoport, Abby. !e Peoples Bank. !e American Prospect. April 1, 2013. http://prospect.org/article/

people%E2%80%99s-bank-0.10. Chapter 4 - State Infrastructure Banks Federal Transit Administration. Accessed December 1st, 2013. http://www.fta.

dot.gov/12868_3538.html.11. Ibid. 12. Puentes, Robert and Jennifer !ompson. Banking on Infrastructure: Enhancing State Revolving Funds for Transporta-

tion, Brookings-Rockefeller, September, 2012, http://www.brookings.edu/~/media/research/$les/papers/2012/9/12%20state%20infrastructure%20investment%20puentes/12%20state%20infrastructure%20investment%20puentes.pdf.

13. Bank of North Dakota. 14. Rapoport. !e Peoples Bank. 15. Building State Development Banks. Public Banking Institute. Oregonians for a State Bank. September, 2010. http://

oregoniansforastatebank.org/wp-content/uploads/2010/10/Building-state-development-banks-0910.pdf. 16. About. Arkansas State Bank Department. Accessed January 19th, 2014. http://banking.arkansas.gov/about.

References

9Food aid was never part of any development policy, other than the one in support of export growth for developed countries. As early as the 1950s, [the Food and Agriculture Organization] had warned of the potentially harmful e#ects of food aid on local agriculture. Driving down food prices and encouraging increased consumption of wheat and dairy, (cheap imports from developed countries, including through food aid) often undermines local agricultural production. Unfortunately, [Marshall Plans are] not always successful, and for many countries, food aid is inte-grated into policies leading to structural food de$cits and increased dependency on food imports. For the poorest countries, such dependency combined with scarce resources to $nance imports has resulted in increased poverty and hunger.

Frederic MousseauFood Aid or Food Sovereignty? Ending World Hunger In Our Time

!e Oakland Institute, October 2005

!e United States should rethink its approach to international, non-emergency food aid. It should partner with micro$nance organizations to improve local agriculture, purchase food aid from local farmers rather than American farmers, work with Feed the Future to improve agricul-tural infrastructure, and gradually reduce the quantity of food given to developing countries.

Food for the FutureAlex Puckett, Katie Lovejoy, Valerie Tucker & Colton Houseman | University of Georgia

The United States spent $450 million on non-emergency food aid in 2012, a 17% increase from 2009.

Food aid caused a $125 million producer loss for Ethiopian farmers in 2012. Purchasing food aid locally could feed 2-4 million more people and shorten

harvest-to-mouth time by 11-14 weeks.

KEY FACTS

The Idea

HistoryFrom 2009 to 2012, the United States gave $1.65 billion in non-emergency food aid to developing countries. American food aid is purchased from U.S. producers, shipped abroad, and then distributed to citizens in countries of need. Although this method does feed the hungry, it hurts the recipient countries agrarian economies and their ability to become self-su%cient. For example, a case study in Ethiopia showed that American food aid caused a loss of $125 million for Ethiopian wheat producers.

However, the solution is not as simple as ending non-emergency food aid. !e Ethiopian case study revealed that the elimination of U.S. food aid would result in an annual net welfare loss of $37 per Ethiopian household because increased consumer prices would outweigh producer gains. Purchasing food aid from Ethiopian producers rather than American producers, though, would keep prices low for consumers and bene$t Ethiopian farmers. In addition, purchasing food aid from farmers in developing countries rather than from American farmers would reduce harvest-to-mouth time by eleven to fourteen weeks and could raise the number of people fed by two to four million.

USAID is the American foreign aid department, and its largest program tackling world hunger is called Food for Peace. Food for Peace was established in 1954 to send our nations surplus agricultural products to countries su#ering from food shortages. However, despite Congress appropriating funds for the program each year in the federal budget, food aid supplies are no longer from surplus stocks. Recently,

10

Non-emergency food aid is clearly an unsustainable investment. Yet, in 2012 alone, the United States in-vested $450 million in non-emergency food aid, which was a $75 million increase from 2009. Investing in local micro$nance initiatives and initially subsidizing local production will allow developing countries to become self-su%cient while also protecting consumers from drastic price changes. !is solution main-tains stability over time because, as local production increases, the United States can gradually reduce its spending on non-emergency food aid.

!e obstacles facing implementation comes from the American agricultural and shipping industries, which see $nancial gain from the current food aid arrangement. However, there are two ways USAID can overcome their objections to reducing the amount of American-produced food aid sent abroad. First, USAID spends much more on emergency food aid than non-emergency food aid: $2.5 billion on emergency aid versus $450 million on non-emergency aid in 2012, and emergency aid will not be a#ected by this policy solution. Second, repayment of microloans will provide a positive return on investment, and USAID can use that capital to subsidize American agribusinesses initially to decrease their yields.

Next Steps1. Partner with microfinance organizations to improve local agricultural production2. Once harvests have increased, purchase food aid from local farmers, effectively subsidiz-

ing local farmers to keep prices low for consumers and to encourage competition in the market place between local and foreign producers.

3. Partner with Feed the Future to educate farmers and work with governments to im-prove agricultural infrastructure.

4. After local agricultural infrastructure and farming technique has improved enough to compete with producers from developed countries, gradually reduced the amount of non-emergency food aid provided to developing countries.

1. US Food Aid and Security. (2013). Food Aid Programs. Retrieved from: foodaid.org/food-aid-programs/food-for-peace

2. Levinsohn, J. & McMillan, M. (March 2007). Does Food Aid Harm the Poor? Household Evidence from Ethiopia. Globalization and Poverty. Retrieved from www.nber.org/chapters/c0109.pdf

3. USAID. The Future of Food Assistance: U.S. Food Aid Reform.Retrieved from: www.usaid.gov/sites/default/files/documents/1869/TheFutureofFoodAssistance-USAidFoodReform.pdf

4. Provost, C. & Lawrence, F. (2012 July 18). US Food Aid Programme Criticised as Corporate Welfare for Grain Giants. The Guardian. Retrieved from: www.theguardian.com/global-development/2012/jul/18/us-multinationals-control-food-aid

5. US Food Aid and Security.6. Ibid.

References

though, there has been a movement away from purchasing mass amounts of American food and ship-ping it to developing countries. For example, Food for Progress is a division of the federal governments Food for Peace program that specializes in increasing the means of foreign farmers to produce goods on their own. !e organization trains farmers in animal and plant health and modern farming methods, improves infrastructure, establishes producer cooperatives, provides microcredit, and develops agri-cultural value chains. Feed the Future, another initiative of the U.S. government launched in 2010, is similar to Food for Progress in that it aids in the development of agricultural markets as a foundation for a sustainable solution to world hunger and poverty.

Analysis

11

Helping the Food-Insecure Purchase Nutritional Food at Farmers Markets Jason Walker, Joe Swanson, Sinthu Ramalingam, Pam Clough, Richard Caban-Cubero, and Jared Sossin | Wake Forest University

Forsyth County farmers markets should leverage the Electronic Bene$t Transfer (EBT) program to make nutritionally dense food more accessible for those reliant on the Supplemental Nutrition Assistance Program (SNAP) for food purchases.

The Idea

Forsyth County, NC, is among the most food-insecure counties in the United States. One in four children in North Carolina are food-insecure, meaning that their consistent access to adequate food is limited by a lack of money and other resources at times during the year; Winston-Salem, the Forsyth County seat, itself was ranked the third most food insecure metropolitan area in the nation in 2010 by the Food Research and Action Center.1,2 Forsyth County has over forty food deserts, or areas where access to fresh fruits and vegetables is limited by lack of availability, transportation, and funds within a one-mile radius or more.3

!e EBT program manages a debit-card like payment system, where users can electronically access their SNAP account, the modern day food stamps program. Many SNAP users rely on EBT for their transac-tions, and EBT makes it easier for charities to donate to SNAP users. Currently, out of the thirteen farm-ers markets in Forsyth County, only one market accepts EBT.4,5 !is is signi$cantly below the national average; slightly fewer than one-in-four farmers markets in America accept EBT.6 Farmers markets provide a regular supply of fresh fruits and vegetables to communities. !ose reliant on EBT cannot purchase food from these farmers markets, and are deprived of a key source of nutritionally dense food.

History

!e Beta Verde team runs the only farmers market in Winston-Salem that accepts EBT. In an interview, they cited several factors that allowed them to purchase a wireless EBT machine.13 Unlike most markets in the city, their market is highly organized with a central bank account, on-site and o#-site sta#, a permanent location, and a vendor fee to cover the markets expenses. !is structure allowed them to join an umbrella organization that awarded grant money to them, which they used to purchase the machine. Unfortunately, most farmers markets in Winston Salem cannot bene$t from these grants, since they lack this level of organization.

!e USDA and various charities provide a large body of grants to cover the costs of farmers markets purchasing EBT infrastructure, and the USDA has published a large body of material to help farmers markets utilize these resources and begin to accept EBT transactions.9 However, the dearth of farmers

Analysis

On average, 14.5% of Forsyth County residents used SNAP in 2011.7,8 Wireless EBT transaction machines cost $900 with a $30 per month internet fee, which is

difficult for most farmers markets to afford.9 One wireless EBT transaction machine can support EBT transactions for a whole market via

the USDA Scrip structure, which enables customers at markets to use an intermediate cur-rency, purchased with EBT, to make vendor transactions.12

KEY FACTS

12

The USDA offers funding to help farmers markets improve and meet the needs of low income people. 9

Available grants range from $2,500-$300,000 (Index). Even the minimum grant covers the cost of a wireless EBT machine and an internet connection for four and a half years.9

The small body of research that exists on the subject suggests that food prices at farmers markets, across the board, are not higher than food prices at grocery stores.11

TALKING POINTS

Forsyth County should create a small o%ce that will reach out to local farmers markets and connect them to preexisting grant money that will enable the markets to purchase EBT infrastructure. !is of-$ce will have only the local focus, so it will be able to adapt to the factors that have prevented national USDA e#orts from helping farmers markets in Forsyth. Furthermore, this o%ce will act as a resource making it easier for anyone to open a new farmers market in food-deserts. Finally, it should help farmers markets reach food-insecure audiences, since farmers markets are widely perceived as being more expen-sive than grocery stores.

1. What Is Food Insecurity? TFBN. Accessed March 7, 2014. http://tfbn.org/food- insecurity/.2. Food Hardship in America. 2010. http://frac.org/wp- content/uploads/2011/03/food_hardship_report_mar2011.pdf 3. USDA Economic Research Service - About the Atlas. Accessed March 7, 2014. http://www.ers.usda.gov/data-

products /food-access-research-atlas/about-the-atlas.aspx 4. Forsyth Futures. 2013. 4. http://www.forsythfutures.org/images/PDFs/forsythcounty_communityfoodsystem_2013.pdf 5. Forsyth County Farmers Markets. NC Cooperative Extension https://www.forsyth.cc/CES/Documents/farmers_mar-

kets.pdf6. Farmers Market Search. Agricultural Marketing Services. USDA. Accessed March17, 2014. 9 Mar 2014. http://

search.ams.usda.gov/farmersmarkets. 7. Food Environment Statistics for Forsyth County, North Carolina. City Data. Accessed March 7, 2014.8. Forsyth County, North Carolina. State & County Quick Facts. US Census Bureau. Accessed March 8, 2014. 9. A Guide to SNAP/EBT at Farmers Markets in North Carolina. USDA. Accessed March 7, 2014. 6 Jan 2014. 10. North Carolina State Salary, Average Salaries | PayScale. Accessed March 15, 2014. http://www.payscale.com/

research/US/State=North_Carolina/Salary. 11. Vermont Farmers Markets and Grocery Stores: A Price Comparison. NOFA: VT. Accessed March 10, 2014.12. EBT Scrip System. USDA. Accessed April 15, 2014. January 13, 2014. http://www.fns.usda.gov/ebt/scrip-system-

paper-scrip-token-or-receipts13. Nor"eet Ne#, Margaret, and Salem Nor"eet Ne#. Interview by Sinthu Ramalingam and Joe Swanson. Personal

Interview. Winston Salem, March, 2014.

References

Next Steps

markets in Winston-Salem that accept EBT proves that more action needs to be taken. To help Forsyth County farmers markets receive these grants, the county should set up a small o%ce whose function would be to help new and existing farmers markets obtain these grant funds. !is assistance could come in the form of business and structuring aid, fundraising, grant application assistance, and training on how to operate EBT machines.

Since over an eighth of the people in Forsyth County purchase with SNAP, accepting EBT opens farmers markets to an unprecedented client base, thereby increasing the pro$tability of farmers in food deserts. In addition, this also provides an easily-accessible source of fresh fruits and vegetables to the residents of food-deserts, where previously they had none. Following standard North Carolina hiring practices, the salary of an administrative assistant and o%ce manager to run the program would be $32,748 and $39,723 per year, respectively.10 With an estimated cost of website and publishing fees of $10,000 per year, this o%ce would cost the county less than $83,000 per year to run.

13

The process of creating and regulating a genetically modified organism takes a mean of 13.1 years and $136 million.4

Regulation alone takes 5.5 years4, and the high cost means that only large compa-nies can afford to pursue GMOs and only in a very limited number of organisms and traits.

A large part of the regulatory burden comes from duplication of assessments in each country of dispersal.

KEY FACTS

Increasing Nutrition through Genetically Modified FoodsErin Hollander | University of Georgia

To alleviate the burdens of high cost and time in the creation and regulation of beneficial genetically modified foods, an international ranking system should be created to rank the safety of GM foods and decrease duplication of assessment between countries.

The Idea

HistoryEach year, between 250,000 and 500,000 children from developing countries go blind due to a vitamin A deficiency. Half of those children die within a year.1 These deaths could be prevented if vitamin A supplements were available to families in areas of risk. One initia-tive combating this issue is the Golden Rice Project. Golden Rice is a genetically modified food, or GM food, that has been engineered to provide over 60% of the recommended daily vitamin A intake per serving.2

GM foods are crops meant for consumption in which the genetic code has been changed us-ing human biotechnology. These organisms can be modified for increased yield, nutritional value, or pesticide resistance, and as such have great potential to contribute to the resolution of the global food crisis. Unfortunately, this potential is tempered by the safety concerns of the long-term effects of GM foods on human and environmental health. Nonetheless, some GM foods, such as Golden Rice, are only modified for increased nutritional content. These foods produce materials that are already consumed naturally and are simply placed in com-mon foods such as rice. This allows families living in poverty to purchase GM food imbued with some necessary nutrient for almost, if not the same price as the traditional food.

Despite being ready for dispersal in the year 2000, Golden Rice has yet to pass all of the regulatory hurdles set for GM foods. The obstacles for Golden Rice and other such public good crops, despite their safety, are nearly insurmountable. A CropLife study4 found that it takes a mean of 13.1 years and $136 million to put a GM food on the market, money that non-profit organizations simply do not have.

One major boundary is the duplication of documents and data-gathering between countries, as each country has its own rules and requirements GM foods must pass before they can be planted. The cost and time it takes to pass each standard highly diminishes what a non-prof-it institution can afford. Only a small fraction of the cost of seeing a GM food to market is in actual safety assessment; the vast majority comes from this duplication of applications and the translation of safety documents into the language of the country.3

14

At the heart of the issue of duplication of regulatory documentation is the control countries wish to have of the genetically modi$ed organisms being imported and grown. !e safety of GM food is not globally accepted, and even benign foods like Golden Rice are viewed with caution. Any global policy relating to GM foods must therefore have a degree of "exibility built in so that countries can decide for themselves which crops to accept. In the case of GM foods, this "exibil-ity can be taken into account through an international system of ranking for risk assessment.

Much like the way chemicals are regulated, an international system of ranking could give a potential crop a rank in each of the two main areas of concern in GM foods: health e#ects and environmental e#ect. Each area has subcategories, as shown in the example ranking label below. !e ranks would be from 1 to 5, with risk increasing as the number increases, just as in chemi-cal regulation. A country, based on its view of GM foods, could use that risk assessment to place their own limit on which foods they accept. For example, if a GM crop that synthesizes zeaxan-thin (another nutrient aiding in eyesight) had a gene "ow score of 2, and a country decides to only accept GM foods with a score of 1, the producer and country both instantly know that the crop is unacceptable. (See Figure 1).

Analysis

!is approach has the dual bene$t of "exibility for countries and e%ciency for producers. !ough the ranking would be standardized, every country would be able to control the safety of the GM crops gaining entrance. Producers would know immediately if their product $t the regulatory standards of the country and could react accordingly, providing incentive to increase the safety of their crops. !e standardized assessment would also decrease the duplication of documents that hinders non-pro$t organizations, resulting in lower costs and more time for regulation of foods such as Golden Rice that are meant only for public health and not for pro$t.

The high cost and time of GM regulations means only big business, not non-profit research institutions, can afford to see a GM food to market.

This keeps beneficial and safe crops such as Golden Rice, which is meant only for pub-lic health and not for profit, from reaching the families who need them.

A standardized, international system of safety ranking would decrease the time and cost of creating a GMO while retaining safety levels and flexibility.

TALKING POINTS

15

Creation of the ranking system would not be di%cult, and could be administered by the Interna-tional Council for Science. !is is a non-governmental organization with members representing 140 countries that work to link scienti$c advances to policy and general bene$t for all. !ey have committees working on policy in various issues, but none at the moment for genetically modi$ed organisms. GMOs represent such a new issue that no international collaboration on regulation has been attempted before. Once a new committee created a ranking system, it would be up to participating countries to decide the levels at which they will accept GMOs. !e cost would be primarily administrative, and once implemented would save money due to decreased assessment materials.

Alleviating the burden that results from these unnecessary regulatory steps would increase the ability of non-pro$t organizations to create and market public good crops such as Golden Rice. With the greater likelihood of the food actually going to production, innovation in the area of public good crops would increase and more bene$cial inventions could be introduced. Develop-ing countries would see improved health from the nutritional advances while decreasing costs of regulation through the streamlined system. !ough safety will remain an issue requiring strict scrutiny, safe and bene$cial crops such as Golden Rice would have a smoother pathway to reach-ing those who need them.

Next Steps

1. Micronutrient De$ciencies. WHO. World Health Organization, n.d. Web. 25 Nov. 2013. .

2. Tang, Guangwen. Carotene in Golden Rice Is as Good as Carotene in Oil at Providing Vitamin A to Children. AJCN.nutrition.org. !e American Journal of Clinical Nutrition, 1 Aug. 2012. Web. .

3. GM Crops: !e Crushing Cost of Regulation. Agbioworld.org. !e AgBioWorld Foundation, n.d. Web. 20 Oct. 2013. .

4. Study: Cost of Bringing a Biotech Crop to Market. CropLife.org. CropLife International. Web. .

References

16

Increasing Voter Turnout with Tax IncentivesJill Nguyen | Hendrix College

Voter turnout rate is decreasing, with less than 60% participation by VEP in the 2012 presidential election and 41.7% VEP in 2010 midterm election1.

Voting-related giveaways and incentives that are only available for voters are cur-rently illegal under 18 U.S.C 597.2

18 U.S.C 597 doesnt distinguish between vote buying (reward for ones vote choice) and turnout buying (reward for just participating).

KEY FACTS

A system of tax incentives would increase voter turnout in federal and state elections, empha-size civic responsibility, and change political culture as a whole.

The Idea

HistoryVoting is undoubtedly an important political right. However, the voter turnout rate in the United States is decreasing, with roughly 58.7% of the voting-eligible population (VEP) taking part in the 2012 presidential election, compared to 62.6% VEP in the 2008.1 Voter turnout rate was even lower during midterm election, with 41.7% VEP in 2010.1

Voting has been made easier and cheaper through early voting, absentee voting, and same-day voter registration. Both the Democratic and Republican parties have attempted to maximize turnout, but only of their own bases.

Financially incentivizing voting is not a new idea. During presidential election years, multiple services have o#ered freebies to customers with an I voted sticker. Many campaigns have of-fered free rides to the polling station on Election Day. In 2006, a ballot referendum proposed to enter all Arizona voters into a 100-million dollars lottery after each general election.2 How-ever, according to Section 597, Chapter 18 of the United States Code titled Expenditures to In"uence Voting, all voting-related giveaways, if only available for voters, are forbidden.3

AnalysisHigh voter turnout strengthens the legitimacy of the democracy, ensures equal political repre-sentation, and changes the culture of politics. In Australia, where the voter turnout rate is usu-ally over 90%, knowing that registered voters from each partys base will vote, politicians focus more on the persuadable middle with bigger issues such as the economy, jobs and education, instead of divided issues like abortion, gay rights and guns control in the United States.4

As there is not distinction between vote buying and turnout buying in 18 USC 597, Congress should add appropriate language to clarify this important distinction. In a recent research on $nancial incentives for voters by Raymond La Raja and Brian Scha#ner, Associ-ate Professors at University of Massachusetts at Amherst, the results show that the incentives would attract more people with lower socio-economic status and education level, which is also the group least represented in politics. Share of voters with low incomes rose by 15 percentage points, while the share of voters with a high school education or less increased by roughly 12 percentage points.5

17

High voter turnout ensures equal political representation and makes politicians focus on big issues such as the economy, jobs, and education instead of divided issues to persuade independent voters.4

Financial incentives attract voters from the lower socio-economic and education status, who are also the least represented in politics.5

Tax deduction incentives that accumulate over the years of consistent voting participation has the potential to be more effective than voter turnout lottery.

TALKING POINTS

Democracy needs active, informed, and educated citizens. Besides tax incentives, Congress should continue making voting quick and convenient. Furthermore, Congress should invest in strong civic edu-cation programs, not only in schools, but also in the workplace, religious institutions and communities. !ese programs should also be accessible to people of low socio-economic status and education, people of color, and the immigrant community.

1. McDonald, Michael, 2012 General Election Turnout Rates, United States Elections Project, July 23, 2013, http://elections.gmu.edu/Turnout_2012G.html.

2. Hamid, Wael Abdel. Incentives to Vote: A Trivial Carrot or a Reliable Solution for Increasing Voting Turnout? Fair Vote, December 9, 2010, http://www.fairvote.org/research-and-analysis/blog/incentives-to-vote-a-trivial-carrot-or-a-reliable-solution-for-increasing-voting-turnout/

3. Expenditures to in"uence voting. Title 18 U.S. Code, Ch. 29 ONLINE. GPO Access. Available: http://www.gpo.gov/fdsys/pkg/USCODE-2011-title18/html/USCODE-2011-title18-partI-chap29-sec597.htm

4. Orstein, Norm, !e U.S. Should Require All Citizens to Vote, !e Atlantic, July 12, 2012, http://www.theatlantic.com/politics/archive/2012/07/the-us-should-require-all-citizens-to-vote/259902/

5. Raja, Raymond and Brian Scha#ner, Buying Voters: !e E#ects of Financial Incentives on Intentions to Vote (Paper presented at the America Political Science Association Annual Meeting, New Orleans, LA, August 30 September 2, 2012), http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2109019

References

Next Steps

Raja and Scha#ners research also suggests that using the lottery system for voters is not an e#ective incentive, as lottery systems o#ering few chances at larger payouts generated no such increases in turnout.5 As the people prefer the certainty of small gains over the uncertainty of large ones, a more e#ective incentive would be tax deduction, which can accumulate over the years with a consistent voting record. As tax is also an important civic duty, tying voting to tax would teach the public about the importance and bene$ts of exercising civic responsibility.

18

In Pennsylvania, 118,000 educators serve 1.8 million public school students daily.1,2 One in five youth currently meets criteria for a mental disorder.3 Half of mental illnesses in children remain untreated each year.4 The economic cost of untreated mental illness is more than $100 billion annually.5

KEY FACTS

Mental Health First Aid in Pennsylvania Public SchoolsErin Hollander | University of Georgia

Public school teachers in Pennsylvania should receive Continuing Professional Education credit for com-pleting the Mental Health First Aid program to promote early detection and treatment of mental illness.

The Idea

HistoryEvery day, children and adolescents living with mental illness struggle to access basic treatment resources. Currently, one in $ve youth meets criteria for a mental disorder6 but only half of a#ected children received treatment in the last year.7 Common mental disorders, including anxiety, mood, behavioral, and substance abuse disorders, often emerge in childhood and adolescence.8 !e average eight to ten year gap between the onset of symptoms and the start of treatment interventions4 is costly both for taxpayers and the health care system as a whole.

Mental Health First Aid (MHFA) is an interactive eight-hour training program that aims to help the public identify, understand, and react to signs of mental illness, or reduce the harm that an individual may cause to themselves or others when having a mental health crisis.9 MHFA strives to increase knowledge and con$dence, reduce stigma, and improve the e#ectiveness of a community in connecting individuals with unmet mental health needs to treatment resources.10

MHFA shows great promise for educators. At a Canadian university, educator training in Mental Health First Aid resulted in a knowledge increase of between 18 and 32 percentage points in every category of mental illness.6 Participants also reported a 30 percent increase in con$dence in their ability and likelihood to react during a mental health crisis. A course for high school teachers in Australia increased teachers knowledge, reduced stigma, and increased con$dence in providing help to students.11

AnalysisPublic school teachers in Pennsylvania should receive Continuing Professional Education (CPE) credit for completing the Mental Health First Aid program. Act 48 of 1999 requires all Pennsyl-vania educators with public school certi$cation to complete 180 hours of CPE every $ve years to remain certi$ed.12 Educators can meet these hours by pursuing collegiate study, completing approved CPE courses, or attending relevant trainings and conferences.13 Included are courses or noncredit activities in the areas of student health and safe and supportive schools,14 under which MHFA would qualify.

If MHFA training reaches just $ve percent of Pennsylvania educators, the program will a#ect 90,000 students.15 Approximately 360,000 Pennsylvania students experience some form of mental illness, with an estimated half of these cases remaining untreated.16 Currently, MHFA training is provided free of charge by several community organizations in southeastern Pennsylvania.17 MHFA is a practical and economical solution for Pennsylvania youth, as every $1 invested in mental health treatment saves $3 to $8 in reduced criminal activity and hospitalizations.18 Amid a

19

The U.S. Surgeon General considers schools to be a major setting for the potential recogni-tion of mental disorders in children and adolescents.20

Mental Health First Aid increases teachers ability to recognize signs of mental illness and provides strategies to connect students to treatment resources.21

Incentivizing teachers to complete MHFA by receiving CPE credit is a cost-effective solution for Pennsylvanias struggling mental health system.

TALKING POINTS

First, the Pennsylvania Department of Education must recognize MHFA as an approved CPE course to incentivize educator attendance. Second, the number of MHFA trainings and enrollment capacities for trainings must increase. To lay the foundation for sustainable success, implementation must begin at the grassroots level, with mental health advocates and educators contacting legislators and the Department of Education to recognize the Mental Health First Aid program as an approved CPE option.

1. Education Law Center, Facts About Public Education in Pennsylvania . Last modi$ed February 2006. Accessed November 21, 2013. http://www.elc-pa.org/pubs/downloads/english/imp-Facts About Public Education in PA.pdf.

2. Pennsylvania Department of Education, Child Accounting Data Files and Reports, Average Daily Attendance 2008-2009. http://www.education.state.pa.us/portal/server.pt/community/reports_and_data_$les/14671.

3. Mental Health: A Report of the Surgeon General. O%ce of the Surgeon General Center for Mental Health Services, National Institute of Mental Health. (1999). http://pro$les.nlm.nih.gov/ps/access/NNBBHZ.pdf (accessed Decem-ber 1, 2013).

4. National Institute of Mental Health, Use of Mental Health Services and Treatment Among Children. Accessed December 1, 2013. http://www.nimh.nih.gov/Statistics/1NHANES.shtml.

5. National Alliance on Mental Illness, What is Mental Illness: Mental Illness Facts. Accessed November 20, 2013. http://www.nami.org/template.cfm?section=about_mental_illness.

6. Mental Health: A Report of the Surgeon General. O%ce of the Surgeon General Center for Mental Health Services, National Institute of Mental Health. (1999). http://pro$les.nlm.nih.gov/ps/access/NNBBHZ.pdf (accessed Decem-ber 1, 2013).

7. National Institute of Mental Health, Use of Mental Health Services and Treatment Among Children. Accessed December 1, 2013. http://www.nimh.nih.gov/Statistics/1NHANES.shtml.

8. Mental Health: A Report of the Surgeon General. O%ce of the Surgeon General Center for Mental Health Services, National Institute of Mental Health. (1999). http://pro$les.nlm.nih.gov/ps/access/NNBBHZ.pdf (accessed Decem-ber 1, 2013).

9. Mental Health First Aid USA, About the Program: Program Overview. Last modi$ed 2009. http://www.mental-health$rstaid.org/cs/program_overview/.

10. Mental Health First Aid USA, First Aid Strategies. Last modi$ed 2009. http://www.mentalhealth$rstaid.org/cs/$rst_aid_strategies.

11. Jorm, A, B Kitchener, M Sawyer, H Scales, and S Cvetkovski. Evaluation of Mental Health First Aid training for high school teachers: A cluster randomized trial. BMC Psychiatry. no. 51 (2010). http://www.biomedcentral.com/content/pdf/1471-244X-10-51.pdf (accessed December 2, 2013).

12. Pennsylvania Department of Education, Act 48 Continuing Professional Education Requirements . Last modi$ed March 2013. http://www.cliu.org/cms/lib05/PA06001162/Centricity/Domain/21/FAQ Act 48 Continuing Profes-sional Education Requirements.pdf.

13. Pennsylvania Department of Education, General Laws and Regulations. http://www.portal.state.pa.us/portal/server.pt/community/laws_and_regulations/20314/general_laws_and_regulations/975030.

14. Pennsylvania Department of Education, Act 48 Continuing Professional Education Requirements . Last modi$ed March 2013. http://www.cliu.org/cms/lib05/PA06001162/Centricity/Domain/21/FAQ Act 48 Continuing Profes-

References

Next Steps

$55 million cut to Pennsylvanias mental health programs in 201219 and continued cost pres-sures in 2013, investing in early identi$cation and treatment can save money for the state while improving outcomes for vulnerable public school students.

20

sional Education Requirements.pdf.15. Pennsylvania Department of Education, Child Accounting Data Files and Reports, Average Daily Attendance 2008-

2009. http://www.education.state.pa.us/portal/server.pt/community/reports_and_data_$les/14671.16. Author calculation: 1.8 million public school students, with 1 in 5 meeting criteria for mental disorder, and half going

untreated17. Mental Health First Aid USA, Current Courses in Your Community. Accessed December 1, 2013. http://www.

mentalhealth$rstaid.org/current_courses.php?city=Philadelphia&State=Pennsylvania&postcode=&search=&distanceFromZip=25.

18. Mental Health Study Group Report. Scope. (2003). http://www.scopexcel.org/scope_studies/mental_health/scope.mentalhealth.studygroupreport.pdf (accessed November 19, 2013).

19. Lippman, Daniel. State Mental Health Cuts Hit Low-Income Patients Hard. !e Hu%ngton Post, 9 19, 2012. http://www.hu%ngtonpost.com/2012/09/19/state-mental-health-cuts_n_1897769.html (accessed January 16, 2014).

20. Mental Health: A Report of the Surgeon General. O%ce of the Surgeon General Center for Mental Health Services, National Institute of Mental Health. (1999). http://pro$les.nlm.nih.gov/ps/access/NNBBHZ.pdf (accessed Decem-ber 1, 2013).

21. Jorm, A, B Kitchener, M Sawyer, H Scales, and S Cvetkovski. Evaluation of Mental Health First Aid training for high school teachers: A cluster randomized trial. BMC Psychiatry. no. 51 (2010). http://www.biomedcentral.com/content/pdf/1471-244X-10-51.pdf (accessed December 2, 2013).

21

In Georgia, the number of osteoporotic fractures and hospital and long-term care costs of fractures are expected to increase to 49,500 and $450 million in year 2025, respectively. Vitamin D deficiency prevention can help reduce the rise. Men and women aged 50 and older in Georgia often do not realize the importance of healthy maintenance of vitamin D levels until they are diagnosed with osteoporosis or have a fracture because of vitamin D deficiency. The only program addressing vitamin D health is the Georgia Osteoporosis Ini-tiative, and it is currently not being funded by the state due to budget cuts. The Medical As-sociation of Georgia (MAG) should issue guidelines on vitamin D for providers to identify and treat patients at high risk for deficiency, and the Georgia Osteoporosis Initiative (GOI) should raise awareness of the guidelines. When providers incorporate the guidelines into patient visits, patients would learn how to make behavioral changes to maintain vitamin D sufficiency and thus have one less risk factor for osteoporosis.

History

The population of men and women aged above 50 will increase by 78% between 2000 and 2025 in Georgia, and there is expected to be a proportionate rise in hospital and long-term care costs due to fractures.

In 2000, there were 27,484 hospitalizations due to fractures; in 2025, there is expected to be 49,509 hospitalizations due to fractures.

Among 158 older people living in Northeast Georgia: 8.2% vitamin D deficient.

KEY FACTS

Reducing Vitamin D Deficiency in Georgiaby Sheela Sheth | University of Gerogia

Issuing and raising awareness of guidelines for providers to identify and treat at-risk patients for vitamin D deficiency would help reduce the expected rise in osteoporotic fractures in Georgia.

The Idea

By being identified and tested for vitamin D deficiency at an early stage, patients aged 50 and older would be more likely to correct the condition based on their providers advice before a fracture occurs. In a study on the effect of physician advice in osteoporosis preven-tion, 90 percent of women would be willing to make behavioral changes to prevent osteopo-rosis, such as taking multivitamins and exercising, based on their physicians recommenda-tions. Therefore, it is likely patients would be willing to make changes to ensure vitamin D sufficiency in the prevention of osteoporosis if given provider advice. This policy would lead to the most awareness throughout Georgia because providers individually reach out to patients. The GOI needs $250,000 per year of state funding to optimally meet its needs in operating its education programs. The program would need this amount of funding every year to raise awareness of the MAGs guidelines to providers. Providers would incorporate the guidelines into practice and advise patients to maintain vitamin D sufficiency. In the long term, patients would improve their bone health and decrease their risk for fractures because vitamin D deficiency has been shown to increase the initiation and propagation of cracks by 22 to 31%.

Analysis

22

Next StepsThe GOI and MAG should create a joint trial program on providers within a specified area using funding from the Healthcare Georgia Foundation. Providers in the trial program would be given guidelines based off the National Osteoporosis Foundation Clinician Guide-lines to educate patients on vitamin D and to screen patients at high risk for vitamin D defi-ciency. Providers would follow up on the usage of the vitamin D guidelines during patient visits through evaluations. After the guidelines are proven effective, the MAG would issue the guidelines for all providers throughout Georgia. The evaluations from the trial program and policy proposal would be presented to the Georgia legislature. The Georgia legislature would fund the GOI to educate providers on the MAGs vitamin D guidelines through newsletters, state health meetings, hospitals, local regional leaders, public health depart-ments, and Rural Health Clinics. Providers would screen patients at high risk for vitamin D deficiency and advise patients on the importance of vitamin D sufficiency in the prevention of osteoporotic fractures.

1. Russel T. Burge et al., The Cost of Osteoporosis in Georgia: Projections for 2000 2025, Procter & Gamble Pharmaceuticals (2000), http://www.gafp.org/documents/osteoporosis_cost_projection.pdf

2. Christine Hsieh et al., Health beliefs and attitudes toward the prevention of osteoporosis in older women, Menopause: The Journal of The North American Menopause Society 69, no.3 (2001), http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104936/

3. Lewis, Richard. Interview by Sheela Sheth. Athens, GA, September 6, 2013. 4. Bjorn Busse et al., Vitamin D Deficiency Induces Early Signs of Aging in Human Bone, Increas-

ing Risk of Fracture, Science Translational Medicine 5, no. 193 (2013), http://stm.sciencemag.org/content/5/193/193ra88.short

5. Russel, Cost of Osteoporosis in Georgia6. Ibid.7. Mary A. Johnson et al., Vitamin D Deficiency and Insufficiency in the Georgia Older Americans

Nutrition Program, Journal of Nutrition for the Elderly 27, no. (2008), http://www.ncbi.nlm.nih.gov/pubmed/18928189

References

Vitamin D deficiency is a risk factor for osteoporosis. Osteoporotic fractures lead to increased medical costs, more need of resources, a

decreased labor force, and higher mortality. Vitamin D guidelines should be issued in Georgia so that providers can educate

and advise at-risk patients.

TALKING POINTS

23

Many of the tourists attracted to Downtown HS must find hotels several miles away.

Restaurants are a large portion of consumer spending in Hot Springs (5th largest at $165,553,171) and most mid-sized tourist towns.

Residential structures with 20 or more households only make up 4.4% of the Hot Springs economy.

KEY FACTS

Revitalization of Historic Downtown Hot Springs by Robert Taylor | Hendrix College

Hot Springs, Arkansas community members and initial investors should come together to create a non-pro$t organization with the goals of creating an Initial Public O#ering (IPO) for the purchase, restoration, and the responsible transition of the buildings utilization in the Hot Springs economy.

The Idea

Downtown Hot Springs, Arkansas has seen rapid deterioration in the past 30 years, leaving many buildings listed on the National Historic Registry vacant and under-utilized. !is is because of the desire of a few downtown property owners to sell their buildings in bulk, instead of indi-vidually. !is has led to stalemates between property owners and prospective buyers who are not willing or able to buy and develop all the buildings at once. By converting these buildings into restaurants, hotels, and residential space, Downtown Hot Springs can become a more attractive tourist destination and sustain better level of business year round.

!is impasse has severely limited the economic potential of Downtown Hot Springs. Many buildings, including the 16-"oor Medical Arts Building, are only occupied by businesses in the bottom "oor. !is story is familiar for the Main Street of countless other mid-sized Southern cities. !is method of non-pro$t facilitated rehabilitation and economic revitalization can be applied as a model for development in similar cases.

History

When looking at Hot Springs employment, 46.4% of the citys working population is employed in the service sector. !is leads residents and onlookers to believe in the three Rs of the Hot Springs economy: restaurants, rooms, and residents. On average Hot Springs is visited by 3 million tourists annually who are attracted to the many lakes and other natural beauty, like the National Park that surrounds Downtown Hot Springs. For this reason, hotel rooms and restaurants are in high demand. Many visitors have to $nd hotels in other parts of town and travel to the downtown area, despite the number of vacant unrestored hotels downtown. When looking at Hot Springs consumer spending from 2010, restaurants are the 5th largest expenditure at $165,553,171. !is shows high demand for both of these services in Hot Springs.

!e last R brings in an aspect of Hot Springs economy largely over shadowed by its tourism sec-tor, the demand for residential living spaces. In 2010, residential purchases were the second largest consumer expenditure, generating $730,117,107 in purchases. When broken down by number of household units by units in structures, we see that apartments and structures with 20 or more house-holds make up only 4.4% of the Hot Springs Housing market. Considering the size of residential

Analysis

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24

Degradation of buildings like those in Hot Springs is often due to the negligence of property owners.

Non-profits formed by business and community leaders can help facilitate the purchase and rehabilitation of these buildings for both public and private benefit.

The non-profits should study and suggest the most practical and sustainable busi-ness models for the utilization of the buildings.

TALKING POINTS

Community members should take the necessary steps to form a non-pro$t to $nd investors to provide the initial capital to create a holding company and issue an IPO for the public ownership of buildings in Downtown Hot Springs, suggest $rms for the restoration of the properties, and provide suggested business models for the sustained use of the revitalized buildings. !e investors could either be investment $rms or individuals with the private capital to purchase the stock which would raise enough capital to purchase the buildings wholesale from the original property owners.

When the buildings have been purchased by the public stockholders, the non-pro$t will be respon-sible for the solicitation of services from architectural, contracting, and development $rms specializ-ing in restoration. !e majority of the capital for these restorations would be provisioned in the stock prices for ownership of the buildings and other sources of equity such as State and Federal tax credits.

!e non-pro$t organization lead by business minded community members would then be respon-sible for the consultation of entrepreneurs and city planners on sustainable business models for the newly restored buildings. !is will be based on target industries such as needed service sector improvements in the area (i.e. restaurants and hotels), and meeting the demand for residential space by increasing the number of available multi-household living structures (i.e. apartments and town-houses).

!is model can be applied to many other towns across the South whose economy relies partially on tourism. Many of these towns are located in areas attractive for their natural beauty and have been visited for many years by vacationers. !e footprint of this history lies in the buildings that have been erected in the towns hay-day years, and have since stood witness to their own degradation and ne-glect. Whether due to urban sprawl or the poor stewardship of property owners, these buildings are unattractive to developers and must be made into more appealing investments if there is any chance of saving them. By applying this model to Hot Springs and other mid-sized towns across the South, communities can take ownership of their history and save their heritage.

1. Market Pro$le: 5 Counties; Garland County; Hot Springs. Rep. N.p.: Esri Market Research, n.d. Hot Springs Metro Partnership Data Center. Web. 13 Mar. 2014. .

2. Nelson, Rex. !e !ree Rs for Downtown Hot Springs Rex Nelsons Southern Fried. Rex Nelsons Southern Fried. N.p., 26 Feb. 2014. Web. 13 Mar. 2014.

References

Next Steps

purchases in 2010, we can see that this is not a lack of demand, but a lack of supply.

When considering the demand for the three Rs of Hot Springs economy, it is easy to see that if hotel rooms, restaurants, and residential living were o#ered downtown, they would thrive. !is would not only aid the tourism industry during the popular tourist seasons, but also residential space, would stimulate the businesses in downtown year round with local clients and customers.

25

The High/Scope Perry Preschool Project found a total cost/benefit ratio of $16.14 for each $1 invested in preschool, in the monetary value of the 2000 dollar when the children in their study reached the age of 40 years.14

The 2011-2012 school year saw a drop in preschool funding nationwide of $500 million dollars, coupled with a stagnation in enrollment rates.11

States fell back in a total of nine of NIEERs quality benchmarks, most of which were for site visits to monitor program quality.15

Only 15 states plus D.C. could be verified as providing enough per-child funding to meet all 10 benchmarks for quality standards.16

KEY FACTS

Shifting the Focus on Preschool ExpansionMadelyn Schorr & Chisolm Allenlundy | University of Alabama

States should discontinue their approach of recklessly creating new preschools and move to a quality over quantity approach, which would focus on establishing a rigorous monitoring system to ensure a consistently high quality of academics and educational infrastructure.

The Idea

In 2011-2012, states spent $5.1 billion1 on preschool funding. With 1,332,663 children enrolled, thats $3,841 spent per child2. !ough these numbers re"ect a decade-long increase in state fund-ing for preschool programs, they are actually signi$cantly lower than in the previous year. !is may signal a new trend in decreased funding as a result of tighter state budgets. While many states have managed to raise enrollment rates for preschool programs, they have yet failed to ensure that new preschools are of high quality. For instance, according to the National Institute for Early Education Research (NIEER), 7 state programs reported losses in benchmarks reporting quality, whereas only 3 states posted gains. !is approach, as we will call a quantity over quality approach, has the e#ect of creating hundreds of preschools that do little to provide a foundation for intellectual growth. In fact, state spending per child has decreased by more than $1,100 since 2001-20023, resulting in decreased quality of numerous programs.5

NIEERs quality benchmark checklist is a product of several research studies that a%rm the im-portance of preschool characteristics such as small sta#, child ratios, and overall program quality6. Currently, only four states public preschool programs meet all ten NIEER benchmarks, and only 32 meet the monitoring benchmark, which requires that site visits be done at least every $ve years7. !ough monitoring is currently not mandated by all states with public preschool programs, those 32 states that do utilize an integrated monitoring system consistently meet more NIEER benchmarks on average8. States that make site visits met an average of 7.78 benchmarks, while states without site visits met only 5.75, barely more than half9. !is is largely due to the fact that regular site visits allow states to verify the e%cacy of individual policy changes made to their respective programs7. In doing so, states can address pressing issues, raise the number of benchmarks met, and improve the overall quality of their programs.

!e most troubling aspect of the quality over quantity approach is the decision to neglect systematic monitoring programs in an attempt to salvage funds. !ese systematic monitoring programs allow states to continually update accreditation, conduct sta# evaluations, and con$rm that the preschool adequately complies with state curriculum. Ignoring this key practice keeps states from constantly

History

26

evaluating and improving their preschool programs resulting in weaker student development and fewer returns on investment.

Americas decades-long decline in competitiveness stems largely from a decline in the relative quality of its education system. By improving preschool across the country, we will ensure that all children have the chance to achieve, both in school and in the workforce. In fact, average bene$ts from a universal preschool system are expected to be as much as $25,000 per child, signi$cantly outweighing the costs10.

As previously stated, one of the most troubling trends in preschool education is the lack of willingness to utilize consistent, thorough monitoring programs. !ese monitoring programs come at a mod-est cost, but highly improve the quality, and thus results, of preschool programs. As NIEER research has a%rmed, monitoring programs allow states to analyze e#ective and ine#ective strategies in their preschools, as well as to address concerns through changes in policy 11.

Some opponents claim that many states are too rural to support high-functioning preschool pro-grams, much less consistent monitoring programs. However, some of the least densely populated states, such as Alaska, Nevada, and Oregon have all managed to produce high-quality preschool programs equipped with active site visits12.

Others contend that constant monitoring is a strain on funding that could be diverted to other needs within these preschool programs. Yet without a sustained emphasis on educational performance, preschools will simply not produce the e#ects that we as a society and our children require.

Moreover, in creating such monitoring systems, states will be able to recover millions of dollars that have been directed toward preschool programs that currently have little to no e#ect on the quality of their students education. For instance, Ohio spends $22,467,862 on pre-school funding only to meet three of NIEERs standards benchmarks13. Monitoring systems will help bridge the gap between output and outcome.

States should begin mandating site visits to every operational preschool site. !ese visits should take place annually, and will ensure that each site meets the high quality standards set forth by the state.

In addition, mandating these visits will certainly require more funding than is currently allotted to most preschool programs. !ere are numerous options that states have for increasing funding including altering school funding formulas to include preschool in typical K-12 education and diverting lottery and sin taxes toward preschools. Such policy decisions would make preschools more recession-proof, especially since they often tend to be the $rst hit in tough economic times.

Next Steps

States that have mandated monitoring systems consistently score higher on other quality checklists, including teacher effectiveness, early learning standards, and staff-student ratios17.

Regular site visits are invaluable in ensuring that tax-funded preschools meet the qual-ity standards that are mandated by the state, and are part of a continuous improve-ment process in state programs.

10 states spend millions of dollars on preschool programs that reap few benefits due to a lack of sufficient monitoring18.

TALKING POINTS

Analysis

27

All of these $xes begin with states having publicly-funded preschool programs. !ough most states have taken steps to create these programs, there are still some states in which no such programs exist. !ese states should act immediately to ensure that they have such pre-k programs in place.

1. Schilder, Diane, Stephanie Kimura, Kim Elliott, and Stephanie Curenton. Perspectives on the Impact of Pre-K Expansion Factors to Consider and Lessons from New York and Ohio. Preschool Policy Brief. no. 21 (2011): 2. http://nieer.org/resources/policybriefs/22.pdf (accessed December 1, 2013).

2. Barnett, W. Steven, Megan E. Carolan, Jen Fitzgerald, and James H Squires. State Preschool Yearbook Executive Summary. !e State of Preschool 2012. (2012): 3-18. http://nieer.org/sites/nieer/$les/year-book2012_executivesummary.pdf (accessed December 1, 2013).

3. Ibid 24. Ibid 25. Ibid 26. Ibid 27. Ibid 28. Ibid 29. Ibid 210. Schweinhart, Lawrence J. , Jeanne Montie, Zongpig Xiang, W. Steven Barnett, Clive R. Belfeild, and Mila-

gros Nores. !e High/Scope Perry Preschool Study !rough Age 40. (2005): 3. http://www.highscope.org/$le/Research/PerryProject/specialsummary_rev2011_02_2.pdf (accessed December 1, 2013).

11. Ibid 212. Barnett, W. Steven, Megan E. Carolan, Jen Fitzgerald, and James H Squires. State Preschool Yearbook Exec-

utive Summary. !e State of Preschool 2011. (2012): 32-157 http://nieer.org/sites/nieer/$les/2011yearbook.pdf (accessed December 1, 2013)

13. Ibid 1214. Ibid 1215. Ibid 1216. Ibid 1217. Ibid 1218. Ibid 12

References