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Reflections on Practice : Access to Health Care / directed by: Nettie Wild ; production agencies: National Film Board of Canada (Montreal), British Columbia Centre for Disease Control. Street Nurse Program (Vancouver)

Montreal : National Film Board of Canada, 2019




reflections

Reflections on Practice : Supervised Injection / directed by: Nettie Wild ; production agencies: National Film Board of Canada (Montreal), British Columbia Centre for Disease Control. Street Nurse Program (Vancouver)

Montreal : National Film Board of Canada, 2019




reflections

Reflections on Practice : From Novice to Expert / directed by: Nettie Wild ; production agencies: British Columbia Centre for Disease Control. Street Nurse Program (Vancouver), National Film Board of Canada (Montreal)

Montreal : National Film Board of Canada, 2019




reflections

UK-Africa Relations: Reflections on the Role of African Diplomacy in London

Invitation Only Research Event

13 January 2014 - 11:00am to 12:00pm

Chatham House, London

Event participants

HE Professor Kwaku Danso-Boafo, High Commissioner for Ghana to the United Kingdom
Chair: Alex Vines OBE, Research Director, Area Studies and International Law; Head, Africa Programme, Chatham House

Rapid economic growth and more widespread political stability have catalyzed increased international engagement with Africa in the past decade, as African states develop more significant roles in the global economy and political cooperation in geopolitics. Accompanying this is a shift in British engagement with African states from one with a development aid emphasis to one focused on trade and political cooperation.

HE Professor Kwaku Danso-Boafo will reflect on his time in London, developments in UK-Africa relations, the role of diplomatic engagements in informing and strengthening bilateral relations and the prospects for intergovernmental cooperation on African and global issues.

Attendance at this event is by invitation only.

Department/project




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Immigration Policy and Less-Skilled Workers in the United States: Reflections on Future Directions for Reform

Notwithstanding the broad consensus on the benefits of highly skilled immigration, the economic role of less-skilled immigrants is one of the more controversial questions in the immigration debate. While less-skilled immigrants bring economic benefits for U.S. consumers, employers, and skilled workers, they impose some costs on U.S. workers competing for similar jobs.




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Reflections from Breakthrough Marine Energy Trials

The lush hills of Strangford Lough are truly a place of magic scenery. Portaferry, a small fishing village, is located one hour’s drive from Belfast in Northern Ireland, and is today perhaps most famous for being close to the location where blockbuster Games of Thrones is filmed. In this idyllic fishing village, struggling with a high unemployment rate and a diminishing population, something new and prosperous is growing. Looking out over the calm waters of Strangford Lough, one could hardly believe that under the ocean surface — that electricity can be produced.




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Some reflections on symmetry: pitfalls of automation and some illustrative examples

In the context of increasing hardware and software automation in the process of crystal structure determination by X-ray diffraction, and based on conference sessions presenting some of the experience of senior crystallographers for the benefit of younger colleagues, an outline is given here of some basic concepts and applications of symmetry in crystallography. Three specific examples of structure determinations are discussed, for which an understanding of these aspects of symmetry avoids mistakes that can readily be made by reliance on automatic procedures. Topics addressed include pseudo-symmetry, twinning, real and apparent disorder, chirality, and structure validation.




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Reflections on a changing Washington, D.C.

Peter Sefton, D.C. Preservation League trustee, reflects on how Washington, D.C. has changed in recent years. (Anacostia Community Museum video series)  

The post Reflections on a changing Washington, D.C. appeared first on Smithsonian Insider.



  • History & Culture
  • Video
  • Anacostia Community Museum

reflections

Award Winning Author And Traveling Researcher Donna Fletcher Crow Celebrates The Power Of Story With Trans-Canada Adventure, Disney World Reflections, Books Detailing Christmas Customs

Crow writes meticulously researched, entertaining novels of romance, history and mystery in an engaging you-are-there style that allows readers to live the history.




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CSS3 Reflections

Using CSS3 and SVG to produce 'reflections' for Firefox 4 and 5 (as well as Safari and Chrome).




reflections

CSS play - Image reflections

A CSS only method of producing image reflections on solid background colors.




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Long-term ecological reflections: writers, philosophers, and scientists meet in the forest

Over the past 7 years, a strong collaboration has emerged between the H.J. Andrews Experimental Forest ecosystem research group and the Spring Creek Project for Ideas, Nature, and the Written Word, an independently funded program for nature writing based in the Department of Philosophy, Oregon State University. The program is called Long-Term Ecological Reflections and it brings together scientists, creative writers, and environmental philosophers to consider new ways to conceptualize and communicate views of long-term ecological change in forests and watersheds and the participation of humans in that change. The program is designed to parallel the Long-Term Ecological Research program, a national science program initiated in 1980 and involving the Andrews Forest. Both programs focus on primary inquiry and have 200-year planning horizons, which have resulted in some uniquely farsighted perspectives and astute ecological observations.




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After 37 years, time for reflections and thanks


Jon Talton, The Seattle Times economics and business columnist for the past 12 years, says goodbye and offers some parting thoughts.




reflections

Podcast: Write It – Reflections on Sanctuary Road (Jan 10, 2020)

MORAVEC, P.: Sanctuary Road Laquita Mitchell, Raehann Bryce-Davis, Joshua Blue, Malcolm J. Merriweather, Dashon Burton, Oratorio Society of New York, Kent Tritle 8.559884 WQXR radio host Terrance McKnight introduces the world premiere recording of an oratorio by composer Paul Moravec and librettist Mark Campbell. It’s a deeply moving tribute to the men and women of the Underground Railroad and to one heroic man in ...more




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Reflections on Campus Collaboration and Virtual Tools

On April 24 Divided Community Project (DCP) Deputy Director Bill Froehlich and Steering Committee Chair Grande Lum joined HNMCP’s Neil McGaraghan and Kyle Strickland (from the Kirwan Institute for the Study of Race and Ethnicity) to record a webinar session for the ABA’s virtual conference. Bill shares a few reflections on the session which focus … Continue reading Reflections on Campus Collaboration and Virtual Tools




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Video: Reflections Of Hope, Caught In Net

The Revelation of Hope Ministries recently shared a video online titled ‘Reflections of Hope Episode 3: Caught in the Net.’ The video follows Taj Pacleb, from the Revelation of Hope Ministries, as he explores various underwater landscapes, focusing predominantly on an experience he had in Bermuda. In the video, Pacleb says, “The ocean is an […]

(Click to read the full article)




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Reflections




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Reflections on the judicial system in Malta

One is often surprised when one reads about the trials and their outcome in Malta. What is most astonishing is how long time it takes in Malta between a crime is committed and the perpetrator’s identity is known to the police and the trial takes place.

The Court House in Valletta, Malta
In today’s The Times one can read about a hold-up that had taken place in 2007. Obviously a firearm was used and goods of substantial value were taken. If the police got to know about the robber’s identity in 2011 one can understand why the trial took place in February 2012, but that seems not to be the case.

One of the most outrageous cases is the one regarding a man, who was jailed in April 2011 and sentenced to 29 years after he was found guilty of the murder of a prostitute who was killed in 1999. The circumstances around the killing and the man who was later convicted were known to the police in a much earlier stage. 

One can reflect in these cases on what the then suspected men did during the time between the crimes and the trials. Were they still on the loose or were they kept in custody without trial for all these years, probably not the latter. One can also wonder how the murdered girl’s relatives felt. All their sorrow must have been experienced once more, especially as Maltese papers publish names and details and even the name of the community where they live.  It is also unfair to a suspect not to have his case tried; he might be innocent. Almost every week you can read about cases like these. 

The same, or even worse, goes for civil cases that can go on for much more than a decade to be ruled by a court.




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SCIE report 68: SCIE learning together - reflections from the South West project

Report 68 published by the Social Care Institute for Excellence (SCIE) in November 2014. This report will help readers to understand the Learning Together methodology.




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Reflections on the Brexit Election

Invitation Only Research Event

6 December 2019 - 8:30am to 9:30am

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Alistair Burt, Conservative Member of Parliament (1983-97 and 2001-19); Minister of State for the Middle East, UK Foreign & Commonwealth Office and Minister of State at the Department for UK International Development (2017-19)

On 12 December 2019, the United Kingdom will hold one of its most crucial elections in the 21st century. The result will have a direct impact on the Brexit process and will most likely determine the country’s future direction for years to come.  

Yet the final outcome is far from predictable. It seems quite certain that the 2019 election is unlikely to produce a clear two-party share of the vote as happened back in 2017. Public trust in politicians is low and party loyalty is looser than ever. Polls show that Brexit it overwhelmingly considered as the main issue among the electorate alongside a deep concern about the future of public services. This raises multiple questions: can the 2019 election represent a chance to unite the country and move on? Will cross-party identities of ‘Leavers’ and ‘Remainers’ translate to how people vote in the election? And what will the outcome mean for Brexit and the future of party politics in Britain? 

Attendance at this event is by invitation only. 

Event attributes

Chatham House Rule

Alina Lyadova

Europe Programme Coordinator




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Reflections from the Munich Security Conference on America’s Role in the World

Invitation Only Research Event

17 February 2020 - 8:00am to 9:15am

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Senator Chris Coons, United States Senator, Delaware
Chair: Dr Leslie Vinjamuri, Director, US and Americas Programme

In the aftermath of World War II, the United States cemented its role as the leader of a new global order, characterized by the creation of international institutions and treaties like the United Nations and North Atlantic Treaty Organization. More recently, however, the United States has appeared to take an inward turn, a trend which has been mirrored across the globe and has led to the international order being challenged more now than ever before.

As the Trump administration and US members of Congress attempt to address multiple challenges from a rising China and a disruptive Russia to a nuclear North Korea and shifting Middle East, Senator Chris Coons will offer his vision for restoring American leadership on the world stage.What is the role of Congress in setting and shaping US foreign policy?  How will the outcome of the consequential 2020 elections shape the future of America’s global role? Would a change in administration necessarily increase prospects of American reengagement, and if so, across which international spheres?

Event attributes

Chatham House Rule

Department/project

US and Americas Programme




reflections

Reflections on the State of Political Discourse




reflections

Reflections from the Munich Security Conference on America’s Role in the World

Invitation Only Research Event

17 February 2020 - 8:00am to 9:15am

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Senator Chris Coons, United States Senator, Delaware
Chair: Dr Leslie Vinjamuri, Director, US and Americas Programme

In the aftermath of World War II, the United States cemented its role as the leader of a new global order, characterized by the creation of international institutions and treaties like the United Nations and North Atlantic Treaty Organization. More recently, however, the United States has appeared to take an inward turn, a trend which has been mirrored across the globe and has led to the international order being challenged more now than ever before.

As the Trump administration and US members of Congress attempt to address multiple challenges from a rising China and a disruptive Russia to a nuclear North Korea and shifting Middle East, Senator Chris Coons will offer his vision for restoring American leadership on the world stage.What is the role of Congress in setting and shaping US foreign policy?  How will the outcome of the consequential 2020 elections shape the future of America’s global role? Would a change in administration necessarily increase prospects of American reengagement, and if so, across which international spheres?

Event attributes

Chatham House Rule

Department/project

US and Americas Programme




reflections

Reflections on the Brexit Election

Invitation Only Research Event

6 December 2019 - 8:30am to 9:30am

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Alistair Burt, Conservative Member of Parliament (1983-97 and 2001-19); Minister of State for the Middle East, UK Foreign & Commonwealth Office and Minister of State at the Department for UK International Development (2017-19)

On 12 December 2019, the United Kingdom will hold one of its most crucial elections in the 21st century. The result will have a direct impact on the Brexit process and will most likely determine the country’s future direction for years to come.  

Yet the final outcome is far from predictable. It seems quite certain that the 2019 election is unlikely to produce a clear two-party share of the vote as happened back in 2017. Public trust in politicians is low and party loyalty is looser than ever. Polls show that Brexit it overwhelmingly considered as the main issue among the electorate alongside a deep concern about the future of public services. This raises multiple questions: can the 2019 election represent a chance to unite the country and move on? Will cross-party identities of ‘Leavers’ and ‘Remainers’ translate to how people vote in the election? And what will the outcome mean for Brexit and the future of party politics in Britain? 

Attendance at this event is by invitation only. 

Event attributes

Chatham House Rule

Alina Lyadova

Europe Programme Coordinator




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Personalized Management of Hyperglycemia in Type 2 Diabetes: Reflections from a Diabetes Care Editors' Expert Forum

Itamar Raz
Jun 1, 2013; 36:1779-1788
Diabetes Care Expert Forum




reflections

Cardiovascular Outcomes Trials in Type 2 Diabetes: Where Do We Go From Here? Reflections From a Diabetes Care Editors Expert Forum

William T. Cefalu
Jan 1, 2018; 41:14-31
Diabetes Care Expert Forum




reflections

Cardiovascular Outcomes Trials in Type 2 Diabetes: Where Do We Go From Here? Reflections From a Diabetes Care Editors Expert Forum

William T. Cefalu
Jan 1, 2018; 41:14-31
Diabetes Care Expert Forum




reflections

The International Migration System: Reflections on the Challenges and Opportunities Ahead

A reflection by MPI's co-founder, Demetrios Papademetriou, as he takes leave from his day-to-day role at MPI on the challenges and opportunities ahead for international migration systems over the next few decades. After opening remarks, Papademetriou engages in a conversation with incoming MPI President Andrew Selee about the trends and realities confronting policymakers and publics.




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Reflections on Business, Leadership, and Branding: Shelly Lazarus ’70

Much has changed in the world of advertising from the picture painted by Mad Men. Shelly Lazarus ’70, Chairman Emeritus, Ogilvy & Mather, was one of the women helping pioneer these changes. Making the journey from ‘the only woman in the room’ to CEO and Chairman of Ogilvy gives Lazarus a lot to reflect on […]




reflections

Angels in this wilderness : reflections on the journey of the Uniting Church in Australia / Andrew Dutney.




reflections

Waiting for the last bus : reflections on life and death / Richard Holloway.

Death -- Philosophy.




reflections

Reclaiming indigenous governance : reflections and insights from Australia, Canada, New Zealand, and the United States

9780816539970 (paperback)




reflections

Reflections on regulatory responses to the Covid-19 pandemic

FSI Briefs No 1, April 2020. Regulatory policy responses should seek to support economic activity while preserving the financial system's soundness and ensuring transparency. The recommendation for banks to make full use of capital and liquidity buffers should go hand in hand with restrictions on dividends and bonuses and clarity concerning the process for rebuilding them. Flexibility in loan classification criteria for prudential and accounting purposes should be complemented with sufficient disclosure on the criteria banks use to assess creditworthiness. The publication of detailed guidance on the application of expected loss provisioning rules, combined with sensible transitional arrangements, may constitute a balanced approach to mitigating the unintended effects of the new accounting standards.




reflections

Reflections on 19 years of leadership

As OM Hong Kong celebrates 25 years, leader Cheuk-chung Lau reflects on the past 19 years and wonders who the next “Joshua” will be.




reflections

Reflections From a Pediatrician Who Went Back to Summer Camp




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Verification Reflections on 2018

In my predictions for 2018 I had identified five key trends driving verification in 2018 – Security, Safety, Application Specificity, Processor Ecosystems and System Design Enablement, all centered around ecosystems. Looking back now as the yea...(read more)




reflections

Reflections on Jewish life in South Africa


I remember my childhood as a kind of idyllic dream where we Jews lived in big houses on large plots surrounded by magnificent gardens.




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Reflections on the Development of Regional Financing Arrangements: Experience from Europe

The European experience could be useful to inspire the future evolution of the Chiang Mai Initiative Multilateralization in the ASEAN+3 membership.




reflections

Reflections on the Development of Regional Financing Arrangements: Experience from Europe

The European experience could be useful to inspire the future evolution of the Chiang Mai Initiative Multilateralization in the ASEAN+3 membership.




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Reflections: My Time as JDE Editor




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Caring for Rohingya Refugees With Diphtheria and Measles: On the Ethics of Humanity [Reflections]

Hundreds of thousands of Rohingya refugees arrived in Bangladesh within weeks in fall 2017, quickly forming large settlements without any basic support. Humanitarian first responders provided basic necessities including food, shelter, water, sanitation, and health care. However, the challenge before them—a vast camp ravaged by diphtheria and measles superimposed on a myriad of common pathologies—was disproportionate to the resources. The needs were endless, resources finite, inadequacies abundant, and premature death inevitable. While such confines force unimaginable choices in resource allocation, they do not define the humanitarian purpose—to alleviate suffering and not allow such moral violations to become devoid of their horrifying meaning. As humanitarian workers, we maintain humanity when we care, commit, and respond to moral injustices. This refusal to abandon others in desperate situations is an attempt to rectify injustices through witnessing and solidarity. When people are left behind, we must not leave them alone.




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View From the Canoe: Co-Designing Research Pacific Style [Reflections]

In 2016, Rose Lamont and Tana Fishman were the first patient-clinician dyad from outside North America to attend the North American Primary Care Research Group (NAPCRG) Patient and Clinician Engagement Program workshop. They returned to New Zealand inspired and formed the Pacific People’s Health Advisory Group and a Pacific practice-based research network (PBRN). They are guided by the principles of co-design, and the Samoan research framework fa’afaletui, which emphasizes a collective approach and importance of reciprocity and relationships. Their collective inquiry aims to reduce health inequalities experienced by Pacific people in South Auckland. Their community group members and PBRN are generating research questions being answered by university-based graduate students. When they embarked, they knew not the direction in which they headed. With guidance, their community members and clinicians have led the way. By giving everyone a say in where they are going and how they get there, they are modeling what they wish to achieve—an egalitarian approach which decreases disparities for Pacific people.




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What I Wish My Doctor Really Knew: The Voices of Patients With Obesity [Reflections]

Few health care professionals receive comprehensive training in how to effectively help their patients with obesity. Yet patients are often wanting, needing, and looking for help when they go to the doctor. We, as a group of patients with obesity, share our common experiences and needs when going to the doctor from a place of honesty and hope, with the assumption that clinicians want to know what their patients really think and feel. Our "wish list" for a treatment plan may represent an ideal, but our hope is that our language will speak to clinicians about how they can help their patients manage their obesity.




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Reflections of an Immigrant CEO 

This blog post was written by Gerhard Koenig, CEO of Arkuda Therapeutics, as part of the From The Trenches feature of LifeSciVC. When I discussed the topic of writing about my experience as an immigrant biotech CEO with Bruce Booth,

The post Reflections of an Immigrant CEO  appeared first on LifeSciVC.




reflections

The End of Sykes-Picot? Reflections on the Prospects of the Arab State System


During much of the past three years, the Syrian civil war has been the most prominent item on the Middle Eastern political agenda and has dominated the political-diplomatic discourse in the region and among policy makers, analysts and pundits interested in its affairs. 

Preoccupation with the Syrian crisis has derived from the sense, apparent since its early phases, that it was much more than a domestic issue. It has, indeed, become a conflict by-proxy between Iran and its regional rivals and the arena of American-Russian competition. It has also had a spillover effect on several neighboring countries and has been a bellwether for the state of the Arab Spring.

As the conflict festered it also prompted a broader discussion and debate over the future of the Arab State system. The collapse of Syria, the ongoing fighting in Iraq, and the general instability in the Middle East has led some observers to question whether the very geography of the region will be changed. Robin Wright, a journalist and scholar at the Woodrow Wilson International Center for Scholars, argues that “the map of the modern Middle East, a political and economic pivot in the international order, is in tatters.” Wright also warns that competing groups and ideologies are pulling the region apart: “A different map would be a strategic game changer for just about everybody, potentially reconfiguring alliances, security challenges, trade and energy flows for much of the world, too.”  Similarly, Parag Khanna, a senior fellow at the New America Foundation, argues, “Nowhere is a rethinking of “the state” more necessary than in the Middle East.” He contends that “The Arab world will not be resurrected to its old glory until its map is redrawn to resemble a collection of autonomous national oases linked by Silk Roads of commerce.” Lt. Colonel Joel Rayburn, writing from the Hoover Institution, points out that the alternative may not be new states but rather simply collapse. “If watching the fall or near-fall of half a dozen regimes in the Arab Spring has taught us anything, it should be that the Arab states that appeared serenely stable to outsiders for the past half century were more brittle than we have understood,” warning darkly, “This conflict could very well touch us all, perhaps becoming an engine of jihad that spews forth attackers bent on bombing western embassies and cities or disrupting Persian Gulf oil markets long before the fire burns out.” 

This discussion touches on a key question: Will the collapse of one or several other Arab states produce a new order in the region? 

The regional order has been threatened before, but today’s challenge is unique. Syria is what has prompted the latest reevaluation of the Skyes-Picot borders, but many of the problems predated the Syrian civil war. Ambitious monarchs in the 1930s and 1940s challenged the order after the colonial period. The doctrine of Pan-Arab Nationalism and Gamal Abd al-Nasir’s messianic leadership in the 1950s and by Saddam Hussein in 1990 again posed a threat. Now it is now challenged not by a powerful state or a sweeping ideology but by the weakness of several Arab states that seem to be on the verge of implosion or disintegration.

This paper assesses the situation in Syria, with an emphasis on what might lead to its de facto partition or lasting collapse. It then examines Syria’s neighbors and their prospects for stability. The paper concludes by exploring how the United States, Israel and Iran might affect this tenuous balance.

Downloads

Image Source: © Muzaffar Salman / Reuters
      
 
 




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Book Review of Al From’s Reflections on the Creation and Rise of the DLC

Phillip Wallach reviews Al From’s new political memoir, The New Democrats and the Return to Power (2013). The book contains a wealth of historical material, including From’s time working in the Clinton transition team from 1992-1993 and his efforts to spread a progressive Third Way abroad during the late 1990s.  One lesson in particular stands out: institutional change is a long slog, requiring a combination of fertile political conditions and reformers well prepared to seize their moment. Yet From notes that a Democratic Leadership Council-style turnaround will be harder for Republicans today because today’s Republicans are more homogeneous and less inclusive than the Democrats of the 1980s.

      
 
 




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LIVE WEBCAST – Pursuing justice in a globalized world: Reflections on the commitment of Madeleine K. Albright

On June 28, the Hague Institute for Global Justice, in partnership with the Brookings Institution and Municipality of the Hague, will host Canadian Minister of Foreign Affairs Lloyd Axworthy for the second annual Madeleine K. Albright Global Justice Lecture. Abi Williams, president of the Hague Institute, will give welcoming remarks and Ted Piccone, senior fellow at the Brookings Institution, will moderate the discussion.

      
 
 




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Too much or too little democracy? Some reflections on Democracy for Realists


Recent political movements within the United States have raised concerns about the health of American democracy. With hyper-partisanship dividing the country and Donald Trump—the most unlikely, unsuitable, and unpopular presidential nominee of a major party in American history—securing the Republican nomination, the question emerges of whether democracy in America has gone awry.  And if so, is it too much or too little democracy that’s to blame?

To help address those questions, in this paper, Thomas E. Mann summarizes and discusses the findings of Christopher Achen and Larry Bartels’ ambitious treatise on American democracy: “Democracy for Realists.” Achen and Bartels contend that the traditional conception of voters as rational, attentive decision-makers does not hold against empirical evidence. Instead, voters are best understood as members of partisan groups, which influence their perception of candidates, issues, and even simple facts. According to Achen and Bartels, perceived social identities drive voting decisions, rather than rationality.

Mann notes that most scholars would agree that voters do not follow the expectations of idealistic models, but draws attention to competing theories that are far less damning to voters’ rationality. In particular, the research of Paul Sniderman and Arthur Lupia suggests that voters are far more capable than Achen and Bartels would assert. In their view, voters have enough rationality and information to ensure a well-functioning democracy.

As Mann summarizes the arguments:  Achen and Bartels believe that citizens and elections are held to impossible, idealistic standards in the folk theory of democracy, which perpetuates myths and works against government responsiveness. Sniderman and Lupia, on the other hand, are offended by those who dismiss citizens as ignorant and incompetent; they seek to defend voters’ dignity and demonstrate the rationality and efficacy of their behavior in American democracy.

What does this scholarship tell us about the coming presidential election, and the future of American democracy?  Ultimately, Mann concludes that Achen and Bartel’s perspective is not anti-democratic, even if it is built on a belief that too much importance is placed on the often random and myopic outcomes of elections.  Instead, Mann believes that “Democracy for Realists” reveals the real democratic deficit facing America is one stemming not from too much democracy, but  from “asymmetry in political resources and representation of different segments of American society.” Truly understanding this problem and its root cause is a step toward strengthening American democracy. 

Downloads

Authors

      




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The future of impact bonds globally: Reflections from a recent Brookings event


“For a not-for-profit it’s the equivalent of venture capital,” said Sir Ronald Cohen, chairman of the Global Social Impact Investing Steering Group, about impact bonds in his keynote address at a recent event at the Brookings Institution. Impact bonds combine results-based financing and impact investing, where investors provide upfront capital for a social service and government agencies, or donors, agree to pay investors back based on the outcomes of the service. At their best, they could allow for innovation, encourage performance management and adaptability, promote learning through evaluation, and create a clear case for investing in what works. However, impact bonds thus far have had immense transaction costs and there are risks that poor execution of the impact bond mechanism could have negative consequences for beneficiaries.

It has been six years since the first impact bond was implemented in March of 2010, and the field is beginning to move from an exploratory stage to looking at systemic change, as Tracy Palandjian, CEO and co-founder of Social Finance U.S. described. The event, “The Global Potential and Limitation of Impact Bonds,” served as a point of reflection for stakeholders at this pivotal stage of the field, bringing together over 500 individuals in the room and on the webcast, including practitioners developing impact bonds around the world. While context matters, there were notable similarities in the motivations and challenges across regions.

Potential value-add

In our presentations of our research and subsequent panels, we focused on the potential value and challenges of combining results-based financing and impact investing through an impact bond. Shri Naveen Jain, mission director of the National Health Mission of Rajasthan, India, who is working to develop an impact bond for maternal and child health services across his entire state, pointed out that the value of a results-based financing contract to him was in the added transparency it provides—the government is able to see what they are paying for, keep service providers accountable, and incentivize providers to achieve better outcomes. Louise Savell, a director at Social Finance U.K., the entity that first put impact bonds on the map, explained that results-based financing contracts are often arranged such that only one portion of the contract is based on results. This, she explained prescribes a model and does not allow for flexibility; furthermore, it forces service providers to bear a significant risk. Impact bonds allow for the entirety of payments to be based on results, which gives the provider full flexibility (at least in theory), but puts the risk of service performance on the investor. The shift of risk to investors could be particularly useful for service delivery in conflict affected areas, where donors are often highly concerned about how money will be used, mentioned Francois de Borchgrave, co-founder and managing director of Kois Invest, who is working on an impact bond with the International Rescue Committee of the Red Cross. The panelists also emphasized that impact bonds are more powerful than results-based financing contracts alone because, if successful, they pay real financial returns to investors. This draws a great deal of attention from policymakers and the public, and the added scrutiny helps in making the investment case for preventive interventions highly explicit. Mayor Ben McAdams of Salt Lake County, Utah said that “data and evidence is bridging a partisan divide” in his state—when the case for investment is clear, policymakers from both sides of the aisle are willing to invest. Impact bonds do not necessarily add value by increasing the total amount of funding available for social services, because investors are repaid if outcomes are achieved. Rather, impact bonds could help increase the outcomes achieved with given funding.

Overall there was agreement that impact bonds have enormous potential to lead to more outcome-focused financing that focuses on preventive interventions and incentivizes collaboration. However two critical considerations for the use of impact bonds arose throughout the day.

Optimal impact bond size

The first consideration discussed was whether or not impact bonds can support innovation or scale. As found in our first report, impact bonds have been relatively small in scale in terms of capital and beneficiaries. The average upfront investment in impact bonds to date is $3.7 million, reaching an average of 1,900 beneficiaries. They also have not, on average, focused on particularly innovative interventions—in fact they have almost all had a relatively strong base of evidence behind them. Views on the panel differed on whether the uses of impact bonds could be expanded—if they could be used for highly innovative pilot programs or proven large scale programs. One perspective was that impact bonds could indeed provide seed capital to test new ideas for service delivery. This would require investors who are willing to test not only the innovation but also this relatively new financing mechanism. Given the high transaction costs that impact bonds entail, however, this may not be the most efficient use of resources. Impact bonds could also reach more beneficiaries per transaction (greater scale) with changes in public procurement and the creation of markets for tradeable impact bond assets. Government can play a role in facilitating larger impact bonds by creating central government outcome payment funds, providing tax breaks for investment in impact bonds, and enabling the development of investment vehicles, all of which are being implemented in the U.K. Impact bonds could also help effective social services reach scale by encouraging government to fund programs at scale after the impact bond is over or by improving data use and performance management in government-funded services broadly.

Outcome evaluation design

A second, and related, discussion happened around evaluation methodology—which may differ depending on whether the impact bond is intended to test an innovative intervention or scale an intervention already backed by significant evidence. The “gold standard” randomized controlled trial (RCT) is the only methodology that eliminates the possibility that impact could be attributed to something other than the intervention, though the majority of impact bonds thus far use evaluation methodologies that are less rigorous. The panelists explained that it is important, however, to consider the status quo—currently, less than 1 percent of U.S. federal spending on social services has been shown to be effective. The same is true in low- and middle-income countries, where there are relatively few impact evaluations given the number of interventions. At the end of the day, the government agency acting as the outcome funder must decide on the importance of attribution to trigger payment through the impact bond in view of the already available evidence of program effectiveness and weigh the criticism that might ensue in the absence of a valid counterfactual.

Challenges

Though impact bonds are a potentially useful tool in the toolbox of many financing mechanisms, there are some significant constraints to their implementation. The biggest barrier to impact bonds and other results-based contracts is the administrative hurdle of contracting for outcomes. Peter Vanderwal, innovative financing lead at the Palladium Group, and Caroline Whistler, co-president and co-founder of Third Sector Capital Partners, both stated that governments often are unable or do not know how to contract for outcomes, and there is a need to invest in their capacity to do so. Appropriation schedules are part of this challenge, governments are often not allowed to appropriate for future years. When an audience member asked how we go about changing the culture in government to one of contracting for outcomes, Mayor McAdams answered that impact bonds may have a contagious effect—contracting for outcomes will be the expectation in the future. Additionally, the transaction costs of establishing the partnership are large relative to other mechanisms, though they may be worthwhile. Jim Sorenson, of the Sorenson Impact Center, pointed out that service provider capacity and data collection systems could be barriers to the development of future impact bonds. There is also still a long way to go in developing outcome measures and in particular in calibrating those outcome measures to low- and middle-income countries.

The role of governments and research groups

The influence that impact bonds have on the provision of quality services globally depends on the quality of implementation. With a rapidly growing market, there will inevitably be “bad” impact bonds in the future. To ensure that impact bonds are used as effectively as possible, governments and the research community have a pivotal role to play in asking the right questions: Will a results-based contract help improve outcomes in this particular case? What should the outcomes be to avoid perverse incentives or potentially negative externalities? And would an impact bond structure add value? 

      
 
 




reflections

This Too Shall Pass: Reflections on the Repositioning of Political Parties

In This Too Shall Pass: Reflections on the Repositioning of Political Parties, Pietro Nivola argues that those who fret that the political parties will never evolve to meet half-way on policy or ideology need only to look to American history to see that this view is wrong-headed.