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Despite the importance of tropical forest conservation in achieving global sustainability goals and the key role of forest-risk commodity trade in driving deforestation, consumer country policy options for reducing imported deforestation have received limited scholarly attention. Drawing on gray literature and a European Commission public consultation, we identify 86 policy options for the European Union to address deforestation. We assess the political feasibility and map the “theory of change” (TOC)—the causal chain through which the policies address deforestation—for each of these policy options, identifying a trade-off between feasibility and potential impacts: information-based and cooperative policies, which dominate our sample, typically exhibit high feasibility, but mostly lack convincing TOCs, while more stringent regulatory and market-based policy options generally have lower feasibility. We propose three principles for overcoming the feasibility-impact dilemma: (1) build policies on proven TOCs, (2) use policy mixes, and (3) work with key stakeholders, supply chains, and regions. Images of distressed orangutans in Indonesia and forest fires in Brazil have increased public awareness of deforestation across the globe. Still, deforestation continues more or less unabated, driven by demand for forest-risk commodities, such as palm, soy, cocoa, and beef. What can the European Union (EU) and other consumer regions do to address this problem? Here we present 86 policy options for the EU to address tropical deforestation, identified through a review of gray literature and EU stakeholder consultation responses. Analyzing these, we show that policy options that are politically feasible policies tend to have a weaker theory of change—the causal chain through which the policies address deforestation—setting up a trade-off between feasibility and impact. However, there are exceptions, such as mandatory due diligence, which show potential impact and appear politically

Agro-food commodity consumption is intricately linked to the loss of the planet’s forests. Complex, global agro-food supply chains, which are shaped by globalization processes, tie distant places together, causing consumption in one region to affect land use in another region, in particular, to drive deforestation. In this thesis, I explore how governance interventions in agro-food commodity supply chains can foster sustainable land use and help deliver deforestation-free agro-food supply chains. I conclude that it is not a lack of governance approaches, which hinders sustainability governance of agro-food commodity supply chains. Rather, a confluence of four specific factors complicates public and private governance. Firstly, the complexity of the problem, in particular the ‘wicked’ nature of agro-food commodity-driven deforestation, causes unclear feedbacks and spatially separated cause-effect mechanisms. Secondly, companies and private sector governance play a crucial, but underappreciated role in delivering governance. I show that company characteristics affect governance, while insufficient commitment among laggards and inadequate support for leaders limit the capacity of private sector governance. Thirdly, public governance plays an increasingly important role by supporting, engaging, and enabling private governance efforts through layered governance. Finally, technological advancements can enable governance by aiding implementation, reducing complexity, increasing accountability, and empowering supply chain actors, but technology is not a silver bullet that solves all governance issues., (SC - Sciences) -- UCL, 2021

Secure land access is vital for Myanmar’s upland households, who rely on crops and forests to meet their subsistence needs. But recent land reforms threaten to undermine customary tenure and land-use practices in Myanmar. This paper combines income accounting methods with access theory to assess how new legislation may affect four Chin communities in the country’s north-west. Our assessment of 94 households’ land-access mechanisms and economic benefits from different types of land reveals existing land-access inequalities among Chin households and demonstrates communities’ continued dependence on environmental resources, especially those from swidden fields, home gardens and forests. A majority of households would lose all of their land-derived income, if they were denied access to communities’ customarily governed land, e.g., under the Vacant, Fallow and Virgin Land Management Law. Policy stakeholders should therefore intervene, to alleviate land-access inequalities among Chin households and to direct Myanmar’s land-system dynamics onto more just development trajectories.

Background: Psoriasis Area and Severity Index (PASI) 90 is suggested to be the new standard endpoint for randomized controlled trials of biologics for psoriasis, whereas treatment guidelines often still refer to PASI 75. Objectives: To analyse in a real-world setting: firstly, what factors are associated with higher levels of treatment response to biologics; secondly, the health-related quality of life gains associated with different response levels in clinical practice. Methods: Biologically na€ıve patients with PASI, Dermatology Life Quality Index (DLQI) and EuroQol (EQ)-5D outcomes before (maximum 6 months) and after (3–12 months) switch to biologics during registration in the Swedish National Registry for Systemic Treatment of Psoriasis (PsoReg) were included (n = 515). Patient characteristics associated with higher treatment response were analysed by regression analyses. Improvements in absolute PASI, DLQI and EQ-5D were assessed in different PASI percentage response levels. Results: High PASI percentage response was associated with higher PASI before switch and lower body mass index. DLQI and EQ-5D improved within all responder groups (P < 0001). The magnitude of improvements in DLQI (P = 002) differed between responder groups. The mean (SD) DLQI improvements for PASI 75<90 responders, PASI 90<100 responders and patients achieving complete skin clearance (PASI 100) were 99 (74), 115 (70) and 80 (61), respectively. Conclusions: PASI percentage change is largely dependent on absolute PASI before switch. Patients in clinical practice lack ‘baseline’ PASI values as they may switch directly from one treatment to another or stay successfully treated for a longer time period. Treatment goals such as PASI 90 are thus not suitable for treatment guidelines or for follow-up in clinical practice.

Introduction: The new European Union (EU) Regulations on medical devices and on in vitro diagnostics provide manufacturers and Notified Bodies with new tools to improve pre-market and post-market clinical evidence generation especially for high-risk products but fail to indicate what type of clinical evidence is appropriate at each stage of the whole lifecycle of medical devices. In this paper we address: i) the appropriate level and timing of clinical evidence throughout the lifecycle of high-risk implantable medical devices; and ii) how the clinical evidence generation ecosystem could be adapted to optimize patient access. Areas covered: The European regulatory and health technology assessment (HTA) contexts are reviewed, in relation to the lifecycle of high-risk medical devices and clinical evidence generation recommended by international network or endorsed by regulatory and HTA agencies in different jurisdictions. Expert opinion: Four stages are relevant for clinical evidence generation: i) pre-clinical, pre-market; ii) clinical, pre-market; iii) diffusion, post-market; and iv) obsolescence & replacement, post-market. Each stage has its own evaluation needs and specific studies are recommended to generate the appropriate evidence. Effective lifecycle planning requires anticipation of what evidence will be needed at each stage

Trade agreements could help to protect human rights, critical ecosystems, and the climate—but only if sustainability becomes a cornerstone of international trade. The EU-Mercosur trade agreement fails to meet our three tenets of sustainable trade agreements: (1) inclusion of local communities, (2) transparency mechanisms to trace commodities and provide open-access information, and (3) enforcement to legally uphold sustainability commitments.

Background: Although biologics introduced a new era in psoriasis care when available a decade ago, it is unclear to what extent the available systemic treatments treat patients adequately. Objective To analyse the clinical severity and quality of life of the psoriasis population in Sweden treated with systemics. Methods: Data included 2,646 patients from the Swedish Registry for Systemic Treatment of Psoriasis. Average Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and EQ-5D were reported. A subgroup of persisting moderate-to-severe psoriasis as defined by PASI≥10 and/or DLQI≥10 after >12 weeks treatment was analysed. Results: Mean (SD) PASI, DLQI, and EQ-5D were 4.12 (4.57), 4.11 (5.24) and 0.79 (0.22). Eighteen percent had persisting moderate-to-severe psoriasis (n = 472). These patients were younger, had higher BMI, had psoriasis arthritis and were smoking to a larger extent (p < 0.01) compared to lower-severity patients (n = 2174). Mean (SD) EQ-5D was also considerably lower 0.63 (0.29) vs. 0.82 (0.19) (p < 0.01). Conclusion: Almost one in every five patients had persisting moderate-to-severe psoriasis, despite ongoing systemic treatment. Both comorbidities and life style factors were associated with persisting moderate-to-severe psoriasis. The considerably lower generic quality of life in these patients demonstrates an unmet need. Subsequently, improved access to biologics and continuous drug development is needed in psoriasis.