Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction — in the specialty and primary care contexts — and derives a series of reforms that would empower primary care physicians and better leverage specialists.

The conceptual promise of relational values, theorized as the principles and virtues of human relationships (with other humans and nature), to motivate sustainability may be observed in its rapid uptake in theoretical and policy domains. Both relying on and impacting nature, agriculture has garnered attention among efforts to apply relational values. However, quantitative measures have received little focus in efforts to operationalize relational values. Guided by the assertion that sustainable agriculture is embedded with both relational and instrumental values (i.e., self-interested (...) ends), this study considers theoretical and methodological challenges and offers a pathway to quantitatively measuring relational values within agriculture, focusing specifically on seeds—an agricultural input embedded with plural values. Drawing on 151 survey responses from seed growers in Vermont, this study assesses how relational and instrumental values are reflected among commercial and non-commercial seed growers and are associated with the presence of crop diversity in their farms and gardens. The findings show that those who sell seeds for income have significantly higher relational values, instrumental values, and crop diversity than those who do not sell seeds. Should these findings be confirmed in future studies, potential exists for policy initiatives encouraging market behavior and its governance to express a range of values beyond instrumental ones exclusively. This paper concludes by arguing that all economic exchange is likely embedded with both relational and instrumental values, meaning that policies and programs that activate a range of values will most likely maximize the impacts of the myriad initiatives pursuing sustainable agriculture. (shrink)

The effects of the COVID-19 pandemic have rippled across the United States’ (US) agri-food system, illuminating considerable issues. US seed systems, which form the foundation of food production, were particularly marked by panic-buying and heightened safety precautions in seed fulfillment facilities which precipitated a commercial seed sector overwhelmed and unprepared to meet consumer demand for seed, especially for non-commercial growers. In response, prominent scholars have emphasized the need to support both formal (commercial) and informal (farmer- and gardener-managed) seed systems to (...) holistically aid growers across various contexts. However, limited attention to non-commercial seed systems in the US, coupled with a lack of consensus surrounding what exactly a resilient seed system looks like, first warrants an exploration into the strengths and vulnerabilities of existing seed systems. This paper seeks to examine how growers navigated challenges in seed sourcing and how this may reflect the resilience of the seed systems to which they belong. Using a mixed-methods approach which includes data from online surveys (n = 158) and semi-structured interviews (n = 31) with farmers and gardeners in Vermont, findings suggest that growers were able to adapt – albeit through different mechanisms depending on their positionality (commercial or non-commercial) within the agri-food system. However, systemic challenges emerged including a lack of access to diverse, locally adapted, and organic seeds. Insights from this study illuminate the importance of creating linkages between formal and informal seed systems in the US to help growers respond to manifold challenges, as well as promote a robust and sustainable stock of planting material. (shrink)

The purpose of this paper is to provide further clarity to the technical and policy difficulties associated with mitigating greenhouse gas emissions from agriculture by identifying and distilling the core tensions which propagate and animate them. We argue that these complexities exist across four critical dimensions: the epistemological, the ethical, the political, and the practical. Adequately confronting the challenge of agricultural emissions will require improved transparency in emissions measurement, increased science communication, enhanced public participatory mechanisms, and the integration of ethical (...) deliberation in scientific and policy discussions. (shrink)

The hydrogen economy has received increasing attention recently. Common reasons cited for investigating hydrogen energy options are improved energy security, reduced environmental impacts, and its contribution to a transition to sustainable energy sources. In anticipation of these benefits, national and local initiatives have been launched in the United States, creating pilot “roadmaps” and technology partnerships to explore hydrogen economy platforms. Although hydrogen can provide several positive improvements over a carbon- or uranium-based energy system, several problems are also likely. As well, (...) competitive technologies (e.g., hybrid vehicles) may offer comparatively greater economic and/or environmental advantages. Before policies to advance a hydrogen energy economy proceed, it is vital that all aspects of hydrogen be compared with other available alternatives. Important questions to ask in this regard are whether a hydrogen economy can fulfill key energy needs and whether there are appropriate roles for hydrogen to play in a sustainable energy future. (shrink)

Pro-poor value chains intend to integrate smallholding farmers into high value markets to contribute to poverty alleviation and food security. Although income benefits of pro-poor value chains have been found, scant evidence exists regarding the potential for these markets to enhance food security. This study focuses on components of food access—dietary diversity, physical and financial access, and social acceptability—among households that participate in pro-poor value chains and non-participating households in the central highlands of Peru where development interventions have created high (...) value market niches for the native potato varieties that smallholding farmers have conserved for thousands of years. Using a mixed methods approach, this study assessed dietary diversity among households that participate and do not participate in pro-poor value chains, as well as their perceptions of their food access. Findings indicated that households that participate in value chains have higher dietary diversity than non-participating households but that these differences are likely due to pre-existing differences in socioeconomic status rather than any causal effect provided by value chains. The study also concluded that while participation in pro-poor value chains sometimes enhance the purchasing power of participating households, they may also weaken financial access, important for both purchasing food and travel to make those purchases. Community perspectives also indicated concerns with the acceptability of diets, which cannot likely be comprehensively addressed by pro-poor value chains. Collectively, the findings from this study cast doubt on the assumption that a linear flow exists between pro-poor value chains and enhanced food access. (shrink)