Need for Increased Accountability in Healthcare

Written by: Isilay Civan MSc, PhDs, LEED AP O+M, as published in the Network, June 2014, vol 22, issue 2

In the past, healthcare providers have solely been incentivized by caring for the sick. However, with the Patient Protection and Affordable Care Act (PPACA), the focus on episodic healthcare delivery is changing to a more comprehensive approach of managing the health of populations. Care providers will now be expected to assume responsibility for treatment over a longer period of time – one that does not end with a patient being discharged. There may be cuts in reimbursements, possibly penalties for dissatisfied patients, medical errors, hospital-acquired infections or hospital readmissions following treatment. This increased accountability, coupled with a potential decline in reimbursements and the overall operational budgets, will make the concept of sustainability even more important.

The PPACA seeks to achieve improved quality and reduced costs in Medicare. As explained in a Medical Construction & Design article by Benjamin Davenny[1], previously, at each discharge, Medicare was paying the hospital an operating base payment along with other payments. Under the PPACA’s value-based purchasing (VBP) program, the government will now hold a small percentage of all operating base payments, which will be distributed to hospitals depending on how they perform on quality measures. Value-based purchasing is budget neutral; therefore, the incentive money paid to hospitals will be equal to the amount withheld, and it will be based on how well hospitals perform relative to each other.

In FY 2013, the VBP performance scores were based 70% on clinical process measures and 30% on patient experiences. The patient experience score was/is based on the (standardized and mandatory) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. Up to 80 points on the patient experience score can be achieved from HCAHPS scores and up to 20 points can be achieved by a consistence score. HCAHPS results contribute to the performance scores and are posted online at www.hospitalcompare.hhs.gov, as required by the Deficit Reduction Act of 2005.

Sustainability and the Hospital Experience

The HCAHPS Survey consists of 32 questions, 7 of which are demographic and 4 are for screening purposes. The remaining 21 questions address the patient’s hospital experience, with two HCAHPS questions directly dealing with the healthcare environment in terms of cleanliness and quietness.

Every challenge can be turned into a unique opportunity. Through a renewed focus on sustainable practices, lower scores may be improved, giving hospitals a chance to rank higher. Because the money they receive will be tied to their score on measurements like HCAHPS survey, the greater their score improvement, the larger share they may get from the overall pie.

There is also a greater need to do more with less. With operating budgets declining and focus on the built environment increasing, metrics and ways for measuring cost-cutting will be more important than ever. According to the 2013 survey[2] of Health Facilities Management Magazine subscribers, only 38% include performance metrics (such as the Environmental Protection Agency (EPA) Energy Star rating, total waste generation or a recycling rate) in their senior management dashboards. And only 45% of responding hospitals conducted energy audits in 2013 — a drop of nearly 5% from 2010. Considering that we cannot manage what we do not measure, hospitals will need to change their ways — soon.

 

Free Help

To that end, three American Hospital Association groups (American Society for Healthcare Engineering, Association for the Healthcare Environment, and the Association for Healthcare Resource & Materials Management) collaborated on a website called the Sustainability Roadmap for Hospitals (www.sustainabilityroadmap.org). It offers free tools and resources showing hospitals how to implement real-world sustainability projects, enhance existing efforts, and share their environmental successes with other facilities. The content includes general information and specific measures for improving a facility's performance, organized under five tabs: Topics, Drivers, Strategies, Implementation, and Resources.

One of the reports referenced on the site (from the Commonwealth Fund[3]) suggests that hospitals can save more than $15 billion in 10 years by implementing such sustainability programs. Hospitals consume 2.5 times more energy per square foot than other commercial buildings, spending more than $8.5 billion dollars annually on energy. As a result, the prospect of saving money on energy costs and reducing reliance on fossil fuels is a huge driver for undertaking sustainability initiatives. Several other opportunities for reducing operational costs cited in the article:

·        Reducing waste costs: The cost of waste disposal, especially disposal of expensive regulated waste, is a common financial driver. Materials consumption in health care facilities results in $10 billion annually in waste disposal costs. Opportunities for cost reduction through smart source reduction and waste management may be as high 40 to 70 % $4 to $7 billion annually.

·        Reducing water costs: Hospitals are water-intensive. Today, water is relatively inexpensive in the United States compared to other parts of the world. (For example, in 2010 in Spokane, water cost $0.25/100 gallons, in El Paso $0.60, and in San Diego $1.38, compared to $2.86/100 gallons in Glasgow, Scotland.) Water prices are predicted to rise around the world and across the United States. As large water users, hospitals have an opportunity to reduce water use and improve water quality.

·        Reducing supply chain costs: Supply chain costs are rising (along with waste, water, and energy costs). Assessing opportunities to maximize material, supply, and equipment use can drive down costs and have a positive environmental impact.

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[1] “Silence is Golden”, Medical Construction & Design, July/August 2013, pgs. 44-47.

[2] “Shades of Green”, Health Facilities Management Magazine, December 2013, pgs. 33-38.

[3] “Can Sustainable Hospitals Help Bend the Cost Curve?”, The Commonwealth Fund, November 2012.

"Same Angle, Different Lenses" Sustainability Series

TAKING THE PEOPLE'S SIDE

 

Written by: Isilay Civan MSc, PhDs, LEED AP O+M, as published in the Network

 

While considering Sustainability, we often forget the most important component – the people. Even though everything we do is supposedly intended to improve human experience in the built environment, the things we tend to focus on, track, benchmark, and manage are only subsets of such impacts (i.e. tracking indoor air quality or managing noise or illuminance levels to ultimately improve human health and employee productivity) .

Anything directly related to the people side, which attempts to quantify and introduce metrics into the financial analysis, is presumed to take away from the validity of the calculations by softening the reliability of the payback analysis. Earlier attempts of specifically quantifying the people side led mostly to unsubstantiated claims, labeled ‘green-washing’, and discouraged the sector from determining better ways of understanding and measuring the true implications. This also led to focusing solely on the secondary aspects that have less complex relations that are easier to calculate and validate. However, recognizing the progress we have made to date in the field of Sustainability, it is time to go back to the drawing board and figure out more reliable metrics that effectively measure the people side.

To underscore the need and importance of such an exercise, the following list of facts, consolidated from notable sources such as World Green Building Council (WGBC)[1], The Commission for Architecture and the Built Environment (CABE)[2], and Terrapin[3], speaks directly to the people side and its potential impact on an organization’s triple bottom line:

·       Employee salaries are the largest expense for any organization (often as high as 60-80% of the total cost of operations and typically 10 to 12 times more than maintaining the building’s infrastructure);

·       Productivity costs (as also shown in the pie chart, the cost per square foot of a given corporate office space being overwhelmingly devoted to salary; 90.3% of productive and unproductive salaries and benefits, while only 8.9% is paid toward rent and mortgage, and 0.8% represents energy costs - BOMA, 2010, US Department of Labor, 2010) can be 112 times greater than energy costs in the workplace;

·       More than 90% of a company’s operating costs are linked to human resources, and financial losses due to absenteeism and presenteeism, a loss of workplace productivity resulting from loss of focus, negative mood, and poor health, account for 4%;

·       A 2% to 5% increase in staff performance can cover the total cost of providing for the organization’s staff accommodation;

·       Current metrics for calculating productivity, engagement, and innovation are typically not fully representative of today’s knowledge-based workforce;

·       Employee productivity in the knowledge economy is less a matter of improving speed and accuracy of routine tasks and more a function of generating new ideas, being creative, working effectively in teams, and generating knowledge that adds value to the organization;

·       The more complex the function, the harder it is to quantify its impact to the overall employee productivity;

·       According to self-reported productivity data, for each 15% increase in workspace satisfaction, there is a 1%-4% increase in productivity;

·       There is a strong relationship between perceived comfort and self-reported productivity, with differences in productivity as high as 25% reported between comfortable and uncomfortable staff;

·       For every 10% reduction in reported Sick Building Syndrome (SBS) symptoms, there is likely to be a 1.1% increase in productivity;

·       Daylighting design has been linked to a 15% reduction in absenteeism in office environments. Increases in productivity of between 2.8% and 20% attributed to increased luminance levels have been found in other studies;

·       In 2010, the US Department of Labor reported an annual absenteeism rate of 3% per employee—or 62.4 hours per year per employee lost—in the private sector. The number is even more dramatic in the public sector - 4%—or over 83 hours lost to absences per year;

·       Loewen and Suedfeld (1992) report improvements of 38% in the performance of simple tasks and 27% for complex tasks when working in an environment with white noise, as compared to tasks in unmasked noise conditions;

·       The potential impact of design for buildings on overall productivity as +12.5% (improved performance) and -17% (hampered performance) for an overall 30 percent change in worker performance in the best and worst buildings.

While there is a growing body of empirical evidence linking building design attributes to productivity, health, and well being, there has not been a consistent method to link the results to financial metrics. Consequently, the industry remains skeptical and continues to under-invest on the people side, causing us to miss out on what can potentially lead to the greatest return on investments.

Similar arguments are being made while discussing the benefits of biophilic design. The term biophilia, stemming from the Greek roots meaning love of life and coined by the social psychologist Erich Fromm, is used to describe the renewed design focus on bringing humans back in contact with nature, and by so doing, achieving much greater productivity goals. To establish evidence of these benefits, we need improved metrics that can better measure the relationship between the physical environment and the employee productivity. We need to find more direct linkages to accurately measure innovation, creativity, and productivity of knowledge workers, and rely less upon the traditional indirect measures (e.g., illness, absenteeism, staff retention, job performance – only as it relates to mental stress/fatigue, healing rates, classroom learning rates, retail sales, violence) that typically have many more variables playing into the overall success/failure of the findings. The failure to act now would do a great injustice to the true value of Sustainability and the ability to realize all that a holistic approach could offer when regarded as a core business target and measured accordingly.

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[1] The Business Case for Green Building: A review of the Costs and Benefits for Developers, Investors and Occupants, WGBC, 2013

[2] The Impact of Office Design on Business Performance, CABE, 2011

[3] The Economics of Biophilia, Terrapin Bright Green LLC, 2012

Performance Formula: Hire for Fit

Just came across this performance formula, which is a function of 3 basic concepts:

The Real Estate Industry Lens: Real Value of Greening on the Valuation and Appraisal of Sustainable Properties

“SAME ANGLE, DIFFERENT LENSES” SUSTAINABILITY SERIES

Cross-Industry Analysis on the True Impacts of Sustainability

The Real Estate Industry Lens: Real Value of Greening on the Valuation and Appraisal of Sustainable Properties

written by Isilay Civan, BArch, MSc, PhD², LEED® AP O+M, Senior Strategy Consultant & Location Leader at HOK Chicago Consulting

as published in the Network, Pg15: http://edition.pagesuite-professional.co.uk//launch.aspx?eid=e2b9fd8b-6dba-4c60-878c-250ee57ba272

As more and more companies begin to invest in greening their portfolios; either as isolated implementations, or through a strategic approach that deals with the entire building/portfolio; there are heightened market-wide expectation of increased value from such improvements. The question remains, however, whether such expectations are being realized. 

From the investors’ perspective, frequently posed questions include: Are we seeing greater demands for green buildings where we can reasonably anticipate an increase in sale prices or rental rates (along with higher absorption and occupancy rates) for longer periods? How about the accountability for and comparability of such findings? Are the simple payback and return on investment calculations we have been using to assess the real estate’s value adequate to determine how much value we can add to the built environment through our sustainability efforts? If not, what is a better way of quantifying the real value of sustainability so it can be realized in savings or shown as proof for good standing, lesser risk, and maintained value for longer durations?

Building owners and occupants are interested in knowing whether green buildings truly provide healthier and more productive built environments. Some environmentally-concious occupants are also concerned about what happens to their individual contributions. For instance, what happens to the sorted recyclables if there is not a robust recycling program at the city level? Do such disconnected efforts still amount to something meaningful or are they worth the investment of time and money?

Studies show that if there is even a perceived disconnect among a series of activities which may make the efforts less useful than initially assumed, exisiting and potential support may be seriously diminished and may end up damaging the organization’s PsyCap (Psychological Capital: the positive and developmental state of an individual as characterized by high self-efficacy, optimism, hope and resiliency, which is argued to be the ultimate competitive edge for organizations at the employee level).

Consider the investor’s perspective on realizing unassailable benefits from greening his portfolio - ultimately a higher valuation. This is dependent what his/her view of sustainability is. If it is a hit and run approach (i.e., grab the low hanging fruit with minimal investment), that is exactly what will be gained - quick gains in a short time frame.

For these efforts to turn into more consistent, longer-term value-added factors, they need to have preset strategic goals (with specific key performance measures (KPIs) attached to each).They need clearly identified action items with measurable metrics and a corrective action plan, to change operation if certain measures are not met. These need to be tracked and to become part of the 5-year strategic plan of the company. This way, a predictive assessment of the property can be made to strategically align the resources and avoid premature obsolescence through repetitive deferred maintenance items that bring the property’s value down.

This is not to suggest that value can only be achieved through substantial capital investments. If one approaches sustainability in a more strategic and comprehensive way, there will be many more opportunities to achieve higher levels of sustainability at a lesser investment, with savings that can be realized over a much longer period. In a strategic approach, rather than simply picking some strategies that meet your budget allocation, you need to choose the ones that potentially achieve three things: 1) help meet the KPIs that you have established; 2) create synergies for multiple savings opportunities; and 3) act as stepping stones for the next best-in-line opportunities for gradual improvements to create a positive ripple effect and bring in further savings at lower costs.

The simplest example is periodically comparing your capital expense (CAPEX) plan with your operational expense (OPEX) plan to assess the optimum timing of building’s system component replacements - when the useful life and the operational cost break even. This gives you the ability to plan for replacements, while continuing to stay sustainable without interruptions to the process. When properly documented, these activities may also raise the value of the building. However, the current accounting principles in real estate valuation do not allow for the recognition of such increase-in-value aspects of the sustainable efforts.

Moreover, we continue to make investment decisions based solely on simple payback or ROI calculations. For the most part, these calculations not only exclude the full life cycle aspect of the buildings or the building systems, they also don’t consider any health, productivity, or consolidated benefits that go beyond the cost savings that may be realized from an isolated initiatives (e.g., connection to nature, workplace design, alternative work, etc.).

 

I suggest that we use the increasing market pressure of greening our buildings to seek a change for better recognition and quantification of the added value to these buildings by virtue of sustainability factors. Start by addressing value considerations beyond the traditional cost savings into our financial statements and ROI calculations. This can strengthen the ability to showcase the long-term potential of greening our built environment and pave the way for improved access to funds for sustainable improvements. Not to act now may potentially hinder governmental support (rebates and incentives) and tenant/investor interest in sustainability. This will make it more challenging when incentives become mandates and penalties are imposed for not adhering to the rules and regulations that are then in place.

To achieve a healthier and more productive built environment, the idea generation and concept development stages should involve strategic thinking, clearly defined goals and a truly integrated design process. Only then can you achieve efficiently run systems with optimized performance. The earlier in the process such concepts are considered, the easier it becomes to achieve truly sustainable goals.

Friday Humor

Looking at Data in 3D

A brilliant way of looking at data and discovering potential linkages between what may initially look like unrelated topics!!!

"Same Angle, Different Lenses" Sustainability Series

Cross-Industry Analysis on the True Impacts of Sustainability:

A Refresher on Obsolescence and Greenwashing

by

Isilay Civan, MSc, Ph.D.s, LEED AP

Senior consultant and the location leader for the HOK Chicago Consulting Group

(as published in http://bit.ly/13AtkzI)

 

In the September 2009 issue of the network, I identified facilities as corporate assets that need to be regularly monitored for numerous types of obsolescence (physical, economic, functional, technological, social, legal/ political, and market), to reduce the risk of premature value depreciation and loss of productivity. I suggested the (then) still rising phenomenon of “green building” strategies as the potential structure for businesses to utilize and green their built environments moving forward.

 

Four years later, this quarterly column will be analyzing the topic of Sustainability from various angles. Even the harshest critics now agree that the concept of sustainability is here to stay and the sooner you get familiar with its true impacts, the better. Additionally, a virus I’ll call “FOBLO” is fast spreading. What started as “FOMO” (Fear of Missing Out) in the social media arena, has progressed into “FOBLO” (Fear of Being Left Out) in the sustainability arena. Today, companies, regardless of industry, simply cannot afford being left out and are under constant pressure to take some kind of sustainability ‘steps’. Many of these claims are still borderline - greenwashing at best. With enhanced (but still mostly voluntary) standards and guidelines paving the way for ‘transparent’ and ‘accurate’ reporting and validation, there is an increased need to understanding true sustainability and being able to distinguish it from false claims. Another strong push may be the fact that, if you do not start cleaning up your act now, your competitor may call you out on such issues – especially in the ‘red ocean’ markets, where competition is fierce.

In subsequent issues, this column - a cross-industry analysis on the true impacts of sustainability - will be entitled Same Angle, Different Lenses. But first, a refresher on The 7 Sins of Greenwashing by Terrachoice, part of the Underwriters Laboratories (UL) Global Network.

The Seven Sins

1 SIN OF THE HIDDEN TRADE-OFF

A claim suggesting that a product is ‘green’ based on a narrow set of attributes without attention to other important environmental issues.

Paper, for example, is not necessarily environmentally- preferable just because it comes from a sustainably- harvested forest. Other important environmental issues in the paper-making process, such as greenhouse gas emissions, or chlorine use in bleaching may be equally important.

2 SIN OF NO PROOF

An environmental claim that cannot be substantiated by easily accessible supporting information or by a reliable third-party certification.

Common examples are facial tissues or toilet tissue products that claim various percentages of post-consumer recycled content without providing evidence.

3 SIN OF VAGUENESS

A claim that is so poorly defined or broad that its real meaning is likely to be misunderstood by the consumer.

‘All-natural’ is an example. Arsenic, uranium, mercury, and formaldehyde are all naturally occurring, and poisonous. ‘All natural’ isn’t necessarily ‘green’.

4 SIN OF WORSHIPING FALSE LABELS

A product that, through either words or images, gives the impression of third-party endorsement where no such endorsement exists.

Fake labels.

5 SIN OF IRRELEVANCE

An environmental claim that may be truthful but is unimportant or unhelpful for consumers seeking environmentally preferable products.

‘CFCfree’ is a common example, since it is a frequent claim despite the fact that CFCs are banned by law.

6 SIN OF THE LESSER OF TWO EVILS

A claim that may be true within the product category, but that risks distracting the consumer from the greater environmental impacts of the category as a whole.

 Organic cigarettes are an example of this, as is the fuel-efficient sport-utility vehicle.

7 SIN OF FIBBING

Environmental claims that are simply false.

The most common examples were products falsely claiming to be Energy Star certified or registered.

The Seven Sins cited above are still all-too-relevant and need to be watched at every step of the way while pursuing sustainability; and hence, been recited here once again as a cornerstone to all the topics that will appear in this column. Expect the following subjects to appear in the upcoming Issues, in no particular order that they may be written and/or come out, depicting the various angles I will use to explore the subject of true sustainability:

 

- Real Estate Industry

- AEC Industry

- Facility Management Industry

- Urban Planning Perspective

- Legal Implications

- Technology Angle

- Healthcare Industry

- Aviation Industry

- Hospitality Industry

- Retail Industry

Please feel free to reach out to me at isilay.civan@hok.com for ideas/subject suggestions on any additional sustainability issues which you would like us to explore.

The UK’s Most ‘Outstanding’ Green Building

The UK’s Most ‘Outstanding’ Green Building:
The building, known as 1 Angel Square, has been designed to deliver a 50 per cent reduction in energy consumption compared to The Co-operative’s current Manchester complex and an 80 per cent reduction in carbon. This will lead to operating costs being lowered by up to 30 per cent.

Redefining the Corporate Real Estate

A newer look at facilities and facility managers as corporate assets

 

VDM Verlag, 2008
ISBN: 9783639002676

(as published in the Commercial Real Estate Network, sep09, vol17, issue3)

In today’s work environment, the competitiveness of an organization is directly related with how effectively and efficiently that business manages its resources. Corporate real estate assets are termed as the fifth resource, after the traditional resources people, technology, information and capital. In addition, for many organizations, facilities-related costs are second only to the cost of labor.

Although these two characteristics should convince organizations that judicious management of their real estate assets is a major factor, expenditures on these buildings are generally regarded as a ‘sunk’ business cost, which cannot be avoided. The prevailing view for most companies is that the level of management associated with controlling facilities-related costs is not sufficiently demanding or sophisticated enough to necessitate the skills of a specialist or the attention of the business’s senior executives. Nevertheless, companies that want to preserve their competitive edge in the market are beginning to see the importance of treating their corporate real estate as an asset and manage them accordingly at the C-Suite level.

They recognize that corporate real estate/facilities fulfill two critical roles in supporting the work of the organization and the realization of its competitive strategy. The first role is to physically support the production process. Corporate real estate provides a central place for people to gather and for work to be done. The second role is the symbolic representation of the organization to the world. The physical setting of the organization is seen by its employees, customers, and suppliers as the embodiment of the company’s values and goals. A sound corporate real estate strategy harnesses both the logistical and symbolic power of workplace and puts it to work to complement the competitive strategy.

Failure to accomplish facilitating these business goals imposes heavy burdens on the organization and its users. These burdens may include lost productivity of people and activities housed in and served by the facility, increased operating costs to overcome the mismatch of needs and facility capability, or increased worker absenteeism and health care costs related to on-the-job stress. Furthermore, the goals of users or owners may change, leading to requirements different from those the facility was initially intended to fulfill. Many of the technologies of modern facilities, as well as the activities they shelter and support, have changed substantially in recent decades and are continuing to change. These changes lead to rising expectations about the services and amenities a facility should provide. Rising expectations can effectively shorten the useful life of a facility and are the essential characteristics of obsolescence. Accommodating rising expectations is often costly, but failing to accommodate change can be even more costly.

Office buildings are typically designed to last for at least 50 – 60 years, and in their initial 15 – 20 years they are expected to serve to the original function they are designed for. Yet, due to the rapid changes in technological advances, office buildings that are 20, 10, even five years old today can be subject to obsolescence. Even new buildings, under certain circumstances, are being renovated to meet the needs of the market before they become inadequate or ineffective due to obsolescence, or turn out to be redundant due to a change in demand for their services. Thus, in today’s world, it is reasonable to consider almost any property not categorized as part of the market’s new-construction stock as an “older building” that is eligible for renovation and/or adaptive reuse. Office buildings are one of the major assets of companies enabling them to maintain their competitive advantage. Successful and effective facility management of corporate assets means highly efficient personnel, which translates into minimum cost and maximum profit. Preventing office buildings from getting obsolete, adaptability to change and emerging technologies protects organizations from foreseeable and excessive costs. All of these facts demonstrate the indisputably important role that facilities play in corporate success.

To minimize the impacts of obsolescence, the aging of a facility should be regularly monitored against the possible changes related to the uses a building or certain spaces within the building are expected to serve (i.e., functional); the cost of continuing to use an existing building, subsystem or component in comparison with the expense of substituting some alternative (economic); the efficiency and service offered by the existing installed technology compared with new and improved alternatives (technological); or the broad influence of changing social goals, political agendas, or changing lifestyles (social, legal/political, market). Such changes are often embodied in the adoption of new standards or codes, rising expectations of performance, major technological change, major change in functional requirements, major organizational change, shifts in property values, poor maintenance or abuse of systems, or aesthetic shifts. These events and shifts spur obsolescence.

Many professionals seemingly use the term “obsolescence” whenever they judge that substantial action is needed to return a facility to full service, and they do not distinguish among the factors giving rise to this need. Yet, new facility uses and their new demands; new materials, technology, and procedures of construction and operation; new air pollutants; and new laws and regulations exemplify changes that lead us to alter design methods and expectations of acceptable service long before older facilities are abandoned. Similarly, changes in organizations, variations in urban real estate markets, and the opportunities presented by new equipment and materials often lead us to renovate long before facilities and their parts are worn out.

Today’s phenomenon for such a change is widely known as “Green Building”, and its leading advocate is USGBC’s Leadership in Energy and Design (LEED) initiative. LEED-EB: OM, short for Leadership in Energy and Design for Existing Buildings: Operations & Maintenance, rating system provides the single greatest opportunity for businesses to green their built environment. By implementing these green building strategies to existing buildings, organizations are able to increase their real estate value, while significantly cutting their operational costs.

Planet Green's top 5 eco TEDTalks

Planet Green's top 5 eco TEDTalks: "

The US cable channel Planet Green counts down their five favorite eco TEDTalks -- with some great big visions to save the planet and the people on it. Some old favorites and some you might have missed. Watch the short video roundup linked above, and watch Planet Green's five top eco TEDTalks right here:

Paul Stamets on 6 ways mushrooms can save the world >>

Chris Jordan pictures some shocking stats >>

Jamie Oliver's TED Prize wish: Teach every child about food >>

Al Gore on averting climate crisis >>

Michael Pritchard's water filter turns filthy water drinkable >>

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