Journal articles on the topic 'Sustainable buildings – United States – Cost effectiveness'

Objective: The purpose of this research study was to link hospital environments to the quality of care and the associated cost of care by examining the relationship among hospital environments and healthcare employee engagement, turnover, illness and injury. Methods: This study used a multi-method research design and quantitative analysis of data sets from participating hospitals. Data included employee survey responses and human resource employee data provided by the hospital system. All statistical tests used an alpha level of .05. The analysis of the survey and human resource employee data tested for significant differences among employees at the participating hospitals; and used correlations and regression analysis to determine the direction and strength of the relationships where significant differences were evident. Results: Results from the survey indicated that perceptions of the built environment affect employee engagement and health and well-being up to 14%. Turnover and injury reductions were significant and resulted in substantial cost differences; $2.17M cost reduction based on the facility replaced and annual cost avoidance of $2.24M when compared to the two newer hospitals that were not Leadership in Energy and Environmental Design (LEED) certified. Conclusions: This study demonstrates that the quality of the hospital environment has social, environmental, and cost implications that aligns with the intention of sustainable design as defined by the United States Green Building Council (USGBC). Developing a built environment that supports productivity, efficiency, safety, and engagement contributes to the prosperity of the healthcare organization.

Buildings have significant impacts on the environment and economy as they were reported by the World Business Council for Sustainable Development in 2009 to account for 40% of the global energy consumption. Building owners are increasingly seeking to integrate sustainability and green measures in their buildings to minimize energy and water consumption as well as life-cycle cost. Due to the large number of feasiblecombinations of sustainability measures, decision makers are often faced with a challenging task that requires them to identify an optimal set of upgrade measures to minimize the building life-cycle cost. This paper presents a model for optimizing the selection of building upgrade measures to minimize the life-cycle cost of existing buildings while complying with owner-specified requirements for building operational performance and budget constraints. The optimization model accounts for initial upgrade cost, operational cost and saving, escalation in utility costs, maintenance cost, replacement cost, and salvage value of building fixtures and equipment, and renewable energy systems. A case study of a rest area building in the state of Illinois in the United States was analyzed to illustrate the unique capabilities of the developed optimization model. The main findings of this analysis illustrate the capabilities of the model in identifying optimal building upgrade measures to achieve the highest savings of building life-cycle cost within a user-specified upgrade budget; and generating practical and detailed recommendations on replacing building fixtures and equipment and installing renewable energy systems.

Abstract In response to a requirement in the Indoor Radon Abatement Act of 1988, The US Environmental Protection Agency (EPA) has been developing 'Model Standards and Techniques for Control of Radon in New Buildings'. A draft of the Model Standards was developed in close co-operation with the building industry and disseminated for public comment in April 1993. A final Standard will be published by the end of 1993. This paper describes the recommended construction techniques and implementation procedures contained in the draft. Use of the recommended standards and techniques is linked to the potential for elevated radon levels that is predicted for different geographical areas of the United States. The paper emphasises the cost-effectiveness of building-in-radon-resistance in new homes, and highlights the use of construction techniques that many builders already use as standard building practice.

In general, European Union Member States attribute great importance to the building sector in reducing their greenhouse gas emissions as part of their climate policy strategies. The present study is aimed at studying what happens if decision-makers do not take any prominent measures to ensure that the building sector realizes more efficient performance. The current European tendencies indicate that the most common approach is to attempt to renovate the existing building stock. However, this is not always the best solution. In Central and Eastern European countries, such as Hungary, the greatest problem encountered in renovations is the outdated heating and electricity supply of the old buildings. Many experts are convinced that these buildings should be demolished now and replaced with new ones in order to achieve more effective performance. This study, besides the environmental matters presents a climate policy-related economic evaluation which strengthens the latter opinion. The purpose of this novel cost effectiveness analysis is to examine the long-term viability of these two approaches (retrofitting strategy vs. the building of new houses) from the aspect of both environmental conformity (climate friendliness) and sustainable economics between 2020 and 2030.

Purpose Oral targeted therapies represent a significant advance for the treatment of patients with chronic lymphocytic leukemia (CLL); however, their high cost has raised concerns about affordability and the economic impact on society. Our objective was to project the future prevalence and cost burden of CLL in the era of oral targeted therapies in the United States. Methods We developed a simulation model that evaluated the evolving management of CLL from 2011 to 2025: chemoimmunotherapy (CIT) as the standard of care before 2014, oral targeted therapies for patients with del(17p) and relapsed CLL from 2014, and for first-line treatment from 2016 onward. A comparator scenario also was simulated where CIT remained the standard of care throughout. Disease progression and survival parameters for each therapy were based on published clinical trials. Results The number of people living with CLL in the United States is projected to increase from 128,000 in 2011 to 199,000 by 2025 (55% increase) due to improved survival; meanwhile, the annual cost of CLL management will increase from $0.74 billion to $5.13 billion (590% increase). The per-patient lifetime cost of CLL treatment will increase from $147,000 to $604,000 (310% increase) as oral targeted therapies become the first-line treatment. For patients enrolled in Medicare, the corresponding total out-of-pocket cost will increase from $9,200 to $57,000 (520% increase). Compared with the CIT scenario, oral targeted therapies resulted in an incremental cost-effectiveness ratio of $189,000 per quality-adjusted life-year. Conclusion The increased benefit and cost of oral targeted therapies is projected to enhance CLL survivorship but can impose a substantial financial burden on both patients and payers. More sustainable pricing strategies for targeted therapies are needed to avoid financial toxicity to patients.

Abstract Mass timber building materials such as cross-laminated timber (CLT) have captured attention in mid- to high-rise building designs because of their potential environmental benefits. The recently updated multistory building code also enables greater utilization of these wood building materials. The cost-effectiveness of mass timber buildings is also undergoing substantial analysis. Given the relatively new presence of CLT in United States, high front-end construction costs are expected. This study presents the life-cycle cost (LCC) for a 12-story, 8,360-m2 mass timber building to be built in Portland, Oregon. The goal was to assess its total life-cycle cost (TLCC) relative to a functionally equivalent reinforced-concrete building design using our in-house-developed LCC tool. Based on commercial construction cost data from the RSMeans database, a mass timber building design is estimated to have 26 percent higher front-end costs than its concrete alternative. Front-end construction costs dominated the TLCC for both buildings. However, a decrease of 2.4 percent TLCC relative to concrete building was observed because of the estimated longer lifespan and higher end-of-life salvage value for the mass timber building. The end-of-life savings from demolition cost or salvage values in mass timber building could offset some initial construction costs. There are minimal historical construction cost data and lack of operational cost data for mass timber buildings; therefore, more studies and data are needed to make the generalization of these results. However, a solid methodology for mass timber building LCC was developed and applied to demonstrate several cost scenarios for mass timber building benefits or disadvantages.

Background: This study aims to analyze the cost of the entire transfusion process in Turkey including evaluation of the cost of transfusion from the perspective of hospital management and determination of savings achieved with the transfusion improvement program. Methods: Invoices, labor, material costs were calculated with micro-costing method, while general production expenses were calculated with gross costing method between January 2018 and December 2019. Unit costs for each blood product were calculated separately by collecting unit acquisition costs, material costs, labor costs, and general production expenses and, then, distributed into six different blood products as follows: erythrocyte suspension, fresh frozen plasma, pooled platelet, apheresis platelet, cryoprecipitate, fresh whole blood. The total costs for 2018 and 2019 were calculated and the savings achieved were estimated. The Turkish Lira was converted into the United States Dollar ($) currency using the purchasing power parity. Results: In 2018/2019, the blood component transfusion cost was $240.90/251.18 for erythrocyte suspension, $120.00/128.67 for fresh frozen plasma, $313.50/322.19 for pooled platelet, $314.24/325.73 for apheresis platelet, $104.95/113.99 for cryoprecipitate, and $189.91/209.09 for fresh whole blood. The total transfusion cost was $6,224,208.33 in 2108 and $5,308,148.43 in 2019. As a result of the transfusion improvement program launched in 2019, the amount of blood components decreased by 23.24%, compared to the previous year, and a saving of $916,059.9 was achieved. Conclusion: The transfusion is a burden for both the hospital management systems and the country's economy. To accurately calculate and manage this economic burden is important for sustainable healthcare services.

Distinct from the existing literature, which mainly focuses on the impacts of green building practices on the owners’ benefits, this paper examines capital market participants’ perceptions of green building, specifically, the cost of equity capital. The study uses data regarding the United States Real Estate Investment Trusts (US REITs) from 2000 to 2016, employing a panel regression analysis and adopting a Price Earnings Growth (PEG) ratio model for the cost of equity capital estimation. We find a negative relationship between green building certification and the cost of equity capital. Our results encourage REITs to participate in green building certification and aim for higher green building rankings. In addition, we examine whether corporate governance could affect the intensity of green building practices in REITs. It is found that corporate governance practices implemented to align shareholders’ and managers’ interests, such as higher institutional holdings and a less dispersed ownership structure, positively impact firms’ resource allocation for green initiatives. The results suggest there could be mutual benefits for both economic profits and sustainable buildings.

According to the U.S. Green Building Council (USGBC), buildings account for a significant amount of environmental degradation. The building sector is the number one producer of global CO2 emissions in the U.S., followed by the transportation and industrial sectors.1 (See Figure 1 for the environmental impact of all U.S. buildings.) The concept of green buildings represents a major paradigm shift in the architectural, construction, and engineering fields. As society increasingly switches its appreciation of buildings from merely size and aesthetics toward environmental stewardship and efficiency, the USGBC's LEED Green Building Rating System has become increasingly popular to follow. Since its inception in 2000, the LEED system has been promoting and monitoring green building practices throughout the United States. With a four-tiered rating scheme including LEED Certified, LEED Silver, LEED Gold, and LEED Platinum, the system currently has 35,000 projects already on their way toward certification.2 In particular, the LEED for Existing Buildings (LEED-EB) system looks to retrofit existing buildings into those that are more sustainable, efficient, and environmentally friendly. Doing so significantly reduces the demand for new resources, as construction managers can recycle and reuse building materials and incorporate them into new designs. This truly is the definition of green building and is the way of the future. By implementing green building practices, many of the adverse environmental impacts of buildings can be dramatically reduced, often for only a one to two percent initial cost premium over the price of conventional construction practice.3 Several environmental benefits of green buildings include improving air and water quality, conserving natural resources, and becoming more energy efficient. Sudies have shown that green buildings, compared to normal buildings, can reduce energy use by 24–50 percent, CO2 emissions by 33–39 percent, water use by 40 percent, and solid waste by 70 percent.4 (See Figure 2 for the impact of green commercial buildings compared to the average commercial building.) In fact, if half of all new construction within the U.S. were built to match these percentages, it would be the equivalent of taking more than one million cars off of the road every year.5 Economic benefits include reducing operating costs, improving employee productivity and satisfaction, and optimizing economic performance over the life cycle of the structure.6 Additionally, health and community benefits include enhancing occupant comfort and health, and contributing to an overall positive environmentally-conscious reputation.7 Furthermore, Taryn Holowka states, “people in green buildings have 40-60 percent fewer incidents of colds, flu, and asthma; patients in green hospitals are discharged as much as two and a half days earlier; and kids in green schools increase their test scores by as much as 18 percent.”8 The U.S. EPA's Region 10 Park Place office building in Seattle was built in 1970. Its owner, Washington Holdings, and building manager, Wright Runstad & Company, have been encouraged by the EPA to use innovative energy conservation design, water conservation, waste reduction, stormwater management, and other strategies to make the structure more sustainable. Following the EPA's Green Building Strategy, which states that the EPA aims to strengthen the foundations of green building and raise public awareness of building-related impacts and opportunities, the Park Place building has become only the fifteenth LEED-EB Platinum building in the world, and one of the most impressive nearly-forty-year-old buildings in the entire United States. By using the LEED-EB Platinum green building rating system, the Park Place building management team has been able to successfully lower the building's energy consumption rate, improve its water efficiency, and make many other beneficial changes—all of which demonstrate just how effective the LEED system is at producing higher performance buildings.

1.0. INTRODUCTION In the United States, K–12 school buildings spend more than $8 billion each year on energy—more than they spend on computers and textbooks combined [1]. Most occupied older buildings demonstrate poor operational performance—for instance, more than 30 percent of schools were built before 1960, and 53 percent of public schools need to spend money on repairs, renovations, and modernization to ensure that the schools' onsite buildings are in good overall condition. And among public schools with permanent buildings, the environmental factors in the permanent buildings have been rated as unsatisfactory or very unsatisfactory in 5 to 17 percent of them [2]. Indoor environment quality (IEQ) is one of the core issues addressed in the majority of sustainable building certification and design guidelines. Children spend a significant amount of time indoors in a school environment. And poor IEA can lead to sickness and absenteeism from school and eventually cause a decrease in student performance [3]. Different building types and their IEQ characteristics can be partly attributed to building age and construction materials. [4] Improving the energy performance of school buildings could result in the direct benefit of reduced utility costs and improving the indoor quality could improve the students' learning environment. Research also suggests that aging school facilities and inefficient equipment have a detrimental effect on academic performance that can be reversed when schools are upgraded. [5] Several studies have linked better lighting, thermal comfort, and air quality to higher test scores. [6, 7, 8] Another benefit of improving the energy efficiency of education buildings is the potential increase in market value through recognition of green building practice and labeling, such as that of a LEED or net zero energy building. In addition, because of their educational function, high-performance or energy-efficient buildings are particularly valuable for institution clients and local government. More and more high-performance buildings, net zero energy buildings, and positive energy buildings serve as living laboratories for educational purposes. Currently, educational/institutional buildings represent the largest portion of NZE (net zero energy) projects. Educational buildings comprise 36 percent of net zero buildings according to a 2014 National New Building Institute report. Of the 58 net zero energy educational buildings, 32 are used for kindergarten through grade 12 (K–12), 21 for higher education, and 5 for general education. [9] Finally, because educational buildings account for the third largest amount of building floor space in the United States, super energy-efficient educational buildings could provide other societal and economic benefits beyond the direct energy cost savings for three reasons: 1) educational buildings offer high visibility that can influence community members and the next generation of citizens, 2) success stories of the use of public funds that returns lower operating costs and healthier student learning environments provide documentation that can be used by others, and 3) this sector offers national and regional forums and associations to facilitate the transfer of best design and operational practices.

The United States Air Force has implemented a dispersed air base strategy to enhance mission effectiveness for near-peer conflicts. Asset dispersal places many smaller bases across a wide geographic area, which increases resupply requirements and logistical complexity. Hybrid energy systems reduce resupply requirements through sustainable, off-grid energy production. This paper presents a novel hybrid energy renewable delivery system (HERDS) model capable of (1) selecting the optimal hybrid energy system design that meets demand at the lowest net present cost and (2) optimizing the delivery of the selected system using existing Air Force cargo aircraft. The novelty of the model’s capabilities is displayed using Clark Air Base, Philippines as a case study. The HERDS model selected an optimal configuration consisting of a 676-kW photovoltaic array, an 1846-kWh battery system, and a 200-kW generator. This hybrid energy system predicts a 54% reduction in cost and an 88% reduction in fuel usage, as compared to the baseline Air Force system. The HERDS model is expected to support planners in their ongoing efforts to construct cost-effective sites that minimize the transport and logistic requirements associated with remote installations. Additionally, the results of this paper may be appropriate for broader civilian applications.

Purpose The purpose of this paper is to ascertain whether energy retrofits need to be directed by public policy intervention or can be encouraged through tax relief that harnesses profit incentives. Existing office space potentially has an economic life of 25 to 40 years. It may be operating inefficiently compared to newer buildings for many years. Designing a market-based incentive system that encourages periodic remodeling which lowers energy usage and carbon emissions would have social benefits. Design/methodology/approach An owner/user case study is developed to test financial feasibility. The empirical study uses publicly available information to examine whether the variables modeled react as anticipated. The regression model incorporates variables of importance to an owner/user. Tax credits and energy deductions, interest rates associated with borrowing and likely electricity and natural gas rate changes are independent variables used to predict the dependent variable new non-residential private construction spending. Findings Investment tax credits (ITCs) coupled with lending has a positive impact on new non-residential commercial construction spending. The value of these benefits is not sufficient to encourage total building energy retrofits, but would encourage low-cost system upgrades. The interest rates associated with borrowing and the debt-service coverage ratio need to be kept low for existing building energy retrofits to be stimulated. Practical implications The case study provides a template that a business can use to determine the financial feasibility of a proposed energy upgrade. It enables the comparison of the marginal cost associated with an update to the present value of the financial benefits likely to be generated. Local real estate tax reductions linked to specific energy upgrades offered by many municipalities can be added to the expected energy savings generated by doing the retrofit. Social implications Tax systems designed to solve environmental pollution problems do not require regulators, inspections or court case decisions and are inherently less intrusive to businesses. Coupling private financial incentives with public policy goals cause energy-saving technologies to be adopted more quickly and with less public outcry. Originality/value The paper specifically considers the factors that influence an owner/user of the property. Rental rates and vacancy losses do not influence a property owner/user. Prior studies looked at revenue enhancements and lower-vacancy rates possibly associated with a green compared to a non-green office building. These studies did not focus on the owner/user paradigm. They reported financial benefits accruing to property owners who lease the office building. Many retrofit studies tended to use CoStar Group’s data, which are collected by a for-profit company and sold to users. The data used in this study come from survey data collected by the Federal Government of the United States of America (USA). It is publicly available to all researchers.

AbstractTwo full-scale building specimens were tested on the shake-table at the EUCENTRE Foundation laboratories in Pavia (Italy), to assess the effectiveness of an innovative timber retrofit solution, within a comprehensive research campaign on the seismic vulnerability of existing Dutch unreinforced masonry structures. The buildings represented the end-unit of a two-storey terraced house typical of the North-Eastern Netherlands, a region affected by induced seismicity over the last few decades. This building typology is particularly vulnerable to earthquake excitation due to lack of seismic details and irregular distribution of large openings in masonry walls. Both specimens were built with the same geometry. Their structural system consisted of cavity walls, with interior load-bearing calcium-silicate leaf and exterior clay veneer, and included a first-floor reinforced concrete slab, a second-floor timber framing, and a roof timber structure supported by masonry gables. A timber retrofit was designed and installed inside the second specimen, providing an innovative sustainable, light-weight, reversible, and cost-effective technique, which could be extensively applied to actual buildings. Timber frames were connected to the interior surface of the masonry walls and completed by oriented strands boards nailed to them. The second-floor timber diaphragm was stiffened and strengthened by a layer of oriented-strand boards, nailed to the existing joists and to additional blocking elements through the existing planks. These interventions resulted also in improved wall-to-diaphragm connections with the inner leaf at both floors, while steel ties were added between the cavity-wall leaves. The application of the retrofit system favored a global response of the building with increased lateral capacities of the masonry walls. This paper describes in detail the bare and retrofitted specimens, compares the experimental results obtained through similar incremental dynamic shake-table test protocols up to near-collapse conditions, and identifies damage states and damage limits associated with displacements and deformations.

One of major factors of deterioration in a microclimate of urban development in the conditions of the Rostov region, is degradation of landscapes owing to violation of water balance of the territory. In article the main reasons for violation of water balance which included natural features of the region, a consequence of anthropogenic influence, climatic changes, etc. are considered. Examples from the world practice of urban planning, which show the relevance and effectiveness of compensation for the effects of anthropogenic im-pacts and climate change using planning methods, are given. The experience of the United States, the Nether-lands, Canada and other countries that use water-saving technologies in planning is considered. The rela-tionship of urban planning and the formation of sustainable urban landscapes is shown. The integration of water-saving technologies into the urban environment can be a means of optimizing landscapes and a means of creating unique urban spaces. Reclamation of the urban landscape of low-rise buildings is a necessary step in creating a modern and comfortable urban environment in the conditions of the Rostov region. Meth-ods are proposed to compensate for negative changes in urban landscapes that can be applied at the stage of urban planning. As well as the proposed methods can be applied in the reconstruction of urban low-rise buildings. The considered methods concern not only urban landscapes, but also agricultural landscapes that surround small and medium-sized cities of the Rostov region. In article the author's concept of the organiza-tion of the low housing estate on a basis Urban- facies is submitted. Planning methods of regulation of water balance of the territory on the basis of models the ecological protective of landscapes are offered: an ecolog-ical core, an ecological corridor and an ecological barrier and also analogs from town-planning practice are considered. The reclamation of urban landscapes based on urban planning methods for regulating the water balance of the territory will allow creating unique urban spaces that are resistant to local climatic conditions and the possible consequences of climate change.

Background. In 2013, the World Health Organization (WHO) revised the 2012 guidelines on use of antiretroviral drugs (ARVs) for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV). The new guidelines recommended lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and breastfeeding women irrespective of CD4 count or clinical stage (also referred to as Option B+). Uganda started implementing Option B+ in 2012 basing on the 2012 WHO guidelines. Despite the impressive benefits of the Option B+ strategy, implementation challenges, including cost burden and mother-baby pairs lost to follow-up, threatened its overall effectiveness. The researchers were unable to identify any studies conducted to assess costs and cost drivers associated with provision of Option B+ services to mother-baby pairs in HIV care in Uganda. Therefore, this study determined costs and cost drivers of providing Option B+ services to mother-baby pairs over a two-year period (2014–2015) in selected health facilities in Jinja district, Uganda. Methods. The estimated costs of providing Option B+ to mother-baby pairs derived from the provider perspective were evaluated at four health centres (HC) in Jinja district. A retrospective, ingredient-based costing approach was used to collect data for 2014 as base year using a standardized cost data capture tool. All costs were valued in United States dollars (USD) using the 2014 midyear exchange rate. Costs incurred in the second year (2015) were obtained by inflating the 2014 costs by the ratio of 2015 and 2014 USA Gross Domestic Product (GDP) implicit price deflator. Results. The average total cost of Option B+ services per HC was 66,512.7 (range: 32,168.2–102,831.1) USD over the 2-year period. The average unit cost of Option B+ services per mother-baby pair was USD 441.9 (range: 422.5–502.6). ART for mothers was the biggest driver of total mean costs (percent contribution: 62.6%; range: 56.0%–65.5%) followed by facility personnel (percent contribution: 8.2%; range: 7.7%–11.6%), and facility-level monitoring and quality improvement (percent contribution: 6.0%; range: 3.2%–12.3%). Conclusions and Recommendations. ART for mothers was the major cost driver. Efforts to lower the cost of ART for PMTCT would make delivery of Option B+ affordable and sustainable.

The health care industry in general and care of chronic pain in particular are described as recessionproof. However, a perfect storm with a confluence of many factors and events —none of which alone is particularly devastating — is brewing and may create a catastrophic force, even in a small specialty such as interventional pain management. Multiple challenges related to interventional pain management in the current decade will include individual and group physicians, office practices, ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPD). Rising health care costs are discussed on a daily basis in the United States. The critics have claimed that health outcomes are the same as or worse than those in other countries, but others have presented the evidence that the United States has the best health care system. All agree it is essential to reduce costs. Numerous factors contribute to increasing health care costs. They include administrative costs, waste, abuse, and fraud. It has been claimed the U.S. health care system wastes up to $800 billion a year. Of this, fraud accounts for approximately $200 billion a year, involving fraudulent Medicare claims, kickbacks for referrals for unnecessary services, and other scams. Administrative inefficiency and redundant paperwork accounts for 18% of health care waste, whereas medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11% of the total. Further, American physicians spend nearly 8 hours per week on paperwork and employ 1.66 clerical workers per doctor, more than any other country. It has been illustrated that it takes $60,000 to $88,000 per physician per year, equal to one-third of a family practitioner’s gross income, and $23 to $31 billion each year in total to interact with health insurance plans. The studies have illustrated that an average physician spends $68,274 per year communicating with insurance companies and performing other non-medical functions. For an office-based practice, the overall total in the United States is $38.7 billion, or $85,276 per physician. In the United States there are 2 types of physician payment systems: private health care and Medicare. Medicare has moved away from the Medicare Economic Index (MEI) and introduced the sustainable growth rate (SGR) formula which has led to cuts in physician payments on a yearly basis. In 2010 and beyond into the new decade, interventional pain management will see significant changes in how we practice medicine. There is focus on avoiding waste, abuse, fraud, and also cutting costs. Evidence-based medicine (EBM) and comparative effectiveness research (CER) have been introduced as cost-cutting and rationing measures, however, with biased approaches. This manuscript will analyze various issues related to interventional pain management with a critical analysis of physician payments, office facility payments, and ASC payments by various payor groups. Key words: Interventional pain management, interventional techniques, physician payment reform, ambulatory surgery center payment, hospital outpatient department payments, sustained growth rate formula, targeted growth rate formula, fraud, abuse, administrative expenses, evidence-based medicine, health care costs

The foundational philosophy that provides the context in which sustainability operates in any given period in history would seem to be key to determining success or failure. In order to have the greatest chance of success, reasonable openness to a wide array of potentially useful ideas would logically appear to be essential. Progress needs context, ignoring neither the truths nor the errors of the past. However, certain blind spots exist that may cause useful ideas of the past to be ignored. This study focuses on the situation of the United States and considers one potential deterrent to long-run effectiveness of sustainability – the routine shunning by Americans of “noble tradition” stemming from the aristocracy and feudalism and its derivatives as anathema to the principles of American democracy. That tradition, though not without its flaws or abuses (no society is free from that), was built arguably on precepts of sustainability – even before the term really existed as it is known today. It is argued that the principles from medieval agrarian society that persisted in one form or another until republican revolutions, the Great War, and finally in the mid-to-late-20th century (depending on the country) are beneficial to consider, and learning from them can benefit modern industry in terms of promoting sustainable practices in systems of production and labour, as well as social responsibility. In order to create a conceptual framework that can be used to consider the potential impact on sustainability programmes of blind spots, a multipoint gravitational model is proposed. The model demonstrates mechanisms by which sustainability efforts may be harmed due to blind spots. Also, the potential for society to impose a cost on firms or individuals that attempt to consider unpopular tradition is considered via payoff analysis of strategic behaviour. That demonstrates the difficulty in breaking through the wall imposed by a blind spot.

The foundational philosophy that provides the context in which sustainability operates in any given period in history would seem to be key to determining success or failure. In order to have the greatest chance of success, reasonable openness to a wide array of potentially useful ideas would logically appear to be essential. Progress needs context, ignoring neither the truths nor the errors of the past. However, certain blind spots exist that may cause useful ideas of the past to be ignored. This study focuses on the situation of the United States and considers one potential deterrent to long-run effectiveness of sustainability – the routine shunning by Americans of “noble tradition” stemming from the aristocracy and feudalism and its derivatives as anathema to the principles of American democracy. That tradition, though not without its flaws or abuses (no society is free from that), was built arguably on precepts of sustainability – even before the term really existed as it is known today. It is argued that the principles from medieval agrarian society that persisted in one form or another until republican revolutions, the Great War, and finally in the mid-to-late-20th century (depending on the country) are beneficial to consider, and learning from them can benefit modern industry in terms of promoting sustainable practices in systems of production and labour, as well as social responsibility. In order to create a conceptual framework that can be used to consider the potential impact on sustainability programmes of blind spots, a multipoint gravitational model is proposed. The model demonstrates mechanisms by which sustainability efforts may be harmed due to blind spots. Also, the potential for society to impose a cost on firms or individuals that attempt to consider unpopular tradition is considered via payoff analysis of strategic behaviour. That demonstrates the difficulty in breaking through the wall imposed by a blind spot.

Abstract Background: Better understanding of the disease biology has led to significant advances in the treatment of CLL. Oral targeted agents such as ibrutinib and idelalisib are currently approved for patients with relapsed CLL. Ibrutinib is also approved for first-line treatment of patients with del(17p). In addition, several other targeted therapies are expected to become available in the near future. These therapies (ibrutinib, idelalisib) have shown to improve survival in Phase III studies. However, their high cost, approaching more than $130,000/year for an indefinite duration of treatment, has raised concerns about their affordability and cost to the society (Shanafelt et al. JOP 2015). Our objective was to project the future prevalence and cost burden of CLL in the context of emerging therapeutic options. Methods: We developed a Markov micro-simulation model representing the CLL population to project the prevalence and total cost of CLL in the United States for each year from 2011 to 2035. Our model was calibrated to the Surveillance, Epidemiology, and End Results (SEER) data and closely predicted the CLL prevalence in 2011. The model included new incidences every year, and considered the individual patient's aging, disease progression, and treatment with the available therapies in the given year. The disease progression was estimated from 10 published clinical trials presenting progression-free and overall survival data in first-line or relapse settings. For each patient, treatment was assigned based on the fitness status (determined by age) and the presence of del(17p). Cost estimation included the cost of drug, treatment administration, and management of adverse events. We simulated changes in the prevalence and the cost of CLL assuming oral targeted therapies as the standard-of-care for patients with relapsed CLL and for patients with del(17p) from 2014 onwards, and in the first-line setting from 2017 onwards (Fig 1A). For comparison, we also ran a scenario assuming chemoimmunotherapy (CIT) remains the standard-of-care from 2011 onwards (Fig 1B). Results: With the emergence of oral targeted therapies, the prevalence of CLL is projected to increase from 120,000 in 2011 to 180,000 in 2025 (Fig 2A). Oral targeted therapies would result in additional 170,000 person-years in the next 10 years in the US. The annual cost of CLL treatment would increase from $0.9 billion in 2011 to $3.5 billion in 2025 (Fig 2B). Compared with CIT, oral targeted therapies would cost additional $15 billion over the course of next 10 years. The increase in prevalence and costs would be driven by substantially improved survival and continuous administration of the expensive oral therapies. Conclusion: The new oral targeted agents represent a significant advance for the treatment of CLL and will substantially increase survival rates. However, they will dramatically increase the cost burden of CLL in the US. Such an economic impact could result in limited access and lower adherence to the oral therapies, which may undermine their clinical effectiveness. Given the increasing number of patients on first-line oral therapy that is continuously administered over an extended duration, a more sustainable pricing for such therapies is needed. Figure 1. Scenarios of treatment strategies with emerging therapeutic options. Figure 1. Scenarios of treatment strategies with emerging therapeutic options. Figure 2. Estimates of prevalence and cost burden for oral targeted therapy and chemoimmunotherapy scenarios. Figure 2. Estimates of prevalence and cost burden for oral targeted therapy and chemoimmunotherapy scenarios. Disclosures Keating: Celgene Corp.: Consultancy; Glaxo-Smith-Kline Inc.: Other: Advisory board.

Social innovations are activities aiming at implementation of social objectives, including mainly the improvement of life of individuals and social groups, together with public policy and management objectives. The essay indicates and discusses the most important contemporary problems, solving of which requires social innovations. Social innovations precondition the progress of civilisation. The world needs not only new technologies, but also new solutions of social and institutional nature that would be conducive to achieving social goals. Social innovations are experimental social actions of organisational and institutional nature that aim at improving the quality of life of individuals, communities, nations, companies, circles, or social groups. Their experimental nature stems from the fact of introducing unique and one-time solutions on a large scale, the end results of which are often difficult to be fully predicted. For example, it was difficult to believe that opening new labour markets for foreigners in the countries of the European Union, which can be treated as a social innovation aiming at development of the international labour market, will result in the rapid development of the low-cost airlines, the offer of which will be available to a larger group of recipients. In other words, social innovations differ from economic innovations, as they are not about implementation of new types of production or gaining new markets, but about satisfying new needs, which are not provided by the market. Therefore, the most important distinction consists in that social innovations are concerned with improving the well-being of individuals and communities by additional employment, or increased consumption, as well as participation in solving the problems of individuals and social groups [CSTP, 2011]. In general, social innovations are activities aiming at implementation of social objectives, including mainly the improvement of life of individuals and social groups together with the objectives of public policy and management [Kowalczyk, Sobiecki, 2017]. Their implementation requires global, national, and individual actions. This requires joint operations, both at the scale of the entire globe, as well as in particular interest groups. Why are social innovations a key point for the progress of civilisation? This is the effect of the clear domination of economic aspects and discrimination of social aspects of this progress. Until the 19th century, the economy was a part of a social structure. As described by K. Polanyi, it was submerged in social relations [Polanyi, 2010, p. 56]. In traditional societies, the economic system was in fact derived from the organisation of the society itself. The economy, consisting of small and dispersed craft businesses, was a part of the social, family, and neighbourhood structure. In the 20th century the situation reversed – the economy started to be the force shaping social structures, positions of individual groups, areas of wealth and poverty. The economy and the market mechanism have become independent from the world of politics and society. Today, the corporations control our lives. They decide what we eat, what we watch, what we wear, where we work and what we do [Bakan, 2006, p. 13]. The corporations started this spectacular “march to rule the world” in the late 19th century. After about a hundred years, at the end of the 20th century, the state under the pressure of corporations and globalisation, started a gradual, but systematic withdrawal from the economy, market and many other functions traditionally belonging to it. As a result, at the end of the last century, a corporation has become a dominant institution in the world. A characteristic feature of this condition is that it gives a complete priority to the interests of corporations. They make decisions of often adverse consequences for the entire social groups, regions, or local communities. They lead to social tensions, political breakdowns, and most often to repeated market turbulences. Thus, a substantial minority (corporations) obtain inconceivable benefits at the expense of the vast majority, that is broad professional and social groups. The lack of relative balance between the economy and society is a barrier to the progress of civilisation. A growing global concern is the problem of migration. The present crisis, left unresolved, in the long term will return multiplied. Today, there are about 500 million people living in Europe, 1.5 billion in Africa and the Middle East, but in 2100, the population of Europe will be about 400 million and of the Middle East and Africa approximately 4.5 billion. Solving this problem, mainly through social and political innovations, can take place only by a joint operation of highly developed and developing countries. Is it an easy task? It’s very difficult. Unfortunately, today, the world is going in the opposite direction. Instead of pursuing the community, empathic thinking, it aims towards nationalism and chauvinism. An example might be a part of the inaugural address of President Donald Trump, who said that the right of all nations is to put their own interests first. Of course, the United States of America will think about their own interests. As we go in the opposite direction, those who deal with global issues say – nothing will change, unless there is some great crisis, a major disaster that would cause that the great of this world will come to senses. J.E. Stiglitz [2004], contrary to the current thinking and practice, believes that a different and better world is possible. Globalisation contains the potential of countless benefits from which people both in developing and highly developed countries can benefit. But the practice so far proves that still it is not grown up enough to use its potential in a fair manner. What is needed are new solutions, most of all social and political innovations (political, because they involve a violation of the previous arrangement of interests). Failure to search for breakthrough innovations of social and political nature that would meet the modern challenges, can lead the world to a disaster. Social innovation, and not economic, because the contemporary civilisation problems have their roots in this dimension. A global problem, solution of which requires innovations of social and political nature, is the disruption of the balance between work and capital. In 2010, 400 richest people had assets such as the half of the poorer population of the world. In 2016, such part was in the possession of only 8 people. This shows the dramatic collapse of the balance between work and capital. The world cannot develop creating the technological progress while increasing unjustified inequalities, which inevitably lead to an outbreak of civil disturbances. This outbreak can have various organisation forms. In the days of the Internet and social media, it is easier to communicate with people. Therefore, paradoxically, some modern technologies create the conditions facilitating social protests. There is one more important and dangerous effect of implementing technological innovations without simultaneous creation and implementation of social innovations limiting the sky-rocketing increase of economic (followed by social) diversification. Sooner or later, technological progress will become so widespread that, due to the relatively low prices, it will make it possible for the weapons of mass destruction, especially biological and chemical weapons, to reach small terrorist groups. Then, a total, individualized war of global reach can develop. The individualisation of war will follow, as described by the famous German sociologist Ulrich Beck. To avoid this, it is worth looking at the achievements of the Polish scientist Michał Kalecki, who 75 years ago argued that capitalism alone is not able to develop. It is because it aggressively seeks profit growth, but cannot turn profit into some profitable investments. Therefore, when uncertainty grows, capitalism cannot develop itself, and it must be accompanied by external factors, named by Kalecki – external development factors. These factors include state expenses, finances and, in accordance with the nomenclature of Kalecki – epochal innovations. And what are the current possibilities of activation of the external factors? In short – modest. The countries are indebted, and the basis for the development in the last 20 years were loans, which contributed to the growth of debt of economic entities. What, then, should we do? It is necessary to look for cheaper solutions, but such that are effective, that is breakthrough innovations. These undoubtedly include social and political innovations. Contemporary social innovation is not about investing big money and expensive resources in production, e.g. of a very expensive vaccine, which would be available for a small group of recipients. Today’s social innovation should stimulate the use of lower amounts of resources to produce more products available to larger groups of recipients. The progress of civilisation happens only as a result of a sustainable development in economic, social, and now also ecological terms. Economic (business) innovations, which help accelerate the growth rate of production and services, contribute to economic development. Profits of corporations increase and, at the same time, the economic objectives of the corporations are realised. But are the objectives of the society as a whole and its members individually realised equally, in parallel? In the chain of social reproduction there are four repeated phases: production – distribution – exchange – consumption. The key point from the social point of view is the phase of distribution. But what are the rules of distribution, how much and who gets from this “cake” produced in the social process of production? In the today’s increasingly global economy, the most important mechanism of distribution is the market mechanism. However, in the long run, this mechanism leads to growing income and welfare disparities of various social groups. Although, the income and welfare diversity in itself is nothing wrong, as it is the result of the diversification of effectiveness of factors of production, including work, the growing disparities to a large extent cannot be justified. Economic situation of the society members increasingly depends not on the contribution of work, but on the size of the capital invested, and the market position of the economic entity, and on the “governing power of capital” on the market. It should also be noted that this diversification is also related to speculative activities. Disparities between the implemented economic and social innovations can lead to the collapse of the progress of civilisation. Nowadays, economic crises are often justified by, indeed, social and political considerations, such as marginalisation of nation states, imbalance of power (or imbalance of fear), religious conflicts, nationalism, chauvinism, etc. It is also considered that the first global financial crisis of the 21st century originated from the wrong social policy pursued by the US Government, which led to the creation of a gigantic public debt, which consequently led to an economic breakdown. This resulted in the financial crisis, but also in deepening of the social imbalances and widening of the circles of poverty and social exclusion. It can even be stated that it was a crisis in public confidence. Therefore, the causes of crises are the conflicts between the economic dimension of the development and its social dimension. Contemporary world is filled with various innovations of economic or business nature (including technological, product, marketing, and in part – organisational). The existing solutions can be a source of economic progress, which is a component of the progress of civilisation. However, economic innovations do not complete the entire progress of civilisation moreover, the saturation, and often supersaturation with implementations and economic innovations leads to an excessive use of material factors of production. As a consequence, it results in lowering of the efficiency of their use, unnecessary extra burden to the planet, and passing of the negative effects on the society and future generations (of consumers). On the other hand, it leads to forcing the consumption of durable consumer goods, and gathering them “just in case”, and also to the low degree of their use (e.g. more cars in a household than its members results in the additional load on traffic routes, which results in an increase in the inconvenience of movement of people, thus to the reduction of the quality of life). Introduction of yet another economic innovation will not solve this problem. It can be solved only by social innovations that are in a permanent shortage. A social innovation which fosters solving the issue of excessive accumulation of tangible production goods is a developing phenomenon called sharing economy. It is based on the principle: “the use of a service provided by some welfare does not require being its owner”. This principle allows for an economic use of resources located in households, but which have been “latent” so far. In this way, increasing of the scope of services provided (transport, residential and tourist accommodation) does not require any growth of additional tangible resources of factors of production. So, it contributes to the growth of household incomes, and inhibition of loading the planet with material goods processed by man [see Poniatowska-Jaksch, Sobiecki, 2016]. Another example: we live in times, in which, contrary to the law of T. Malthus, the planet is able to feed all people, that is to guarantee their minimum required nutrients. But still, millions of people die of starvation and malnutrition, but also due to obesity. Can this problem be solved with another economic innovation? Certainly not! Economic innovations will certainly help to partially solve the problem of nutrition, at least by the new methods of storing and preservation of foods, to reduce its waste in the phase of storage and transport. However, a key condition to solve this problem is to create and implement an innovation of a social nature (in many cases also political). We will not be able to speak about the progress of civilisation in a situation, where there are people dying of starvation and malnutrition. A growing global social concern, resulting from implementation of an economic (technological) innovation will be robotisation, and more specifically – the effects arising from its dissemination on a large scale. So far, the issue has been postponed due to globalisation of the labour market, which led to cheapening of the work factor by more than ten times in the countries of Asia or South America. But it ends slowly. Labour becomes more and more expensive, which means that the robots become relatively cheap. The mechanism leading to low prices of the labour factor expires. Wages increase, and this changes the relationship of the prices of capital and labour. Capital becomes relatively cheaper and cheaper, and this leads to reducing of the demand for work, at the same time increasing the demand for capital (in the form of robots). The introduction of robots will be an effect of the phenomenon of substitution of the factors of production. A cheaper factor (in this case capital in the form of robots) will be cheaper than the same activities performed by man. According to W. Szymański [2017], such change is a dysfunction of capitalism. A great challenge, because capitalism is based on the market-driven shaping of income. The market-driven shaping of income means that the income is derived from the sale of the factors of production. Most people have income from employment. Robots change this mechanism. It is estimated that scientific progress allows to create such number of robots that will replace billion people in the world. What will happen to those “superseded”, what will replace the income from human labour? Capitalism will face an institutional challenge, and must replace the market-driven shaping of income with another, new one. The introduction of robots means microeconomic battle with the barrier of demand. To sell more, one needs to cut costs. The costs are lowered by the introduction of robots, but the use of robots reduces the demand for human labour. Lowering the demand for human labour results in the reduction of employment, and lower wages. Lower wages result in the reduction of the demand for goods and services. To increase the demand for goods and services, the companies must lower their costs, so they increase the involvement of robots, etc. A mechanism of the vicious circle appears If such a mass substitution of the factors of production is unfavourable from the point of view of stimulating the development of the economy, then something must be done to improve the adverse price relations for labour. How can the conditions of competition between a robot and a man be made equal, at least partially? Robots should be taxed. Bill Gates, among others, is a supporter of such a solution. However, this is only one of the tools that can be used. The solution of the problem requires a change in the mechanism, so a breakthrough innovation of a social and political nature. We can say that technological and product innovations force the creation of social and political innovations (maybe institutional changes). Product innovations solve some problems (e.g. they contribute to the reduction of production costs), but at the same time, give rise to others. Progress of civilisation for centuries and even millennia was primarily an intellectual progress. It was difficult to discuss economic progress at that time. Then we had to deal with the imbalance between the economic and the social element. The insufficiency of the economic factor (otherwise than it is today) was the reason for the tensions and crises. Estimates of growth indicate that the increase in industrial production from ancient times to the first industrial revolution, that is until about 1700, was 0.1-0.2 per year on average. Only the next centuries brought about systematically increasing pace of economic growth. During 1700- 1820, it was 0.5% on an annual average, and between 1820-1913 – 1.5%, and between 1913-2012 – 3.0% [Piketty, 2015, p. 97]. So, the significant pace of the economic growth is found only at the turn of the 19th and 20th century. Additionally, the growth in this period refers predominantly to Europe and North America. The countries on other continents were either stuck in colonialism, structurally similar to the medieval period, or “lived” on the history of their former glory, as, for example, China and Japan, or to a lesser extent some countries of the Middle East and South America. The growth, having then the signs of the modern growth, that is the growth based on technological progress, was attributed mainly to Europe and the United States. The progress of civilisation requires the creation of new social initiatives. Social innovations are indeed an additional capital to keep the social structure in balance. The social capital is seen as a means and purpose and as a primary source of new values for the members of the society. Social innovations also motivate every citizen to actively participate in this process. It is necessary, because traditional ways of solving social problems, even those known for a long time as unemployment, ageing of the society, or exclusion of considerable social and professional groups from the social and economic development, simply fail. “Old” problems are joined by new ones, such as the increase of social inequalities, climate change, or rapidly growing environmental pollution. New phenomena and problems require new solutions, changes to existing procedures, programmes, and often a completely different approach and instruments [Kowalczyk, Sobiecki, 2017].

Residential and commercial buildings account for more than half of the electricity consumption in the United States. There are numerous practical solutions to make buildings more energy efficient and sustainable. Although it is well-established that green buildings are socially, environmentally, and economically beneficial, there is still a lack of green buildings in the residential sector. The installation and upfront costs for these houses are very high. This research aims to facilitate a broader understanding of the cost benefits of energy efficient and sustainable residences. The Life cycle cost analysis (LCCA) approach and energy simulation tools have been utilized and integrated for assessing the traditional single-family residence in the United States. A comparative study has been carried out including passive and net-zero energy through energy simulation software. This analysis will benefit academic researchers and industry practitioners to analyze and evaluate challenges and opportunities in energy efficient and sustainable residences.

Proponents of decentralized forest governance make a compelling case that community forest enterprises (CFEs) can aid in sustainable and equitable utilization of forest resources. The effectiveness of CFEs is thus dependent on their ability to balance social, environmental, and financial performance. In this paper, we examine the relationship between a commonly recommended differentiation strategy and CFE effectiveness. Using data obtained through a survey administered on 51 CFEs located in the Cascadia region (British Columbia province of Canada; and Oregon and Washington states of the United States), we find that CFEs pursuing a differentiation strategy are able to balance social, environmental, and financial objectives. Further, recognizing that all CFEs cannot pursue a differentiation strategy, and some may not even have a defined strategic orientation, the paper compares social, environmental, and financial performance of CFEs pursuing a differentiation strategy, a hybrid strategy (a combination of differentiation and cost leadership strategy), and no defined strategy. This analysis reveals that CFEs pursuing a hybrid strategy deliver better financial performance than those with no defined strategy, but are similar to those pursuing a differentiation strategy.

Background: Metabolic syndrome has become a significant problem, with the American Diabetes Association estimating the cost of diabetes and pre-diabetes in the United States alone to be $322 billion per year. Numerous clinical trials have demonstrated the efficacy of low-carbohydrate diets in reversing metabolic syndrome and its associated disorders.Aim: This study was designed to examine how voluntary adherents to a low-carbohydrate diet rate its effectiveness and sustainability using an online survey.Setting and methods: The 57-question survey was administered online and shared internationally via social media and ‘low-carb’ communities. Where appropriate, chi-squared tests and paired t-tests were used to analyse the responses.Results: There were 1580 respondents. The majority of respondents had consumed less than 100 g of carbohydrates per day for over a year, typically for reasons of weight loss or disease management. There was a reported decrease in waist circumference and weight with a simultaneous decrease in hunger and increase in energy level. Of those who provided laboratory values, the majority saw improvements in their HbA1c, blood glucose measurements, and lipid panel results. There was a reduction in usage of various medications, and 25% reported medication cost savings, with average monthly savings of $288 for those respondents. In particular, the usage of pain relievers and anti-inflammatories dropped with a simultaneous decreased rating of pain and increase in mobility.Conclusion: We conclude that low-carbohydrate diets are a sustainable method of metabolic syndrome reversal in a community setting.

Background and Purpose: The availability of oncology biosimilars is deemed as a fundamental strategy to achieve sustainable health care. However, there is scarce systematic evidence on economic effectiveness of cancer biosimilars. We aimed to synthesize evidence from pharmacoeconomic evaluation of oncology biosimilars globally, provide essential data and methodological reference for involved stakeholders.Materials and Methods: This systematic review was conducted in PubMed, embase, the Cochrane library, CRD, ISPOR and NICE utill December 31, 2019. Information on basic characteristics, evaluation methodology and results were extracted. Quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards Checklist.Results: For 17 studies identified (13 from Europe and four from United States), the overall quality was generally acceptable. A total of seven biological molecules involved with filgrastim, EPOETIN α, and trastuzumab leading the three. The mostly common evaluation perspective was payer, but the time horizon varied greatly. There were ten studies which adopted cost minimization analysis to evaluate efficiency while seven studies adopted budget impact analysis to address affordability, with cost ratio and cost saving being its corresponding primary endpoint. Although the comparability of included studies was limited and specific results were largely affected by uptake and price discount rates of the oncology biosimilar, the comprehensive results consistently favored its promotion.Conclusion: Globally, the economic evaluation of cancer biosimilars is in its initial phase. However, limited evidence from developed countries consistently supported both cost-effectiveness of efficiency and affordability of oncology biosimilars, while they were largely affected by uptake and price discount rate.

The release of Al Gore’s An Inconvenient Truth and his subsequent training of thousands of Climate Presenters marks a critical transition point in communication around climate change. An analysis of Al Gore’s An Inconvenient Truth presentation and of the guidelines we were taught as Presenters in The Climate Project, show they reflect the marketing principles that the World Wildlife Fund (WWF) report Weathercocks and Signposts (Crompton) argues cannot achieve the systemic and transformational changes required to address global warming. This paper will consider the ultimate effectiveness of social marketing approaches to Climate change communication and the Al Gore Climate Project in the light of the WWF critique. Both the film and the various slideshow presentations of An Inconvenient Truth conclude with a series of suggestions about how to “how to start” changing “the way you live.” The audience is urged to: Reduce your own emissions Switch to green power Offset the rest Spread the word The focus on changing individual consumption in An Inconvenient Truth is also reflected in the climate campaign page Get Involved on the website of the Australian Conservation Foundation (ACF)—the Australian partner in Al Gore’s The Climate Project (TCP). Al Gore’s Climate Project, with over 3,000 Climate Presenters worldwide, could be seen as a giant experimental test of the merits of marketing approaches to social change as compared to the recommendations in the WWF critique authored by Crompton. In Orion magazine, Derrick Jensen has described this emphasis on “personal consumption” instead of “organized political resistance” as “a campaign of systematic misdirection.” Jensen points out that “even if every person in the United States did everything the movie suggested, U.S. carbon emissions would fall by only 22 percent.” The latest scientific reports show we are on the edge of a tipping point into catastrophic climate change—runaway warming which would render the planet uninhabitable for most life forms, including humans (Hansen et al 13). To reduce the risk of catastrophic climate change to a still worrying 13% we need significant action between now and 2012, and carbon dioxide levels will need to be stabilised at between 350 and 375 parts per million by 2050 (Elzen and Meinshausen 17). Because Americans and Australians are taking far more than our share of the global atmospheric commons, we need to reduce our emissions to less than 90% below 1990 levels by 2050 as our share of the global emission reduction targets (Elzen and Meinshausen 24; Garnaut 283). In other words, if one takes the science seriously there is a huge shortfall between the reductions which can be achieved by individual changes to consumption and the scale of reductions that are required to reduce the risk of catastrophic climate change to a half-way tolerable level. The actions being promoted as solutions are nowhere near “inconvenient” enough to solve the problem. Like Crompton and Jensen I was inclined to take the gap between goal and means as overwhelming evidence for the inadequacy of marketing approaches emphasising changes to individual consumption choices. Like them I was concerned that the emphasis on consumption in marketing approaches may even reinforce the consumerism and materialism that drives the growth in emissions. Whilst being generally critical of marketing approaches, Crompton says he accepts the importance marketers place on tailoring the message to fit the motivations of the target audience (25). However, while Crompton describes Rose and Dade’s “Values Modes analysis” as “a sophisticated technique for audience segmentation” (21), he rejects the campaign strategies designed around the target audiences they identify (23). Market segmentation provides communications practitioners with the “extensive knowledge of whom you are trying to reach and what moves them” which is one of the “three must haves” of a successful communication campaign (Fenton 3). Rose and Dade’s segmentation analysis categorises people based on the motivational hierarchy in Maslow’s Hierarchy of Needs. They identify three population groupings—the Settlers, driven by security; the Prospectors, esteem driven; and the Pioneers, who are motivated by intrinsic values (1). As with Maslow’s hierarchy these “Values Modes” are developmentally dynamic. The satisfaction of more basic needs, like physical safety and economic security, support a developmental pathway to the next level. Just as the satisfaction of the need for social acceptance and status free the individual to become motivated by self-actualisation, universal and compassionate ethics, and transcendence. Because individuals move in and out of Values Modes, depending on the degree to which economic, social and political conditions facilitate the satisfaction of their needs, the percentage of the population in each group varies across time and location (Rose and Dade 1). In 2007 the UK population was 20% Settlers, 40% Prospectors, and 40% Pioneers (Rose and Dade 1), but the distribution in other countries would need to be determined empirically. Rose et al provide a strategic rationale for a marketing based climate campaign targeted at changing the behaviours of Prospectors, rather than appealing to Pioneers. While the Pioneers are 40% of the population, they don’t like being “marketed at,” they seek out information for themselves and make up their own minds, and “will often have already considered your ideas and decided what to do” (6). They are also well catered for by environmental groups’ existing ethical and issues based campaigns (3). Prospectors, on the other hand, are the 40% of the population which are the “least reached” by existing ethical or issues oriented environmental campaigning; are the most enthusiastic (or “voracious”) consumers, so their choices will sway business; and they tend to be swinging voters, so if their opinions change it will sway politicians (4). Rose et al (13) found that in order to appeal to Prospectors a climate change communications campaign should: Refer to local, visible, negative changes involving loss or damage [In the UK] show the significance of UK emissions and those of normal people (i.e. like them) Use interest in homes and gardens Deploy the nag factor of their children Create offers which are above all easy, cost-effective, instant and painless Prospectors don’t like, and will be put off by campaigns that (Rose et al 13): Talk about the implications: too remote and they are not very bothered Use messengers (voices) which lack authority or could be challenged Criticise behaviours (e.g. wrong type of car, ‘wasting’ energy in your home) Ask them to give things up Ask them to be the first to change (amongst their peers) Invoke critical judgement by others Crompton recommends an environmental campaign that attempts to persuade Prospectors that they are wrong in thinking material consumption and “ostentatious displays of wealth” contribute to their happiness. Prospectors see precisely these sorts of comments by Concerned Ethicals as a judgemental criticism of their love of things, and a denial of their need for the acceptance and approval of others. Maslow’s developmental model, as well as the Value Modes research, would suggest that Crompton’s proposal is the exact opposite of what is required to move Prospectors into the Pioneer value mode. It is by accepting the values people have, and allowing them to meet the needs that drive them, that they can move on to more intrinsically motivated action. Crompton would appear to fall into the common “NGO or public sector campaign […] trap” of devising a campaign based on what will appeal to the 10% of the population that are Concerned Ethicals, but in the process “particularly annoy or intimidate” the strategically significant 40% of the population that are Prospectors (Rose et al 8). Crompton ignores the evidence from marketing campaign research that campaigns can’t directly change people’s basic motivations, while they can change people’s behaviours if they target their existing motivations. Contrary to Crompton’s claim that promoting green consumption will reinforce consumerism and materialism (16), Rose and Dade base their campaign strategy on the results of research into cognitive dissonance, which show that if you can get someone to act a certain way, they will alter their beliefs and preferences, as well as their self concept, to fit with their actions. Crompton confuses a tactic in a larger game, with the end goal of the game. “The trick is to get them to do the behaviour, not to develop the opinion” (Rose, “VBCOP” 2). Prospectors are persuaded to adopt a behaviour if they see it as “in,” and as what everyone else like them is doing. They are more easily persuaded to buy a product than adopt some other sort of behavioural change. The next part of an environmental marketing strategy like this is to label, praise and reward the behaviour (Futerra 11). Rose suggests that Prospectors can be engaged politically if governments are called on to recognise and reward the behaviour “say by giving them a tax break or paying them for their rooftop energy contribution” (“VBCOP” 3). Once governments have given such rewards, both Settlers and Propectors will fight to keep them, where they are normally disinclined to fight political battles. Once Prospectors identify themselves as, for example, in favour of renewable energy, politicians can be persuaded they need to act to get and keep votes, and business can be persuaded to change in order to continue to attract buyers for their products. In order to achieve the scale of emission reductions required individuals need to change their consumption patterns; politicians need to change the regulatory and planning context in which both individual and corporate decisions are made; and the economic system needs to be transformed so it internalises environmental costs and operates within environmental limits. Social marketing analyses have identified changing Prospectors buying habits as the wedge, or leverage point that can lead to such a cascading set of social, political and economic changes. Just as changing Prospector product choices can be exploited as a key leverage point, Al Gore identified getting United States commitment to emission reduction as a key leverage point towards achieving global commitments to binding reduction targets. Because the United States had the highest national greenhouse emissions, and was one of the two industrialised countries who had failed to sign the Kyoto Protocol, changing behaviour and belief in the United States was strategically critical to achieving global action on emissions reduction. Al Gore initially attempted to get the United States to sign the Kyoto Protocol and commit to emission reduction by working directly at the political level, without building the popular support for action that would encourage other politicians to support his proposals. In the movie, Al Gore talks about the defeat of his initial efforts to get the United States to sign the Kyoto Protocol, and of his recognition of the need to gain wider public support before political action would be taken. He talks about the unsuitability of the mass news media as a vehicle for achieving social and political change on climate emissions. The priority given to conflict as a news value means journalists focus on the personalities involved in disputes about climate change rather than provide an analysis of the issue. When climate experts explain the consensus position of the Intergovernmental Panel on Climate Change (IPCC), they are “balanced” with opposing statements from the handful of (commonly fossil fuel industry funded) climate deniers. Because climate emissions are part of a complex process of slow change occurring over long time lines they do not fit easily into standard news values like timeliness, novelty and proximity (Harrison). When Al Gore realised he wouldn’t be able to gain the wider public support he needed through the mass news media he began a quest to spread his message “meeting by meeting,” “person by person.” Al Gore turned his slide show into a movie in order to deliver the message to more people than he could reach face to face, and then trained Presenters to reach even more people. When the movie won an Oscar for Best Documentary it turned Al Gore into something of a celebrity. Al Gore’s celebrity status rubs off on Climate Presenters through their association with him, giving them access to community and business groups across the world. When a celebrity recommends or displays a behaviour, Prospectors are more likely to see it as the in thing and thus more willing to do the recommended action. The movie created an opportunity for Al Gore to be a more persuasive messenger than he had been as a politician. Al Gore began The Climate Project to increase the impact of the movie and spread the message further than he could take it by himself. The multiplication of modes of communicating the message fits with Fenton Communications’ “Rule of Three.” In Now Hear This they say the target audience “should read about us in the paper, see us on TV, hear about us from a neighbour and a friend […] have their kid mention us […] and so on” (17). The Presenter training emphasises the “direct communication, especially face to face” recommended by Rose (“To do” 174). During the Presenter training Al Gore warned of the danger of being too negative as it risked moving people “from denial to despair without stopping to act,” and of the need to present the story in such a way as to create hope. This is backed up by the communications marketing literature, which warns that “negative messages may actually induce despair and actually [sic] paralysis while the positive focus can inspire” (Boykoff 172). While it employs dramatic visual images and animations, the movie tends to downplay the potential severity of the consequences of runaway global warming, and presents these in a way that gives the impression of a contracted time frame for the consequences of warming in order to activate motivation based on near term implications. The movie responds to Prospectors’ disinterest in distant implication of climate change by emphasising near-term threats, such as the rising monetary cost of damages, as well as threats to life and property from disease, drought, fire, flood, storm, and rising sea levels. After training an initial round of American Presenters, Al Gore identified training Australian Presenters as the next strategic priority. While Australia’s collective emissions are small, our per capita emissions are higher than those of Americans, and as the only other industrialised nation that had not signed, it was believed our becoming a signatory to the Kyoto Protocol would increase the pressure on the United States to sign. The ACF provided Australian Presenters with additional slides containing vivid images of Australian impacts, and Presenters were encouraged to find their own examples to illustrate impacts relevant to specific local audiences. The importance of identifying local impacts to persuade and move their audiences is impressed upon Presenters during the training. Regular slide updates reinforce this priority. While authors like Crompton and Jensen note the emphasis on changes in consumption as suggested solutions to climate change, other elements of the presentation are just as important in appealing to Prospectors. Prospectors want to belong and gain status by doing whatever is highly regarded by others. The presentation has numerous slides emphasising who else has made commitments to Kyoto and emission reduction. The American presentation includes lists of other countries, and towns and states in the United States that had signed up to Kyoto. The Australian presentation includes graphics emphasising the overwhelming number of Australians who support action. Prospectors don’t like being asked to give things up, and the presentation insists on the high cost of failing to act, compared to the small cost of acting now. Doing something to stop climate change is presented as easy and achievable. Contrary to Crompton’s claim that promoting green consumption would not build the widespread awareness and support for the more far-reaching government action that is required to achieve systemic change (9), the results of recent opinion research show that upwards of 80% of Americans support effective and wide-ranging action to reduce emissions and develop new renewable energy technologies (Climate Checklist). Whereas it would not have been surprising if the financial crisis had dimmed the degree of enthusiasm for action to reduce greenhouse emissions, the high support for action on climate change in their polling continues to encourage the Australian government to use it as a wedge issue against the opposition. Without high levels of public support, there would be little or no chance that politicians would be willing to vote for measures that will reduce emissions. That the push for change in individual consumption choices was only ever one tactic in a wider campaign is also demonstrated by the other projects instigated by Al Gore and his team. Projects like RepoWEr America and WE can solve the climate crisis leverage the interest developed by the Climate Project to increase public pressure on politicians to support regulatory change. The RepoWEr America and WE can solve the climate crisis sites target individuals as citizens and make it easy for them to participate in the political process. Forms help them sign petitions, write letters and meet with their elected officials, write for newspapers and call in to talkback radio, and organise local community meetings or events. Al Gore’s own web site adds a link to the Live Earth company to add to these arsenals. Live Earth “creates innovative, engaging events and media that challenge global leaders, local communities and every individual to actively participate in solving our planet's urgent environmental crises.” These sites provide the infrastructure to make it easy for individuals to move into action in the political domain. But they do it in ways that will appeal to Prospectors. They involve fun, their actions are celebrated, prizes are offered, the number of people involved is emphasised so they feel part of the “happening” thing. RepoWEr America and WE can solve the climate crisis help Prospectors to engage in political action in order to achieve regulatory change. Finally, or first, Al Gore’s Generation Investment Management Company, operating since 2004, is oriented towards systemic transformation in the economic system, so that economic drivers are aligned with sustainability imperatives. Al Gore and his partner David Blood reject Gross Domestic Product—the current measure of economic growth, and a major driver of unsustainable economic activity—as “dangerously imprecise in its ability to account for natural and human resources” and challenge business to accept the “need to internalize externalities” in order to create a sustainable economy. In their Thematic Research Highlights, Al Gore’s Generation company critiques the “Hedonic Treadmill”—which puts “material gains ahead of personal happiness” (32), and challenges “governments, companies, and individuals [...] to broaden their scope of responsibility to match their sphere of influence” (13). While the Climate Project would appear to ignore the inadequacy of individual consumption change as a means of emission reduction, the information and analysis targeted at business by Generation demonstrates this has not been ignored in the overall strategy to achieve systemic change. Al Gore suggests that material consumption should no longer be the measure of economic welfare, an argument he backs with an analysis showing business that long term wealth creation depends on accepting environmental and social sustainability as priorities. While An Inconvenient Truth promotes consumption change as the (inadequate) solution to Global Warming, this is just one strategically chosen tactic in a much larger and coordinated campaign to achieve systemic change through regulatory change and transformation of the economic system. References Australian Conservation Foundation. “Get Involved.” 27 Aug. 2009 < http://www.acfonline.org >. Path: Campaigns; Climate Project; Get Involved. Al Gore. AlGore.com. 27 Aug. 2009 < http://www.algore.com/ >. An Inconvenient Truth. Dir. Davis Guggenheim. Paramount Classics and Participant Productions, 2006. Boykoff, Maxwell T. “Book Review on: Creating a Climate for Change: Communicating Climate Change and Facilitating Social Change. Eds. Susanne C. Moser and Lisa Dilling.” International Journal of Sustainability Communication 3 (2008): 171-175. 24 Aug. 2009 < http://www.ccp-online.org/docs/artikel/03/3_11_IJSC_Book_Review_Boykoff.pdf >. Climate Checklist: Recent Opinion Research Findings and Messaging Tips. 2007 Sightline Institute. 27 Aug. 2009. < http://www.sightline.org/research/sust_toolkit/communications-strategy/flashcard2-climate-research-compendium/ >. Crompton, Tom. Weathercocks and Signposts. World Wildlife Fund. April 2008. 27 Aug. 2009 < http://www.wwf.org.uk/filelibrary/pdf/weathercocks_report2.pdf >. Den Elzen, Michel, and Malte Meinshausen. “Meeting the EU 2°C Climate Target: Global and Regional Emission Implications”. Report 728001031/2005. 18 May 2005. 24 Aug. 2009 < http://www.rivm.nl/bibliotheek/rapporten/728001031.pdf >. Fenton Communications. Now Hear This: The 9 Laws of Successful Advocacy Communications. Fenton Communications. 2009. 24 Aug. 2009. < http://www.fenton.com/FENTON_IndustryGuide_NowHearThis.pdf >. Futerra Sustainability Communications. New Rules: New Game. 24 Aug. 2009 < http://www.futerra.co.uk/downloads/NewRules:NewGame.pdf >. Garnaut, Ross. “Targets and Trajectories.” The Garnaut Climate Change Review: Final Report. 2008. 277–298. 24 Aug. 2009 < http://www.garnautreview.org.au/pdf/Garnaut_Chapter12.pdf >. Generation Investment Management. Thematic Research Highlights. May 2007. 28 Aug. 2009 < http://www.generationim.com/media/pdf-generation-thematic-research-v13.pdf >. Generation Investment Management LLP 2004-09. < http://www.generationim.com/ >. Gore, Al and David Blood. “We Need Sustainable Capitalism: Nature Does Not Do Bailouts.” Generation Investment Management LLP. 5 Nov. 2008. 28 Aug. 2009 < http://www.generationim.com/sustainability/advocacy/sustainable-capitalism.html >. Hansen, James, Makiko Sato, Pushker Kharecha, David Beerling, Valerie Masson-Delmotte, Mark Pagani, Maureen Raymo, Dana L. Royer and James C. Zachos. “Target Atmospheric CO2: Where Should Humanity Aim?” Open Atmospheric Science Journal 2 (2008): 217-231. 24 Aug. 2009 < http://www.columbia.edu/~jeh1/2008/TargetCO2_20080407.pdf >. Harrison, Karey. “Ontological Commitments and Bias in Environmental Reporting.” Environment and Society Conference. Sunshine Coast, Australia, 1999. Jackson, Tim. Prosperity without Growth? The Transition to a Sustainable Economy. Northern Ireland, Scotland and Wales. Sustainable Development Commission. 30 March 2009. 5 Oct. 2009 < http://www.sd-commission.org.uk/publications/downloads/prosperity_without_growth_report.pdf >. Jensen, Derrick. “Forget Shorter Showers: Why Personal Change Does not Equal Political Change?” Orion July/Aug. 2009. 5 Aug. 2009 < http://www.orionmagazine.org/index.php/articles/article/4801/ >. Live Earth. Live Earth 2009. 28 Aug. 2009 < http://liveearth.org/en >. RepoWEr America. The Alliance for Climate Protection. 2009. 27 Aug. 2009 < http://www.repoweramerica.org >. Rose, Chris, and Pat Dade. Using Values Modes. campaignstrategy.org 2007 < http://www.campaignstrategy.org/articles/usingvaluemodes.pdf >. Rose, Chris, Les Higgins and Pat Dadeii. “Who Gives a Stuff about Climate Change and Who's Taking Action—Part of the Nationally Representative British Values Survey.” 2008. 27 Aug. 2009 < http://www.campaignstrategy.org/whogivesastuff.pdf >. Rose, Chris, Pat Dade, and John Scott. Research into Motivating Prospectors, Settlers and Pioneers to Change Behaviours That Affect Climate Emissions. campaignstrategy.org 2007. 27 Aug. 2009 < http://www.campaignstrategy.org/articles/behaviourchange_climate.pdf >. Rose, Chris. “To Do and Not to Do.” How to Win Campaigns: 100 Steps to Success. London: Earthscan Publications, 2005. Rose, Chris. “VBCOP—A Unifying Campaign Strategy Model”. Campaignstrategy.org March 2009. 27 Aug. 2009 < http://www.campaignstrategy.org/articles/VBCOP_unifying_strategy_model.pdf >. The Climate Project. 27 Aug. 2009 < http://www.theclimateproject.org/ >. Turner, Graham. “A Comparison of the Limits to Growth with 30 Years of Reality.” Socio-Economics and the Environment in Discussion. CSIRO Working Paper Series. Canberra: CSIRO Sustainable Ecosystems. June 2008. 5 Oct. 2009 < http://www.csiro.au/files/files/plje.pdf >. WE Can Solve the Climate Crisis. 2008-09. The Alliance for Climate Protection. 27 Aug. 2009 < http://www.wecansolveit.org >.

The foundational philosophy that provides the context in which sustainability operates in any given period in history would seem to be key to determining success or failure. In order to have the greatest chance of success, reasonable openness to a wide array of potentially useful ideas would logically appear to be essential. Progress needs context, ignoring neither the truths nor the errors of the past. However, certain blind spots exist that may cause useful ideas of the past to be ignored. This study focuses on the situation of the United States and considers one potential deterrent to long-run effectiveness of sustainability – the routine shunning by Americans of “noble tradition” stemming from the aristocracy and feudalism and its derivatives as anathema to the principles of American democracy. That tradition, though not without its flaws or abuses (no society is free from that), was built arguably on precepts of sustainability – even before the term really existed as it is known today. It is argued that the principles from medieval agrarian society that persisted in one form or another until republican revolutions, the Great War, and finally in the mid-to-late-20th century (depending on the country) are beneficial to consider, and learning from them can benefit modern industry in terms of promoting sustainable practices in systems of production and labour, as well as social responsibility. In order to create a conceptual framework that can be used to consider the potential impact on sustainability programmes of blind spots, a multipoint gravitational model is proposed. The model demonstrates mechanisms by which sustainability efforts may be harmed due to blind spots. Also, the potential for society to impose a cost on firms or individuals that attempt to consider unpopular tradition is considered via payoff analysis of strategic behaviour. That demonstrates the difficulty in breaking through the wall imposed by a blind spot.

Introduction Documentary film has grown significantly in the past decade, with high profile films such as Fahrenheit 9/11, Supersize Me, and An Inconvenient Truth garnering increased attention both at the box office and in the news media. In addition, the rising prominence of web-based media has provided new opportunities for documentary to create social impact. Films are now typically released with websites, Facebook pages, twitter feeds, and web videos to increase both reach and impact. This combination of technology and broader audience appeal has given rise to a current landscape in which documentary films are imbedded within coordinated multi-media campaigns. New media have not only opened up new avenues for communicating with audiences, they have also created new opportunities for data collection and analysis of film impacts. A recent report by McKinsey and Company highlighted this potential, introducing and discussing the implications of increasing consumer information being recorded on the Internet as well as through networked sensors in the physical world. As they found: "Big data—large pools of data that can be captured, communicated, aggregated, stored, and analyzed—is now part of every sector and function of the global economy" (Manyika et al. iv). This data can be mined to learn a great deal about both individual and cultural response to documentary films and the issues they represent. Although film has a rich history in humanities research, this new set of tools enables an empirical approach grounded in the social sciences. However, several researchers across disciplines have noted that limited investigation has been conducted in this area. Although there has always been an emphasis on social impact in film and many filmmakers and scholars have made legitimate (and possibly illegitimate) claims of impact, few have attempted to empirically justify these claims. Over fifteen years ago, noted film scholar Brian Winston commented that "the underlying assumption of most social documentaries—that they shall act as agents of reform and change—is almost never demonstrated" (236). A decade later, Political Scientist David Whiteman repeated this sentiment, arguing that, "despite widespread speculation about the impact of documentaries, the topic has received relatively little systematic attention" ("Evolving"). And earlier this year, the introduction to a special issue of Mass Communication and Society on documentary film stated, "documentary film, despite its growing influence and many impacts, has mostly been overlooked by social scientists studying the media and communication" (Nisbet and Aufderheide 451). Film has been studied extensively as entertainment, as narrative, and as cultural event, but the study of film as an agent of social change is still in its infancy. This paper introduces a systematic approach to measuring the social impact of documentary film aiming to: (1) discuss the context of documentary film and its potential impact; and (2) argue for a social science approach, discussing key issues about conducting such research. Changes in Documentary Practice Documentary film has been used as a tool for promoting social change throughout its history. John Grierson, who coined the term "documentary" in 1926, believed it could be used to influence the ideas and actions of people in ways once reserved for church and school. He presented his thoughts on this emerging genre in his 1932 essay, First Principles of Documentary, saying, "We believe that the cinema's capacity for getting around, for observing and selecting from life itself, can be exploited in a new and vital art form" (97). Richard Barsam further specified the definition of documentary, distinguishing it from non-fiction film, such that all documentaries are non-fiction films but not all non-fiction films are documentaries. He distinguishes documentary from other forms of non-fiction film (i.e. travel films, educational films, newsreels) by its purpose; it is a film with an opinion and a specific message that aims to persuade or influence the audience. And Bill Nichols writes that the definition of documentary may even expand beyond the film itself, defining it as a "filmmaking practice, a cinematic tradition, and mode of audience reception" (12). Documentary film has undergone many significant changes since its inception, from the heavily staged romanticism movement of the 1920s to the propagandist tradition of governments using film to persuade individuals to support national agendas to the introduction of cinéma vérité in the 1960s and historical documentary in the 1980s (cf. Barnouw). However, the recent upsurge in popularity of documentary media, combined with technological advances of internet and computers have opened up a whole new set of opportunities for film to serve as both art and agent for social change. One such opportunity is in the creation of film-based social action campaigns. Over the past decade, filmmakers have taken a more active role in promoting social change by coordinating film releases with action campaigns. Companies such as Participant Media (An Inconvenient Truth, Food Inc., etc.) now create "specific social action campaigns for each film and documentary designed to give a voice to issues that resonate in the films" (Participant Media). In addition, a new sector of "social media" consultants are now offering services, including "consultation, strategic planning for alternative distribution, website and social media development, and complete campaign management services to filmmakers to ensure the content of nonfiction media truly meets the intention for change" (Working Films). The emergence of new forms of media and technology are changing our conceptions of both documentary film and social action. Technologies such as podcasts, video blogs, internet radio, social media and network applications, and collaborative web editing "both unsettle and extend concepts and assumptions at the heart of 'documentary' as a practice and as an idea" (Ellsworth). In the past decade, we have seen new forms of documentary creation, distribution, marketing, and engagement. Likewise, film campaigns are utilizing a broad array of strategies to engage audience members, including "action kits, screening programs, educational curriculums and classes, house parties, seminars, panels" that often turn into "ongoing 'legacy' programs that are updated and revised to continue beyond the film's domestic and international theatrical, DVD and television windows" (Participant Media). This move towards multi-media documentary film is becoming not only commonplace, but expected as a part of filmmaking. NYU film professor and documentary film pioneer George Stoney recently noted, "50 percent of the documentary filmmaker's job is making the movie, and 50 percent is figuring out what its impact can be and how it can move audiences to action" (qtd. in Nisbet, "Gasland"). In his book Convergence Culture, Henry Jenkins, coined the term "transmedia storytelling", which he later defined as "a process where integral elements of a fiction get dispersed systematically across multiple delivery channels for the purpose of creating a unified and coordinated entertainment experience" ("Transmedia"). When applied to documentary film, it is the elements of the "issue" raised by the film that get dispersed across these channels, coordinating, not just an entertainment experience, but a social action campaign. Dimensions of Evaluation It is not unreasonable to assume that such film campaigns, just like any policy or program, have the possibility to influence viewers' knowledge, attitudes, and behavior. Measuring this impact has become increasingly important, as funders of documentary and issue-based films want look to understand the "return on investment" of films in terms of social impact so that they can compare them with other projects, including non-media, direct service projects. Although we "feel" like films make a difference to the individuals who also see them in the broader cultures in which they are embedded, measurement and empirical analysis of this impact are vitally important for both providing feedback to filmmakers and funders as well as informing future efforts attempting to leverage film for social change. This type of systematic assessment, or program evaluation, is often discussed in terms of two primary goals—formative (or process) and summative (or impact) evaluation (cf. Muraskin; Trochim and Donnelly). Formative evaluation studies program materials and activities to strengthen a program, and summative evaluation examines program outcomes. In terms of documentary film, these two goals can be described as follows: Formative Evaluation: Informing the Process As programs (broadly defined as an intentional set of activities with the aim of having some specific impact), the people who interact with them, and the cultures they are situated in are constantly changing, program development and evaluation is an ongoing learning cycle. Film campaigns, which are an intentional set of activities with the aim of impacting individual viewers and broader cultures, fit squarely within this purview. Without formulating hypotheses about the relationships between program activities and goals and then collecting and analyzing data during implementation to test them, it is difficult to learn ways to improve programs (or continue doing what works best in the most efficient manner). Attention to this process enables those involved to learn more about, not only what works, but how and why it works and even gain insights about how program outcomes may be affected by changes to resource availability, potential audiences, or infrastructure. Filmmakers are constantly learning and honing their craft and realizing the impact of their practice can help the artistic process. Often faced with tight budgets and timelines, they are forced to confront tradeoffs all the time, in the writing, production and post-production process. Understanding where they are having impact can improve their decision-making, which can help both the individual project and the overall field. Summative Evaluation: Quantifying Impacts Evaluation is used in many different fields to determine whether programs are achieving their intended goals and objectives. It became popular in the 1960s as a way of understanding the impact of the Great Society programs and has continued to grow since that time (Madaus and Stufflebeam). A recent White House memo stated that "rigorous, independent program evaluations can be a key resource in determining whether government programs are achieving their intended outcomes as well as possible and at the lowest possible cost" and the United States Office of Management and Budget (OMB) launched an initiative to increase the practice of "impact evaluations, or evaluations aimed at determining the causal effects of programs" (Orszag 1). Documentary films, like government programs, generally target a national audience, aim to serve a social purpose, and often do not provide a return on their investment. Participant Media, the most visible and arguably most successful documentary production company in the film industry, made recent headlines for its difficulty in making a profit during its seven-year history (Cieply). Owner and founder Jeff Skoll reported investing hundreds of millions of dollars into the company and CEO James Berk added that the company sometimes measures success, not by profit, but by "whether Mr. Skoll could have exerted more impact simply by spending his money philanthropically" (Cieply). Because of this, documentary projects often rely on grant funding, and are starting to approach funders beyond traditional arts and media sources. "Filmmakers are finding new fiscal and non-fiscal partners, in constituencies that would not traditionally be considered—or consider themselves—media funders or partners" (BRITDOC 6). And funders increasingly expect tangible data about their return on investment. Says Luis Ubiñas, president of Ford Foundation, which recently launched the Just Films Initiative: In these times of global economic uncertainty, with increasing demand for limited philanthropic dollars, assessing our effectiveness is more important than ever. Today, staying on the frontlines of social change means gauging, with thoughtfulness and rigor, the immediate and distant outcomes of our funding. Establishing the need for evaluation is not enough—attention to methodology is also critical. Valid research methodology is a critical component of understanding around the role entertainment can play in impacting social and environmental issues. The following issues are vital to measuring impact. Defining the Project Though this may seem like an obvious step, it is essential to determine the nature of the project so one can create research questions and hypotheses based on a complete understanding of the "treatment". One organization that provides a great example of the integration of documentary film imbedded into a larger campaign or movement is Invisible Children. Founded in 2005, Invisible Children is both a media-based organization as well as an economic development NGO with the goal of raising awareness and meeting the needs of child soldiers and other youth suffering as a result of the ongoing war in northern Uganda. Although Invisible Children began as a documentary film, it has grown into a large non-profit organization with an operating budget of over $8 million and a staff of over a hundred employees and interns throughout the year as well as volunteers in all 50 states and several countries. Invisible Children programming includes films, events, fundraising campaigns, contests, social media platforms, blogs, videos, two national "tours" per year, merchandise, and even a 650-person three-day youth summit in August 2011 called The Fourth Estate. Individually, each of these components might lead to specific outcomes; collectively, they might lead to others. In order to properly assess impacts of the film "project", it is important to take all of these components into consideration and think about who they may impact and how. This informs the research questions, hypotheses, and methods used in evaluation. Film campaigns may even include partnerships with existing social movements and non-profit organizations targeting social change. The American University Center for Social Media concluded in a case study of three issue-based documentary film campaigns: Digital technologies do not replace, but are closely entwined with, longstanding on-the-ground activities of stakeholders and citizens working for social change. Projects like these forge new tools, pipelines, and circuits of circulation in a multiplatform media environment. They help to create sustainable network infrastructures for participatory public media that extend from local communities to transnational circuits and from grassroots communities to policy makers. (Abrash) Expanding the Focus of Impact beyond the Individual A recent focus has shifted the dialogue on film impact. Whiteman ("Theaters") argues that traditional metrics of film "success" tend to focus on studio economic indicators that are far more relevant to large budget films. Current efforts focused on box office receipts and audience size, the author claims, are really measures of successful film marketing or promotion, missing the mark when it comes to understanding social impact. He instead stresses the importance of developing a more comprehensive model. His "coalition model" broadens the range and types of impact of film beyond traditional metrics to include the entire filmmaking process, from production to distribution. Whiteman (“Theaters”) argues that a narrow focus on the size of the audience for a film, its box office receipts, and viewers' attitudes does not incorporate the potential reach of a documentary film. Impacts within the coalition model include both individual and policy levels. Individual impacts (with an emphasis on activist groups) include educating members, mobilizing for action, and raising group status; policy includes altering both agenda for and the substance of policy deliberations. The Fledgling Fund (Barrett and Leddy) expanded on this concept and identified five distinct impacts of documentary film campaigns. These potential impacts expand from individual viewers to groups, movements, and eventually to what they call the "ultimate goal" of social change. Each is introduced briefly below. Quality Film. The film itself can be presented as a quality film or media project, creating enjoyment or evoking emotion in the part of audiences. "By this we mean a film that has a compelling narrative that draws viewers in and can engage them in the issue and illustrate complex problems in ways that statistics cannot" (Barrett and Leddy, 6). Public Awareness. Film can increase public awareness by bringing light to issues and stories that may have otherwise been unknown or not often thought about. This is the level of impact that has received the most attention, as films are often discussed in terms of their "educational" value. "A project's ability to raise awareness around a particular issue, since awareness is a critical building block for both individual change and broader social change" (Barrett and Leddy, 6). Public Engagement. Impact, however, need not stop at simply raising public awareness. Engagement "indicates a shift from simply being aware of an issue to acting on this awareness. Were a film and its outreach campaign able to provide an answer to the question 'What can I do?' and more importantly mobilize that individual to act?" (Barrett and Leddy, 7). This is where an associated film campaign becomes increasingly important, as transmedia outlets such as Facebook, websites, blogs, etc. can build off the interest and awareness developed through watching a film and provide outlets for viewers channel their constructive efforts. Social Movement. In addition to impacts on individuals, films can also serve to mobilize groups focused on a particular problem. The filmmaker can create a campaign around the film to promote its goals and/or work with existing groups focused on a particular issue, so that the film can be used as a tool for mobilization and collaboration. "Moving beyond measures of impact as they relate to individual awareness and engagement, we look at the project's impact as it relates to the broader social movement … if a project can strengthen the work of key advocacy organizations that have strong commitment to the issues raised in the film" (Barrett and Leddy, 7). Social Change. The final level of impact and "ultimate goal" of an issue-based film is long-term and systemic social change. "While we understand that realizing social change is often a long and complex process, we do believe it is possible and that for some projects and issues there are key indicators of success" (Barrett and Leddy, 7). This can take the form of policy or legislative change, passed through film-based lobbying efforts, or shifts in public dialogue and behavior. Legislative change typically takes place beyond the social movement stage, when there is enough support to pressure legislators to change or create policy. Film-inspired activism has been seen in issues ranging from environmental causes such as agriculture (Food Inc.) and toxic products (Blue Vinyl) to social causes such as foreign conflict (Invisible Children) and education (Waiting for Superman). Documentary films can also have a strong influence as media agenda-setters, as films provide dramatic "news pegs" for journalists seeking to either sustain or generation new coverage of an issue (Nisbet "Introduction" 5), such as the media coverage of climate change in conjunction with An Inconvenient Truth. Barrett and Leddy, however, note that not all films target all five impacts and that different films may lead to different impacts. "In some cases we could look to key legislative or policy changes that were driven by, or at least supported by the project... In other cases, we can point to shifts in public dialogue and how issues are framed and discussed" (7). It is possible that specific film and/or campaign characteristics may lead to different impacts; this is a nascent area for research and one with great promise for both practical and theoretical utility. Innovations in Tools and Methods Finally, the selection of tools is a vital component for assessing impact and the new media landscape is enabling innovations in the methods and strategies for program evaluation. Whereas the traditional domain of film impact measurement included box office statistics, focus groups, and exit surveys, innovations in data collection and analysis have expanded the reach of what questions we can ask and how we are able to answer them. For example, press coverage can assist in understanding and measuring the increase in awareness about an issue post-release. Looking directly at web-traffic changes "enables the creation of an information-seeking curve that can define the parameters of a teachable moment" (Hart and Leiserowitz 360). Audience reception can be measured, not only via interviews and focus groups, but also through content and sentiment analysis of web content and online analytics. "Sophisticated analytics can substantially improve decision making, minimize risks, and unearth valuable insights that would otherwise remain hidden" (Manyika et al. 5). These new tools are significantly changing evaluation, expanding what we can learn about the social impacts of film through triangulation of self-report data with measurement of actual behavior in virtual environments. Conclusion The changing media landscape both allows and impels evaluation of film impacts on individual viewers and the broader culture in which they are imbedded. Although such analysis may have previously been limited to box office numbers, critics' reviews, and theater exit surveys, the rise of new media provides both the ability to connect filmmakers, activists, and viewers in new ways and the data in which to study the process. This capability, combined with significant growth in the documentary landscape, suggests a great potential for documentary film to contribute to some of our most pressing social and environmental needs. A social scientific approach, that combines empirical analysis with theory applied from basic science, ensures that impact can be measured and leveraged in a way that is useful for both filmmakers as well as funders. In the end, this attention to impact ensures a continued thriving marketplace for issue-based documentary films in our social landscape. References Abrash, Barbara. "Social Issue Documentary: The Evolution of Public Engagement." American University Center for Social Media 21 Apr. 2010. 26 Sep. 2011 ‹http://www.centerforsocialmedia.org/›. Aufderheide, Patricia. "The Changing Documentary Marketplace." Cineaste 30.3 (2005): 24-28. Barnouw, Eric. Documentary: A History of the Non-Fiction Film. New York: Oxford UP, 1993. Barrett, Diana and Sheila Leddy. 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IntroductionWe five friends clinked glasses in our favourite wine and cocktail bar, and considered our next collaborative writing project. We had seen M/C Journal’s call for articles for a special issue on ‘regional’ and when one of us mentioned the television program, Escape from the City, we began our critique:“They haven’t featured Armidale yet, but wouldn’t it be great if they did?”“Really? I mean, some say any publicity is good publicity but the few early episodes I’ve viewed seem to give little or no screen time to the sorts of lifestyle features I most value in our town.”“Well, seeing as we all moved here from the city ages ago, let’s talk about what made us stay?”We had found our next project.A currently popular lifestyle television show (Escape from the City) on Australia’s national public service broadcaster, the ABC, highlights the limitations of popular cultural representations of life in a regional centre. The program is targeted at viewers interested in relocating to regional Australia. As Raymond Boyle and Lisa Kelly note, popular television is an important entry point into the construction of public knowledge as well as a launching point for viewers as they seek additional information (65). In their capacity to construct popular perceptions of ‘reality’, televisual texts offer a significant insight into our understandings and expectations of what is going on around us. Similar to the concerns raised by Esther Peeren and Irina Souch in their analysis of the popular TV show Farmer Wants a Wife (a version set in the Netherlands from 2004–present), we worry that these shows “prevent important aspects of contemporary rural life from being seen and understood” (37) by the viewers, and do a disservice to regional communities.For the purposes of this article, we interrogate the episodes of Escape from the City screened to date in terms of the impact they may have on promoting regional Australia and speculate on how satisfied (or otherwise) we would be should the producers direct their lens onto our regional community—Armidale, in northern NSW. We start with a brief précis of Escape from the City and then, applying an autoethnographic approach (Butz and Besio) focusing on our subjective experiences, we share our reflections on living in Armidale. We blend our academic knowledge and knowledge of everyday life (Klevan et al.) to argue there is greater cultural diversity, complexity, and value in being in the natural landscape in regional areas than is portrayed in these representations of country life that largely focus on cheaper real estate and a five-minute commute.We employ an autoethnographic approach because it emphasises the socially and politically constituted nature of knowledge claims and allows us to focus on our own lives as a way of understanding larger social phenomena. We recognise there is a vast literature on lifestyle programs and there are many different approaches scholars can take to these. Some focus on the intention of the program, for example “the promotion of neoliberal citizenship through home investment” (White 578), while others focus on the supposed effect on audiences (Tsay-Vogel and Krakowiak). Here we only assert the effects on ourselves. We have chosen to blend our voices (Gilmore et al.) in developing our arguments, highlighting our single voices where our individual experiences are drawn on, as we argue for an alternative representation of regional life than currently portrayed in the regional ‘escapes’ of this mainstream lifestyle television program.Lifestyle TelevisionEscape from the City is one of the ‘lifestyle’ series listed on the ABC iview website under the category of ‘Regional Australia’. Promotional details describe Escape from the City as a lifestyle series of 56-minute episodes in which home seekers are guided through “the trials and tribulations of their life-changing decision to escape the city” (iview).Escape from the City is an example of format television, a term used to describe programs that retain the structure and style of those produced in another country but change the circumstances to suit the new cultural context. The original BBC format is entitled Escape to the Country and has been running since 2002. The reach of lifestyle television is extensive, with the number of programs growing rapidly since 2000, not just in the United Kingdom, but internationally (Hill; Collins). In Australia, they have completed, but not yet screened, 60 episodes of Escape from the City. However, with such popularity comes great potential to influence audiences and we argue this program warrants critical attention.Like House Hunters, the United States lifestyle television show (running since 1997), Escape from the City follows “a strict formula” (Loof 168). Each episode uses the same narrative format, beginning with an introduction to the team of experts, then introducing the prospective house buyers, briefly characterising their reasons for leaving the city and what they are looking for in their new life. After this, we are shown a map of the region and the program follows the ‘escapees’ as they view four pre-selected houses. As we leave each property, the cost and features are reiterated in the written template on the screen. We, the audience, wait in anticipation for their final decision.The focus of Escape from the City is the buying of the house: the program’s team of experts is there to help the potential ‘escapees’ find the real estate gem. Real estate value for money emerges as the primary concern, while the promise of finding a ‘life less ordinary’ as highlighted in the opening credits of the program each week, seems to fall by the wayside. Indeed, the representation of regional centres is not nuanced but limited by the emphasis placed on economics over the social and cultural.The intended move of the ‘escapees’ is invariably portrayed as motivated by disenchantment with city life. Clearly a bigger house and a smaller mortgage also has its hedonistic side. In her study of Western society represented in lifestyle shows, Lyn Thomas lists some of the negative aspects of city life as “high speed, work-dominated, consumerist” (680), along with pollution and other associated health risks. While these are mentioned in Escape from the City, Thomas’s list of the pleasures afforded by a simpler country life including space for human connection and spirituality, is not explored to any satisfying extent. Further, as a launching point for viewers in the city (Boyle and Kelly), we fear the singular focus on the price of real estate reinforces a sense of the rural as devoid of creative arts and cultural diversity with a focus on the productive, rather than the natural, landscape. Such a focus does not encourage a desire to find out more and undersells the richness of our (regional) lives.As Australian regional centres strive to circumvent or halt the negative impacts of the drift in population to the cities (Chan), lifestyle programs are important ‘make or break’ narratives, shaping the appeal and bolstering—or not—a decision to relocate. With their focus on cheaper real estate prices and the freeing up of the assets of the ‘escapees’ that a move to the country may entail, the representation is so focused on the economics that it is almost placeless. While the format includes a map of the regional location, there is little sense of being in the place. Such a limited representation does not do justice to the richness of regional lives as we have experienced them.Our TownLike so many regional centres, Armidale has much to offer and is seeking to grow (Armidale Regional Council). The challenges regional communities face in sustaining their communities is well captured in Gabriele Chan’s account of the city-country divide (Chan) and Armidale, with its population of about 25,000, is no exception. Escape from the City fails to emphasise cultural diversity and richness, yet this is what characterises our experience of our regional city. As long-term and satisfied residents of Armidale, who are keenly aware of the persuasive power of popular cultural representations (O’Sullivan and Sheridan; Sheridan and O’Sullivan), we are concerned about the trivialising or reductive manner in which regional Australia is portrayed.While we acknowledge there has not been an episode of Escape from the City featuring Armidale, if the characterisation of another, although larger, regional centre, Toowoomba, is anything to go by, our worst fears may be realised if our town is to feature in the future. Toowoomba is depicted as rural landscapes, ‘elegant’ buildings, a garden festival (the “Carnival of the Flowers”) and the town’s history as home of the Southern Cross windmill and the iconic lamington sponge. The episode features an old shearing shed and a stock whip demonstration, but makes no mention of the arts, or of the University that has been there since 1967. Summing up Toowoomba, the voiceover describes it as “an understated and peaceful place to live,” and provides “an attractive alternative” to city life, substantiated by a favourable comparison of median real estate prices.Below we share our individual responses to the question raised in our opening conversation about the limitations of Escape from the City: What have we come to value about our own town since escaping from city life?Jane: The aspects of life in Armidale I most enjoy are, at least in part, associated with or influenced by the fact that this is a centre for education and a ‘university town’. As such, there is access to an academic library and an excellent town library. The presence of the University of New England, along with independent and public schools, and TAFE, makes education a major employer, attracting a significant student population, and is a major factor in Armidale being one of the first towns in the roll-out of the NBN/high-speed broadband. University staff and students may also account for the thriving cafe culture, along with designer breweries/bars, art house cinema screenings, and a lively classical and popular music scene. Surely the presence of a university and associated spin-offs would deserve coverage in a prospective episode about Armidale.Alison: Having grown up in the city, and now having lived more than half my life in an inner-regional country town, I don’t feel I am missing out ‘culturally’ from this decision. Within our town, there is a vibrant arts community, with the regional gallery and two local galleries holding regular art exhibitions, theatre at a range of venues, and book launches at our lively local book store. And when my children were younger, there was no shortage of sporting events they could be involved with. Encountering friends and familiar faces regularly at these events adds to my sense of belonging to my community. The richness of this life does not make it to the television screen in episodes of Escape from the City.Kerry: I greatly value the Armidale community’s strong social conscience. There are many examples of successful programs to support diverse groups. Armidale Sanctuary and Humanitarian Settlement sponsored South Sudanese refugees for many years and is currently assisting Ezidi refugees. In addition to the core Sanctuary committee, many in the local community help families with developing English skills, negotiating daily life, such as reading and responding to school notes and medical questionnaires. The Backtrack program assists troubled Aboriginal and non-Aboriginal youth. The program helps kids “to navigate their relationships, deal with personal trauma, take responsibility […] gain skills […] so they can eventually create a sustainable future for themselves.” The documentary film Backtrack Boys shows what can be achieved by individuals with the support of the community. Missing from Escape from the City is recognition of the indigenous experience and history in regional communities, unlike the BBC’s ‘original’ program in which medieval history and Vikings often get a ‘guernsey’. The 1838 Myall Creek massacre of 28 Wirrayaraay people, led to the first prosecution and conviction of a European for killing Aboriginals. Members of the Indigenous and non-Indigenous community in Armidale are now active in acknowledging the past wrongs and beginning the process of reconciliation.Josie: About 10am on a recent Saturday morning I was walking from the car park to the shopping complex. Coming down the escalator and in the vestibule, there were about thirty people and it occurred to me that there were at least six nationalities represented, with some of the people wearing traditional dress. It also struck me that this is not unusual—we are a diverse community as a result of our history and being a ‘university city’. The Armidale Aboriginal Cultural Centre and Keeping Place was established in 1988 and is being extended in 2019. Diversity is apparent in cultural activities such as an international film festival held annually and many of the regular musical events and stalls at the farmers’ market increasingly reflect the cultural mix of our town. As a long-term resident, I appreciate the lifestyle here.Wendy: It is early morning and I am walking in a forest of tall trees, with just the sounds of cattle and black cockatoos. I travel along winding pathways with mossy boulders and creeks dry with drought. My dog barks at rabbits and ‘roos, and noses through the nooks and crannies of the hillside. In this public park on the outskirts of town, I can walk for two hours without seeing another person, or I can be part of a dog-walking pack. The light is grey and misty now, the ranges blue and dark green, but I feel peaceful and content. I came here from the city 30 years ago and hated it at first! But now I relish the way I can be at home in 10 minutes after starting the day in the midst of nature and feeling part of the landscape, not just a tourist—never a possibility in the city. I can watch the seasons and the animals as they come and go and be part of a community which is part of the landscape too. For me, the first verse of South of My Days, written by a ‘local’ describing our New England environment, captures this well:South of my days’ circle, part of my blood’s country,rises that tableland, high delicate outlineof bony slopes wincing under the winter,low trees, blue-leaved and olive, outcropping granite-clean, lean, hungry country. The creek’s leaf-silenced,willow choked, the slope a tangle of medlar and crabapplebranching over and under, blotched with a green lichen;and the old cottage lurches in for shelter. (Wright 20)Whilst our autoethnographic reflections may not reach the heady heights of Judith Wright, they nevertheless reflect the experience of living in, not just escaping to the country. We are disappointed that the breadth of cultural activities and the sense of diversity and community that our stories evoke are absent from the representations of regional communities in Escape from the City.Kate Oakley and Jonathon Ward argue that ‘visions of the good life’, in particular cultural life in the regions, need to be supported by policy which encourages a sustainable prosperity characterised by both economic and cultural development. Escape from the City, however, dwells on the material aspects of consumption—good house prices and the possibility of a private enterprise—almost to the exclusion of any coverage of the creative cultural features.We recognise that the lifestyle genre requires simplification for viewers to digest. What we are challenging is the sense that emerges from the repetitive format week after week whereby differences between places are lost (White 580). Instead what is conveyed in Escape from the City is that regions are homogenous and monocultural. We would like to see more screen time devoted to the social and cultural aspects of the individual locations.ConclusionWe believe coverage of a far richer and more complex nature of rural life would provide a more ‘realistic’ preview of what could be ahead for the ‘escapees’ and perhaps swing the decision to relocate. Certainly, there is some evidence that viewers gain information from lifestyle programs (Hill 106). We are concerned that a lifestyle television program that purports to provide expert advice on the benefits and possible pitfalls of a possible move to the country should be as accurate and all-encompassing as possible within the constraints of the length of the program and the genre.So, returning to what may appear to have been a light-hearted exchange between us at our local bar, and given the above discussion, we argue that television is a powerful medium. We conclude that a popular lifestyle television program such as Escape from the City has an impact on a large viewing audience. For those city-based viewers watching, the message is that moving to the country is an economic ‘no brainer’, whereas the social and cultural dimensions of regional communities, which we posit have sustained our lives, are overlooked. Such texts influence viewers’ perceptions and expectations of what escaping to the country may entail. Escape from the City exploits regional towns as subject matter for a lifestyle program but does not significantly challenge stereotypical representations of country life or does not fully flesh out what escaping to the country may achieve.ReferencesArmidale Regional Council. Community Strategic Plan 2017–2027. Armidale: Armidale Regional Council, 2017.“Backtrack Boys.” Dir. Catherine Scott. Sydney: Umbrella Entertainment, 2018.Boyle, Raymond, and Lisa W. Kelly. “Television, Business Entertainment and Civic Culture.” Television and New Media 14.1 (2013): 62–70.Butz, David, and Kathryn Besio. “Autoethnography.” Geography Compass 3.5 (2009): 1660–74.Chan, Gabrielle. Rusted Off: Why Country Australia Is Fed Up. Australia: Vintage, 2018.Collins, Megan. Classical and Contemporary Social Theory: The New Narcissus in the Age of Reality Television. Routledge, 2018.Gilmore, Sarah, Nancy Harding, Jenny Helin, and Alison Pullen. “Writing Differently.” Management Learning 50.1 (2019): 3–10.Hill, Annette. Reality TV: Audiences and Popular Factual Television. London: Routledge, 2004.iview. “Escape from the City.” Sydney: Australian Broadcasting Corporation, 2019.Klevan, Trude, Bengt Karlsson, Lydia Turner, Nigel Short, and Alec Grant. “‘Aha! ‘Take on Me’s’: Bridging the North Sea with Relational Autoethnography.” Qualitative Research Journal 18.4 (2018): 330–44.Loof, Travis. “A Narrative Criticism of Lifestyle Reality Programs.” Journal of Media Critiques 1.5 (2015): 167–78.O’Sullivan, Jane, and Alison Sheridan. “The King Is Dead, Long Live the King: Tall Tales of New Men and New Management in The Bill.” Gender, Work and Organization 12.4 (2005): 299–318.Oakley, Kate, and Jonathon Ward. “The Art of the Good Life: Culture and Sustainable Prosperity.” Cultural Trends 27.1 (2018): 4–17.Peeren, Esther, and Irina Souch. “Romance in the Cowshed: Challenging and Reaffirming the Rural Idyll in the Dutch Reality TV Show Farmer Wants a Wife.” Journal of Rural Studies 67.1 (2019): 37–45.Sheridan, Alison, and Jane O’Sullivan. “‘Fact’ and ‘Fiction’: Enlivening Health Care Education.” Journal of Health Orgnaization and Management 27.5 (2013): 561–76.Thomas, Lyn. “Alternative Realities: Downshifting Narratives in Contemporary Lifestyle Television.” Cultural Studies 22.5 (2008): 680–99.Tsay-Vogel, Mina, and K. Maja Krakowiak. “Exploring Viewers’ Responses to Nine Reality TV Subgenres.” Psychology of Popular Media Culture 6.4 (2017): 348–60.White, Mimi. “‘A House Divided’.” European Journal of Cultural Studies 20.5 (2017): 575–91.Wright, Judith. Collected Poems: 1942–1985. Sydney: Angus & Robertson, 1994.

Introduction The counterculture that arose during the 1960s and 1970s left lasting social and political reverberations in developed nations. This was a time of increasing affluence and liberalisation which opened up remarkable political opportunities for social change. Within this context, an array of new social movements were a vital ingredient of the ferment that saw existing norms challenged and the establishment of new rights for many oppressed groups. An expanding arena of concerns included the environmental damage caused by 200 years of industrial capitalism. This article examines one aspect of a current environment movement in Australia, the anti-Coal Seam Gas (CSG) movement, and the part played by participants. In particular, the focus is upon one action that emerged during the recent Bentley Blockade, which was a regional mobilisation against proposed unconventional gas mining (UGM) near Lismore, NSW. Over the course of the blockade, the conventional ritual of waving at passers-by was transformed into a mechanism for garnering broad community support. Arguably, this was a crucial factor in the eventual outcome. In this case, we contend that the wave, rather than a countercultural artefact being appropriated by the mainstream, represents an everyday behaviour that builds social solidarity, which is subverted to become an effective part of the repertoire of the movement. At a more general level, this article examines how counterculture and mainstream interact via the subversion of “ordinary” citizens and the role of certain cultural understandings for that purpose. We will begin by examining the nature of the counterculture and its relationship to social movements before discussing the character of the anti-CSG movement in general and the Bentley Blockade in particular, using the personal experience of one of the writers. We will then be able to explore our thesis in detail and make some concluding remarks. The Counterculture and Social Movements In this article, we follow Cox’s understanding of the counterculture as a kind of meta-movement within which specific social movements are situated. For Cox (105), the counterculture that flourished during the 1960s and 1970s was an overarching movement in which existing social relations—in particular the family—were rejected by a younger generation, who succeeded in effectively fusing previously separate political and cultural spheres of dissent into one. Cox (103-04) points out that the precondition for such a phenomenon is “free space”—conditions under which counter-hegemonic activity can occur—for example, being liberated from the constraints of working to subsist, something which the unprecedented prosperity of the post WWII years allowed. Hence, in the 1960s and 1970s, as the counterculture emerged, a wave of activism arose in the western world which later came to be referred to as new social movements. These included the civil rights movement, women’s liberation, pacifism and the anti-nuclear and environment movements. The new movements rejected established power and organisational structures and tended, some scholars argued, to cross class lines, basing their claims on non-material issues. Della Porta and Diani claim this wave of movements is characterised by: a critical ideology in relation to modernism and progress; decentralized and participatory organizational structures; defense of interpersonal solidarity against the great bureaucracies; and the reclamation of autonomous spaces, rather than material advantages. (9) This depiction clearly announces the countercultural nature of the new social movements. As Carter (91) avers, these movements attempted to bypass the state and instead mobilise civil society, employing a range of innovative tactics and strategies—the repertoire of action—which may involve breaking laws. It should be noted that over time, some of these movements did shift towards accommodation of existing power structures and became more reformist in nature, to the point of forming political parties in the case of the Greens. However, inasmuch as the counterculture represented a merging of distinctively non-mainstream ways of life with the practice of actively challenging social arrangements at a political level (Cox 18–19; Grossberg 15–18;), the tactic of mobilising civil society to join social movements demonstrates in fact a reverse direction: large numbers of people are transfigured in radical ways by their involvement in social movements. One important principle underlying much of the repertoire of action of these new movements was non-violence. Again, this signals countercultural norms of the period. As Sharp (583–86) wrote at the time, non-violence is crucial in that it denies the aggressor their rationale for violent repression. This principle is founded on the liberal notion, whose legacy goes back to Locke, that the legitimacy of the government rests upon the consent of the governed—that is, the people can withdraw their consent (Locke in Ball & Dagger 92). Ghandi also relied upon this idea when formulating his non-violent approach to conflict, satyagraha (Sharp 83–84). Thus an idea that upholds the modern state is adopted by the counterculture in order to undermine it (the state), again demonstrating an instance of counterflow from the mainstream. Non-violence does not mean non-resistance. In fact, it usually involves non-compliance with a government or other authority and when practised in large numbers, can be very effective, as Ghandi and those in the civil rights movement showed. The result will be either that the government enters into negotiation with the protestors, or they can engage in violence to suppress them, which generally alienates the wider population, leading to a loss of support (Finley & Soifer 104–105). Tarrow (88) makes the important point that the less threatening an action, the harder it is to repress. As a result, democratic states have generally modified their response towards the “strategic weapon of nonviolent protest and even moved towards accommodation and recognition of this tactic as legitimate” (Tarrow 172). Nevertheless, the potential for state violence remains, and the freedom to protest is proscribed by various laws. One of the key figures to emerge from the new social movements that formed an integral part of the counterculture was Bill Moyer, who, in conjunction with colleagues produced a seminal text for theorising and organising social movements (Moyer et al.). Many contemporary social movements have been significantly influenced by Moyer’s Movement Action Plan (MAP), which describes not only key theoretical concepts but is also a practical guide to movement building and achieving aims. Moyer’s model was utilised in training the Northern Rivers community in the anti-CSG movement in conjunction with the non-violent direct action (NVDA) model developed by the North-East Forest Alliance (NEFA) that resisted logging in the forests of north-eastern NSW during the late 1980s and 1990s (Ricketts 138–40). Indeed, the Northern Rivers region of NSW—dubbed the Rainbow Region—is celebrated, as a “‘meeting place’ of countercultures and for the articulation of social and environmental ideals that challenge mainstream practice” (Ward and van Vuuren 63). As Bible (6–7) outlines, the Northern Rivers’ place in countercultural history is cemented by the holding of the Aquarius Festival in Nimbin in 1973 and the consequent decision of many attendees to stay on and settle in the region. They formed new kinds of communities based on an alternative ethics that eschewed a consumerist, individualist agenda in favour of modes of existence that emphasised living in harmony with the environment. The Terania Creek campaign of the late 1970s made the region famous for its environmental activism, when the new settlers resisted the logging of Nightcap National Park using nonviolent methods (Bible 5). It was also instrumental in developing an array of ingenious actions that were used in subsequent campaigns such as the Franklin Dam blockade in Tasmania in the early 1980s (Kelly 116). Indeed, many of these earlier activists were key figures in the anti-CSG movement that has developed in the Rainbow Region over the last few years. The Anti-CSG Movement Despite opposition to other forms of UGM, such as tight sands and shale oil extraction techniques, the term anti-CSG is used here, as it still seems to attract wide recognition. Unconventional gas extraction usually involves a process called fracking, which is the injection at high pressure of water, sand and a number of highly toxic chemicals underground to release the gas that is trapped in rock formations. Among the risks attributed to fracking are contamination of aquifers, air pollution from fugitive emissions and exposure to radioactive particles with resultant threats to human and animal health, as well as an increased risk of earthquakes (Ellsworth; Hand 13; Sovacool 254–260). Additionally, the vast amount of water that is extracted in the fracking process is saline and may contain residues of the fracking chemicals, heavy metals and radioactive matter. This produced water must either be stored or treated (Howarth 273–73; Sovacool 255). Further, there is potential for accidents and incidents and there are many reports—particularly in the United States where the practice is well established—of adverse events such as compressors exploding, leaks and spills, and water from taps catching fire (Sovacool 255–257). Despite an abundance of anecdotal evidence, until recently authorities and academics believed there was not enough “rigorous evidence” to make a definitive judgment of harm to animal and human health as a result of fracking (Mitka 2135). For example, in Australia, the Queensland Government was unable to find a clear link between fracking and health complaints in the Tara gasfield (Thompson 56), even though it is known that there are fugitive emissions from these gasfields (Tait et al. 3099-103). It is within this context that grassroots opposition to UGM began in Australia. The largest and most sustained challenge has come from the Northern Rivers of New South Wales, where a company called Metgasco has been attempting to engage in UGM for a number of years. Stiff community opposition has developed over this time, with activists training, co-ordinating and organising using the principles of Moyer’s MAP and NEFA’s NVDA. Numerous community and affinity groups opposing UGM sprang up including the Lock the Gate Alliance (LTG), a grassroots organisation opposing coal and gas mining, which formed in 2010 (Lock the Gate Alliance online). The movement put up sustained resistance to Metgasco’s attempts to establish wells at Glenugie, near Grafton and Doubtful Creek, near Kyogle in 2012 and 2013, despite the use of a substantial police presence at both locations. In the event, neither site was used for production despite exploratory wells being sunk (ABC News; Dobney). Metgasco announced it would be withdrawing its operations following new Federal and State government regulations at the time of the Doubtful Creek blockade. However it returned to the fray with a formal announcement in February 2014 (Metgasco), that it would drill at Bentley, 12 kilometres west of Lismore. It was widely believed this would occur with a view to production on an industrial scale should initial exploration prove fruitful. The Bentley Blockade It was known well before the formal announcement that Metgasco planned to drill at Bentley and community actions such as flash mobs, media releases and planning meetings were part of the build-up to direct action at the site. One of the authors of this article was actively involved in the movement and participated in a variety of these actions. By the end of January 2014 it was decided to hold an ongoing vigil at the site, which was still entirely undeveloped. Participants, including one author, volunteered for four-hour shifts which began at 5 a.m. each day and before long, were lasting into the night. The purpose of a vigil is to bear witness, maintain a presence and express a point of view. It thus accords well with the principle of non-violence. Eventually the site mushroomed into a tent village with three gates being blockaded. The main gate, Gate A, sprouted a variety of poles, tripods and other installations together with colourful tents and shelters, peopled by protesters on a 24-hour basis. The vigils persisted on all three gates for the duration of the blockade. As the number of blockaders swelled, popular support grew, lending weight to the notion that countercultural ideas and practices were spreading throughout the community. In response, Metgasco called on the State Government to provide police to coincide with the arrival of equipment. It was rumoured that 200 police would be drafted to defend the site in late April. When alerts were sent out to the community warning of imminent police action, an estimated crowd of 2000 people attended in the early hours of the morning and the police called off their operation (Feliu). As the weeks wore on, training was stepped up, attendees were educated in non-violent resistance and protestors willing to act as police liaison persons were placed on a rotating roster. In May, the State Government was preparing to send up to 800 police and the Riot Squad to break the blockade (NSW Hansard in Buckingham). Local farmers (now a part of the movement) and activist leaders had gone to Sydney in an effort to find a political solution in order to avoid what threatened to be a clash that would involve police violence. A confluence of events, such as: the sudden resignation of the Premier; revelations via the Independent Commission against Corruption about nefarious dealings and undue influence of the coal industry upon the government; a radio interview with locals by a popular broadcaster in Sydney; and the reputed hesitation of the police themselves in engaging with a group of possibly 7,000 to 10,000 protestors, resulted in the Office for Coal Seam Gas suspending Metgasco’s drilling licence on 15 May (NSW Department of Resources & Energy). The grounds were that the company had not adequately fulfilled its obligations to consult with the community. At the date of writing, the suspension still holds. The Wave The repertoire of contention at the Bentley Blockade was expansive, comprising most of the standard actions and strategies developed in earlier environmental struggles. These included direct blocking tactics in addition to the use of more carnivalesque actions like music and theatre, as well as the use of various media to reach a broader public. Non-violence was at the core of all actions, but we would tentatively suggest that Bentley may have provided a novel addition to the repertoire, stemming originally from the vigil, which brought the first protestors to the site. At the beginning of the vigil, which was initially held near the entrance to the proposed drilling site atop a cutting, occupants of passing vehicles below would demonstrate their support by sounding their horns and/or waving to the vigil-keepers, who at first were few in number. There was a precedent for this behaviour in the campaign leading up to the blockade. Activist groups such as the Knitting Nannas against Gas had encouraged vehicles to show support by sounding their horns. So when the motorists tooted spontaneously at Bentley, we waved back. Occupants of other vehicles would show disapproval by means of rude gestures and/or yelling and we would wave to them as well. After some weeks, as a presence began to be established at the site, it became routine for vigil keepers to smile and wave at all passing vehicles. This often elicited a positive response. After the first mass call-out discussed above, a number of us migrated to another gate, where numbers were much sparser and there was a perceived need for a greater presence. At this point, the participating writer had begun to act as a police liaison person, but the practice of waving routinely was continued. Those protecting this gate usually included protestors ready to block access, the police liaison person, a legal observer, vigil-keepers and a passing parade of visitors. Because this location was directly on the road, it was possible to see the drivers of vehicles and make eye contact more easily. Certain vehicles became familiar, passing at regular times, on the way to work or school, for example. As time passed, most of those protecting the gate also joined the waving ritual to the point where it became like a game to try to prise a signal of acknowledgement from the passing motorists, or even to win over a disapprover. Police vehicles, some of which passed at set intervals, were included in this game. Mostly they waved cheerfully. There were some we never managed to win over, but waving and making direct eye contact with regular motorists over time created a sense of community and an acknowledgement of the work we were doing, as they increasingly responded in kind. Motorists could hardly feel threatened when they encountered smiling, waving protestors. By including the disapprovers, we acted inclusively and our determined good humour seemed to de-escalate demonstrated hostility. Locals who did not want drilling to go ahead but who were nevertheless unwilling to join a direct action were thus able to participate in the resistance in a way that may have felt safe for them. Some of them even stopped and visited the site, voicing their support. Standing on the side of the road and waving to passers-by may seem peripheral to the “real” action, even trivial. But we would argue it is a valuable adjunct to a blockade (which is situated near a road) when one of the strategies of the overall campaign is to win popular backing. Hence waving, whilst not a completely new part of the repertoire, constitutes what Tilly (41–45) would call innovation at the margins, something he asserts is necessary to maintain the effectiveness and vitality of contentious action. In this case, it is arguable that the sheer size of community support probably helped to concentrate the minds of the state government politicians in Sydney, particularly as they contemplated initiating a massive, taxpayer-funded police action against the people for the benefit of a commercial operation. Waving is a symbolic gesture indicating acknowledgement and goodwill. It fits well within a repertoire based on the principle of non-violence. Moreover, it is a conventional social norm and everyday behaviour that is so innocuous that it is difficult to see how it could be suppressed by police or other authorities. Therein lies its subversiveness. For in communicating our common humanity in a spirit of friendliness, we drew attention to the fact that we were without rancour and tacitly invited others to join us and to explore our concerns. In this way, the counterculture drew upon a mainstream custom to develop and extend upon a new form of dissent. This constitutes a reversal of the more usual phenomenon of countercultural artefacts—such as “hippie clothing”—being appropriated or co-opted by the prevailing culture (see Reading). But it also fits with the more general phenomenon that we have argued was occurring; that of enticing ordinary residents into joining together in countercultural activity, via the pathway of a social movement. Conclusion The anti-CSG movement in the Northern Rivers was developed and organised by countercultural participants of previous contentious challenges. It was highly effective in building popular support whilst at the same time forging a loose coalition of various activist groups. We have surveyed one practice—the wave—that evolved out of mainstream culture over the course of the Bentley Blockade and suggested it may come to be seen as part of the repertoire of actions that can be beneficially employed under suitable conditions. Waving to passers-by invites them to become part of the movement in a non-threatening and inclusive way. It thus envelops supporters and non-supporters alike, and its very innocuousness makes it difficult to suppress. We have argued that this instance can be referenced to a similar reverse movement at a broader level—that of co-opting liberal notions and involving the general populace in new practices and activities that undermine the status quo. The ability of the counterculture in general and environment movements in particular to innovate in the quest to challenge and change what it perceives as damaging or unethical practices demonstrates its ingenuity and spirit. This movement is testament to its dynamic nature. References ABC News. Metgasco Has No CSG Extraction Plans for Glenugie. 2013. 30 July 2014 ‹http://www.abc.net.au/news/2013-01-22/metgasco-says-no-csg-extraction-planned-for-glenugie/4477652›. Bible, Vanessa. 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