Today’s landmark deal between six world powers and Iran, which would limit Iran’s nuclear program in exchange for lifting economic sanctions, was an important step toward stopping Iran from building a nuclear bomb.

However, the key challenge for the international community will be making sure Iran keeps its part of the bargain, according to Stanford experts.

“Both sides have made a series of compromises that will help Iran’s economy in exchange for constraining its nuclear capabilities – and that’s a deal worth making, in my view,” said Scott Sagan, the Caroline S.G. Munro professor of political science and senior fellow at the Center for International Security and Cooperation.

“Iran will still have a technical capability to develop nuclear weapons, given the technology and materials that they have, but under this deal it will both take them a much longer period of time and would require them to take actions that would be easily discerned by the International Atomic Energy Agency, so it constrains their break-out capabilities in important ways.”

[[{"fid":"219719","view_mode":"crop_870xauto","fields":{"format":"crop_870xauto","field_file_image_description[und][0][value]":"","field_file_image_alt_text[und][0][value]":"","field_file_image_title_text[und][0][value]":"Final plenary session at the United Nations Office in Vienna, Austria. Photo credit: U.S. State Department","field_credit[und][0][value]":"","field_caption[und][0][value]":"","field_related_image_aspect[und][0][value]":"","thumbnails":"crop_870xauto","pp_lightbox":false,"pp_description":false},"type":"media","attributes":{"title":"Final plenary session at the United Nations Office in Vienna, Austria. Photo credit: U.S. State Department","width":"870","style":"width: 400px; height: 266px; float: right; margin-left: 15px","class":"media-element file-crop-870xauto"}}]]The U.S.-led negotiations also included fellow United Nations Security Council members Britain, China, France, and Russia, as well as Germany – a group known collectively as as the "P5+1."

Sig Hecker, former Los Alamos National Laboratory director and senior fellow at Stanford’s Center for International Security and Cooperation, said the nuclear deal was “hard-won and is better than any other reasonably achievable alternative.”

“Iran agreed to considerably greater restrictions on its program than what I thought was possible before the Joint Plan of Action was signed in November 2013,” said Hecker.

Abbas Milani, director of Iranian studies at Stanford and an affiliate at the Center for Democracy Development and the Rule of Law, called it the “least bad deal” for both Iran and the international community.

“Nobody gets everything they want,” Milani said. “Every side gets some of what they want.”

Under the deal, Iran would be allowed to continue to enrich uranium for peaceful purposes in its energy and health industries.

But it would have to reduce the number of its centrifuges from 19,000 to 6,000, and cut its stockpile of low enriched uranium down from more than 20 thousand pounds to about 660 pounds.

“Reducing that stockpile actually lengthens the breakout time more than any other measure,” said Hecker.

These limits were designed to increase the “breakout time” it would take for Iran to produce enough fissile material to make a nuclear weapon from the current two to three months, to one year over a period of the next 10 years.

The agreement still faces a series of political hurdles before it gets implemented, and will face tough scrutiny from a Republican-controlled U.S. Congress, as well as the parliaments of European countries that were parties to the talks.

“I think it’s going to be hard for the U.S. Congress and [European] parliaments to kill the deal and be perceived as the ones who would rather have a war than give diplomacy a chance,” said Thomas Fingar, distinguished fellow at the Freeman Spogli Institute for International Studies.

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“The key is going to be the effectiveness of the verification procedures and IAEA access,” Fingar said.

“There’s an element of trust, but a far more important part is the rigorous verification protocols.”

As soon as the IAEA confirms that Iran is abiding by the terms of the agreement, economic sanctions can be lifted.

Sagan warned that the international community should not be surprised if Iran pushed the limits of the agreement, and should be ready to reimpose economic sanctions if Iran violated the deal.

“We should anticipate that Iranian opponents to the agreement will try to stretch it and do things that are potential violations and that we have to call them on that, and not treat every problem that we see as unexpected,” said Sagan.

“We should anticipate such problems and be ready, if necessary, to reimpose sanctions. Having the ability to reimpose sanctions is the best way to deter the Iranians from engaging in such violations.”

But Hecker said the international community should focus on incentivizing Iran.

“The best hope is to make the civilian nuclear path so appealing – and then successful – that Tehran will not want to risk the political and economic consequences of that success by pursuing the bomb option,” he said.

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Iran faced the threat of military action if it continued to press forward with its nuclear program.

While Russia and China had both signaled that they were likely to abandon the sanctions regime if talks fell apart.

One of the key challenges to reaching an agreement was “finding a language that would allow both parties to declare victory”, according to Milani.

“Iran has clearly made some very substantive concessions, but Iran has also been allowed to keep enough of its infrastructure so that it can declare at least partial victory for the domestic political audience."

Now the scramble is on in Tehran to claim credit for the deal.

Reformists, led by current Iranian President Hassan Rouhani and former president Akbar Hashemi Rafsanjani, hope it will strengthen their hand as they head into the next election.

On the other side of the political spectrum, conservatives believe it could give them the edge in the battle to succeed Ayatollah Ali Khamenei as Iran’s Supreme Leader.

“They understand that whoever gets the credit for this will be in a much better position to determine the future leadership and future direction of Iran’s foreign policy,” said Milani.

It’s too early to tell what impact the agreement might have on Iran’s foreign policy, which is often at odds with U.S. interests in hot spots like Iraq, Syria, Yemen and Afghanistan. But Sagan said today’s deal was an important step in making sure that future conflicts with Iran don’t go nuclear.

“Hopefully those disagreements will be played out without the shadow of nuclear weapons hanging over the future, and that’s a good thing.”

Foreign aid to the public health sectors of developing countries often appears to be allocated backwards: The global burden of non-communicable diseases such as diabetes or heart disease is enormous – yet they receive little health aid. 

By comparison, the global burden of HIV is much smaller, yet it receives more health aid than any other single disease.

So will a wholesale reversal in health aid priorities improve global health? The answer, according to a new study by Stanford researchers, is that if the goal is to maximize the health benefits from each donor dollar, health aid is actually allocated pretty well.

Still, reallocating foreign aid to step up the fight against malaria and TB could lead to greater overall health improvements in developing nations. And it could be done without spending more money, the researchers have found.

Eran Bendavid, an assistant professor in the Department of Medicine and a core faculty member at the Center for Health Policy and Center for Primary Care and Outcomes Research, and three Stanford research assistants write in the July issue of Health Affairs that more health aid is going to disease categories with more cost-effective interventions.

"What we found, somewhat to our surprise, is that in nearly all countries, more aid was flowing to finance priorities with more cost-effective options,” Bendavid said in an interview. “That is partly because more aid was flowing to the treatment and prevention of infectious diseases such as HIV and malaria, and their management can be relatively inexpensive, even if the burden of these diseases is lower than that of non-communicable diseases.”

Bendavid, an infectious disease physician, added: “Conversely, even though the burden of non-communicable diseases is high and growing, addressing these chronic conditions such as diabetes and heart disease is, broadly, more costly than the unfinished infectious disease agenda.”

The authors also show that just because health aid is broadly allocated toward better cost-effectiveness does not mean that it cannot be better allocated.

The biggest gains would come from taking some of the foreign aid earmarked for HIV or maternal, newborn or child health, and putting it toward programs to treat malaria and tuberculosis, they write.

The Stanford research team reviewed the literature for cost-effectiveness of interventions targeting five disease categories: HIV, malaria, tuberculosis, non-communicable disease and maternal, newborn and child health.

What they found was that aid from wealthy nations to developing ones might be allocated efficiently, but that the money is not always spent in the best interest of curbing the communicable diseases that would improve the overall health of a nation.

It is crucial, therefore, to further study the consequences of realignment of donor funds.

Public health aid is critical to most developing countries. Development assistance from high-income countries to public health sectors of low- and middle-income countries amounts to nearly 40 percent of public health spending in countries with a per capita GDP of less than $2,000.

The researchers focused on 20 countries that received the greatest total amount of aid between 2008 and 2011, a period of historically unprecedented growth in health aid. Development assistance has since flattened, however, so the authors believe it’s increasingly important to consider best value when investing limited resources.

The 20 countries studied ­– from Afghanistan to Zambia – received $58 billion out of the total $103.2 billion in recorded health aid disbursements to 170 countries between 2001 and 2011.

“Over the period of 2001-2011, a greater amount of disbursements flowed to HIV programs than any other disease category,” the authors write. “On average, interventions addressing malaria and had the lowest incremental cost-effectiveness ratio (ICER), which indicates that malaria interventions could yield greater health improvements from each dollar compared with the interventions having a higher ICER.”

The authors analyzed the data and determined that the alignment improves if up to 61 percent of HIV aid is reallocated for TB control and up to 80 percent is reallocated for malaria control.

“Our evidence suggests that the greatest improvements in the efficiency of global health dollars could result from reallocating funds to malaria and TB control programs,” the authors write.

“This study shows, for the first time, that the current allocation of health aid is generally aligned with the cost-effectiveness of targeted interventions. Contrary to common views that advocate for reprioritization toward non-communicable diseases, our data suggest that the alignment could best be improved by focusing on malaria and TB, especially where addressing those diseases is highly cost effective.”

The other authors of the study are Andrew Duong and Gillian Raikes, both research assistants in the Program of Human Biology; and Charlotte Sagan, a RA in the School of Medicine.

Rates of obesity in the United States remain extremely high. New statistics show that nearly two-thirds of adults are at an unhealthy weight and that – for the first time ever – obese Americans now outnumber those who are merely overweight.

Two Stanford public health law experts say one of biggest culprits of the obesity epidemic – on top of fast foods and our sedentary lifestyle – are sugary drinks.

And they believe the sweet spot for public health law in curbing the adverse effects of sugar-sweetened beverages (SSBs) lies in the strategic use of measures such as higher SSB taxes, limits on advertisements targeting kids, and restrictions on soft drinks and sugar-sweetened teas and sports drinks in government institutions, such as public schools.

“It’s always possible to get more and better evidence about the effectiveness of public health laws,” says David Studdert, a professor of medicine at the Stanford School of Medicine, professor at the Stanford Law School and core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research.

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“But enough is already known about the promise of some legal interventions to curb SSB consumption – significant tax hikes and advertising restrictions are two good examples – to be fairly confident that they would make a difference.”

Studdert is the lead author of a review paper published July 7 in PLoS Medicine, entitled, “Searching for Public Health Law’s Sweet Spot: The Regulation of Sugar-Sweetened Beverages.”

Studdert and senior author Michelle Mello, professor of law and professor of health research and policy at the School of Medicine, and co-author Jordan Flanders, a former Stanford Law School student, argue that sugary drinks are a substantial, yet preventable contributor to the global burden of obesity and associated health conditions.

A new study published June 29 in the American Heart Association journal Circulation linked the consumption of sugary drinks to an estimated 184,000 adult deaths each year, with more than 25,000 of those Americans. The study, conducted by researchers from Tufts University, found that the beverages are responsible for an estimated 133,000 of those deaths from diabetes, 45,000 from cardiovascular disease and 6,450 from cancer.

While Americans’ consumption of sugary drinks has plateaued, according to the Tufts study, about three-fourths of the deaths due to SSBs are now in developing countries. Mexico leads with 24,000 total deaths. The United States still ranks fourth, however, just behind South Africa and Morocco.

The Stanford researchers say the evidence shows that sugary drinks are contributors to the global obesity epidemic, but the appropriate reach of regulation to curtail SSB consumptions remains highly contested.

The main regulatory approaches to SSBs are higher taxes, restrictions on the availability of the sugar-sweetened drinks in schools, restrictions on advertising and marketing, labeling requirements and government procurement and benefits standards.

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“Finding public health law’s sweet spot requires regulatory approaches that are capable both of achieving measurable improvements to public health and of winning victories in courts of law and public opinion,” the researchers write.

Over the last decade, many national, state, and local governments have introduced laws aimed at curbing consumption of sugar-sweetened beverages (SSBs), especially by children. The main regulatory approaches have been taxes, restrictions on the availability of SSBs in schools, calls for controls on advertising and marketing, labeling requirements, and government procurement and benefits standards.

But efforts to regulate the drinks often encounter stiff opposition, including claims that the laws are inequitable, do not achieve their goals, and have negative economic effects.

New York City’s attempt to ban the sale of jumbo-sized sugary drinks sold in city restaurants, theaters and food carts triggered international headlines and a firestorm of opposition. The soft drink industry embarked on a multimillion-dollar campaign to block the proposal championed by former Mayor Michael Bloomberg.

The proposal died last year when the New York State Court of Appeals ruled that the city’s Board of Health had “exceeded the scope of its regulatory authority.”

Taxes on SSBs, the most commonly adopted measure, vary widely, the authors write. A few countries, most notably several South Pacific island nations, where obesity rates are among the highest in the world, have introduced very high taxes on sugary drinks.

But most sugar-sweetened beverage taxes add between 5 and 9 cents per liter. This is well short of the level that experts argue is needed to significantly affect consumption and weight outcomes: a sales tax of at least 20 percent of the container’s price or a specific excise tax of 1 cent per ounce.

“In the United States, there have been many government proposals to introduce or raise taxes – most unsuccessful,” the authors write. “The beverage industry has invested heavily in public relations firms and `grassroots’ organizations to oppose the initiatives.”

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Berkeley, Calif., recently became the first U.S. city to pass an SSB tax, a penny-per-ounce excise on soda distributors, but a similar ballot measure in nearby San Francisco failed. At least 22 states have proposed SSB taxes since 2010, but only one state, Washington, passed a measure at the level recommended by economists – and it was repealed the following year in a voter referendum.

Yet U.S. childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years, according to the Centers for Disease Control and Prevention. More than one-third of children and adolescents are overweight or obese.

“There is broad consensus in the public health community that reducing the influence of advertising is a critical step in addressing the spread of childhood obesity,” the authors say.

The United States and Canada have sought to regulate advertisers through a soft approach — mainly via voluntary guidelines and pressure to self-regulate, the authors write.

“These appear to have had only a modest impact on marketing practices,” they said. “U.S. regulators face considerable legal barriers in going further, including courts’ increasingly expansive interpretations of the scope of protected commercial speech under the First Amendment. Unless judicial currents shift, it will remain extremely difficult to impose restrictions on SSB advertising.”

Mello said low- and middle-income countries should anticipate that SSB companies will increasingly target them as promising markets, and that those developing countries should start crafting their regulatory responses now.

“Our experience with tobacco control teaches us that lower- and middle-income countries need to become wary when product regulation in the U.S. tightens,” Mello said. “Like squeezing a balloon, it pushes companies to intensify their marketing efforts overseas, and our public health problems get exported."

And, the authors note, while policy nudges have become fashionable, “there are dangers in treading too lightly.” “Strategies such as calorie labels, portion caps, and small beverage taxes preserve consumer freedom but are typically too modest to affect consumer behavior – and such modesty can be recast as arbitrariness. Industry opposition will come whether the intervention is modest or aggressive but should be easier to combat if officials can show their policy is effective,” they wrote.

“One somewhat surprising message that comes from reviewing how courts have handled challenges to SSB laws is that regulators can run greater risks of having their laws struck down if they are too timid,” Studdert said.

“Courts weigh effectiveness, and modest attempts to change behavior are often ineffective,” he said. “So one piece of advice regulators in this area should consider is to ‘go big or go home’.”

The United Nations has thus far fulfilled its charter to prevent a third world war, but with 60 million refugees, continued bloodshed with unresolved civil conflicts and terrorism spreading like cancer, the world's leading peacekeeping organization must spearhead global action, U.N. Secretary-General Ban Ki-moon said Friday at Stanford on the 70th anniversary of the international organization.

Ban, the U.N.'s eighth secretary-general, did not rest on any laurels during his speech at a public event sponsored by the Walter H. Shorenstein Asia-Pacific Research Center (APARC). "I humbly accept criticism that the U.N. is not doing enough," he said. 

However, the situation could have been worse if not for the United Nations, he continued. "Without peacekeepers, or without the U.N.'s continued humanitarian assistance and advocacy of human rights, I'm afraid to tell you that this world would have been poorer, more dangerous and even bloodier without the United Nations."

Ban's visit to Stanford – his second to the university in less than three years – was part of a trip to the Bay Area to commemorate the signing of the U.N. charter. In 1945, representatives from 50 nations gathered in San Francisco to create the United Nations – an international organization aimed at saving future generations from the "scourge of war."

Today, the United Nations has grown to 193 member nations. Its challenges – from climate change and poverty to civil wars and terrorism – have never been greater, Ban said.

"This is a critical year; 2015 is a year of global action," he said. "The U.N. cannot do it alone. We need strong solidarity among government, business communities and civil societies, from each and every citizen."

The fact that so many young people around the globe are drawn to violent narratives is worrisome, Ban said. "Violent terrorism is spreading like cancer around the world."

The rise in terrorist activities stems from "a failure of leadership," he said. That's why the United Nations needs to develop a comprehensive plan of action to address extremism, he maintained.

The U.N.'s 70th anniversary coincidentally fell on a momentous day of tragedy and celebration around the world. Dozens were killed when terrorists launched horrific attacks across three continents – in France, Tunisia and Kuwait – fueling anger, sadness and fear of more violence.

But in the United States, celebrations rang out in response to a landmark U.S. Supreme Court ruling that legalizes same-sex marriages nationwide.

Ban, who has long advocated for equality and last year pushed the United Nations to recognize same-sex marriages of its staff, drew a round of applause when he heralded the court ruling as "a great step forward for human rights."

The June 26 event was co-sponsored by Shorenstein APARC and the Freeman Spogli Institute for International Studies at Stanford University, with promotional co-sponsors Asia Society, Asia Foundation and the World Affairs Council of Northern California. 

May Wong is a freelance writer for the Stanford News Service.

Coverage and related multimedia links:

Remarks at Stanford University by Ban Ki-moon (U.N. News Centre, 6/26/15)

Photos of Ban Ki-moon at Stanford University (U.N. Photo, 6/26/15)

At Stanford University, Ban says U.N. ready to build a better future for all (U.N. News Centre, 6/27/2015)

U.N. Secretary-General Ban Ki-moon welcomes growing engagement of India, China (NDTV, 6/27/2015)

U.N. Secretary-General Ban Ki-moon speaks at Stanford, celebrates U.N.'s 70th anniversary (Stanford Daily, 6/29/15)

Hoover archival photographs featured at lecture delivered by U.N. Secretary-General Ban Ki-moon (Hoover Institution, 6/29/2015)

Maria Polyakova, an assistant professor of health research and policy at the Stanford School of Medicine, is this year’s recipient of the Ernst-Meyer Prize, which recognizes original research about risk and health insurance economics.

Polyakova, who wrote her thesis, “Regulation of Public Health Insurance,” while working on her Ph.D. in economics at MIT, was given the award by The Geneva Association, an international insurance economics think tank based in Switzerland.

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Courbage said the topic not only had considerable academic interest, but also was “an important public policy issue in both the United States and Europe.

“This work makes extremely useful insights about an important area of public policy that has yet to get the attention it needs: the interaction of regulation with important demand and supply-side features of private insurance markets.”

Polyakova said she was honored to receive the award and thanked her thesis committee for their “unbounded support” of her work.

“I am especially grateful to Amy Finkelstein for inspiring my interest in social insurance in general, and health insurance, in particular,” she said. “I hope to continue my work in this area."

A summary of Polyakova’s thesis will be published in the July 2015 issue of The Geneva Association’s Insurance Economics newsletter.