Search Results (148)

Background/Objectives: Environmental air pollution and structural barriers to preventive dental care are increasingly recognized as determinants of population health inequalities. However, their combined association with oral disease burden across European Union (EU) Member States remains insufficiently examined. This study evaluated whether ambient particulate matter (PM2.5) exposure is associated with oral health outcomes and whether preventive system capacity modifies this association. Methods: An ecological panel analysis was conducted using country-level data from the 27 EU Member States for the period 2020–2023. Age-standardized prevalence of untreated dental caries (primary outcome), edentulism (secondary outcome), and periodontal diseases (exploratory outcome) were obtained from the Global Burden of Disease database. PM2.5 exposure was operationalized using national mean annual baseline values. Preventive care access was proxied by the percentage of the population reporting unmet dental care needs (Eurostat EU-SILC). Pooled panel regression models with year fixed effects and country-clustered robust standard errors were estimated. An interaction term between PM2.5 exposure and unmet dental care needs was included to assess effect modification. Results: PM2.5 exposure was not independently associated with caries prevalence after adjustment for preventive access and GDP per capita. However, a statistically significant interaction was observed: higher PM2.5 levels were associated with increased caries prevalence in countries reporting greater unmet dental care needs. PM2.5 exposure was positively associated with edentulism prevalence, independent of preventive access. No significant associations were detected for periodontal diseases. Conclusions: Based on this ecological analysis of European Union Member States, higher PM2.5 exposure in combination with greater unmet dental care needs was associated with higher population-level caries prevalence, whereas PM2.5 exposure alone showed a positive association with edentulism prevalence. These findings are exploratory and should be interpreted with caution, given the use of aggregated country-level data, the potential for ecological fallacy, and the absence of causal inference. Further individual-level and longitudinal studies are needed to clarify these relationships and their underlying mechanisms. Full article

The accelerating diffusion of artificial intelligence (AI) in Europe raises pressing distributional questions about employment, social cohesion, and sustainable development in disadvantaged regions. Research has concentrated on advanced urban economies, leaving the implications of AI for peripheral small and medium-sized enterprises (SMEs) operating under weak human capital, thin digital infrastructure, and constrained social capital, underexplored. We examine the interplay between AI adoption, social capital formation, workforce dynamics, and sustainable development in Eastern Macedonia and Thrace (EMT), one of the EU’s least developed regions. Regional unemployment and educational-attainment data from Eurostat and ELSTAT are incorporated as contextual evidence anchoring the qualitative findings. Drawing on Bitsani’s Biocultural City framework which treats human, social, and cultural capital as interdependent dimensions of regional sustainability, we thematically analysed twelve semi-structured interviews with SME owners and managers conducted in early 2025 using Atlas.ti, yielding 19 codes grouped into six categories. Knowledge deficits and financial constraints emerge as primary barriers, while external technology partnerships, targeted education, and economic incentives operate as enablers, all mediated by social and human capital availability. Read through this framework, AI adoption in peripheral economies emerges less as a purely technological or financial challenge than as a social and human capital one, embedded in a biocultural environment shaped by brain drain, institutional thinness, and weak civic intermediation. Without parallel investment in digital literacy, organizational culture, and inter-firm networks, AI risks reproducing rather than reducing employment inequalities. The study draws policy implications for EU Cohesion programming and Sustainable Development Goals 4, 8, 9, 10, and 17. Full article

With the growing energy demand and concerns about environmental impacts, green hydrogen has become one of the main alternatives for a clean and reliable energy future. Brazil presents itself as one of the main potential suppliers of this renewable fuel, considering its resource abundance, such as solar irradiation. Therefore, the present study aims to evaluate in detail the hydrogen production potential of one of Brazil’s main states when it comes to solar power potential, Minas Gerais. The potential for each of the 853 municipalities of the region was assessed individually using three different methodologies, indicating that the state could produce 2365.2 TWh of electricity or 47.3 Mt_H2/year (with a maximum variation of 3.4% between the methodologies), nearly five times the EU’s projected 2030 hydrogen import demand. This estimation, however, was significantly reduced when only areas with a slope lower than 8% were considered, decreasing land availability by 40% and cutting hydrogen potential by 18.8 Mt/year. On the other hand, increasing power density from 4 to 15 MWh/km² almost tripled hydrogen production potential, while electrolyzer efficiency also presented a positive effect on hydrogen output. Finally, the comparison of hydrogen potential with Human Development Index (HDI) data indicates that the most productive mesoregions often coincide with lower human development levels, particularly in the “Norte de Minas” and “Jequitinhonha” mesoregions, highlighting the opportunity to align energy transition with regional development goals. Therefore, targeted investments in these regions could generate jobs, boost income, and reduce inequalities, reinforcing green hydrogen as both an environmental and social driver. Full article

This paper investigates the macroeconomic determinants of Romania’s budget deficit over the post-EU accession period, drawing on quarterly data from Q1 2007 to Q2 2025. Using an Autoregressive Distributed Lag (ARDL) model, we identify both short- and long-run relationships between the fiscal balance and a set of macroeconomic fundamentals. Real GDP growth proves to be the most robust positive determinant, with a short-run coefficient of 0.2718 and a long-run multiplier of 0.5152—a finding that firmly establishes sustained economic expansion as the primary structural force behind fiscal improvement. Inflation is positively associated with fiscal balance, consistent with nominal revenue buoyancy outpacing expenditure indexation in the short run. Public debt exerts a persistent negative effect, confirming that accumulated borrowing generates structural pressure on fiscal outcomes over time. A fiscal persistence parameter of 0.4724 reveals that nearly half of any quarter’s deficit is carried forward from the previous one—a feature that compounds temporary shocks into prolonged imbalances. Bounds testing confirms cointegration, validating the long-run interpretation of the estimated multipliers. The results contribute to the literature on fiscal reaction functions in emerging EU economies, particularly by documenting the interaction between cyclical conditions, external imbalances, and fiscal sustainability. The findings carry direct implications for the long-term sustainability of Romania’s public finances and welfare state. Persistent fiscal deficits and compounding debt dynamics constrain the government’s capacity to finance public investment, social transfers, and the green transition—highlighting the interdependence between fiscal consolidation and broader sustainability goals aligned with sustainable development goals: Decent Work and Economic Growth, Reduced Inequalities, and Partnerships for the Goals. Full article

The expansion of the European Union Emissions Trading System to road transport and buildings (ETS2) raises significant concerns regarding the distributive social impacts of carbon pricing on vulnerable households, particularly in regions characterized by high car dependency, limited public transport accessibility, and pronounced territorial inequalities. This paper aims to develop an integrated conceptual framework for analyzing transport poverty in the context of ETS2 and the just climate transition. The study adopts a conceptual–analytical approach based on a structured literature review of peer-reviewed publications and EU policy documents, combined with a qualitative policy analysis focused on Bulgaria as a critical case. The paper identifies six interacting analytical dimensions of transport poverty—economic vulnerability, spatial vulnerability, mobility dependency, infrastructure vulnerability, climate-policy exposure, and social vulnerability—and maps the causal pathways through which carbon pricing mechanisms may intensify mobility deprivation, particularly among low-income, rural, and forced-car-ownership households. The analysis demonstrates that ETS2 may exacerbate existing socio-spatial inequalities unless accompanied by well-designed compensatory, accessibility-oriented, and territorially sensitive policy measures. The Bulgarian case illustrates the specific structural risk factors prevalent in Central and Eastern European countries. The paper contributes to the emerging academic literature on transport poverty by positioning it as a critical dimension of the just climate transition and by providing a conceptual foundation for future empirical research within the ACTETS2 project framework. Full article

The transformation of the labour market is a significant challenge for sustainable regional development, especially in countries with pronounced socioeconomic inequalities. This study aims to analyse the spatial disparities in the Bulgarian labour market at the regional level (NUTS 3, districts) for the period of 2021–2024, combining descriptive spatial analysis, multidimensional cluster analysis, and Local Indicator of Spatial Association (Local Moran’s I-LISA). The analysis is based on three key indicators: employment rates, unemployment rates, and the relative wage index, calculated against the national average. The results of the descriptive analysis reveal clear spatial imbalances, with low labour income persisting in many districts despite relatively high employment rates. The cluster analysis identifies four types of labour markets with specific socioeconomic profiles, confirming that the spatial disparities are a result of specific combinations of indicators and economic specialisation at the regional level. The LISA analysis further reveals the existence of spatially stable cores of vulnerability and local spatial anomalies that highlight the importance of regional context and spatial proximity. The results indicate the need for a spatially differentiated approach in regional policies in line with the objectives of SDG8, SDG10, the European Pillar of Social Rights, and the EU’s cohesion policy. Full article

Background/Objectives: Health system socio-economic inequities in dental care are a long-standing problem in Europe. The issue gained increased relevance during the recent pandemic due to service disruption and socio-economic inequities that become even more pronounced under such circumstances. However, while preventive dental programs are considered key elements of public health, little is known about their role in addressing equity in accessing dental care among different countries and over time between them. This research aims at investigating the relationship between preventive dental policy, socio-economic factors, and the inability to get appropriate dental care within EU member states. Methods: A longitudinal panel dataset at the country level, consisting of data collected during 2020 through 2024, was assembled using open sources of statistics from Europe and other international statistical databases. The dependent variable used in the study was the percentage of the population that had unmet dental care need because of cost. Independent variables were the presence or absence of preventive policies related to dentistry, educational attainment, gross domestic product per capita, unemployment rate, number of dentists, and out-of-pocket expenses. Balanced panel datasets and regressions with robust standard errors in random-effects models were estimated. Interaction terms were created to test the moderating effect of education level on the relationship between policies and access to care. Results: Cross-country variations in terms of the prevention policy environment, socio-economic status, and unmet dental care need were found from descriptive analysis. The higher level of out-of-pocket payment was always related to the higher unmet dental care need, while the lower GDP countries displayed poorer access. Using the balanced panel random-effects model, preventive dental policies and the interaction between preventive policies and educational level were insignificant factors predicting the unmet dental care need. On the other hand, higher out-of-pocket payments, education, and dentists per million population had nearly significant positive relationships. In the sensitivity analysis, GDP per capita showed a negative association, whereas dentists per million population remained positively associated with unmet dental care need. Conclusions: The findings suggest that inequalities in access to dental care during and after the COVID-19 period were shaped primarily by financial and structural determinants rather than by the presence of preventive policies alone. While preventive programs remain an important component of long-term oral health strategies, reducing direct household payment burden and strengthening health system capacity may represent more immediate mechanisms for maintaining equitable access to dental services during periods of system disruption. Full article

This paper investigates how climate shelter initiatives implemented in European cities interact with National Adaptation Strategies (NAS) and National Adaptation Plans (NAP), assessing the degree of vertical integration between local practices and national climate adaptation frameworks. As urban heat increasingly threatens public health and exacerbates socio-spatial inequalities, climate shelters, conceived as networks of safe, accessible public spaces providing thermal comfort and social support, have emerged as innovative adaptation tools; however, their recognition within national policy architectures remains uneven across the EU. This study adopts a qualitative–comparative design structured in three phases: (i) a systematic review of NAS and NAP in the 27 EU Member States through keyword screening and classification of references as explicit, implicit, or absent; (ii) a mapping of climate shelter initiatives across 244 NUTS-2 capital cities; and (iii) an integrative cross-analysis of national frameworks and local implementation patterns. According to our results, only 4 Member States explicitly refer to climate shelters, 11 include implicit references, and 12 show no recognition, while 88 cities implement 97 initiatives, predominantly based on Nature-based Solutions and schoolyard transformations; 5 recurring governance configurations reveal bottom-up, top-down, and hybrid dynamics, demonstrating that local experimentation can anticipate, complement, and potentially reshape national adaptation policies. Full article

Climate-related economic losses across Europe have evolved from isolated environmental shocks to persistent, structurally embedded fiscal risks, posing a direct challenge to the long-term fiscal sustainability of European states. This study presents an empirical framework for diagnosing and quantifying this transformation across 38 European countries between 1980 and 2023. Combining regime-switching time-series models with a two-part panel design, we identify temporal shifts and spatial asymmetries in loss exposure. Our findings reveal the emergence of a high-loss regime from the early 2000s, alongside a widening inequality in national vulnerability, with countries such as France, Germany, Italy, and Spain bearing a disproportionate burden. This concentration raises critical questions about the sustainability and equity of current EU risk-sharing frameworks. The two-part model further disaggregates the probability of experiencing losses from their conditional magnitude, enabling country-level estimates of expected annual losses. These results highlight the limitations of current fiscal instruments, which remain reactive and fail to align with the spatial and temporal dynamics of climate risk. We argue for a shift from climate loss management to climate loss governance, underpinned by predictive analytics, differentiated policy tools, and a reorientation of EU fiscal solidarity mechanisms. By quantifying, measuring, and spatially disaggregating climate-related fiscal exposure, this study contributes directly to the sustainability agenda: it demonstrates that climate losses are no longer exogenous disruptions but endogenous features of the European economic landscape that must be integrated into sustainable development planning, fiscal governance, and EU-level adaptation policy. Full article

As the European population ages, the sustainability of pension systems faces a trilemma: the structural conflict between achieving benefit adequacy, fiscal stability, and labor market flexibility. This study investigates the primary research hypothesis that these three objectives involve trade-offs under current institutional designs. We examine the structural interrelationships between economic development, population health, and institutional pension characteristics across the EU’s 27 member states. Using cross-sectional data from Eurostat and the OECD from 2023, the study employs a multivariate framework, including Multiple Factor Analysis (MFA) and Principal Component Analysis (PCA), to visualize latent trade-offs. Non-parametric statistical tests were applied to validate structural differences between the Nordic, Continental, Southern, and Central and Eastern European (CEE) welfare regimes. The paper’s central argument is that pension sustainability is less a demographic inevitability and more a path-dependent result of institutional “exit cultures” and regional health-wealth traps. The analysis explains 56.7% of the total variance across two primary dimensions, revealing a persistent east–west divide where GDP per capita and Healthy Life Years (HLYs) at age 65 are strongly coupled. Additionally, the analysis identified a fundamental sustainability trade-off: countries with higher pension expenditures and replacement rates, such as those in the Southern and Continental clusters, have significantly earlier labor market exit ages. Statistical evidence shows that the gender pension gap is the most significant factor in differentiating welfare regimes, with the CEE region showing significantly lower inequality than the Western cluster. Ultimately, the findings contribute to public administration literature by demonstrating that policy interventions must prioritize addressing the culture of early retirement in Western countries and the health-wealth trap in Eastern countries to ensure long-term viability. Full article

Early in 2020, the WHO recommended that existing drugs be evaluated as a repurposed resource to fight the SARS-CoV-2 pandemic. Here, we investigate the trends of using repurposed and off-label drugs among people living with HIV in Central and Eastern Europe (CEE). From November 2020 to May 2021, data on the clinical outcomes of HIV-positive patients diagnosed with COVID-19 were collected on eCRFs (SurveyMonkey^® platform, Inc. San Mateo, CA, USA). Factors associated with the off-label drugs available at this time (chloroquine, hydroxychloroquine, favipiravir, oseltamivir, and lopinavir/ritonavir) were identified using logistic regression models. Of the 557 HIV-positive patients assessed with COVID-19 disease, 67 (12.0%) received off-label drugs, as well as 11.6% (16/138) of hospitalized and 12.2% (51/419) of ambulatory patients (p = 0.8564). In the adjusted logistic regression model, higher odds of off-label drug use were found in patients who had their diagnoses confirmed by an RT PCR test (aOR 5.08 [95%CI 1.17–22.0], p = 0.0396), and who came from a non-EU region (aOR 6.79 [95%CI 3.51–13.1], p < 0.0001). The only factor decreasing the odds of off-label drug use was co-infection (aOR 0.31 [95%CI 0.10–0.94], p < 0.0395). In a cohort of HIV patients from the CEE, 12% were prescribed off-label drugs for COVID-19. Symptomatic patients with confirmed SARS-CoV-2 infection or who were from non-EU countries were more likely to receive a repurposed drug. Drug repurposing is an immediate solution to emerging pandemics. All data regarding the safety and effectiveness of such use should be monitored, reported, and publicly available. Access patterns within and outside the EU should be analyzed to prevent potential inequalities in access to care during epidemics in European settings. Full article

This article examines the policy drift of the 1st Right, Portugal’s main housing program, originally designed to guarantee the right to adequate housing for families in situations of severe deprivation. This study aims to analyze how the program’s integration into the EU’s Recovery and Resilience Plan (RRP) reconfigured its redistributive objectives. Taking the Lisbon Metropolitan Area (LMA) as a critical case, this study employs a mixed-methods approach, combining systematic documentary and legislative analysis (2018–2025), discourse analysis of official communications, and empirical analysis of 18 municipal Local Housing Strategies, supplemented by financial execution data from RRP monitoring reports. The results reveal three interlinked forms of policy drift: (i) territorial deviation, driven by unequal municipal capacities and resource absorption; (ii) instrumental deviation, resulting from the prioritization of rehabilitation of pre-existent public housing stock over the provision of new housing; and (iii) social deviation, marked by the expansion of eligibility criteria that extend benefits to middle-income groups. Together, these dynamics demonstrate how a social-rights-based housing policy can be reshaped when integrated into a financial recovery framework, such as the RRP. This article contributes to international debates on housing governance by demonstrating how multilevel financing mechanisms can reinforce territorial inequalities, reorient policy instruments, and dilute redistributive objectives—even within ostensibly progressive recovery frameworks. It concludes by advocating for stronger social performance monitoring, differentiated instruments for distinct target groups, and improved temporal alignment between social policy objectives and EU funding cycles. Full article

Background/Objectives: Health literacy represents the ability to access, understand, appraise, and apply health information for making appropriate health decisions. It is closely linked to education, income, employment, and overall health outcomes. Limited health literacy is associated with poor self-care, inadequate treatment adherence, and increased healthcare utilization. This study aimed to assess the level of health and medication adherence behaviors among primary health care users in Montenegro and examine its association with key demographic and socioeconomic factors. Methods: A cross-sectional, multicenter study was conducted among 202 primary health care users at the Primary Healthcare Center Danilovgrad, Plav and Ulcinj, Montenegro. Data were collected using a demographic questionnaire, the standardized European Health Literacy Questionnaire (HLS-EU-Q-47), and the Attitudes towards Medication Adherence Self-Reported Questionnaire (ADHERE-7). Statistical analyses included descriptive statistics, χ² tests, and univariate and multivariate regression. Results: The mean HLS-EU-Q Index was 33.55 ± 8.05. Significant differences in literacy levels were observed by age (p = 0.022), material status (p = 0.043), and self-rated health (p = 0.020). In multivariate ordinal regression analysis, lower income (<400 €) was associated with lower odds of belonging to a higher health literacy category (OR = 0.22, 95% CI: 0.02–0.92, p = 0.039), while no statistically significant associations were observed for gender, education level, or employment status after adjustment. The mean ADHERE-7 score of the study population was 21.78 ± 5.19. When analyzed in relation to the level of health literacy, the highest mean ADHERE-7 score was observed among participants with excellent health literacy (24.28 ± 4.90). Lower levels of health literacy were associated with lower odds of belonging to higher health literacy categories among participants reporting selected non-adherence behaviors, including missing therapy 3–4 times per week (OR = 0.30), frequently skipping prescribed medication when feeling well (OR = 0.03), and reducing or omitting therapy due to perceived lack of benefit or high costs (OR range: 0.10–0.31). Conclusions: Health literacy among primary care users in Montenegro is moderate, with a substantial proportion exhibiting limited literacy. Low income is a key determinant of limited literacy, and limited health literacy was associated with poorer medication adherence. Targeted educational and policy interventions are needed to improve health literacy and reduce health inequalities. Full article

Even though environmental health and climate change are rapidly intensifying the severity of determinants of disease and inequity, training for health professionals in these areas remains fragmented across Europe. To address this gap, the European Medical Association (EMA), in collaboration with the European Network on Climate and Health Education (ENCHE), the International Network on Public Health and Environment Tracking (INPHET) and University College London, convened a one-day hybrid roundtable in London on 17 September 2025, focused on “Preparing Health Professionals for Environmental Health and Climate Change: A Challenge for Europe”. The programme combined keynote presentations on global and European policy, health economics and curriculum design with three disease-focused roundtables (respiratory, cardiovascular and neurological conditions), each examining the following topics: (A) climate and environment as preventable causes of disease; (B) healthcare as a source of environmental harm; and (C) capacity building through education and training. Contributors highlighted how environmental epidemiology, community-based prevention programmes and sustainable clinical practice can be integrated into teaching, illustrating models from respiratory, cardiovascular, surgical and neurological care. EU-level speakers outlined the policy framework (European Green Deal, Zero Pollution Action Plan and forthcoming global health programme) and tools through which professional and scientific societies can both inform and benefit from European action on environment and health. Discussions converged on persistent obstacles, including patchy national commitments to decarbonising healthcare, isolated innovations that are not scaled and curricula that do not yet embed sustainability in examinable clinical competencies. The conference concluded with proposals to develop an operational education package on environmental and climate health; map and harmonise core competencies across undergraduate, postgraduate and Continuing -professional-development pathways; and establish a permanent EMA-led working group to co-produce a broader position paper with professional and scientific societies. This conference report summarises the main messages and is intended as a bridge between practice-based experience and a formal EMA position on environmental-health training in Europe. Full article

This article examines labor market dynamics in Bulgaria, Italy, and the United Kingdom by integrating demographic pressures, wage and labor cost adjustment, redistribution mechanisms, inequality outcomes, and digital readiness into a single comparative framework. This study first applies hierarchical clustering to a harmonized EU country panel for 2017–2024, using GDP per capita in PPS, average annual wage, and unemployment rate to position the three countries within the European convergence space and income–labor cost groupings. The results show that Bulgaria belongs to a low-income, fast-converging group, with nominal wages and hourly labor costs more than doubling, strong real-wage growth from a low base, and an improving price level index. At the same time, unemployment fell to below the EU average, yet income inequality remains persistently high. Italy represents a high-income but slow-growing labor market, in which real wages have declined, and labor costs per hour remain above the EU mean with a significant non-wage component. Unemployment remains relatively elevated, indicating divergence in workers’ purchasing power despite high income levels. The UK has labor costs in the mature high-income range, low unemployment, and the lowest tax wedge for low-wage workers, but with relatively high and volatile inequality. This study shows that wage dynamics, labor cost composition, and tax–benefit structures jointly mediate the translation of macroeconomic performance into household outcomes, generating distinct policy trade-offs across the three labor market configurations. Digital indicators further suggest that income level is not a sufficient predictor of digital engagement and that the observed aggregate labor market trends do not indicate a sharp employment contraction contemporaneous with the diffusion of technical innovations, such as generative AI. Full article