Search Results (346)

This study analyses the conditions under which co-opetition improves the supply of healthcare services in Benin. Using non-centralised administrative data from a sample of public and private health centres, we apply network theory and negative binomial regression to assess the extent to which competition affects collaboration between public and private healthcare providers. We found that competition reduces the degree of collaboration between private and public health providers. However, the COVID-19 pandemic significantly mitigated this effect, highlighting the potential for competition within the healthcare system without compromising social welfare. Notwithstanding that, we show that these benefits are not sustained over time. These findings have policy implications for the sustainability of health system financing in Africa, particularly by promoting sustainable financial mechanisms for the private sector and more inclusive governance structures. Full article

As digital technologies and food environments evolve, ensuring children’s food safety has become a pressing public health priority. This study examines how the policy discourse on children’s dietary safety in Korea has shifted over time by applying Latent Dirichlet Allocation (LDA) topic modeling to news articles from 2010 to 2024. Using a large-scale news database (BigKinds), the analysis identifies seven key themes that have emerged across five phases of the national Comprehensive Plans for Safety Management of Children’s Dietary Life. These include experiential education, data-driven policy approaches, safety-focused meal management, healthy dietary environments, nutritional support for children’s growth, customized safety education, and private-sector initiatives. A significant increase in digital keywords—such as “big data” and “artificial intelligence”—highlights a growing emphasis on data-oriented policy tools. By capturing the evolving language and priorities in food safety policy, this study provides new insights into the digital transformation of public health governance and offers practical implications for adaptive and technology-informed policy design. Full article

This paper analyzes the factors affecting the willingness to pay of urban households concerned with efficient waste management in Bangladesh. The multistage random sampling approach selected 1400 families from seven major cities in Bangladesh. This study addresses the socioeconomic and environmental factors that influence urban households’ willingness to pay for improved waste management services in Bangladesh. This study uniquely contributes to the literature by providing a large-scale empirical analysis of 1470 households using a logit model, revealing income, education, and environmental awareness as key predictors of WTP. Detailed survey data from respondents were then analyzed using a logit model based on the contingent valuation method. Indeed, the logit model showed that six variables (education, monthly income, value of the asset, knowledge of environment, and climate change) had a statistically significant effect on the WTP of the households. The results show that 63% of respondents were willing to pay BDT 250 or more per month. The most influential factors driving this willingness to pay were income (OR = 1.35), education level (OR = 1.45), and environmental awareness (OR = 3.56). These variables all contribute positively towards WTP. The idea is that families have some socioeconomic characteristics, regardless of which they are ready to pay for a higher level of waste collection. It is recommended that government interference be affected through various approaches, as listed below: support for public–private sector undertaking and disposal, an extensive cleaning campaign, decentralized management, cutting waste transport costs, and privatization of some waste management systems. These could be used to develop solutions to better waste management systems and improve public health. Full article

This study explores how private sector initiatives within the tourism industry can contribute to public health outcomes and Sustainable Development Goal 3 (SDG 3) through sustainable agricultural practices. Using a mixed-methods approach that combines a systematic literature review with an in-depth case study, the research examines how integrated strategies—such as pesticide-free farming, biodiversity enhancement, and edible landscape design—can reduce environmental health risks, improve nutritional quality, and promote local resilience. A series of sustainability interventions are analyzed using key performance indicators (KPIs) related to pesticide use, organic production, pollinator conservation, and community engagement. The findings reveal that business-led sustainability models can support systemic change when grounded in clear metrics and cross-sector collaboration. Although the absence of pre-2019 baseline data and direct health outcome measurements limit causal inference, the study provides a valuable blueprint for aligning private enterprise practices with global health and sustainability objectives. The implications are relevant for policymakers, hospitality operators, and public health stakeholders aiming to foster synergies between tourism, agriculture, and well-being. Full article

Background and Objectives: Acute infections among elite athletes are predominantly attributed to upper respiratory tract pathogens. From a practical standpoint, medical personnel responsible for the healthcare of professional football players should be aware of this and develop infection prevention strategies. This pilot study aimed to investigate the prevalence of respiratory infections in football players using multiplex rapid diagnostic tests targeting four respiratory pathogens. Materials and Methods: The mean age of the participants was 32.76 ± 10.96 years. Among the participants, 32 were professional football players, with a mean age of 26.5 years, SD + 5.3, and 18 were members of staff, with a mean age of 44.3 years, SD + 8.6. In the present study, participants were followed up over a period of 6 months (from October 2024 to March 2025). Results: Among the participants and among a total of 1078 tests, 10 tests were found to be positive. We recorded a proportion of 0.46% for Flu-A, 0.27% for Flu-B, 0.18% for SARS-CoV-2, and 0 positive tests for RSV and adenovirus. There were six days of absence for players and staff and the proportion of total absenteeism was calculated as 3.7%. Univariate analysis revealed no statistically significant difference in infection risk between staff and players (odds ratio: 0.3795; 95% confidence interval: 0.07843–1.735). Conclusions: The multiplex rapid diagnostic test platform has a demonstrated ease of use and appears to be a reliable and safe method for distinguishing contagious symptomatic individuals from non-contagious individuals in occupational settings. Early identification of respiratory infections facilitates improved clinical management, thereby enhancing the quality of care for both athletes and supporting staff. Full article

Although the transition to electric vehicles (EVs) is well underway and expected to continue in global car markets, most vehicles on the world’s roads will be powered by internal combustion engine vehicles (ICEVs) and fossil fuels for the foreseeable future, possibly well past 2050. Thus, good environmental performance and effective emission control of ICE vehicles will continue to be of paramount importance if the world is to achieve the stated air and climate pollution reduction goals. In this study, we review 228 publications and identify four main issues confronting these objectives: (1) cheating by vehicle manufacturers, (2) tampering by vehicle owners, (3) malfunctioning emission control systems, and (4) inadequate in-service emission programs. With progressively more stringent vehicle emission and fuel quality standards being implemented in all major markets, engine designs and emission control systems have become increasingly complex and sophisticated, creating opportunities for cheating and tampering. This is not a new phenomenon, with the first cases reported in the 1970s and continuing to happen today. Cheating appears not to be restricted to specific manufacturers or vehicle types. Suspicious real-world emissions behavior suggests that the use of defeat devices may be widespread. Defeat devices are primarily a concern with diesel vehicles, where emission control deactivation in real-world driving can lower manufacturing costs, improve fuel economy, reduce engine noise, improve vehicle performance, and extend refill intervals for diesel exhaust fluid, if present. Despite the financial penalties, undesired global attention, damage to brand reputation, a temporary drop in sales and stock value, and forced recalls, cheating may continue. Private vehicle owners resort to tampering to (1) improve performance and fuel efficiency; (2) avoid operating costs, including repairs; (3) increase the resale value of the vehicle (i.e., odometer tampering); or (4) simply to rebel against established norms. Tampering and cheating in the commercial freight sector also mean undercutting law-abiding operators, gaining unfair economic advantage, and posing excess harm to the environment and public health. At the individual vehicle level, the impacts of cheating, tampering, or malfunctioning emission control systems can be substantial. The removal or deactivation of emission control systems increases emissions—for instance, typically 70% (NO_x and EGR), a factor of 3 or more (NO_x and SCR), and a factor of 25–100 (PM and DPF). Our analysis shows significant uncertainty and (geographic) variability regarding the occurrence of cheating and tampering by vehicle owners. The available evidence suggests that fleet-wide impacts of cheating and tampering on emissions are undeniable, substantial, and cannot be ignored. The presence of a relatively small fraction of high-emitters, due to either cheating, tampering, or malfunctioning, causes excess pollution that must be tackled by environmental authorities around the world, in particular in emerging economies, where millions of used ICE vehicles from the US and EU end up. Modernized in-service emission programs designed to efficiently identify and fix large faults are needed to ensure that the benefits of modern vehicle technologies are not lost. Effective programs should address malfunctions, engine problems, incorrect repairs, a lack of servicing and maintenance, poorly retrofitted fuel and emission control systems, the use of improper or low-quality fuels and tampering. Periodic Test and Repair (PTR) is a common in-service program. We estimate that PTR generally reduces emissions by 11% (8–14%), 11% (7–15%), and 4% (−1–10%) for carbon monoxide (CO), hydrocarbons (HC), and oxides of nitrogen (NO_x), respectively. This is based on the grand mean effect and the associated 95% confidence interval. PTR effectiveness could be significantly higher, but we find that it critically depends on various design factors, including (1) comprehensive fleet coverage, (2) a suitable test procedure, (3) compliance and enforcement, (4) proper technician training, (5) quality control and quality assurance, (6) periodic program evaluation, and (7) minimization of waivers and exemptions. Now that both particulate matter (PM, i.e., DPF) and NO_x (i.e., SCR) emission controls are common in all modern new diesel vehicles, and commonly the focus of cheating and tampering, robust measurement approaches for assessing in-use emissions performance are urgently needed to modernize PTR programs. To increase (cost) effectiveness, a modern approach could include screening methods, such as remote sensing and plume chasing. We conclude this study with recommendations and suggestions for future improvements and research, listing a range of potential solutions for the issues identified in new and in-service vehicles. Full article

The private healthcare sector in Romania, led by prominent players such as Medlife, Regina Maria, Medicover and Sanador, has become a cornerstone of the country’s healthcare system. However, achieving sustainability in this sector remains a challenge. This study evaluates sustainability practices in Romania’s private medical sector using the Triple Bottom Line (TBL) framework, comparing them to those of the EU, USA and Japan. Using statistical methods and benchmarking, we identify correlations between healthcare expenditures, financing schemes and sustainability metrics. A bibliographic review highlights global trends in sustainable healthcare management, including environmental, social and economic strategies and provides insights into the cost-effectiveness of green initiatives. Special focus is given to the role of technology in driving sustainability through innovations in telemedicine, digital health records and operational optimization. Using statistical methods (Pearson and Spearman correlation coefficients), we have performed an analysis of health expenditure data for EU countries, the USA and Japan. The dataset was extracted from the Organisation for Economic Co-operation and Development (OECD) data portal and included various health expenditure indicators, financing schemes and administrative data for all EU countries, the USA and Japan for the period 2018–2023. We have performed a structured analysis that explores correlations between these indicators, with a focus on financial schemes, expenditures and management sustainability. The analysis shows strong correlations between healthcare expenditures, financing schemes and administrative costs. Countries with efficient governance, balanced financing and proactive population health strategies (e.g., Japan and Nordic countries) demonstrate better management sustainability. However, countries like the USA and Eastern EU nations face challenges due to high administrative costs and inefficient financing models, respectively. Addressing these issues is critical to sustaining healthcare systems in the long term. The findings reveal that while Romanian providers excel in patient satisfaction and technological innovation, they lag behind their European counterparts in environmental sustainability and equitable access. Recommendations are proposed to address these gaps, drawing on successful strategies implemented in other European healthcare systems. This study fills a gap in the literature by providing a structured analysis of sustainability practices in Romania’s private healthcare sector, contextualized within a global comparative framework. Full article

In recent decades, the intensification of extreme events, such as floods, earthquakes, and hydrogeological instability, together with the spread of pollutants harmful to health, has highlighted the vulnerability of territories and the need to direct urban policies towards sustainable strategies. The built assets and the real estate sector play a key role in this context; indeed, being among the first ones to be exposed to the effects of climate change, they serve as a crucial tool for the implementation of governance strategies that are more focused on environmental issues. However, the insufficient allocation of public resources to interventions to secure the territory has made it essential to involve private capital interested in combining the legitimate needs of performance with the “ethicality” of the investment. In light of the outlined framework, real estate managers are called upon to take into consideration the environmental risks associated with real estate investments and accurately represent them to investors, especially in the fundraising phase. The tools currently used for the analysis of such risks are based on their perception measured by the “risk premium” criterion, reconstructed on the basis of previous trends and the analyst’s expertise. The poor ability to justify the nature of the risk premium and the uncertainty about future scenario evolutions make this approach increasingly less valid. The present work, starting from the aspects of randomness of the risk premium criterion, aims at its evolution through the inclusion of environmental risk components (seismic, hydrogeological, and pollution). Full article

Objectives: This study investigates the presence of crowding-in or crowding-out effects of long-term care insurance (LTCI) on older adults’ care in Korea. Additionally, it examines the influence of old-age income security and private systems, including private transfer income and private health insurance, on these effects. The analysis focuses on three aspects: family-provided care, private non-family care, and total care expenses. Methods: This study conducted logistic and linear regression. Logistic regression was used to examine the likelihood of receiving family-provided and private non-family care, while linear regression analyzed factors associated with total care expenditures. Results: The results reveal a crowding-in effect for family care, as greater utilization of public LTCI is positively associated with family-provided care. However, the relationship between public LTCI and private non-family care was not statistically significant, suggesting that the crowding-in effect on private care systems remains limited. Lastly, LTCI utilization was significantly associated with higher care expenditures. It is noteworthy that the current public LTCI in Korea has low coverage, resulting in insufficient care provision. Consequently, there is growing activity in the private care sector. Conclusions: These findings highlight the need for a more integrated approach to long-term care in Korea, balancing public, private, and family care resources. To achieve quality integrated long-term care for older people, policymakers should focus on expanding public LTCI coverage while fostering coordination between family caregivers and professional care services, ensuring a comprehensive and high-quality care system that meets the diverse needs of Korea’s aging population. Full article

Artificial intelligence, the simulation of human intelligence by computers and machines, has found its way into healthcare, helping surgeons, doctors, radiologists, and many more. However, over 80% of healthcare professionals consists of people working in allied health professions such as nurses, physiotherapists, and midwives. Considering the aging of the general population around the world, the workforce shortages in these occupations are especially crucial. As the COVID-19 pandemic demonstrated, globally, most healthcare systems are strained, and there is a consensus that current healthcare systems are not sustainable with the increasing challenges. AI is often viewed as one of the potential solutions for not only reducing the strain on the healthcare workforce, but also to sustain the current workforce. Still, most AI applications are being developed for the medical community and often allied health is overlooked or not even considered despite comprising a large proportion of the total workforce. In addition, the interest of the private sector to invest specifically in the allied health workforce is low since the financial incentive is low. This paper provides examples of AI solutions for seven important allied health professions. To increase the uptake of AI solutions in allied healthcare, AI companies need to connect more with professional associations and be as patient-oriented as many claim to be. There also needs to be more AI schooling for allied healthcare professionals to increase adoption of these AI solutions. Full article

The construction industry plays a key role in economic development but continues to face challenges in promoting employee well-being, particularly mental health and social sustainability. While existing decision-making tools emphasize environmental and economic factors, the social dimension remains largely overlooked, creating a significant gap in both research and practice. To address this, the study develops a decision support tool (DST) to help construction organizations prioritize strategic investments that enhance employee social sustainability. The tool is based on a hybrid multi-criteria decision-making framework, combining the Analytical Hierarchy Process (AHP) with Fuzzy MOORA to integrate both quantitative and qualitative assessments. A literature review, along with findings from a previous empirical study, identified 27 validated criteria, grouped into seven core sustainability alternatives. Additionally, five decision criteria (cost, risk, compatibility, return on investment, and difficulty) were refined through expert interviews. The DST was implemented as a modular Excel-based tool allowing users to input data, conduct pairwise comparisons, evaluate alternatives using linguistic scales, and generate a final ranking through defuzzification. A case study in a private construction company showed Training and Development and Work Environment as top priorities. An online expert focus group confirmed the DST’s clarity, usability, and strategic relevance. By addressing the often-neglected social pillar of sustainability, this tool offers a practical and transparent framework to support decision-making, ultimately enhancing employee well-being and organizational performance in the construction sector. Full article

Background: The COVID-19 pandemic highlighted the crucial role of community preventive behaviors in controlling the virus’ spread. Studies show that people’s risk perceptions and awareness significantly contribute to the containment and prevention of infections by motivating adoption of desired actions and behaviors. This study aimed at assessing the role of risk communication and factors that influenced responses during the COVID-19 pandemic in rural communities in Western Kenya. Methods: A descriptive cross-sectional study was conducted using a quantitative research approach, collecting data from 806 individuals across Kisumu, Vihiga, and Kakamega counties. Descriptive statistics were used to detail the demographic characteristics of the study population, while logistic regression analysis estimated the associations between risk communication and demographic characteristics on COVID-19 vaccine acceptance, compliance with mitigation behaviors, perceived severity, and perceived susceptibility. Results: The results showed that 55% of participants were male and 45% were female, with an average moderate compliance with safety measures (mean = 5.15). A significant portion of participants wore face masks (85.3%), practiced hand hygiene (78.9%), and avoided close contact behaviors (66.6%). Most respondents received information through mass media (86.1%) and health workers (72.9%). Compliance with COVID-19 mitigation measures was highest among those who trusted information from official institutions, health professionals, and mass media, compared to social media, with increased odds of 2.7 times and 2.5 times, respectively. Higher risk perception was significantly associated with older age groups (above 50 years), being male, and working in the private sector. Effective risk communication significantly influenced risk perception, compliance with COVID-19 measures, and vaccination acceptance. Conclusions: The findings suggest that effective risk communication strategies are critical during public health emergencies and hence implications for future public health crises. The results underscore the importance of targeted communication and tailored interventions to improve compliance and vaccine acceptance among different demographic groups, ensuring a more robust public health response during outbreaks and pandemics. Full article

Cities’ role as major hubs of human activity and economic development is essential in attaining sustainable development, fostering a balance between economic, social, and environmental development, especially in light of the growing concern over Anthropocene-induced environmental issues like global warming and climate change. The United Nations Sustainable Development Goals (SDGs) represent a historic call for coordinated international action in this area, with SDG 11 specifically identifying “Sustainable Cities and Communities” as a primary objective. Therefore, it is clear that a paradigm shift in our approach to these challenges in terms of our thinking, sensibility, behavior, and responses is necessary. Implicitly, in view of their pivotal role in environmental sustainability, development of “smart” cities as healthy, citizen-friendly, economically viable, and sustainable cities for our future generations in today’s globally integrated world, as predominant centers of human settlement and activity with multinational enterprises driving economic growth, gains the immediate attention of researchers. In this light, this study aims to identify and thereafter prioritize key indicators of a smart city using the structured and consistency-focused best–worst multi-criteria decision-making (BWM) method, suitable for expert-driven decision-making with limited comparisons. While the UN’s SDG 11 promotes safe and resilient cities, our findings suggest a disparity in how local officials prioritize certain dimensions such as safety or recreation. This disconnect warrants closer examination of localized policy drivers. The findings of this study indicate that according to experts, among others, the priority themes are, in order, water and sanitation, wastewater, health, the environment, and the economy. Thus, these represent a key take-away for multinational enterprises for identifying and assessing significant thrust domains and areas of opportunity for intervention and contribution to the UN SDGs. It also enables a replicable framework for synergy between the public and private sectors towards contrastive intervention in other cities across the globe. Full article

Brazil is among the four largest global food producers and is a significant consumer of pesticides. However, the current management of pesticide residues in Brazil faces substantial challenges, including fragmented data, limited access to reliable information, and weak inter-institutional coordination. These shortcomings hinder effective monitoring and enforcement. This study evaluates the existing framework for managing pesticide residues in food, water, and soil in Brazil, identifying gaps and proposing strategies for improvement. Key recommendations include the establishment of an inter-institutional steering committee, the development of a unified digital platform for data sharing, and the implementation of a National Pesticide Residue Management Programme (NPRMP). The NPRMP would define measurable targets to reduce contamination in food and the environment, promote sustainable agricultural practices, and enhance the monitoring of pesticide residues. Capacity-building through continuous professional training and public education campaigns is essential to ensure the programme’s successful implementation. Financial resources may be drawn from various sources, including budgetary allocations by the federal government; donations from individuals or legal entities, whether public or private, domestic or international; funds from the National Fund for Scientific and Technological Development (FNDCT); and contributions from the National Environmental Fund. This integrated approach aims to reinforce regulatory mechanisms, safeguard public health, and ensure environmental conservation within the context of Brazil’s expanding agricultural sector. Full article

This paper examines the financial health risks that private sector water, sanitation, and hygiene (WASH) businesses in rural Vietnam face. It investigates the challenges faced by water operators and sanitation suppliers involved in donor-funded development projects aimed at supporting poor and vulnerable households. Through surveys and focus group discussions with 15 suppliers who worked in public–private partnerships, this research examines the financial risk factors affecting water and sanitation suppliers and their impact on financial viability through two case studies. For water operators, the risks primarily involve infrastructure management, operational costs, and revenue instability. In the sanitation sector, risks center around fluctuating material prices, limited business expansion capital, and household affordability. This study highlights the dual role of government and donor subsidies, which enhance service accessibility but potentially distort market dynamics. It also underscores the need for targeted financial and policy interventions, including better access to microfinance, regulatory improvements, and human resource development. The findings aim to inform strategies for government, donors, and private sector actors in similar WASH development contexts to enhance financial sustainability, ensuring inclusive WASH services in underserved areas. This paper contributes to policy discussions by proposing mechanisms to balance public–private collaboration while fostering market resilience and equitable access to WASH services in emerging economies similar to that of Vietnam. Full article