Consumer willingness to pay for a pharmaceutical disposal program in Serbia: A double hurdle modeling approach

What are the Revealed and Stated Population Preferences for Environmental Sustainability in Healthcare? A Scoping Review

OBJECTIVE

Collective changes in healthcare practices are required to ensure real environmental gains. As patient-centred care is increasingly considered to enhance the ability of health systems to meet the expectations of the population, it is crucial for policymakers and health professionals to account for the preferences of the wider public regarding environmentally friendly healthcare. This article synthesises and appraises evidence from empirical studies to understand how people value environmental concerns when making decisions within medical-related or pharmaceutical sectors.

METHODS

We conducted electronic searches of the PubMed, Scopus, and Embase literature databases. Studies were eligible if they conducted a quantitative experiment to understand participants' preferences regarding sustainability and green initiatives in the medical sector or for pharmaceuticals.

RESULTS

Of the 1138 documents identified, 32 studies were deemed eligible. More than 60% were published since 2020. Different methods were used to elicit the revealed and/or stated preferences of participants. In most studies, respondents valued the environment positively and were willing to change their behaviour or practices to support sustainability. However, concerns such as disease severity or clinical effectiveness of medicines or medical interventions were often prioritised over environmental considerations. The wide heterogeneity in study participants emphasises the need to involve all stakeholders to achieve the transition to a greener and sustainable healthcare system.

CONCLUSION

The identified studies used various methods but were consistent in finding broad support for environmental considerations within the healthcare sector.

Towards a circular economy: Development of a support tool for designing reverse logistics systems

Reverse Logistics (RL) of end-of-use/end-of-life products is a key approach for supporting the transition to a circular economy. However, lack of knowledge and experience in designing RL is one of the barriers for companies in implementing successful RL. This research proposes an RL support tool (RLST) for designing RL systems, developed through iterative cycles of theoretical development and empirical testing/feedback from potential users. The RLST builds upon the principles of configuration systems to adapt the various aspects of RL design into a knowledge base and, subsequently, into an Excel-based support tool - in addition to allowing companies to assess their motivation/driver and set the context (e.g., product characteristics, the existence and nature of Extended Producer Responsibility (EPR) legislation), it supports the design of the RL network/channel and other aspects such as stakeholder collaboration, legislation, consumer behaviour and incentives, use of digital technologies, key performance indicators and factors around governance/programme management. Such a tool can be helpful for practitioners in addressing the knowledge gaps, stimulating discussions among stakeholders for scenario building and for analysing how different scenarios might work. The research advances the knowledge on RL systems design for the circular economy along with, for the first time, building knowledge and application of configuration systems in the field of RL.

Enhancing environmental sustainability through a household pharmaceuticals take-back program in Jordan

Most homes have unwanted, discarded, unused, or expired pharmaceuticals. These pharmaceuticals can pose health risks if they are not properly disposed of. Active pharmaceutical ingredients have been detected in water resources at an alarming level globally and recently in Jordanian waters. Unfortunately, no programs or regulations are addressing this problem in Jordan. This study aims to provide a comprehensive evaluation of the stakeholders' potential involvement in establishing a pharmaceutical take-back program in Jordan. The study was designed to determine the focal points of establishing a pharmaceutical take-back program using a qualitative cross-sectional approach and using a force field analysis to put together a plan for a successful program in Jordan. The study conducted three surveys using structured questionnaires and interviews with officials to evaluate the attitude toward the pharmaceutical take-back program, awareness of environmental impacts, and current conditions of household pharmaceuticals in Jordan. The questionnaires were assigned to the public, pharmaceutical manufacturers, and pharmaceutical warehouses. The interviews were conducted with the Ministry of Environment, pharmaceutical manufacturers, and pharmaceutical warehouses. Most of the pharmaceutical producers (85% manufacturers and 94% warehouses) refused to participate voluntarily in the program due to the extra cost incurred. On the other hand, the public and the Ministry of Environment were supportive of establishing the program. The study revealed that there is a lack of awareness among the public toward household pharmaceuticals. About 77% of the public questionnaire respondents reported they had not received any information on how to dispose safely of their unwanted pharmaceuticals. Also, about 61% reported that they have concerns that household pharmaceuticals might contaminate the water resources in Jordan. Following the questionnaires' analysis, the study determined the main forces against establishing a pharmaceutical take-back program as the unwillingness of producers to participate, weak logistic support, lack of public awareness, and low public participation. A force field analysis (FFA) was conducted based on the forces determined from the questionnaires. Accordingly, the study recommends developing a comprehensive legislation and regulatory framework for household pharmaceuticals' recovery, establishing a monitoring entity, securing funds, and implementing a long-term awareness and education plan to support the establishment of a pharmaceutical take-back program in Jordan.

Event-related potentials for investigating the willingness to recycle household medical waste

Household medical waste (HMW) recycling in the reverse supply chain has become a primary channel for infectious, toxic, or radioactive substances for environmental protection and a circular economy. Recycling managers need to understand the recycling decision-making mechanisms of households to improve the intention-behavior gap and recycling participation rate, especially in cognitive neuroscience. This study designed an event-related potential (ERPs) experiment to explore the differences in ERPs components between the willingness and unwillingness to make recycling decisions. Our findings confirmed that willingness and unwillingness to recycle can lead to a significant difference in the P300 and N400 scores. A larger P300 was evoked by willingness rather than unwillingness in the prefrontal, frontal, and frontal-temporal regions. This indicates that willingness to recycle results from a rational choice in the decision-making process. However, a larger N400 was evoked by unwillingness rather than willingness in the parietal, parietal-occipital, and occipital regions. A negative wave was evoked in households unwilling to recycle because they thought it was dangerous and unsanitary, causing a higher conflict with intrinsic cognition. The combination of HMW recycling decisions and neurology may accurately measure pro-environmental decision-making processes through brain science. Advancing the knowledge of psychological and brain mechanism activities for understanding pro-environmental choices. In turn, this can help recycling managers to accurately understand household demands for increasing the recycling intention and designing effective HMW take-back systems to solve the intention-behavior gap related to the global recycling dilemma.

Modeling Predictors of Medication Waste Reduction Intention in Algeria: Extending the Theory of Planned Behavior

COVID-19 caused an increase in the demand for medications, which led to an increase in pharmaceutical waste and there is no doubt that this contributes to environmental pollution. Hence, it became necessary to search for how to protect and improve the environment by encouraging the behavior of medication waste reduction. Accordingly, this study aims to investigate the factors affecting intentions to reduce medication waste. Considering this, we develop an extended theory of planned behavior (TPB) framework by incorporating the constructs of moral obligation, environmental awareness, and medication waste risk perception. Using the convenience sampling method and based on a self-administered questionnaire, a total of 225 usable responses were collected in five Algerian cities. The results showed that positive attitudes (β = 0.316, p < 0.001), moral obligation (β = 0.291, p < 0.001), environmental awareness (β = 0.227, p < 0.001), perceived behavior control (PBC) (β = 0.151, p = 0.001), greater perceived risks (β = 0.127, p < 0.001), and subjective norm (β = 0.096, p < 0.05) significantly and positively influence the medication waste minimization intention. Furthermore, our analyses revealed that the extended TPB model explained 73.40% of the intention variance. In conclusion, we have explored the intentions, and there may be a gap between intent and actual behavior. Therefore, we recommend future studies to examine the factors affecting the actual behavior of medication waste reduction and to investigate environmental ethics and religious commitment as predictors of waste reduction intentions.

Pharmaceutical waste management system - Are the current techniques sustainable, eco-friendly and circular? A review

Most households and healthcare facilities usually dispose of contaminated, unused, or expired (CUE) medicines with municipal wastes, the disposal of which usually amounts to $790/ton in the USA and £450/ton in the UK. Solid (e.g., tablets, capsules, powders) and semi-solid (e.g., ointment, creams) pharmaceuticals are managed with incineration/pyrolysis, encapsulation, and engineered landfills, whereas wastewater treatment plants (WWTPs) are recommended for liquid pharmaceutical wastes (PWs). However, to date, the sustainability and eco-friendliness profile of these techniques are only subjectively ensured, leading to controversial viewpoints in many guidelines. Each technique has relative strengths and weaknesses, and their comparative weighting to maximize these profiles is sought after. The present comprehensive review aims to fulfil knowledge gaps in this regard. Four electronic databases (e.g., PubMed/MEDLINE, Scopus, and ScienceDirect) were searched for PW management (PWM)-related qualitative and quantitative articles published till December 31, 2022. Articles without details of waste disposal techniques and their health and environmental impacts were excluded. Based on the literature review, we determine that incineration can be considered a sustainable option for solid and semi-solid PWs, and WWTPs can be eco-friendly for liquid PWs, whereas encapsulation and landfilling are less sustainable. It is high time that objectively proven sustainable and eco-friendly techniques be implemented for PWM based on their dosage forms or nature of hazards. Medicine take-back, eco-pharmacovigilance, extended producer responsibility, co-payment, and life cycle analysis of pharmaceuticals focusing on reduction, reuse/re-dispensing can be integrated to make existing models sustainable, circular, and eco-friendly.

A hybrid machine learning-mathematical programming optimization approach for municipal solid waste management during the pandemic

This paper provides a mathematical optimization strategy for optimal municipal solid waste management in the context of the COVID-19 epidemic. This strategy integrates two approaches: optimization and machine learning models. First, the optimization model determines the optimal supply chain for the municipal waste management system. Then, machine learning prediction models estimate the required parameters over time, which helps generate future projections for the proposed strategy. The optimization model was coded in the General Algebraic Modeling System, while the prediction model was coded in the Python programming environment. A case study of New York City was addressed to evaluate the proposed strategy, which includes extensive socioeconomic data sets to train the machine learning model. We found the predicted waste collection over time based on the socioeconomic data. The results show trade-offs between the economic (profit) and environmental (waste sent to landfill) objectives for future scenarios, which can be helpful for possible pandemic scenarios in the following years.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10668-023-03354-2.

Closing the loop: Establishing reverse logistics for a circular economy, a systematic review

Reverse Logistics (RL) of end-of-use/end-of-life products has become a vital part of circular economy practices for manufacturers. However, significant quantities of resources are still landfilled instead of being recovered. With mounting pressure on businesses to address the sustainability crises (resources, climate change, waste, toxicity) on account of the take-make-dispose-based linear economy, companies today realise the importance of RL but face several barriers to implementing it, including a lack of knowledge. Although several studies have investigated different aspects of RL in various industries in different country settings, less attention has been devoted to developing a systematic and holistic approach for designing and implementing RL. To address these gaps, this paper reviews 116 scholarly articles published between 2011 and 2021 to identify attributes related to the design and implementation of RL systems. Based on a systematic literature review, a conceptual framework is presented covering the key activities, drivers and barriers, stakeholder engagement and performance management in RL. Such a framework can support companies evaluate different approaches and strategies, as well as the opportunities and challenges of designing and implementing RL and transitioning towards a Circular Economy.

Nanohybrid catalysts with porous structures for environmental remediation through photocatalytic degradation of emerging pollutants

Water supplies have been seriously challenged by new emerging pollutants, which are difficult to remove by traditional wastewater treatment. Thus, new technologies such as catalytic advanced oxidation processes have merged as suitable solutions; however, the drawbacks of typical catalysts limit their application. To overcome this issue, new materials with enhanced textural properties have been developed, showing that their porosity and chemical nature influence their potential as a catalyst. Herein, the recent progress in highly porous catalysts and their suitable deployment to effectively nano-remediate the polluted environmental matrices are reviewed in detail. First, following a brief introduction, several environmental pollutants of emerging concerns from different sectors, including pharmaceutical residues, endocrine-disrupting chemicals (EDCs), pesticides, and hazardous dyes are also introduced with relevant examples. To effectively tackle the sustainable remediation of emerging pollutants, this work also focuses on the multifunctional features of nanohybrid porous materials that act as catalysts constructs to degrade emerging pollutants. The influence of surface reactive centers, stability, bandgap energies, light absorption capacities, and pollutants adsorption capacities are also discussed. Successful examples of the employment of nanohybrid porous catalysts for the degradation of pharmaceutical pollutants, EDCs, pesticides, and hazardous dyes are summarized. Finally, some challenges faced by nanohybrid porous materials to achieve their potential application as advanced catalysts for environmental remediation have been identified and presented herein.

Household Pharmaceutical Waste Management Practices in the Johannesburg Area, South Africa

Pharmaceutical wastes are expected to increase given the increasing population growth rates and rapidly rising economic burden of human diseases. This challenge calls for appropriate measures for the management of such hazardous wastes. The purpose of this survey was to document and investigate existing practices for the handling, storage, and disposal of household pharmaceutical wastes (HPWs) in the Johannesburg area. Primary data were collected via online surveys with self-administered questionnaires completed by respondents. The research found that 77% (n = 286) of respondents claimed some knowledge about HPWs. Types of medicines that contributed to HPWs included painkillers or analgesics (73%, n = 270) and drugs for treating colds and flu-related illnesses (52%; n = 193). Although there were a few exceptions, the respondents generally exhibited strong disagreements with environmentally unfriendly and health-threatening disposal practices. Moreover, most participants were willing to return expired medicines to pharmacies (40.7%, n = 151), whereas only 8.6% (n = 32) opposed this solution. Awareness levels tended to vary with employment status, educational qualifications, and place of residence. However, place of residence and household size did not correlate with types of pharmaceutical waste. Additionally, the study found that education attainments significantly influenced the willingness of respondents to return pharmaceutical wastes. Finally, there were no significant differences amongst respondents in terms of waste disposal practices. Altogether, the findings suggest the need for targeted efforts to bring about sustainable waste management at a household level.

Optimal waste management during the COVID-19 pandemic

There have been many problems generated by the COVID-19 pandemic. One of them is the worrying increase in the generation of medical waste due to the great risk they represent for health. Therefore, this work proposes a mathematical model for optimal solid waste management, proposing a circular value chain where all types of waste are treated in an intensified industrial park. The model selects the processing technologies and their production capacity. The problem was formulated as a mixed-integer linear programming problem to maximize profits and the waste processed, minimizing environmental impact. The proposed strategy is applied to the case study of the city of New York, where the increase in the generation of medical waste has been very significant. To promote recycling, different tax rates are proposed, depending on the amount of waste sent to the landfill. The results are presented on a Pareto curve showing the trade-off between profits and processed waste. We observed that the taxes promote recycling, even of those wastes that are not very convenient to recycle (from an economic point of view), favoring profits, reducing the environmental impact, and the risk to health inherent to the medical waste.

Willingness to Pay for Implementation of an Environmentally Friendly Pharmaceutical Policy in Finland-A Discrete Choice Experiment Study

The use of pharmaceuticals is their main pathway to the environment, making the public a major stakeholder in environmentally friendly pharmaceutical policies, including an environmental classification system for medicines. We studied the Finnish adult population's (n = 2030) preferences and willingness to pay (WTP) for an environmentally friendly pharmaceutical policy by means of an online survey employing a discrete choice experiment (DCE). We also studied the relative importance of the policy attributes, namely, the environmental impact, geographical scope, available information about the environmental impact of a pharmaceutical, and the effect of the respondents' general environmental attitudes on the WTP. The total annual WTP of the Finnish adult population ranges from 37 million to 134 million euros, depending on the attribute levels. Moreover, the environmental attitude of a respondent had a significant impact on the WTP. Generally, the environmental impact of the policy was the most important attribute, the geographical scope of the policy the second, and information about the environmental impact of pharmaceuticals was the third most important attribute. However, the most environmentally friendly respondents preferred information as the second important attribute. This study provides insights into the environmental valuations of the public to be used in preparing new pharmaceutical policy measures.

Labor Endowment, Cultivated Land Fragmentation, and Ecological Farming Adoption Strategies among Farmers in Jiangxi Province, China

A deeper understanding of the factors that influence the ecological farming adoption strategies of farmers can help in developing effective adaptation measures to mitigate the degradation of cultivated land quality and ecological degradation. This study used a stratified random sampling technique to select 1488 households in Jiangxi Province, while the double-hurdle model was used to analyze the influence of labor endowments (LEs) and cultivated land fragmentation (CLF) on ecological farming decision-making. The results indicate that LEs and CLF play important roles in farmers’ decision-making with regard to ecological farming. To be more specific, the total household population and CLF have negative effects on adoption willingness, while the number of laborers has a positive effect. For the degree of adoption, the total household population has a negative effect, while the number of laborers and part-time employment have positive effects. In addition, farmers’ ecological farming behavior is also influenced by factors such as education, agricultural income, cooperatives, and agricultural subsidies. Overall, farmers have a high willingness to adopt ecological farming, but the degree of actual adoption is low. This is not conducive to the promotion of ecological farming techniques and the sustainable development of agriculture in China. The study proposes that the government should further improve financial investment and provide relevant technical services. In addition, a temporary work platform should be set up for farmers to encourage them to find other work during the agricultural low season.

Identifying what shapes the words and actions of residents' environmentally friendly express packaging: Evidence from a two-stage payment model

Voluntary purchase of environmentally friendly products is crucial to alleviating ecological degradation caused by human activities that revealing residents' payment decision-making mechanism is indispensable. Most current studies do not distinguish residents' payment decision-making behavior as a two-stage process of willingness to pay (WTP) and expected payment (EP), and research on negative factors needs to be deepened. To make up for the shortcomings, this study decomposes residents' environmentally friendly express packaging payment decision-making behavior into WTP and EP, and selects positive and negative antecedent variables. Then, the Double-Hurdle Model is used to explore the effects of variables. The results show that residents' EP is 2.68-3.89 RMB per item. Performance expectancy has a positive effect, and risk perception has a negative effect on WTP and EP. Additionally, influencing factors of WTP and EP differ, with facilitating conditions enhancing WTP, while social influence and green advertising acceptance promoting EP. Interestingly, effort expectancy has a positive impact on WTP but a negative effect on EP. Female residents with higher education and family monthly income have higher WTP and EP. The research shed light on residents' payment and recommendations on the promotion of environmentally friendly products are further proposed.

Decontamination of emerging pharmaceutical pollutants using carbon-dots as robust materials

Environmental pollution is a critical issue that requires proper measures to maintain environmental health in a sustainable and effective manner. The growing persistence of several active pharmaceutical residues, such as antibiotics like tetracycline, and anti-inflammatory drugs like diclofenac in water matrices is considered an issue of global concern. Numerous sewage/drain waste lines from the domestic and pharmaceutical sector contain an array of toxic compounds, so-called "emerging pollutants" and possess adverse effects on entire living ecosystem and damage its biodiversity. Therefore, effective solution and preventive measures are urgently required to sustainably mitigate and/or remediate pharmaceutically active emerging pollutants from environmental matrices. In this context, herein, the entry pathways of the pharmaceutical waste into the environment are presented, through the entire lifecycle of a pharmaceutical product. There is no detailed review available on carbon-dots (CDs) as robust materials with multifunctional features that support sustainable mitigation of emerging pollutants from water matrices. Thus, CDs-based photocatalysts are emerging as an efficient alternative for decontamination by pharmaceutical pollutants. The addition of CDs on photocatalytic systems has an important role in their performance, mainly because of their up-conversion property, transfer photoinduced electron capacities, and efficient separation of electrons and holes. In this review, we analyze the strategies followed by different researchers to optimize the photodegradation of various pharmaceutical pollutants. In this manner, the effect of different parameters such as pH, the dosage of photocatalyst, amount of carbon dots, and initial pollutant concentration, among others are discussed. Finally, current challenges are presented from a pollution prevention perspective and from CDs-based photocatalytic remediation perspective, with the aim to suggest possible research directions.

Medication take-back programs in Qatar: Parental perceptions

Purpose:

To identify parental perception of a take-back program for medications.

Materials and Methods:

A cross-sectional study using a questionnaire was conducted at Hamad Medical Corporation, the only tertiary pediatric hospital in the State of Qatar at the time of the study. Qatar is a rapidly developing country with limited national data on the awareness of medication misuse among adults living with children at home and on the safety practices regarding medication disposal.

Results:

305 questionnaires were completed (response rate = 90%). More than 80% of parents were in between 20 and 39 years of age, 70% of them were females, and 80% were college graduates. Approximately 90% of participants have immediate relatives who were taking medications for chronic diseases. Almost 60% of parents stated that they keep unused medications at home, whereas 10% were not aware of the fate of the left over medications. Approximately 95% of the parents dispose the expired medications. In terms of the mode of disposing the medications, 66% of caregivers dispose the medication bottle or package in the trash can, whereas 14% remove the medications from the bottles or packages and throw them in the trash, and 15% put them through the drain. When asked if participants read disposal measures in the medication pamphlet, only 10% answered “always,” whereas 26% answered “sometimes.” Participants were asked if they have heard of any medications take-back programs, 75% answered no, whereas 14% were not sure. However, almost 60% of them will use the take-back program if available and 18% were not sure.

Conclusion:

Parents residing in the State of Qatar have deficiencies in knowledge about medication disposal. Parent's attitudes and perceptions are considered indispensable targets for community health intervention. Our next step is to share our data with the ministry of health to spread awareness about the proper disposal of medicines and take-back programs in Qatar.

Targeted eco-pharmacovigilance as an optimized management strategy for adverse effects of pharmaceuticals in the environment

From a perspective of drug administration, eco-pharmacovigilance (EPV) has been proposed as a new approach to prevent the environmental risks posed by pharmaceutical emerging contaminants. However, it is impracticable to practice unitary and rigor EPV process for all the pharmaceutical substances with complex and diversified chemical, biological or toxicological properties. We proposed the "targeted EPV" that is the science and activities associated with the targeted detection, evaluation, understanding, and prevention of adverse effects of high-priority hazardous pharmaceuticals in the environment, especially focusing on the control of main anthropogenic sources of pharmaceutical emission among key stakeholders in high-risk areas could be used as an optimized management strategy for pharmaceutical pollution. "Targeted EPV" implementation should focus on the targeted monitoring of the occurrence of high-priority pharmaceuticals in environmental samples, the targeted reporting of over-standard discharge, the targeted management for main emission sources, the targeted legislation and researches on high-priority pharmaceutical pollutants, as well as the targeted educational strategies for specific key populations.

Optimization of municipal solid waste management using a coordinated framework

Municipal solid waste (MSW) management is an important but complex logistical problem. The deployment of MSW management systems is hindered by the ever-growing generation of waste and the often insufficient infrastructure to manage, process, and dispose of waste. This paper presents a coordinated framework for complex MSW management systems. The framework accommodates multiple key stakeholders in MSW systems, such as suppliers of waste, consumers of waste and derived products, and providers of transportation and processing services. Here, the stakeholders submit bids to a coordinator that solves an optimization problem to determine allocations and clearing prices that maximize the collective profit for all stakeholders and that balance supply and demand for waste and products. Furthermore, the clearing process guarantees that the individual profits are non-negative (no stakeholder loses money). Notably, the framework operates as a competitive market that accelerates transactions between stakeholders and that handles complex logistical constraints that would be difficult to handle in peer-to-peer transactions. The framework also facilitates the integration of policy incentives and the monetization of environmental impacts. In this regard, we evaluate a tax applied to open dump disposal. To illustrate the applicability, an MSW system in Mexico was analyzed as a case study. Results reveal that taxation can be used to incentivize the provision of services for all stakeholders. Specifically, we found that an appropriate tax can completely avoid disposal in open dumps. A tax of 5.1 USD/tonne was identified as the minimum penalization that avoids diverting waste to open dumps.