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Wang Y, Zhang C. Impact of policy response on health protection and economic recovery in OECD and BRIICS countries during the early stages of the COVID-19 pandemic. Public Health 2023; 217:7-14. [PMID: 36827784 PMCID: PMC9870755 DOI: 10.1016/j.puhe.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES During the early stages of the COVID-19 pandemic, the full reopening of the economy typically accelerated viral transmission. This study aims to determine whether policy response could contribute to the dual objective of both reducing the spread of the epidemic and revitalising economic activities. STUDY DESIGN This is a longitudinal study of Organization for Economic Cooperation and Development (OECD) and Brazil, Russia, India, Indonesia, China, and South Africa (BRIICS) from the first quarter (Q1) of 2020 to the same period of 2021. METHODS From a health-economic perspective, this study established a framework to illustrate the following outcomes: suppression-prosperity, outbreak-stagnancy, outbreak-prosperity and suppression-stagnancy scenarios. Multinomial logistic models were used to analyse the associations between policy response with both the pandemic and the economy. The study further examined two subtypes of policy response, stringency/health measures and economic support measures, separately. The probabilities of the different scenarios were estimated. RESULTS Economic prosperity and epidemic suppression were significantly associated with policy response. The effects of policy response on health-economic scenarios took the form of inverse U-shapes with the increase in intensity. 'Leptokurtic', 'bimodal' and 'long-tailed' curves demonstrated the estimated possibilities of suppression-prosperity, outbreak-prosperity and suppression-stagnancy scenarios, respectively. In addition, stringency/health policies followed the inverted U-shaped pattern, whereas economic support policies showed a linear pattern. CONCLUSIONS It was possible to achieve the dual objective of economic growth and epidemic control simultaneously, and the effects of policy response were shaped like an inverse U. These findings provide a new perspective for balancing the economy with public health during the early stages of the pandemic.
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Affiliation(s)
| | - C. Zhang
- Corresponding author. Department of Sociology, School of Social Sciences, Tsinghua University, Beijing, 100084, China. Tel.: +86 10 62794966
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Lignou S, Sheehan M. Children with medical complexities: their distinct vulnerability in health systems' Covid-19 response and their claims of justice in the recovery phase. Med Health Care Philos 2023; 26:13-20. [PMID: 36383340 PMCID: PMC9667430 DOI: 10.1007/s11019-022-10119-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/27/2022] [Accepted: 10/12/2022] [Indexed: 05/30/2023]
Abstract
In this paper, we discuss the lack of consideration given to children in the COVID-19 health systems policy response to the pandemic. We do this by focusing on the case of children with complex medical needs. We argue that, in broad terms, health systems policies that were implemented during the pandemic failed adequately to meet our obligations to both children generally and those with complex medical needs by failing to consider those needs and so to give them fair protection against harm and disadvantage. We argue that justice requires that the distinct needs and vulnerabilities of children with medical complexities are explicitly integrated and prioritised in decisions concerning healthcare and operational planning in the recovery phase and beyond.
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Affiliation(s)
- Sapfo Lignou
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Mark Sheehan
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Khan N, Charles KJ. When Water Quality Crises Drive Change: A Comparative Analysis of the Policy Processes Behind Major Water Contamination Events. Expo Health 2022; 15:1-19. [PMID: 36196073 PMCID: PMC9522453 DOI: 10.1007/s12403-022-00505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/17/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
The occurrence of major water contamination events across the world have been met with varying levels of policy responses. Arsenic-a priority water contaminant globally, occurring naturally in groundwater, causing adverse health effects-is widespread in Bangladesh. However, the policy response has been slow, and marked by ineffectiveness and a lack of accountability. We explore the delayed policy response to the arsenic crisis in Bangladesh through comparison with water contamination crises in other contexts, using the Multiple Streams Framework to compare policy processes. These included Escherichia coli O157:H7 and Campylobacter in Walkerton, Canada; lead and Legionella in Flint, Michigan, USA; and chromium-6 contamination in Hinkley, California, USA. We find that, while water contamination issues are solvable, a range of complex conditions have to be met in order to reach a successful solution. These include aspects of the temporal nature of the event and the outcomes, the social and political context, the extent of the public or media attention regarding the crisis, the politics of visibility, and accountability and blame. In particular, contaminants with chronic health outcomes, and longer periods of subclinical disease, lead to smaller policy windows with less effective policy changes. Emerging evidence on health threats from drinking water contamination raise the risk of new crises and the need for new approaches to deliver policy change.
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Affiliation(s)
- Nameerah Khan
- School of Geography and the Environment, University of Oxford, Oxford, OX1 3QY UK
| | - Katrina J. Charles
- School of Geography and the Environment, University of Oxford, Oxford, OX1 3QY UK
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Käffer A, Mahlich J. Culture and COVID-19-related mortality: a cross-sectional study of 50 countries. J Public Health Policy 2022. [PMID: 35995942 DOI: 10.1057/s41271-022-00363-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
Using a cross-sectional sample of 50 countries we investigate the influence of Hofstede’s six-dimensions of culture on COVID-19 related mortality. A multivariable regression model was fitted that controls for health-related, economic- and policy-related variables that have been found to be associated with mortality. We included the percentage of population aged 65 and above, the prevalence of relevant co-morbidities, and tobacco use as health-related variables. Economic variables were GDP, and the connectedness of a country. As policy variables, the Oxford Stringency Index as well as stringency speed, and the Global Health Security Index were used. We also describe the importance of the variables by means of a random forest model. The results suggest that individualistic societies are associated with lower COVID-19-related mortality rates. This finding contradicts previous studies that supported the popular narrative that collectivistic societies with an obedient population are better positioned to manage the pandemic.
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Khan MA, Naqvi HA, Hakeem MM, Din GMU, Iqbal N. Economic and financial impact of the COVID-19 pandemic in South Asia. Environ Sci Pollut Res Int 2022; 29:15703-15712. [PMID: 34636009 PMCID: PMC8504559 DOI: 10.1007/s11356-021-16894-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
The world is facing a COVID-19 pandemic outbreak with an unprecedented and enormous impact on the lives of humankind. The economic engine has suffered a big blow in economic and financial performance in all the regions. South Asian countries are also trying to cope with the challenges posed by the pandemic. This paper attempts to understand the severity of the pandemic, the responses by the governments of the region, and the way forward. The pandemic affected the services, manufacturing, trade, supply chain, and particularly the small businesses, which disrupted all the economic indicators, forecasts, and growth patterns. The paper also discusses the strategies devised by the countries to counter the shocks of pandemics and what new opportunities are identified under the circumstances.
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Li X, Lai W, Wan Q, Chen X. Role of professionalism in response to the COVID-19 pandemic: Does a public health or medical background help? China Econ Rev 2022; 71:101733. [PMID: 35058684 PMCID: PMC8702613 DOI: 10.1016/j.chieco.2021.101733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/14/2021] [Accepted: 12/14/2021] [Indexed: 06/09/2023]
Abstract
In response to the outbreak of coronavirus disease 2019 (COVID-19), there have been substantial variations in policy response and performance for disease control and prevention within and across nations. It remains unclear to what extent these variations may be explained by bureaucrats' professionalism, as measured by their educational background or work experience in public health or medicine. To investigate the effects of officials' professionalism on their response to and performance in fighting the COVID-19 pandemic, we collect information from the résumés of government and Party officials in 294 Chinese cities, and integrate this information with other data sources, including weather conditions, city characteristics, COVID-19-related policy measures, and health outcomes. We show that, on average, cities whose top officials had public health or medical backgrounds (PHMBGs) had a significantly lower infection rate than cities whose top officials lacked such backgrounds. We test the mechanisms of these effects and find that cities whose officials had a PHMBG implemented community closure more rapidly than those lacked such backgrounds. Our findings highlight the importance of professionalism in combating the pandemic.
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Affiliation(s)
- Xun Li
- School of Economics and Management, Wuhan University, China
| | - Weizheng Lai
- Department of Economics, University of Maryland, United States of America
| | - Qianqian Wan
- School of Economics and Management, Wuhan University, China
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, United States of America
- Department of Economics, Yale University, United States of America
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Abstract
The Covid-19 pandemic led to an unprecedented decline of economic activity at the globe scale. To slow down the spread of the virus, most governments reacted with various measures of social distancing, such as mobility controls, business and school closures, etc. We investigate the short-term impact of social distancing measures on the US labour market, using a panel threshold model with high frequency (weekly) data on unemployment across US states allowing for heteroscedasticity. Labour is a key input in production, and thus a good proxy for the state of the economy. We find that changes in the restrictiveness of mandated social distancing, as measured by the Oxford Stringency Index, exert a strong impact on unemployment. The bulk of the reaction of unemployment to a change in the social distancing restrictions does not arise immediately, but with a delay of 2-4 weeks. In addition, the impact is asymmetric. If the policies switch to tighter regulations, the increase in unemployment is quicker and higher in absolute value than a decrease after relaxation. The state of the pandemic, proxied by the number of new infections and fatalities, constitutes only a marginal factor.
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Affiliation(s)
| | - Daniel Gros
- Centre for European Policy Studies (CEPS), Brussels, Belgium
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Jackson M, Lee Williams J. COVID-19 mitigation policies and psychological distress in young adults. SSM Ment Health 2021; 2:100027. [PMID: 34608462 PMCID: PMC8482549 DOI: 10.1016/j.ssmmh.2021.100027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has seen an unusually high proportion of the population suffering from mental health difficulties, but of particular concern is the disproportionate increase in psychological distress among younger adults. In this article, we exploit an explanatory sequential mixed-methods design to examine which aspects of the COVID-19 pandemic 18-25-year-olds found most challenging. We report analyses of American Voices Project (AVP) qualitative in-depth interview data, a MyVoice text-message open-ended survey, and Census Bureau Household Pulse Survey (HPS) data, all collected in 2020. Our interview and text-message results show that young adults were distressed about the effects of COVID-19 on the health of loved ones and older Americans. Young adults expressed concerns that the pandemic was not being treated sufficiently seriously by some politicians and the general public. The policy response was seen to be inadequate to the task of containing the disease, and some feared that the pandemic would never end. Statistical analyses of the HPS confirm that young adults' scores on the HPS's anxiety scale were significantly negatively associated with state-level policy responses. Overall, our results show that young adults found virus mitigation strategies challenging, but that a strong policy response was associated with reduced levels of psychological distress. Our results suggest that public health policy might have also operated as mental health policy during the COVID-19 pandemic.
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Affiliation(s)
- Michelle Jackson
- Department of Sociology, 450 Jane Stanford Way, Stanford University, CA, 94305, USA
| | - Joanna Lee Williams
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ, 08854-8020, USA
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Zhu J, Yan W, Zhu L, Liu J. COVID-19 pandemic in BRICS countries and its association with socio-economic and demographic characteristics, health vulnerability, resources, and policy response. Infect Dis Poverty 2021; 10:97. [PMID: 34238368 PMCID: PMC8264992 DOI: 10.1186/s40249-021-00881-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background Little attention has been paid to the comparison of COVID-19 pandemic responses and related factors in BRICS (Brazil, Russia, India, China, and South Africa) countries. We aimed at evaluating the association of daily new COVID-19 cases with socio-economic and demographic factors, health vulnerability, resources, and policy response in BRICS countries. Methods We conducted a cross-sectional study using data on the COVID-19 pandemic and other indicators of BRICS countries from February 26, 2020 to April 30, 2021. We compared COVID-19 epidemic in BRICS countries and analyzed related factors by log-linear Generalized Additive Model (GAM) models. Results In BRICS countries, India had the highest totally of confirmed cases with 18.76 million, followed by Brazil (14.45 million), Russia (4.81 million), and South Africa (1.58 million), while China (0.10 million) had the lowest figure. South Africa had the lowest rate of administered vaccine doses (0.18 million) among BRICS countries as of April 30, 2021. In the GAM model, a 1 unit increase in population density and policy stringency index was associated with a 5.17% and 1.95% growth in daily new COVID-19 cases (P < 0.001), respectively. Exposure–response curves for the effects of policy stringency index on daily new cases showed that there was a rapid surge in number of daily new COVID-19 cases when the index ranged from 0 to 45. The number of infections climbed slowly when the index ranged from 46 to 80, and decreased when the index was above 80 (P < 0.001). In addition, daily new COVID-19 cases (all P < 0.001) were also correlated with life expectancy at birth (-1.61%), extreme poverty (8.95%), human development index (-0.05%), GDP per capita (-0.18%), diabetes prevalence (0.66%), proportion of population aged 60 and above (2.23%), hospital beds per thousand people (-0.08%), proportion of people with access to improved drinking water (-7.40%), prevalence of open defecation (0.69%), and annual tourist/visitor arrivals (0.003%), after controlling other confounders. Different lag structures showed similar results in the sensitivity analysis. Conclusions Strong policy response is crucial to control the pandemic, such as effective containment and case management. Our findings also highlighted the importance of reducing socio-economic inequalities and strengthening the resilience of health systems to better respond to public health emergencies globally. Graphic abstract ![]()
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Affiliation(s)
- Jingmin Zhu
- Department of Economics, University of Birmingham, Birmingham, B15 2TT, UK
| | - Wenxin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Haidian District, No. 38, Xueyuan Road, Beijing, 100191, China
| | - Lin Zhu
- Center for Primary Care and Outcomes Research, School of Medicine, Center for Health Policy, Freeman Spogli Institute for International Studies, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305-2004, USA
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Haidian District, No. 38, Xueyuan Road, Beijing, 100191, China. .,Institute for Global Health and Development, Peking University, No. 5 Yiheyuan Road, Haidian, Beijing, 100871, China. .,National Health Commission Key Laboratory of Reproductive Health, Peking University, No. 38, Xueyuan Road, Haidian, Beijing, 100191, China.
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10
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Abstract
The fast-moving coronavirus disease 2019 (COVID-19) called for a rapid response to slowing down the viral spread and reduce the fatality associated to the pandemic. Policymakers have implemented a wide range of non-pharmaceutical interventions to mitigate the spread of the pandemic and reduce burdens on healthcare systems. An efficient response of healthcare systems is crucial to handle a health crisis. Understanding how non-pharmaceutical interventions have contributed to slowing down contagions and how healthcare systems have impacted on fatality associated with health crisis is of utmost importance to learn from the COVID-19 pandemic. We investigated these dynamics in Italy at the regional level. We found that the simultaneous introduction of a variety of measures to increase social distance is associated with an important decrease in the number of new infected patients detected daily. Contagion reduces by 1% with the introduction of lockdowns in an increasing number of regions. We also found that a robust healthcare system is crucial for containing fatality associated with COVID-19. Also, proper diagnosis strategies are determinant to mitigate the severity of the health outcomes. The preparedness is the only way to successfully adopt efficient measures in response of unexpected emerging pandemics.
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Affiliation(s)
| | - Marco Tappi
- University of Foggia, Via Napoli 25, 71122 Foggia, Italy
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Van Nguyen Q, Cao DA, Nghiem SH. Spread of COVID-19 and policy responses in Vietnam: An overview. Int J Infect Dis 2020; 103:157-161. [PMID: 33220442 PMCID: PMC7674968 DOI: 10.1016/j.ijid.2020.11.154] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives Despite the proximity and high travel flows with China, Vietnam has been able to contain the spread of coronavirus disease 2019 (COVID-19). This study describes the characteristics of COVID-19 infections in Vietnam and policy responses to identify potential factors contributing to the relative success of Vietnam in containing this pandemic. Methods Narrative analyses were applied to describe the pandemic and policy responses. Descriptive statistics, generalized linear regression, and a susceptible-infected-recovered model were used to explore the effectiveness of Vietnamese policy responses to COVD-19. Results To date, Vietnam is one of the few countries that have successfully control the spread of COVID-19. As of 26 October 2020, Vietnam has had 1169 cases of COVID-19, of which 1061 people recovered and 35 people died from the disease. COVID-19 infected patients in Vietnam were relatively younger than those in other countries with an average age of 36. Most of the infected cases were from international travels. Policy responses in Vietnam were implemented early and strictly. Conclusions Despite the proximity to China, where COVID-19 emerged, Vietnam has experienced a small number of COVID-19 infections and fatalities compared with other countries. Most infected patients were relatively young, and exposure was attributed to international travel. Early policy interventions were the main factors that contributed to the success of Vietnam to date.
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Affiliation(s)
- Quang Van Nguyen
- College of Economics, Technology and Fisheries, Ly Nhan Tong Street, Dinh Bang, Tu Son, Bac Ninh, Viet Nam; TIMAS - Thang Long University, Hanoi, Viet Nam.
| | - Dung Anh Cao
- Academy of International Studies, Thanh Liet, Thanh Tri, Hanoi, Viet Nam.
| | - Son Hong Nghiem
- Centre for Applied Health Economics, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia.
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Geng J, Long R, Chen H, Li Q. Urban residents' response to and evaluation of low-carbon travel policies: Evidence from a survey of five eastern cities in China. J Environ Manage 2018; 217:47-55. [PMID: 29587200 DOI: 10.1016/j.jenvman.2018.03.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/15/2018] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
To address the problems of excessive energy consumption and global climate change, the Chinese government has issued numerous policies to guide urban residents' low-carbon travel behavior. To evaluate the validity of these policies from the perspective of public opinion, this study summarizes 22 policies from the four vantage points of economics, administration, technology, and public information and then measures residents' response to and evaluation of policies based on survey data on 1977 urban residents using stratified random sampling in five cities in eastern China. The results indicate that from the viewpoint of policy response, administrative policies for promoting public transport show the highest degree of response, followed by public information, technological, and economic policies. Specifically, the responses to parking and congestion fee policies are relatively stronger than those to vehicle purchase tax, vehicle and vessel tax, and fuel surcharge policies. Moreover, the responses to fuel surcharge policy are even weaker than car-restriction policies, including license-plate number restriction, license-plate lottery, and license-plate auction policies. From the viewpoint of policy evaluation, administrative policies for promoting public transport obtain the highest evaluations, followed by economic and technological policies. Residents' evaluations of car-restriction and public information policies are the lowest. In addition, a four-paradigm model is introduced to illustrate residents' reactions to each policy in terms of response and evaluation. Finally, several implementation strategies, including the anterior, concurrent, optional, core, supporting, and assisting policy options are proposed to guide urban residents' low-carbon travel behavior.
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Affiliation(s)
- Jichao Geng
- School of Economics and Management, Anhui University of Science and Technology, Huainan, Anhui, 232001, PR China.
| | - Ruyin Long
- School of Management, China University of Mining and Technology, Xuzhou, Jiangsu, 221116, PR China.
| | - Hong Chen
- School of Management, China University of Mining and Technology, Xuzhou, Jiangsu, 221116, PR China.
| | - Qianwen Li
- School of Management, China University of Mining and Technology, Xuzhou, Jiangsu, 221116, PR China.
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Wallbank LA, MacKenzie R, Beggs PJ. Environmental impacts of tobacco product waste: International and Australian policy responses. Ambio 2017; 46:361-370. [PMID: 27844421 PMCID: PMC5347528 DOI: 10.1007/s13280-016-0851-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 05/19/2023]
Abstract
The health risks of tobacco consumption are well established, but there is less awareness of the global environmental impacts of smoking. The by-products of the 6.3 trillion cigarettes smoked annually are filters (butts) that contain benzene, nicotine, cadmium, and dozens of other chemicals. It is estimated that between one- and two-thirds of all filters are discarded on roads, pavements, and green spaces. Butt litter as an environmental and public health hazard is a relatively new field of study, but recent research and findings have clear global implications. While this article focuses specifically on the situation in Australia, where cigarette butts are consistently the most littered item identified in national clean-up campaigns, the material reviewed has clear international environmental implications. The article first reviews existing literature on filter composition and toxicology, clean-up costs, regulatory response, and key policy actors. It then describes the scale of the butt litter problem in Australia using existing data, and analyses potential remedies at both the domestic and international levels.
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Affiliation(s)
- Lucinda A. Wallbank
- Department of Environmental Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109 Australia
| | - Ross MacKenzie
- Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, NSW 2109 Australia
| | - Paul J. Beggs
- Department of Environmental Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, NSW 2109 Australia
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Chavkin W, Leitman L, Polin K. Conscientious objection and refusal to provide reproductive healthcare: a White Paper examining prevalence, health consequences, and policy responses. Int J Gynaecol Obstet 2014; 123 Suppl 3:S41-56. [PMID: 24332234 DOI: 10.1016/s0020-7292(13)60002-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Global Doctors for Choice-a transnational network of physician advocates for reproductive health and rights-began exploring the phenomenon of conscience-based refusal of reproductive healthcare as a result of increasing reports of harms worldwide. The present White Paper examines the prevalence and impact of such refusal and reviews policy efforts to balance individual conscience, autonomy in reproductive decision making, safeguards for health, and professional medical integrity. OBJECTIVES AND SEARCH STRATEGY The White Paper draws on medical, public health, legal, ethical, and social science literature published between 1998 and 2013 in English, French, German, Italian, Portuguese, and Spanish. Estimates of prevalence are difficult to obtain, as there is no consensus about criteria for refuser status and no standardized definition of the practice, and the studies have sampling and other methodologic limitations. The White Paper reviews these data and offers logical frameworks to represent the possible health and health system consequences of conscience-based refusal to provide abortion; assisted reproductive technologies; contraception; treatment in cases of maternal health risk and inevitable pregnancy loss; and prenatal diagnosis. It concludes by categorizing legal, regulatory, and other policy responses to the practice. CONCLUSIONS Empirical evidence is essential for varied political actors as they respond with policies or regulations to the competing concerns at stake. Further research and training in diverse geopolitical settings are required. With dual commitments toward their own conscience and their obligations to patients' health and rights, providers and professional medical/public health societies must lead attempts to respond to conscience-based refusal and to safeguard reproductive health, medical integrity, and women's lives.
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Affiliation(s)
- Wendy Chavkin
- Global Doctors for Choice, New York, USA; College of Physicians and Surgeons, Columbia University, New York, USA; Mailman School of Public Health, Columbia University, New York, USA.
| | | | - Kate Polin
- Global Doctors for Choice, New York, USA
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