Trends and determinants of physician migration in Peru: insights from a middle-income country

The Great Recession, following the 2008 financial crisis, led many governments to adopt programmes of austerity. This had a lasting impact on health system functionality, resources, staff (numbers, motivation and morale) and patient outcomes. This study aimed to understand how health system resilience was impacted and how this affects readiness for subsequent shocks. A realist review identified legacies associated with austerity (proximal outcomes) and how these impact the distal outcome of health system resilience. EMBASE, CINAHL, MEDLINE, EconLit and Web of Science were searched (2007-May 2021), resulting in 1081 articles. Further theory-driven searches resulted in an additional 60 studies. Descriptive, inductive, deductive and retroductive realist analysis (utilising excel and Nvivo) aided the development of context-mechanism-outcome configurations (CMOCs), alongside stakeholder engagement to confirm or refute emerging results. Causal pathways, and the interplay between context and mechanisms that led to proximal and distal outcomes, were revealed. The refined CMOCs and policy recommendations focused primarily on workforce resilience. Five CMOCs demonstrated how austerity-driven policy decisions can impact health systems when driven by the priorities of external agents. This created a real or perceived shift away from the values and interests of health professionals, a distrust in decision-making processes and resistance to change. Their values were at odds with the realities of implementing such policy decisions within sustained restrictive working conditions (rationing of staff, consumables, treatment options). A diminished view of the profession and an inability to provide high-quality, equitable, and needs-led care, alongside stagnant or degraded working conditions, led to moral distress. This can forge legacies that may adversely impact resilience when faced with future shocks. This review reveals the importance of transparent, open communication, in addition to co-produced policies in order to avoid scenarios that can be detrimental to workforce and health system resilience.

Social determinants of health equity.

This study aims to investigate the relationship between education and alcohol-related morbidity and the role that low job control and heavy physical workload play in explaining these associations among men and women in Sweden. This register-based cohort study (SWIP cohort) includes over three million individuals registered in Sweden in 2005. Job control and physical workload were measured using a job exposure matrix linked to the index person based on their registered occupation at baseline. Alcohol-related morbidity was measured through diagnoses in the national patient registers between 2006 and 2020. Cox proportional hazards regression models were built to estimate associations between education and alcohol-related morbidity. Reductions in hazard ratios (HRs) were calculated after adjusting for job control, physical workload, and other covariates. Models were also stratified by sex. Lower levels of education predicted a higher risk of alcohol-related morbidity (HR: 2.55 95% confidence interval: 2.49–2.62 for the lowest educated compared to the highest). Low job control and heavy physical workload both played roles in explaining educational differences in alcohol-related morbidity even after accounting for sociodemographic and health factors (15.1% attenuation for job control and 18.3% for physical workload among the lowest educated). Physical workload explained a larger proportion of the associations among men compared to women. Lower levels of education were associated with an increased risk of alcohol-related morbidity and working conditions partly explained these associations beyond what was explained by sociodemographic and health factors. Improving working conditions could therefore prevent some cases of alcohol-related morbidity.

The COVID-19 pandemic has significantly changed the patterns of employees’ behaviour, especially in the retail sector, which requires continuous contact with consumers. The anti-pandemic measures based on physical distance, wearing medical and protective equipment, application of barriers, frequent disinfection of work surfaces and space, use of strict protocols, and safety standards significantly complicate working conditions. This paper aims to analyse and define incentives for upgrading work and working conditions in retail during the COVID-19 pandemic. The scientific importance of the paper is reflected in the fact that analytically and systematically, it defines incentives that will support the behaviour of employees during crises affecting the retail sector. Unlike existing research in trade and retail, which indicated the importance of individual incentives for improving working conditions in periods of crisis, the contribution of this paper is in the comprehensive analysis, systematization, and definition of the importance of all incentives for improving the working conditions of employees in the retail sector. In this context, empirical research was conducted on a sample of 255 employees and it tested the importance of incentives to improve working conditions such as: maintaining a safe and healthy working environment, how to treat infected workers and workers in contact, the existence of detailed instructions for employees and consumers, organizing transportation for workers, financial incentives for employees, reduction of the scope of business activities, shortening of working hours of facilities, security protocols and digitalization of work processes. The survey was conducted among employees in SMEs and large retail chains. The set hypotheses were tested using the Path Analysis or Structural Modeling (SEM) method. The correlation between the retailer size and the differences in the incentives’ impact was assessed by employing Multiple Regression Analysis. The research results showed significant deviations in the mentioned incentives depending on the size of the retailer. Based on the obtained results, a set of measures was proposed that social policymakers and retail facility management should implement to improve working conditions in retail and establish a social safety net that will support employees in times of crisis. Guidelines for future research are provided in the paper. Keywords: working conditions, work incentives, position of workers, retailing, COVID-19 pandemic.

According to the World Health Organization, inadequate antenatal care increases risks for both mothers and children, many of which can be prevented through regular screening, timely treatment, and adoption of healthy behaviors. Evidence suggests that healthcare recipients (HCRs) who receive quality care tend to be more hopeful and engaged in their care, while hope among healthcare providers (HCPs) can reduce burnout and enhance their ability to deliver quality services. This study explores the role of hope in healthcare delivery among HCRs and HCPs in rural Northern Rwanda, focusing on three key dimensions of hope: interconnectedness, readiness for change, and future orientation. Using a qualitative design, the research draws on focus group discussions and key informant interviews. Thematic analysis was conducted to identify key factors influencing hope and to generate recommendations for embedding hope in healthcare at individual, interpersonal, and health system levels. The analysis mapped a quadruple of areas serving as both facilitators and barriers of hope; relationships, care experiences, continuous learning, and working conditions. Respectful communication by HCPs fostered trust and positively influenced HCRs’ engagement. Faith, learning opportunities, and positive health system encounters supported future orientation and confidence. While HCPs showed strong commitment to care, their motivation was often challenged by resource constraints and poor working environments. The study highlights the importance of aligning quality care strategies with factors that promote hope. Strengthening relational care, promoting continuous learning, and improving work conditions can foster a more hopeful and resilient health system. Prioritizing such approaches can enhance both patient engagement and provider well-being across primary care settings.

From Intention to Action: Operationalizing AGA Diversity Policy to Combat Racism and Health Disparities in Gastroenterology

Mental health challenges are common in individuals with cancer, but accessing support remains a gap, particularly in outpatient oncology. Real-world factors influencing staff's ability to integrate mental health assessment and support into workflows are unclear. We aimed to (1) identify and explore factors influencing the assessment and management of mental health in outpatient oncology and (2) identify factors that influence normalising support for mental health during cancer treatment. Through an exploratory qualitative approach, data was collected via focus groups with oncology healthcare professionals at a major metropolitan hospital. Reflexive thematic analysis revealed seven themes. Staff recognised the critical need for mental health support during treatment. However, staff participation in mental health assessment and referral processes was impeded by feelings of futility due to the lack of available oncology-specific services. Staff reported insufficient resources and time constraints, and reliance on experiential knowledge rather than the preferred support from clinicians with mental health training. Staff highlighted inequities in access to mental health support which exacerbate disparities in care provision. Staff reported that a lack of role clarity and responsibilities hindered monitoring of patient mental health management and contributed to a perceived lack of accountability. Short-term initiatives such as improved documentation, creation of central referral pathways and clinical supervision for all staff were reported as desirable. While systemic resource constraints were acknowledged, oncology staff also identified several feasible, shorter-term initiatives they felt would be helpful and desirable until mental health professionals can be integrated into oncology outpatient care.

This study presents survey results assessing the impact of the American Cancer Society (ACS) health equity (HE) training on staff knowledge, attitudes, and beliefs about HE and social determinants of health (SDOH). This study is a quasi-experimental design examining survey responses over time and comparing responses from staff who participated in ACS HE training sessions and education opportunities and those who did not. An electronic Web survey was distributed to all ACS and American Cancer Society Cancer Action Network (ACS CAN) staff in each of the 3 years that the training was held (2018-2020). ACS and ACS CAN staff who chose to take the survey were included in the study. Engagement with training hosted by the ACS HE team was examined. Training sessions were intended to introduce staff to HE and SDOH in the context of cancer outcomes and provide staff with the skills to become HE champions in the organization. This study examines whether participation in training sessions hosted by the HE team had an impact on knowledge of HE terms, attitudes, and beliefs about HE and engagement with HE. Trained respondents had a significantly higher HE knowledge summary score (98%) than those who were not trained (79%, SD = 0.26100, P < .001). Respondents who participated in training were more likely to believe that they could advance HE through their work at ACS and ACS CAN (88% compared with 66% of those who were not trained, SD = 0.47300, P < .001). Respondents who participated in training scored an average of 4.7 out of 6 on HE engagement compared with 3.8 among the untrained (SD = 1.425, P < .001). These findings demonstrate that participation in HE training is associated with higher levels of knowledge about HE and stronger personal attitudes and beliefs about the importance of addressing SDOH. This is a foundational step in staff taking action to integrate HE concepts into their day-to-day work toward reducing inequities in access to cancer treatment and health outcomes.

The Expert Panel on Effective ways of investing in health (EXPH) is an interdisciplinary and independent group established by the European Commission to provide non-binding independent advice on matters related to effective, accessible and resilient health systems. In a prior opinion on resilient health and social care following the COVID-19 pandemic, the EXPH recommended that aggravated levels of psychological distress should be recognized as a public health priority. In January 2021, EXPH received a mandate to examine what is known about interventions to support the mental health needs of essential workers, with a particular emphasis on the health workforce. The objective of this workshop is to present and discuss the findings and recommendations from the Opinion on this matter. The value added offered by this workshop is three-fold. First, it offers a multidisciplinary perspective on the mental health of the health force. Second, its findings on promising and/or effective interventions are evidence-based. Third, it provides a pan-European consensus opinion on a path forward towards providing support to this vulnerable group at multiple levels - from European and national policy to senior managers to occupational and mental health practitioners. The workshop will consist of 4 5-to-10-minute presentations from EXPH members and Opinion collaborators. After the first two presentations, there will be a brief 7-minute reaction session with the audience. After the last presentation, 15-20 minutes will be spent engaging in interactive discussion between the workshop panel members and the audience using a series of prescribed discussion questions. In the first presentation, the chair of the Opinion will introduce the EXPH and its collaborators and provide an overview of the mandate. In the second presentation, the conceptual framework for responding to the questions posed by the European Commission and key determinants of mental health in the health workforce will be presented. The third presentation will describe cost-effective and promising interventions relative to mental health of the health workforce and then detail conditions for the cost-effective, affordable, and inclusive. The fourth and final presentation will address the recommendations and corresponding action points garnered from this work. The interactive discussion questions to be posed to the audience include: To what extent do you see these recommendations as valuable? Has anything important been overlooked? What changes in public health research and practice are needed to effectively support the mental health of the health workforce?Key messages Appropriate guidance frameworks needs to be established, in some cases deserving legal status, to clearly establish mental wellbeing as an important workplace responsibility within organisations.The organisation, as opposed to the individual worker, is to be held accountable for worker wellbeing.

Biodiversity conservation work can be challenging but rewarding, and both aspects have potential consequences for conservationists' mental health. Yet, little is known about patterns of mental health among conservationists and its associated workplace protective and risk factors. A better understanding might help improve working conditions, supporting conservationists' job satisfaction, productivity, and engagement, while reducing costs from staff turnover, absenteeism, and presenteeism. We surveyed 2311 conservation professionals working in 122 countries through an internet survey shared via mailing lists, social media, and other channels. We asked them about experiences of psychological distress, working conditions, and personal characteristics. Over half were from and worked in Europe and North America, and most had a university-level education, were in desk-based academic and practitioner roles, and responded in English. Heavy workload, job demands, and organizational instability were linked to higher distress, but job stability and satisfaction with one's contributions to conservation were associated with lower distress. Respondents with low dispositional and conservation-specific optimism, poor physical health, and limited social support, women, and early-career professionals were most at risk of distress in our sample. Our results flag important risk factors that employers could consider, although further research is needed among groups underrepresented in our sample. Drawing on evidence-based occupational health interventions, we suggest measures that could promote better working conditions and thus may improve conservationists' mental health and abilities to protect nature.

The article investigates the ways and means of improving and perfecting the state of labor protection at transport enterprises of Ukraine through the implementation of international standards for risk management and occupational safety. A detailed analysis of international standards for occupational safety, and their main benefits that improve the health and safety of enterprises. The object of research is international standards on occupational safety and risk management. The purpose of the work is to analyze the implementation and use of international standards on occupational safety and risk management at Ukrainian transport enterprises. Research methods - analytical. Quality management of labor protection at enterprises is one of the priority areas of transport enterprises in order to reduce occupational injuries and improve working conditions. In order to effectively manage labor protection in transport enterprises, the authors of the article propose the introduction of international standards in the field of occupational safety and risk management in Ukraine. Examining the chosen topic, it was found that in many works that devoted to the application of international standards on occupational safety was not a generalization of all regulations and standards on labor protection and risk management in the enterprise. The main directions for the implementation of international standards for occupational safety and risk management in transport enterprises of Ukraine are proposed. The results of research can be recommended for implementation in the management system of labor protection at transport enterprises of Ukraine. KEY WORDS: INTERNATIONAL STANDARDS, OCCUPATIONAL HEALTH AND SAFETY, SAFE WORKING CONDITIONS, RISK ASSESSMENT, IMPROVING OCCUPATIONAL HEALTH AND SAFETY CONDITIONS, MANAGEMENT SYSTEM.

Our world is changing, and with it, academic dentistry must think and act anew! Dental education in the United States and Canada is challenged to produce a culturally and structurally competent workforce that will serve the needs of an aging population and the expectations of an increasingly globally connected and diverse society. As these two countries become even more racially/ethnically diverse, dental education must also increase the number of students of color graduating and entering the oral health professions and expand opportunities for historically underrepresented and marginalized groups to enter the academic ranks and assume leadership positions. Additionally, dental schools play a major role in advancing the care and treatment of underserved and disadvantaged populations. Through their triad missions of education, research, and service, the 68 US dental schools, excluding the four provisional schools, serve as dental “safety nets” for those who lack access to care in the dental private practice system. Since 2011, new dental schools now exist in California, Florida, Illinois, Maine, Missouri, New York, North Carolina, Texas, and Utah, and additional dental schools are in the planning stages. These new institutions have an opportunity to improve health equity through increased community engagement and academic/community partnerships. Important to their mission, dental schools also serve as bastions for biomedical and behavioral research and transformative curriculum changes that will use newer technology from research and discovery. America has one of the best oral health care delivery systems in the world, as evidenced by outcomes such as a longer lifespan with tooth retention, fluoridated water resulting in a 60% reduction in dental caries, and Americans valuing their oral health as seen in increased annual visits to the dentist for preventive and restorative care.1 However, these data are valid for those who can afford and access dental care. The United States Public Health Service (USPHS) identifies 6803 Dental Health Professional Shortage Areas (DHPSAs) where access to dental care is minimal or missing. An estimated 64 million adults and children reside in these DHPSAs. Additionally, the USPHS estimates that 11,181 more dentists are needed for a dentist-to-U.S.-population ratio of 1:3000.1 The practice of dentistry is changing. As with medicine, dentistry is seeing a decline in solo practice models. Only 24% of the 1381 graduating respondents to the 2021 ADEA Survey of US Dental School Seniors indicated they plan to enter solo practice.2 New dental professionals are emerging, such as dental therapists and community dental health coordinators. New practice models exist in Alaska, Arizona, Maine, Minnesota, Oregon, Vermont, and Washington. Three seminal reports, Dental Education at the Crosswords: Challenges and Change,3 Oral Health in America: A Report of the Surgeon General,4 and Missing Persons: Minorities in Health Professions,5 continue to influence dental education policy and trends, especially related to health equity, disparities, and access to dental care. Additionally, the 2021 release of the National Institutes of Health (NIH) report, Oral Health in America: Advances and Challenges, serves as a foundation for additional work in these areas.6 On the global health agenda, oral health is no longer a neglected issue. Approximately 3.5 million people throughout the world suffer from oral health diseases, and most of these individuals are socioeconomically disadvantaged or live in poverty. Furthermore, 10% of the world's population has severe periodontal (gum) disease, and globally, an estimated 530 million children suffer from dental caries of primary teeth.7 To call attention to this important issue, the World Health Organization's World Health Assembly adopted a May 2021 resolution on oral health, which also recognizes the intersections between oral health and achieving other United Nations Sustainable Development Goals, such as goal three on health and well-being.8 Additionally, it calls for the development of a framework that aligns oral health and noncommunicable diseases with universal health coverage agendas.9 Within the United States, the Healthy People 2030 initiative (US Department of Health and Human Services) also challenges our ability to reduce caries and improve oral health care.10 As more and more dental education faculty and administrators retire, academic dentistry must address succession planning, improve the representation of historically underrepresented persons in the academic ranks, and strengthen the belongingness factor for women, people of color, and marginalized groups. We must have hard conversations about gender equity and parity, antiracism, immigration, individuals with disabilities/abilities, social determinants of health, universal healthcare, and supporting the LGBTQ+ community. These difficult conversations must include actionable plans with accountability measures and transparency. We must use the data from ADEA's recent climate study of U.S. and Canadian dental schools and allied dental education programs, and other data, to create a culture of respect and design strategies that truly ensure a welcoming, safe, just, and humanistic environment in which all students, faculty, staff, residents, and fellows can succeed and have the resources to become their best. We must not only tangibly demonstrate that we believe in faculty inclusivity, but that the doors of academic dentistry are truly open to everyone. Furthermore, dental education must develop collective partnerships and networks to better invest in and provide more accessible oral health care and considerably expand the equitable pathways and opportunities to become oral healthcare professionals. This issue of the Journal of Dental Education (JDE) forces us to look back as we face not only current and post-pandemic health equity challenges, but also the disruptions which have rocked our society over the last several years and launched major new movements, such as MeToo, Black Lives Matter, Neurodiversity, and Stop Asian American Pacific Islander Hate. However, throughout this issue we also look forward to the future, imagining 21st-century leadership and envisioning an educational system that graduates students who not only have 21st-century competencies but who can address 21st-century complexities. ADEA's initiative “New Thinking for the New Century” is primed to help us embrace these changes and challenges. Lessons from our nation's history, dental education, world events, and current and post-pandemic health equity and economic challenges provide opportunities for transformative changes. Together, we must develop more integrated and resilient health systems and develop strategies to provide more inclusive and humanistic environments in dental education. Opportunities to catalyze institutional changes exist in interprofessional education (IPE), curriculum changes involving academic-community partnerships for community empowerment (ACE), diversifying dental education (DDE), research and technology development (RTD), and academic leadership reimagining (ALR). IPE: Opportunities for curriculum changes exist that improve graduates’ cultural and structural competency and increase access to equitable and affordable healthcare for the underserved. In 1997, only two dental schools had active IPE. Today, IPE is an accreditation mandate that affects all accredited dental schools. Additionally, IPE creates critical connections among students and residents in different health professions and provides early foundational team-based training. This foundational team-based learning provides the building blocks to advance future culturally competent patient-centered models that truly integrate oral, mental, behavioral, and primary health to improve access, patient safety, and treatment quality for persons living in poor, rural, and underresourced communities. ACE: Opportunities exist for sustainable academic-community partnerships that support educational goals and provide dental care to communities via outreach services by dental and dental hygiene students and faculty. The ADEA/W.K. Kellogg Foundation Minority Dental Faculty Development and Inclusion Program provided a model for sustainable partnerships that include pipeline and pathway recruitment, foundation and corporate support for institutional changes, and other resources. DDE: Opportunities to create a more inclusive and humanistic environment across dental education exist not only by participating in the ADEA climate study but through strategic planning and engaging in collective efforts to address key findings. Additionally, expanding pathway initiatives, such as the Summer Health Professions Education Program and the Texas A&M College of Dentistry's Bridge to Dentistry program, provide academic enrichment and career development opportunities to K-16 students who are historically underrepresented in dentistry. The ADEA Faculty Diversity Toolkit is a guide for dental education to develop faculty recruitment and retention plans to address related barriers and challenges.11 ADEA's new strategic recruitment plan, combined with the implementation of a new customer relationship management platform, will allow us to personalize outreach and connect to more diverse students. ADEA's efforts to bring the academic health professions together to increase the number of men of color entering dentistry and other health professions are also important avenues by which we seek to improve access and health equity in the United States. RTD: Opportunities exist for increased collaboration between the NIH and US dental schools through traditional research funding and community-based research grants that focus on improving the health of communities of color. An effort to include more dental schools in program project/center grants will increase patient-centered research and data outcomes. Salivary diagnosis, implantology, artificial intelligence, and robotics offer new avenues for dental discovery, translational research, and research collaboration. ALR: Reimagining leadership training in dental education will be a challenge for the ADEA Leadership Institute, Student Diversity Leadership Program, and other ADEA leadership development programs. Programs such as the Enid A. Neidle Scholar-in-Residence Program for women and the Executive Leadership in Academic Medicine program at Drexel University will continue to play a major role in developing academic leadership pipeline and pathway programs for the future. The ADEA Chapters for Students, Residents, and Fellows and ADEA's Academic Dental Careers Fellowship Program provide support and training for students interested in academic careers. Reimagining leadership, mentoring, and training programs will increase effective, collaborative, and diverse pathways to academic leadership in the future. Additionally, these mentoring and leadership development programs continue to serve important roles and progress has been made in some areas. For example, at the time of our writing, 25 (30%) of the deans (interim and permanent) at the 82 US and Canadian dental schools (including the four provisional schools) were women.12 In 2022, among deans (interim and permanent) at the 72 US dental schools (including the four provisional schools), 20 (28%) were women.12 Additionally, in 2022, 14 (19%) of the 72 US dental school deans (interim and permanent), including the four provisional schools, were people of color.12 In terms of student diversity at the 68 US dental schools (excluding the four provisional schools), 56% of the 2021 dental school first-time enrollees were women, and 20% of first-time enrollees were from historically underrepresented racially/ethnically diverse student populations.13 Although these numbers show some progress, they also reflect the important work that still needs to be done to expand leadership opportunities, implement succession planning strategies, and increase the number of historically underrepresented and marginalized students, faculty, staff, residents, and fellows in leadership positions throughout all facets of academic dentistry and oral health. The global pandemic has created a crisis with opportunities for collaboration similar to the period of innovation following World War II when battles were won against diseases such as smallpox, diphtheria, and polio. Additionally, dental educational institutions have the chance to not only expand upon gender equality but also lead in framing the dialogue on race and ethnicity to advance health equity and improve pathways and opportunities for historically underrepresented and marginalized students, fellows, faculty, staff, and residents. We do not know where new science, globalization, artificial intelligence, geo-political shifts, cyber threats, innovation, and societal challenges will lead us. However, we do know that global collaboration and resources will be required to build resilient health systems in the future that eliminate disease and promote good health and well-being for all. This includes dental education and oral health organizations working closely with governments, civil societies, the academic health professions, and other key health care and research stakeholders to address the increasing impact of climate threats and environmentally adverse health risks that are disproportionately impacting our most vulnerable populations and overall public health.14, 15 Additionally, our collective efforts will be required to create more inclusive, humanistic, accessible, and equitable environments throughout dental education where each person thrives, feels a strong connection, and has a sense of belonging. Let us, therefore, use this issue of the JDE for personal and institutional reflection to sharpen our moral imaginations and strengthen our dedication to inclusivity and our commitment to health equity. Most of all, let these pages challenge us to both think and act new! The authors have no conflicts of interests. This article is published in the Journal of Dental Education as part of a special issue. Manuscripts for this issue were solicited by invitation and peer reviewed. Any opinions expressed are those of the authors and do not represent the Journal of Dental Education or the American Dental Education Association.

Work-related injuries date back to antiquity. Attempts to resolve these work-related challenges have, inter alia, led to the establishment of the professions of Ergonomics, Occupational Therapy, Physiotherapy, Occupational Hygiene, and Biokinetics. The objective of this article is to illustrate the value of Ergonomic principles as an adjunct to the profession of Biokinetics. Insofar as Ergonomics addresses the physical and environmental risks which predispose and precipitate injuries, the profession of Ergonomics is primarily concerned with the practice of eradicating work-related challenges that impede human-machine interfacing, and which adversely influence work productivity and employee health. While Occupational Therapy and Biokinetics, by rehabilitating work-related injuries, assist in improving working conditions, little is known about the exact interface between the professions of Ergonomics and Biokinetics. The Google Scholar database was consulted in order to determine the relationship between Ergonomics and Biokinetics. The key words used were ergonomics and biokinetics and lead to the identification of 545 records, none of which pertained to the aforementioned subject. A subsequent search was conducted using the key words work-related musculoskeletal injuries and biokinetics. This search identified 925 records, the number of which were reduced to 42 (4.76%) after the exclusion of patents (n = 24), citations (n = 3), and nonbiokinetic work-related injury research (n = 856). Given that many work-related injuries are managed through the use of biokinetic rehabilitation, knowledge of the physical ergonomic risk factors at play will afford biokineticists an enhanced understanding of the etiology of work-related injuries, thereby helping to improve the vigor of the rehabilitation.

This article presents a systematic review of public policies aimed at ensuring equitable access to health services within the framework of the Sustainable Development Goals (SDGs). By analyzing 55 studies published between 2015 and 2024, the research identifies key strategies, patterns, and institutional innovations that have reshaped the architecture of health policies. In addition, comparative experiences from developing and developed countries are incorporated, allowing for a deeper understanding of regional dynamics and their particular challenges. The results demonstrate that effective alignment with the SDGs, particularly Goals 3 and 10, has contributed to the consolidation of more resilient, inclusive, and accountable health systems, especially in contexts of crisis. It highlights that these advances are especially relevant in the face of health emergencies, such as pandemics, where equity in access to services is critical for the sustainability of the system. The study concludes that health equity cannot be achieved through fragmented interventions, but rather through structural transformations based on political commitment, regulatory clarity, and social participation. It also underscores the importance of intersectoral governance and international cooperation as fundamental pillars for achieving equitable universal coverage. Finally, it is recommended that monitoring and evaluation mechanisms be strengthened to ensure that the policies implemented maintain their focus on equity and human rights.

Improving working conditions and promoting employees' motivation and ability to perform boosts capacity for innovation and corporate competitiveness. The Preventive Occupational Health and Safety funding priority of the German Federal Ministry of Education and Research (BMBF) has established a platform to address the challenges of the modern work environment from the perspective of occupational health and safety policy. Demographic change is influencing general conditions, and Preventive Occupational Health and Safety needs to be repositioned accordingly. The integration of health and safety into work practices and the support of cross-company stakeholders are prerequisites for successful integration of prevention within companies. This article discusses the relationship between capacity to innovate and prevention in terms of the current dilemmas surrounding the potential for innovation (cf. Sect. 1). These dilemmas characterize the challenges addressed by the Preventive Occupational Health and Safety funding priority and its focus groups (cf. Sect. 2). To this end, the findings of the focus groups vis-a-vis the respective issues are presented in summarized form (cf. Sect. 3). Based on the approach of “Taking prevention forward”, the research results are summarized and the potential of prevention as a field for future development explored in the “Aachener Impuls zur betrieblichen Gesundheitsforderung und Pravention in der modernen Arbeitswelt” (“Aachen Impulse on the promotion of occupational health and prevention in the modern work environment”). The article concludes by presenting the funding priority within the context of European prevention strategies.