high-GDP Countries Research Articles

Immediate Impact of the COVID-19 Pandemic on Heart and Kidney Transplantation andtheRecovery Trends in 30 Developed andLess-Developed Countries.

BACKGROUND The COVID-19 pandemic had multifaceted and disproportionate impacts on various countries. We investigated the decline of heart and kidney transplantation in 2020 and recovery trends in 2020, 2021, and 2022 in 30 developed and developing countries, considering COVID-19 incidence and mortality and pandemic-time economic variables. MATERIAL AND METHODS Data were obtained from reliable open databases. Nations were grouped by hierarchical cluster analysis into high-gross domestic product (GDP), mid-GDP, and low-GDP countries. Expected transplant numbers for 2020 to 2021 were estimated by the artificial neural network method using data from 2015 to 2019. Effect size and its inference were determined through the Hodges-Lemann estimate and Wilcoxon signed-rank test, respectively. The possible disproportionate effect was estimated by the Jonckheere-Tersptra test. Associations between transplantation and economic variables, COVID-19 caseload, and mortality were examined using Kendall rank correlation analysis. RESULTS All nations experienced a decline in 2020 and some real recovery in 2020 to 2022. For high-GDP countries, decline was insignificant and recovery was marginal; for mid-GDP countries, decline was significant for heart and deceased kidneys and recovery was modest; for low-GDP countries, decline was significant for heart, live kidneys, and deceased kidneys and recovery was marginal. The low-GDP countries were disproportionally negatively impacted, although the associations between the impact and economic variables, COVID-19 incidence, and COVID-19 mortality were statistically insignificant. CONCLUSIONS More inclusive studies of socioeconomic and cultural factors that affected the impact of the COVID-19 pandemic in different countries can be useful for better preparedness and reducing disruption in healthcare in future global pandemics.

Use of, Satisfaction with, and Opportunities for Midwifery Care in the United States

Among high-GDP countries, the United States is the only country that has an increasing maternal mortality rate. As such, the evaluation of factors related to the care experience is essential to developing effective interventions. In the United States, 82% of births are attended by obstetricians-gynecologists and only 8% by nurse-midwives. There is a need to examine women’s perceptions of the quality of care of various types of health care providers. The goal of this pregnancy pathways study was to better understand U.S. women’s perspectives on challenges and gaps in the pregnancy experience, including descriptions of interactions and relationships with various types of health care providers.

Green Growth, Green Technology, and Environmental Health: Evidence From High-GDP Countries.

Green growth is an exceptional strategy for sustainable development. It provides a pathway to combat environmental issues and the use of natural resources. This study investigates the effects of green technology and environmental factors on green growth in high-gross domestic product (GDP) countries from 2000 to 2020. In addition, it also probes the linear and nonlinear effects of GDP on green growth. To do so, we employ an advanced econometric approach, e.g., a cross-sectional autoregressive distributed lags estimator for long and short runs. The outcomes demonstrate that the linear effect of GDP is positive for green growth. On the contrary, the nonlinear effect of GDP has a negative magnitude for green growth. Besides, green technology substantially increases green growth. Energy consumption is found to be an important influencer, and it decreases green growth. Environmental factors such as emissions, according to the findings, also reduce green growth in the sample countries. It is worth noting that the joint effects of energy consumption and emissions deteriorate green growth in countries. Based on empirical findings, for policy makers, this study suggests that high-GDP countries should manage their economic and environmental activities in order to increase the amount of green growth that may protect the ecological environment.

Decomposing the Healthy Immigrant Effect: The Role of GDP of Birth Country in Immigrant Health.

Drawing on the social-ecological systems perspective of health, this study explores whether the deteriorating trend of immigrant health over time differs depending on immigrants' pre-migration macro-level factors in their birth country. Using the Household, Income, and Labor Dynamics in Australia survey (N = 1,847), we conducted an HLM analysis to examine the association among GDP per capita in the birth country, length of stay, and immigrants' health status post-migration. Support was found for both the negative association between the length of stay and health and the positive association between the GDP of the birth country and health. The negative association between length of stay and health was stronger among immigrants from low GDP countries compared to those from high GDP countries. Our findings suggest the importance of the population-level characteristics of the birth country in understanding healthy immigrant effect post-migration.

Patient-reported factors influencing the choice of their kidney replacement treatment modality.

BackgroundAccess to various kidney replacement therapy (KRT) modalities for patients with end-stage kidney disease differs substantially within Europe.MethodsEuropean adults on KRT filled out an online or paper-based survey about factors influencing and experiences with modality choice (e.g. information provision, decision-making and reasons for choice) between November 2017 and January 2019. We compared countries with low, middle and high gross domestic product (GDP).ResultsIn total, 7820 patients [mean age 59 years, 56% male, 63% on centre haemodialysis (CHD)] from 38 countries participated. Twenty-five percent had received no information on the different modalities, and only 23% received information >12 months before KRT initiation. Patients were not informed about home haemodialysis (HHD) (42%) and comprehensive conservative management (33%). Besides nephrologists, nurses more frequently provided information in high-GDP countries, whereas physicians other than nephrologists did so in low-GDP countries. Patients from low-GDP countries reported later information provision, less information about other modalities than CHD and lower satisfaction with information. The majority of modality decisions were made involving both patient and nephrologist. Patients reported subjective (e.g. quality of life and fears) and objective reasons (e.g. costs and availability of treatments) for modality choice. Patients had good experiences with all modalities, but experiences were better for HHD and kidney transplantation and in middle- and high-GDP countries.ConclusionOur results suggest European differences in patient-reported factors influencing KRT modality choice, possibly caused by disparities in availability of KRT modalities, different healthcare systems and varying patient preferences. Availability of home dialysis and kidney transplantation should be optimized.

Results of the European EDITH nephrologist survey on factors influencing treatment modality choice for end-stage kidney disease.

BackgroundAccess to forms of dialysis, kidney transplantation (Tx) and comprehensive conservative management (CCM) for patients with end-stage kidney disease (ESKD) varies across European countries. Attitudes of nephrologists, information provision and decision-making may influence this access and nephrologists may experience several barriers when providing treatments for ESKD.MethodsWe surveyed European nephrologists and kidney transplant surgeons treating adults with ESKD about factors influencing modality choice. Descriptive statistics were used to compare the opinions of professionals from European countries with low–, middle– and high–gross domestic product purchasing power parity (GDP PPP).ResultsIn total, 681 professionals from 33 European countries participated. Respondents from all GDP categories indicated that ∼10% of patients received no information before the start of renal replacement therapy (RRT) (P = 0.106). Early information provision and more involvement of patients in decision-making were more frequently reported in middle- and high-GDP countries (P < 0.05). Professionals’ attitudes towards several treatments became more positive with increasing GDP (P < 0.05). Uptake of in-centre haemodialysis was sufficient to 73% of respondents, but many wanted increased uptake of home dialysis, Tx and CCM. Respondents experienced different barriers according to availability of specific treatments in their centre. The occurrence of barriers (financial, staff shortage, lack of space/supplies and patient related) decreased with increasing GDP (P < 0.05).ConclusionsDifferences in factors influencing modality choice when providing RRT or CCM to adults with ESKD were found among low-, middle- and high-GDP countries in Europe. Therefore a unique pan-European policy to improve access to treatments may be inefficient. Different policies for clusters of countries could be more useful.

Valuing Density: An Evaluation of the Extent to which American, Australian, and Canadian Cities Account for the Climate Benefits of Density through Environmental Review

This study looks at the extent to which major cities in the United States, Australia, and Canada assess the climate impacts of densification through the environmental review process. Research indicates that greater urban density is associated with lower household greenhouse gas (GHG) emissions in high GDP countries. Yet there is reason to believe that cities may be taking a parochial approach to evaluating the climate impacts of rezonings in their environmental reviews that fails to consider the environmental costs of maintaining low density. In this study, we survey the legal and policy frameworks governing the environmental review in American, Australian, and Canadian cities to determine the extent to which they consider and analyze the GHG benefits of land use changes that increase urban density. We also analyze environmental review documents for proposals to increase residential density in cities to determine the extent to which policy makers have incorporated empirical knowledge regarding the relationship between density and GHGs emissions into their environmental reviews of proposed land use changes. We find that very few cities of those we surveyed use a formal environmental review process for analyzing the GHG impacts of land use changes. In addition, the small number of cities in our survey that analyze the GHG implications of land use changes do not appear to comprehensively consider the broader GHG benefits of densification. In fact, cities that assess the GHG impacts of zoning changes appear more likely to consider densification as causing climate harms rather than climate benefits.

Disease burden metrics and the innovations of leading pharmaceutical companies: a global and regional comparative study

BackgroundThe recent innovation activities of global top-tier pharmaceutical companies in accordance with global and regional health concerns were investigated in order to identify their innovations contributing to population health.Methods“Innovation activity” was defined as the number of drugs for which R&D activities have been reported within the last three years. Such activities were measured by collecting the data on drug developments and classifying them by developer company, phase of development, therapeutic use, and the country in which the development conducted. Subsequently, we examined and compared the correlations between the global innovation activities of the top 20 pharmaceutical companies and the disease burden measured in disability-adjusted life years (DALYs) by income level and region. In addition, this study analyzed the association between country-specific innovations and DALYs in the corresponding countries.ResultsAt a global level, the innovation activities were not associated with global DALYs. However, when analyzed by income level, the innovation activities were associated with DALYs in high income and upper middle income countries while it was not associated with DALYs in low middle income and low income countries. In terms of region, correlations were found between the innovation activities and DALYs in the European region, the Americas, and the Western Pacific region whereas such correlations were not found in the African, Eastern Mediterranean, and South-East Asian regions. Similar to the analyses by income level and region, correlations between country-specific innovations and DALYs were only found in high income or high GDP countries. In addition, an empirical analysis of several cases including Canada, Germany, South Korea, and the United Kingdom revealed that pharmaceutical innovation is more closely related to market size than disease burden.ConclusionsThis study identified that discrepancies between pharmaceutical innovation and public health needs, i.e., disease burden values, have persisted until recently. To alleviate this imbalance, both public and private sectors should not only fulfill their respective roles and responsibilities regarding these issues, but also make strategic and collaborative efforts such as Product Development Partnerships (PDPs) directed toward public health improvement.

Factors Affecting Canine Obesity Seem to Be Independent of the Economic Status of the Country—A Survey on Hungarian Companion Dogs

For a companion dog, the most important environmental factor is the owner, who is responsible for providing everything that is necessary for the health and welfare of the dog. Still, one of the most often compromised measures of an average companion dog is its body condition, with overweight and obese animals representing a growing welfare problem around the world. Using an extensive online survey that was distributed among Hungarian dog owners, we wanted to know whether those obesogenic factors that were identified mostly in high-GDP countries' pet dog populations would hold their relevance in a much lower average income country as well. We found several associations between the body condition of canine companions and various demographics, environmental and behavioral factors. Older dogs reportedly had an accelerating propensity for being overweight. Joint activity and performing dog sports both reduced the likelihood of being an overweight dog. Main food types also had significant associations with the body condition of dogs-meanwhile, the feeding of commercial dog food (kibble) and/or leftovers of human meals coincided with being overweight, dogs that were fed (fully, or at least partly) with raw food were less likely overweight. In the case of owner-reported behavioral problems, the food-related issues (stealing food, overeating, etc.) were clustered to a dimension together with problem behaviors such as excessive barking and overt aggression. Beyond showing a good agreement with earlier surveys on associated factors with canine obesity, our study revealed some interesting new details that could be used in the prevention of overweight problems in dogs.

Leisure beliefs and the subjective well-being of nations

ABSTRACT The policies of most governments focus on improving material prosperity. Yet, wealth only weakly predicts well-being. It is therefore important to understand whether factors other than money shape the happiness of nations. Here, we construct a data set of 79 countries (N = 220,000) and explore whether differences in the prioritization of time (leisure) vs. money (work) explain cross-country differences in happiness. Consistent with our predictions, countries whose citizens value leisure more than work report higher subjective well-being at the country and individual level. These effects hold in high and low GDP countries. Critically, we find evidence for a novel mechanism: people who value leisure over work are less negatively impacted by financial instability. Moving beyond individual welfare, the value that nations place on leisure vs. work fundamentally shapes happiness.

Time arrow in published clinical studies/trials indexed in MEDLINE: a systematic analysis of retrospective vs. prospective study design, from 1960 to 2017

Clinical studies/trials are experiments or observations on human subjects considered by the scientific community the most appropriate instrument to answer specific research questions on interventions on health outcomes. The time-line of the observations might be focused on a single time point or to follow time, backward or forward, in the so called, respectively, retrospective and prospective study design. Since the retrospective approach has been criticized for the possible sources of errors due to bias and confounding, we aimed this study to assess if there is a prevalence of retrospective vs. prospective design in the clinical studies/trials by querying MEDLINE. Our results on a sample of 1,438,872 studies/trials, (yrs 1960–2017), support a prevalence of retrospective, respectively 55% vs. 45%. To explain this result, a random sub-sample of studies where the country of origin was reported (n = 1,576) was categorized in high and low-income based onthe nominal Gross Domestic Product (GDP) and matched with the topic of the research. As expected, the absolute majority of studies/trials are carried on by high-income countries, respectively 86% vs. 14%; even if a slight prevalence of retrospective was recorded in both income groups, for the most part prospective studies are carried out by high-GDP countries, 85% vs. 15%. Finally, the differences in the design of the study are understandable when considering the topic of the research.

PCP15 - WHY EUROPEAN CROSS-BORDER INITIATIVES ON DRUG PROCUREMENT MAY FAIL?

Over recent years, ten European cross-country collaborations for drug procurement emerged to contain pharmaceutical costs. These initiatives encompass thirty countries. Although they share multiple objectives, the ultimate goal is a joint procurement of expensive medicines, leveraging the population size of involved countries. The prominent one is the Valletta Declaration. It gathers countries with a broad range of GDP and population size. The lack of operational framework is delaying the procurement initiation. To be attractive, they should operate like a single market with a unique price and a simultaneous access; however it is unlikely due to heterogeneous affordability. Due to subsidiarity principle of pricing policies, delegation of price negotiation to Valletta group will require national legislation. Large countries are not ready to give up their additional negotiation power and are looking for a second national negotiation, while smaller countries expect a single negotiation and a same net price for all countries. Low GDP countries expect subsidies from high GDP countries through differential pricing to ensure simultaneous launch which may not happen. Some countries, such as Spain and Portugal have organised joint tenders for generics and biosimilars until the Valletta framework is clarified. BeneluxA-I is expected to be the most promising collaboration; it gathers homogeneous countries with close culture and vision. The first attempt for joint procurement failed highlighting the limited power negotiation despite a quite well established framework. Other initiatives gather small countries, except Poland, with low affordability making them unattractive for providers to offer significant rebates. The top five markets in EU represent 75% of the whole European market providing them a strong negotiation power and leaving the smaller markets unease to achieve substantial discounts even when joining forces. Joined procurement requires a European Union engagement together with a differential pricing to help low affordability countries.

An exploratory study of the determinants of information technology hardware production: a country-level analysis

ABSTRACTThis research examines empirically factors influencing IT hardware production by employing a country-level data set for 1985–2009. Our results show that IT hardware production is driven by various country-level factors, but the impacts of these factors differ for two types of IT hardware. Electronic data processing (EDP) production has shifted to low GDP countries where wage levels are low, and a large portion of EDP produced in these countries tend to be exported to high GDP countries where demand is high. While the gap has decreased, however, medical and industrial equipment (MIE) production is still largely done in advanced economies. These findings imply that losing the manufacturing base in the U.S. might not be an issue for certain types of products, such as EDP, but it could be a serious issue for MIE. Thus, policies must be industry specific; a ‘one-size-fits-all’ policy would not work for the global IT industry.

Does governance play a role in the distribution of invasive alien species?

Invasive alien species (IAS) constitute a major threat to global biological diversity. In order to control their spread, a detailed understanding of the factors influencing their distribution is essential. Although international trade is regarded as a major force structuring spatial patterns of IAS, the role of other social factors remains unclear. Despite studies highlighting the importance of strong governance in slowing drivers of biodiversity loss such as logging, deforestation, and agricultural intensification, no study has yet analyzed its contribution to the issue of IAS. Using estimates of governance quality and comprehensive spatiotemporal IAS data, we performed multiple linear regressions to investigate the effect of governance quality upon the distribution of species listed under “100 of the worst” IAS in 38 Eurasian countries as defined by DASIE. Our model suggested that for countries with higher GDP, stronger governance was associated with a greater number of the worst IAS; in contrast, for the lowest GDP countries under analysis, stronger governance was associated with fewer of these IAS. We elucidate how the quality of governance within a country has implications for trade, tourism, transport, legislation, and economic development, all of which influence the spread of IAS. While our findings support the common assumption that strengthening governance benefits conservation interventions in countries of smaller economy, we find that this effect is not universal. Stronger governance alone cannot adequately address the problem of IAS, and targeted action is required in relatively high‐GDP countries in order to stem the influx of IAS associated with high volumes of trade.

Determinants of Pro-Environmental Consumption: Multicountry Comparison Based upon Big Data Search

The Korean government has promoted a variety of environmental policies to revitalize pro-environmental consumption, and the government’s budget for this purpose has increased. However, there is a lack of quantitative data and analysis regarding the effects upon the pro-environmental consumption of education and changing public awareness of the environment. In addition, to improve pro-environmental consumption, the determinant and hindrance factors of pro-environmental consumption should be analyzed in advance. Accordingly, herein we suggest a pro-environmental consumption index that represents the condition of pro-environmental consumption based on big data queries and use the index to analyze determinants of and hindrances to pro-environmental consumption. To verify the reliability of the proposed indicator, we examine the correlation between the proposed indicator and Greendex, an existing survey-based indicator. In addition, we conduct an analysis of the determinants of pro-environmental consumption across 13 countries based upon the proposed indicator. The index is highest for Argentina and average for Korea. An analysis of the determinants shows that the levels of health expenditure, the ratio of the population aged over 65 years, and past orientation are significantly negatively related to the pro-environmental consumption index, but the level of preprimary education is significantly positively related with it. We also find that high-GDP countries have a significantly positive relationship between economy growth and pro-environmental consumption, but low-GDP countries do not have this relationship.

The perverse impact of external reference pricing (ERP): a comparison of orphan drugs affordability in 12 European countries. A call for policy change

ABSTRACTObjective: The study compared the relative cost differences of similar orphan drugs among high and low GDP countries in Europe: Bulgaria, France, Germany, Greece, Hungary, Italy, Norway, Poland, Romania, Spain, Sweden, UK.Methods: Annual treatment costs per patient were calculated. Relative costs were computed by dividing the costs by each economic parameter: nominal GDP per capita, GDP in PPP per capita, % GDP contributed by the government, government budget per inhabitant, % GDP spent on healthcare, % GDP spent on pharmaceuticals, and average annual salary. An international comparison of the relative costs was done using UK as the reference country and results were analysed descriptively.Results: 120 orphan drugs were included. The median annual costs of orphan drugs in all countries varied minimally (cost ratios: 0.87 to 1.08). When the costs were adjusted using GDP per capita, the EU-5 and Nordic countries maintained minimal difference in median cost. However, the lower GDP countries showed three to six times higher relative costs. The same pattern was evident when costs were adjusted using the other economic parameters.Conclusion: When the country’s ability to pay is taken into consideration, lower GDP countries pay relatively higher costs for similarly available orphan drugs in Europe.

Interaction of reward seeking and self-regulation in the prediction of risk taking: A cross-national test of the dual systems model.

In the present analysis, we test the dual systems model of adolescent risk taking in a cross-national sample of over 5,200 individuals aged 10 through 30 (M = 17.05 years, SD = 5.91) from 11 countries. We examine whether reward seeking and self-regulation make independent, additive, or interactive contributions to risk taking, and ask whether these relations differ as a function of age and culture. To compare across cultures, we conduct 2 sets of analyses: 1 comparing individuals from Asian and Western countries, and 1 comparing individuals from low- and high-GDP countries. Results indicate that reward seeking and self-regulation have largely independent associations with risk taking and that the influences of each variable on risk taking are not unique to adolescence, but that their link to risk taking varies across cultures. (PsycINFO Database Record

What do urologists think patients need to know when starting on androgen deprivation therapy? The perspective from Canada versus countries with lower gross domestic product

BackgroundAndrogen deprivation therapy (ADT) side effects are numerous and negatively impact prostate cancer patients’ quality of life. There is considerable discrepancy though among Canadian urologists regarding what ADT side effects and side effect management strategies. Little is known about global differences in ADT patient education.MethodsInternational respondents were recruited via online posting and at an international urology conference. Hypotheses suggest that economic and cultural differences influence patient education practices; therefore, international respondents were divided into 3 categories (high, medium, and low gross domestic product).ResultsNo differences were found between responses from Canadian urologists and high GDP countries. Compared to responses from low GDP countries, Canadian urologists are more likely to endorse informing patients about: osteoporosis, loss of muscle mass, weight gain, fatigue/sleep disturbance, relationship changes, cognitive changes, and loss of body hair. Infertility was the only side effect more often disclosed by urologists in low GDP counties. Recommended management strategies for hot flashes are more likely to be pharmaceutical in Canada, and behavioral in low GDP countries. Management strategies for gynecomastia are emphasized more in low GDP countries. Physical exercise is endorsed consistently more often by Canadian urologists.ConclusionsADT educational practices vary greatly between Canada and lower GDP countries. Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.

Comments by Suresh Narayanan, on Export of Recyclable Materials: Evidence from Japan

Suresh Narayanan: This paper tests the waste haven hypothesis (WHH), which examines the exporting of physical waste materials from countries with stringent environmental regulations to countries where such regulations are lax. The paper focuses on Japan as the exporter of waste and 31 Asian and developed countries as the potential importers of wastes—by implication nations with lax environmental regulations. The paper limits itself to four recyclable resource materials.This version is a much improved one, with the authors having incorporated many of the earlier suggestions. The paper now discusses more explicitly the gains of both developing countries and Japan from the trade in waste. The authors’ data on the regulation index has improved and, more importantly, they find that the regulation gap (the differences in environmental regulations between Japan and the countries that import waste) significantly affects the waste trade. In other words, they contend that their findings now support the WHH that Japan exports waste to countries with less stringent environmental regulations. It is worth noting that the previous version did not.I am still unclear if the predictions the authors set out to test (“high-GDP countries with high wage rates will export to low-GDP countries with low wage rates that have lax regulations and are not too far away”) actually come out of the WHH framework. The better known pollution haven hypothesis (PHH) suggests that highly polluting firms in developed countries with stringent environmental regulations will redirect investment or relocate to countries with the lowest environmental standards or weakest enforcement. This suggests three testable propositions:The WHH as advanced by Kellenberg (2012) differs from the PHH only in the sense that it refers to exports of physical waste rather than the relocation of polluting industries to countries with lax environmental regulations. Are the predictions that the authors set out to test the equivalent testable propositions from the WHH? Despite a better discussion of the WHH in this version, this point is not any clearer. According to D’Amato Mazzanti, and Montini (2013), Kellenberg stressed the importance of structural (population density), market price (gate fees), and technology/capacity as well as regulatory stringency and enforcement in influencing the waste trade. How do the predictions outlined by the authors tie in with the factors outlined by Kellenberg? Distance, for example, received no mention in the WHH.The empirical findings of the authors indicate that countries with a higher GDP, lower per capita income, and location near Japan were more likely to import waste from Japan. Furthermore, high-quality waste was more likely to be exported because of the difficulty of recycling low-quality waste. Finally, their findings suggest that importing countries that implemented stringent environmental regulations were less likely to import waste products.It puzzles me that the authors were only concerned with the sign and significance of the coefficients. Granted, the model might have issues of specification, data, and measurement errors. Despite these limitations, the authors have gone ahead with their estimates. Therefore, they should not have stopped at presenting just the estimated coefficients, which offer no direct interpretation. It would have been more meaningful to present the associated probabilities as well, with the caveat that they are indicative rather than conclusive.Of the variables influencing the waste trade, only environmental regulation serves as a direct policy handle that can be manipulated, if necessary. But this does not necessarily mean that it should be. Therefore, I found it surprising that the authors recommend that all Asian countries should impose substantial tariff rates uniformly on all types of waste to reduce waste export. This is a curious suggestion to make, especially because the authors had argued earlier that lower income countries have some advantages from engaging in the waste trade. Why would they want to restrict a trade that they were benefiting from?Perhaps the policy prescription, if any, that might be made on the basis of their finding is that low income countries should re-evaluate their costs and benefits from engaging in this trade to ensure that they import only waste that they can handle without putting their recycling workers or the environment at risk. Environmental regulations can then be tightened to ensure that hazardous waste is kept out and only safe wastes are imported.The authors make two other useful suggestions. First, countries engaging in exporting waste should inspect it to ensure that only clean and nontoxic recyclables are distributed. Second, importing countries should ensure that they have recycling facilities with environmentally sound technology to handle the waste. Neither of these insights, however, comes directly from the findings of the study.

Accounting for “land-grabbing” from a biocapacity viewpoint

The comparison of the Ecological Footprint and its counterpart (i.e. biocapacity) allow for a classification of the world's countries as ecological creditors (Ecological Footprint lower than biocapacity) or debtors (Ecological Footprint higher than biocapacity). This classification is a national scale assessment on an annual time scale that provides a view of the ecological assets appropriated by the local population versus the natural ecological endowment of a country. We show that GDP per capita over a certain threshold is related with the worsening of the footprint balance in countries classified as ecological debtors. On the other hand, this correlation is lost when ecological creditor nations are considered. There is evidence that governments and investors from high GDP countries are playing a crucial role in impacting the environment at the global scale which is significantly affecting the geography of sustainability and preventing equal opportunities for development. In particular, international market dynamics and the concentration of economic power facilitate the transfer of biocapacity related to “land grabbing”, i.e. large scale acquisition of agricultural land. This transfer mainly occurs from low to high GDP countries, regardless of the actual need of foreign biocapacity, as expressed by the national footprint balance. A first estimation of the amount of biocapacity involved in this phenomenon is provided in this paper in order to better understand its implications on global sustainability and national and international land use policy.