Inter-provincial Disparities Research Articles

How Does Cross-City Patient Mobility Impact the Spatial Equity of Healthcare in China?

The phenomenon of patient mobility is becoming increasingly frequent, altering the actual service ranges of hospitals across various cities. However, its impact on the spatial equity of healthcare services at the national scale has yet to be fully explored. This paper aims to reveal the impact of intercity patient mobility on healthcare equity in China. Using one million patient mobility records from online healthcare platforms, we construct the 2023 Cross-City Patient Mobility Network in China and identify the patterns of cross-city patient mobility. Furthermore, we employ the Dagum Gini coefficient to measure the spatial disparities in per capita healthcare services before and after patient mobility. The results show that: (1) cross-city patient mobility exhibits administrative boundary effects and reflects the administrative hierarchy system, yet megacities extend their healthcare service ranges beyond provincial and urban agglomeration boundaries; (2) patient mobility enhances the equity of per capita healthcare services at both intra-provincial and inter-provincial levels, with inter-provincial disparities contributing significantly more than intra-provincial disparities—a trend further reinforced by patient mobility. This study not only provides a methodological framework for understanding the impact of patient mobility on the healthcare system but also offers empirical support for public health policymaking.

Canadian Association for the Study of the Liver Single Topic Conference on Hepatitis B Virus: ‘Progress toward hepatitis B elimination in Canada’

Hepatitis B virus (HBV) infection affects >290 million people worldwide, including ∼250,000 Canadians, and it stands as a leading cause of end-stage liver disease and liver cancer. The World Health Assembly has set goals for HBV elimination by 2030, aiming for a >90% reduction in incidence and a 65% reduction in deaths compared to 2015. However, as of 2023, no countries were on track to achieve these targets. In Canada, challenges in HBV elimination persist due to the lack of a universal birth dose vaccine and interprovincial disparities in screening and care linkage. The Canadian Association for the Study of the Liver (CASL) and the Canadian Hepatitis B Network hosted the Inaugural Progress toward Hepatitis B Elimination Meeting in Calgary, Alberta, Canada (September 29, 2023 to October 1, 2023). This collaborative platform brought together national and international clinicians, laboratory providers, public health researchers, policymakers, and community-based organizations interested in HBV and hepatitis Delta virus (HDV) / HBV coinfection. The workshop was held during the National Day of Truth and Reconciliation (September 30, 2023) to commemorate the tragic legacy of residential schools in Canada, and it highlighted the need to promote meaningful reconciliation with Indigenous peoples. Key outcomes of the summit included establishing objectives for HBV elimination, advocating for adherence to global targets, universal screening and birth dose vaccination, equitable access to antiviral treatment across all provinces/territories, and addressing special populations. This overview highlights the presentations and emphasizes the importance of collaboration among stakeholders, public health agencies, and government entities to strive for HBV elimination in Canada.

Mobile Government Service Promotion Strategies: Exploring Sustainable Development Pathways Based on Provincial Government Practices in China

The level of mobile government services has become a crucial metric for modernizing a government’s governance capabilities, and it plays a significant role in promoting sustainable development. This study aims to explore the key factors influencing the level of mobile government services across 31 provinces in China, along with their combinatory pathways. Using the technology–organization–environment (TOE) framework and employing fuzzy-set qualitative comparative analysis (fsQCA), this study conducts an in-depth analysis of mobile government service levels across these provinces, focusing on the dimensions of technology, organization, and environment. The results identify three pathways that promote high levels of mobile government services: technology–organization, technology–environment, and internal–external linkage-driven pathways. These pathways offer viable strategies for achieving sustainable development in mobile government services. Additionally, this study identifies two pathways associated with lower service levels, technology deficiency, and organization–environment misalignment, highlighting key factors that hinder sustainable development. The findings suggest that organizational and environmental factors can complement each other based on technological conditions, internet penetration rates, and citizen participation levels. Based on these insights, this study recommends that provincial governments proactively explore sustainable development pathways, optimize the “technology–organization–environment” conditions to harness synergies, and work towards enhancing mobile government service levels, thereby reducing inter-provincial disparities and advancing sustainable development.

Study on Interprovincial Equity and the Decoupling of Carbon Emissions in the Construction Industry—A Case Study in China

Interprovincial disparities in carbon emissions from the construction industry (CECI) are an important challenge for future emissions reductions. Based on the CECI data of 30 provinces in China from 2010 to 2020, the interprovincial equity and decoupling of CECI were examined in this study. The conclusions are as follows: (1): The main CECI growth regions were the eastern Bohai Rim region and the Pearl River Delta region. Heilongjiang basically achieved a CECI carbon peak in 2016. (2) The three northeastern provinces and western provinces were the main high–high and low–low aggregation areas, respectively. The greatest degree of inequality was found in the western provinces. The inequality between the eastern and western areas was the largest, while the inequality between the central and western areas was the smallest. The inequality in CECI in the north–south region decreased year by year. (3) The decoupling status of Shandong and some western provinces has significantly worsened, while the decoupling status of Sichuan, Yunnan, and some eastern developed provinces has been improving. These conclusions will contribute to the improvement of regional emission reduction strategies.

Disparity and driving forces of energy consumption in China's provincial urban residential sector under the carbon neutrality target

China's escalating urbanization contributes significantly to carbon emissions, necessitating an efficient, equitable decarbonization strategy in the urban residential sector. However, an overview of the regional-inequal implications underlying this sector's carbon-neutral pathways is, to our knowledge, still pending. Here, we employ a province-level bottom-up technology optimization model to evaluate energy consumption implications and driving forces, particularly inter-provincial disparities, under various carbon neutrality pathways. We have observed that regional disparities in energy access are largely determined by different carbon cap allocation strategies. Additionally, energy intensity is the key factor influencing changes in energy consumption in scenarios of carbon neutrality compared to scenarios without carbon policies. Furthermore, energy intensity is linked to regional energy consumption disparities across scenarios, with short-term impacts mainly through energy intensity and long-term impacts through energy structure. The study presents a cost-minimizing, equitable carbon neutrality pathway for China's urban residential sector at the provincial level, highlighting that equitable carbon reduction policies promote provincial energy consumption equity compared to cost-efficient strategies. Additionally, the analysis offers guidance for formulating and implementing equitable energy transition policies.

Barriers and Unequal Access to Timely Molecular Testing Results: Addressing the Inequities in Cancer Care Delays across Canada.

Genomic medicine is a powerful tool to improve diagnosis and outcomes for cancer patients by facilitating the delivery of the right drug at the right dose at the right time for the right patient. In 2023, a Canadian conference brought together leaders with expertise in different tumor types. The objective was to identify challenges and opportunities for change in terms of equitable and timely access to biomarker testing and reporting at the education, delivery, laboratory, patient, and health-system levels in Canada. Challenges identified included: limited patient and clinician awareness of genomic medicine options with need for formal education strategies; failure by clinicians to discuss genomic medicine with patients; delays in or no access to hereditary testing; lack of timely reporting of results; intra- and inter-provincial disparities in access; lack of funding for patients to access testing and for laboratories to provide testing; lack of standardized testing; and impact of social determinants of health. Canada must standardize its approach to biomarker testing across the country, with a view to addressing current inequities, and prioritize access to advanced molecular testing to ensure systems are in place to quickly bring innovation and evidence-based treatments to Canadian cancer patients, regardless of their place of residence or socioeconomic status.

Regional disparities, dynamic evolution, and spatial spillover effects of urban-rural carbon emission inequality in China

ObjectiveThis study recalculates the carbon emissions of urban and rural residents in China, analyzing the dynamic evolution trends of urban and rural carbon emissions. It explores the spatial spillover effects centered around the inequality in carbon emissions between urban and rural areas.MethodsThe study calculates the carbon emissions of urban and rural residents in each province based on the IPCC method. Non-parametric kernel density estimation is employed to depict the dynamic evolution characteristics of national, urban, and rural carbon emissions. The Theil Index is used to measure the disparities in urban and rural carbon emissions in major strategic regions, further applying the Theil Index to evaluate the inequality of urban and rural carbon emissions across provinces. This helps identify the driving factors affecting the inequality of urban and rural carbon emissions and their spatio-temporal effects.FindingCarbon emissions from urban and rural residents in China present a divergent development pattern. Urban emissions have increased, with inter-provincial disparities widening; rural emissions tend to stabilize, with slight growth in inter-provincial gaps. The overall inequality of carbon emissions in various regions of China experiences a three-phase journey of rise, decline, and stabilization. Urban inequality first increases then decreases, while rural inequality gradually lessens, showing clear regional and urban-rural differences. Market and government factors significantly impact the inequality of urban and rural carbon emissions. The development of the digital economy aids in reducing inequality and generates significant spatial spillover effects. The relationship between economic development level and carbon emission inequality is U-shaped. Industrial structure optimization can reduce urban-rural inequality, but its spatial spillover effect is not significant. Government intervention has limited effects, while environmental regulations may increase inequality. Opening up to the outside world helps reduce inequality, and the impact of population density is complex.

Data-driven models for the risk of infection and hospitalization during a pandemic: Case study on COVID-19 in Nepal

The newly emerging pandemic disease often poses unexpected troubles and hazards to the global health system, particularly in low and middle-income countries like Nepal. In this study, we developed mathematical models to estimate the risk of infection and the risk of hospitalization during a pandemic which are critical for allocating resources and planning health policies. We used our models in Nepal’s unique data set to explore national and provincial-level risks of infection and risk of hospitalization during the Delta and Omicron surges. Furthermore, we used our model to identify the effectiveness of non-pharmaceutical interventions (NPIs) to mitigate COVID-19 in various groups of people in Nepal. Our analysis shows no significant difference in reproduction numbers in provinces between the Delta and Omicron surge periods, but noticeable inter-provincial disparities in the risk of infection (for example, during Delta (Omicron) surges, the risk of infection of Bagmati province is: ∼ 98.94 (89.62); Madhesh province: ∼ 12.16 (5.1); Karnali province ∼31.16 (3) per hundred thousands). Our estimates show a significantly low level of hospitalization risk during the Omicron surge compared to the Delta surge (hospitalization risk is: ∼10% in Delta and ∼2.5% in Omicron). We also found significant inter-provincial disparities in the hospitalization rate (for example, ∼ 6% in Madhesh province and ∼ 21% in Sudur Paschim) during the Delta surge. Moreover, our results show that closing only schools, colleges, and workplaces reduces the risk of infection by one-third, while a complete lockdown reduces the infections by two-thirds. Our study provides a framework for the computation of the risk of infection and the risk of hospitalization and offers helpful information for controlling the pandemic.

Evaluation of Agricultural Eco-Efficiency and Its Spatiotemporal Differentiation in China, Considering Green Water Consumption and Carbon Emissions Based on Undesired Dynamic SBM-DEA

Both agricultural output and environmental pollution in China show certain characteristics of spatiotemporal variation due to the evolution and inter-provincial disparities of resource endowment, economic development level, and production mode. This paper considered the green water consumption, carbon emissions in agricultural production, and the persistent role of fixed asset investment, constructed an undesired dynamic SBM-DEA model, and evaluated the agricultural eco-efficiency (AEE) of 31 provinces in China from 2007 to 2018, analyzing the spatiotemporal differentiation. The results show that, during 2007–2018, the following can be concluded: (1) The AEE of 31 provinces in China showed the characteristics of an overall stable rise from 0.64 to 0.70 but uneven development among regions from 2007 to 2018. (2) The averages of either the agricultural resource consumption efficiency index or pollution emission efficiency index in 31 provinces slightly increased over time, while the average value of the agricultural fixed asset investment efficiency index showed a decline in volatility. The spatial discrepancy of any index mainly stems from the index disparity between groups with a high AEE and groups with a low one, with contribution rates of more than 85%. (3) It is recommended to emphasize strengthening communication and cooperation between provinces with high and low AEE and implement distinct regional strategies to improve AEE.

Estimates of incidence, prevalence, mortality, and disability-adjusted life years of lung cancer in Iran, 1990-2019: A systematic analysis from the global burden of disease study 2019.

Lung cancer is one of the leading cancers, with a high burden worldwide. As a developing country, Iran is facing with population growth, widespread tobacco use, demographic and epidemiologic changes, and environmental exposures, which lead to cancers becoming a severe concern of public health in Iran. We aimed to examine the burden of lung cancer and its risk factors in Iran. We utilized the Global Burden of Disease 2019 data and analyzed the total burden of the lung cancer and seven related risk factors by sex, age at national and sub-national levels from 1990 to 2019. The lung cancer age-standardized death rate increased from 11.8 (95% Uncertainty Interval: 9.7-14.4) to 12.9 (11.9-13.9) per 100,000 between 1990 and 2019. This increase was among women from 5 (4.2-7.1) to 8 (7.2-8.8) per 100,000; in contrast, there was a decline among men from 18.5 (14.8-22.6) to 17.8 (16.2-19.4) per 100,000. The burden of lung cancer is concentrated in the advanced age groups. Smoking with 53.5% of total attributable deaths (51.0%-55.9%) was the leading risk factor. At the provincial level, there was a wide range between the lowest and highest, from 8.3 (7.0-10.0) to 19.1 (16.4-22.0) per 100,000 population in the incidence rate and from 8.7 (7.3-10.3) to 20.6 (17.7-24.0) per 100,000 population in mortality rate, respectively in Tehran and West Azerbaijan provinces in 2019. The increasing trend of lung cancer burden among the entire Iranian population, the inter-provincial disparities, and the significant rise in burden of this cancer in women necessitate the urgent implementation and development of policies to prevent and manage lung cancer burden and strategies to reduce exposure to risk factors.

CHANGES OF SPATIAL DISPARITIES IN SATELLITE-DERIVED PM2.5 EXPOSURES OVER 2010–2019 IN CHINA

Abstract. Air pollution, especially fine particulate matter (PM2.5), has attracted extensive attention due to its adverse impacts on public health. Although PM2.5 pollution was significantly reduced in China over time, while little is known how the spatial disparity of PM2.5 exposure has evolved, especially from both absolute and relative perspectives. Here, we estimate the long-term PM2.5 exposures in China based on satellite observations and convolutional neural network, and characterize the spatial disparity of PM2.5 exposure using Theil index and rank-rank relationship. The result shows that both PM2.5 exposure and absolute spatial disparity were substantially reduced between 2010 and 2019. The nation-wide concentrations (Theil index) declined from 48.0µg/m3 (0.13) to 35.5µg/m3 (0.054). The inter-provincial disparities dominate the overall disparity in 2010, while the intra-provincial disparity contributed the most in 2019. However, while absolute disparities have diminished, relative disparities persist. PM2.5 exposures in the least 20th percentile polluted cities have increased over time, while exposures in other regions declined. On average, the more (less) polluted cities in 2010 were still the more (less) polluted cities in 2019 (except for the very most 2 percentile polluted cities), indicating that the population in more polluted cities still experiences more air pollution than others. Spatial pattern of relative disparity changes was also observed. Overall, understanding not only absolute spatial disparity but also relative disparity is required to help formulate targeted policies for an equitable environment, leaving nobody behind.

Not All Canadian Cancer Patients Are Equal-Disparities in Public Cancer Drug Funding across Canada.

Canada lacks a national drug insurance plan. The home province or territory of a patient determines which cancer drugs are available on the public formulary, who is eligible for public coverage and what portion of the financial burden of cancer care falls to the individual. This narrative review describes the current interprovincial disparities in access to cancer drugs across Canada. Health technology assessment (HTA) of drugs at a provincial and territory level is a closed process, does not necessarily follow the recommendations of national HTA and leads to further delays in drug access. The public coverage of take-home cancer drugs (THCDs) in Ontario and the Atlantic provinces is often fragmented, unnecessarily complex and a barrier to cancer drug access. Policy solutions to address inter-provincial formulary variation and poor access to THCDs are discussed.

Inter-provincial disparity of COVID-19 transmission and control in Nepal

Despite the global efforts to mitigate the ongoing COVID-19 pandemic, the disease transmission and the effective controls still remain uncertain as the outcome of the epidemic varies from place to place. In this regard, the province-wise data from Nepal provides a unique opportunity to study the effective control strategies. This is because (a) some provinces of Nepal share an open-border with India, resulting in a significantly high inflow of COVID-19 cases from India; (b) despite the inflow of a considerable number of cases, the local spread was quite controlled until mid-June of 2020, presumably due to control policies implemented; and (c) the relaxation of policies caused a rapid surge of the COVID-19 cases, providing a multi-phasic trend of disease dynamics. In this study, we used this unique data set to explore the inter-provincial disparities of the important indicators, such as epidemic trend, epidemic growth rate, and reproduction numbers. Furthermore, we extended our analysis to identify prevention and control policies that are effective in altering these indicators. Our analysis identified a noticeable inter-province variation in the epidemic trend (3 per day to 104 per day linear increase during third surge period), the median daily growth rate (1 to 4% per day exponential growth), the basic reproduction number (0.71 to 1.21), and the effective reproduction number (maximum values ranging from 1.20 to 2.86). Importantly, results from our modeling show that the type and number of control strategies that are effective in altering the indicators vary among provinces, underscoring the need for province-focused strategies along with the national-level strategy in order to ensure the control of a local spread.

Regional carbon imbalance within China: An application of the Kaya-Zenga index

Considering the enlarging inter-provincial disparities in China as regards carbon emissions and carbon intensity (carbon emissions per unit gross domestic product), this paper is the first study to investigate the inter-provincial carbon imbalance by constructing and employing the Kaya-Zenga index. We use China's panel data of provincial-level carbon emissions over 1995–2016 to quantitatively measure the levels of inter-provincial imbalance and polarization in carbon emissions and carbon intensity. Further, we decompose the Kaya-Zenga index into different contributing factors both regionally and structurally and perform a scenario analysis to identify the corresponding regionally differentiated countermeasures regarding carbon emission reduction. The results show that the imbalance in carbon emissions is mainly caused by imbalances in population scale and income level, while the imbalance in carbon intensity predominantly results from imbalances in energy efficiency and energy mix. In addition, for heavy manufacturing provinces, the respective emission-reduction strategy should aim at lowering energy intensity through local technology improvement and inter-regional technology transfer. For light manufacturing and high technology provinces, carbon emission reduction is harder to be achieved; however, a mix of policies of improving energy efficiency, optimizing energy mix, and industrial upgrading should be implemented. The results of the scenario analysis indicate that reducing imbalance in carbon intensity under different scenarios can lead to a substantial reduction in carbon emissions (up to 10%).

Population Growth and Inter-Provincial Economic Disparity

Pakistan’s population growth is the highest in Asia, yet savings is the lowest. By looking at the concept and meaning of development, this paper analyzes how population growth, along with problems of bad governance, inter-provincial and intra-provincial economic disparities, and poor–rich divides have affected Pakistan’s economic development. The study focuses on the relationship between population growth and economic development by looking at the Malthusian population trap theory, taking Pakistan as a contemporary case study. Also discussed is whether population growth is an actual problem behind poverty and underdevelopment, or whether the problem is caused by something else, such as unequal distribution of wealth between developed and developing nations or poor–rich divides. The paper addresses the political Left’s point of view and looks at inter-provincial economic disparity in Pakistan. Having discussed the problems of population growth and inter-provincial economic disparity in Pakistan through comparative study of Punjab, the most populated and highly developed province, with other provinces of Pakistan, specifically Balochistan, through analyzing the merger of Balochistan with Pakistan to the emergence of the Baloch separatist movement, this paper shows possible ways to resolve these issues in light of social, political, and religious issues prevailing in Pakistani society today.

Changing incidence of reported viral hepatitis in China from 2004 to 2016: an observational study

ObjectiveChina’s national hepatitis burden is high. This study aims to provide a detailed national-level description of the reported incidence of viral hepatitis in China during 2004–2016.DesignObservational study.SettingData were obtained from...

Macroeconomic shocks in China: Do the distributional effects depend on the regional source?

There is a growing consensus that, as part of China’s “New Normal”, economic growth will slow permanently. Given China’s geographic diversity, the slowdown will likely have differential effects on China’s provinces which will interact with existing disparities. We investigate whether confining the initial effect of an aggregate shock to one of three regions (coast, centre and west) affects the inter-provincial distribution of its effects over time. We use two alternative models: a restricted VAR model of 28 provinces and three regions and a sequence of 28 four-equation VAR models. We find that the two methods give remarkably similar results—a shock to a particular region’s output has its main effects on the provinces in that region, although this differs over time and across regions. A shock which originates in the coastal region affects mainly the coastal provinces in both the short and long runs so that a growth reduction is likely to ameliorate existing inter-provincial disparities. However, there is more diffusion of the effects of a central shock, particularly in the long run. A shock to the western region also generates spillover effects in the long run although these are to the coastal provinces so that a growth slowdown will tend to reduce existing disparities.

A Comparative Analysis of Residential Energy Consumption in Urban and Rural China: Determinants and Regional Disparities.

Residential energy consumption (REC) has become increasingly important in constructing an energy-saving and environment-friendly society in China. The main purpose of this study is to provide a more in-depth analysis of the determinants of REC from an urban-rural segregation perspective, and quantify the contributions of individual determinants to the regional disparities of REC. Based on the extended STIRPAT (the stochastic impacts by regression on population, affluence, and technology) model, seemingly unrelated regression (SUR) estimation is employed to examine the impacts of various determinants of urban REC per capita (URECP) and rural REC per capita (RRECP) in a sample of China’s 30 provinces over the period 2007–2016. Then, following the results of SUR, this paper tries to explore the reasons for interprovincial disparities of URECP and RRECP by using the Shapley value decomposition. The empirical results show that income level and heating lead to an increase in URECP, while other factors, including the share of natural gas, average temperature, child dependency ratio and gross dependency ratio, significantly decrease URECP. In terms of RRECP, it is shown that old-age dependency ratio, income level and the share of coal consumption positively influence RRECP, while average temperature has a negative effect on RRECP. Specially, the effect of gross dependency ratio on RRECP is positive, indicating the non-working-age population causes more energy use than the working-age population in rural areas. According to the Shapley decomposition, rather than social-economic variables, climate and heating factors contribute the most to the interprovincial differences in URECP. Furthermore, it is found that income level is the most important factor accounting for inter-provincial differences in RRECP. The findings of this research are of great interest, not only to scholars in REC-related fields, but also to decision makers.

A Spatio-Temporal Pattern and Socio-Economic Factors Analysis of Improved Sanitation in China, 2006⁻2015.

Ensuring an adequate and safe access to sanitation is essential to prevent diseases. Using provincial spatial panel data reported in the China Health Statistical Yearbook and the China Statistical Yearbook, this paper analyzed the spatio-temporal characteristics of improved rural sanitation in 30 Chinese provinces during the period 2006–2015, and analyzed factors that may affect improved sanitation rates in rural China. Spatial autocorrelations of improved sanitation rates were computed via Global and Local Moran’s I firstly, and then, inter-provincial disparities of improved sanitation were assessed by using the Theil index estimator; finally, the spatial panel model was employed to examine the potential socio-economic factors. Spatial autocorrelations results suggested that the provincial improved sanitation rates changes affect both the provinces themselves and the adjacent regions; Analysis of the spatial panel model revealed that factors such as GDP per capita, investment proportion ratio, centralized water supply, rural residents’ expenditure were positively associated with improved sanitation rates, and illiteracy rate of people older than 15 was negatively related with improved sanitation rates. Socio-economic factors had affected the improved sanitation rates in 30 provinces in rural China. Thus, a series of policies, socio-economic measures and personal latrine literacy education should be given to improve the status of improved sanitation rates in rural China.

Stitching the gaps in the Canadian public drug coverage patchwork? A review of provincial pharmacare policy changes from 2000 to 2010

Objectives To describe recent changes and identify emergent trends in public drug benefit policies in Canada from 2000 to 2010. Methods For each province, we tracked pharmacare design (namely eligibility, premiums, and patient cost-sharing) over time for three beneficiary groups: social assistance recipients, seniors, and the general non-senior population. We assess which plan designs are emerging as a national standard, where the gaps in public coverage remain, and implications for progress towards national pharmacare. Results Expansion of public drug coverage has been limited. For social assistance recipients, first-dollar coverage is the standard. Seniors coverage remains varied, though means testing of eligibility or cost-sharing is common. Seniors benefits were significantly expanded in only one province. As of 2010, six provinces have embraced age irrelevant catastrophic income-based coverage, in some, resulting in the elimination of seniors drug benefits. Conclusions Universal income-based catastrophic coverage appears to be emerging as an implicit national standard for provincial pharmacare. However, due to the variation and high level of patient cost-sharing required under these programs, convergence on this model does not equate to substantial progress towards expanding coverage or reducing interprovincial disparities. Leverage of federal spending power to promote standards for public drug coverage is necessary to uniformly protect Canadians against high drug costs.