Occupational Health Behaviors Research Articles

PREDICTING SELF-ASSESSED HEALTH STATUS IN WOMEN: WHAT COUNTS FOR GERMAN MIDWIVES AND MEDICAL OFFICE ASSISTANTS?

Previous studies on women's work and health have tended to summarize women's occupations in broad categories and ignore job-specific workload. We compared occupational characteristics, burnout, health behaviour, and predictors of subjective health status between German midwives and medical office assistants (MOAs). We conducted a cross- sectional survey using a standardized questionnaire with items addressing aspects of the occupational biography, job characteristics, unpaid work, social support, gender role orientation, and health status and behaviour. Burnout was measured using the Maslach Burnout Inventory (MBI, Maslach and Jackson 1986). Altogether 386 questionnaires for midwives and 552 questionnaires for MOAs were sent out (response rates 60.4% and 44.1% respectively). Chi-square- and Mann-Whitney-U-tests and multiple regression models were conducted. Significant group differences were found regarding, for example, satisfaction with salary and control. More midwives than MOAs would choose their profession again (p<0.001). The level of burnout was medium for MOAs. Midwives had medium levels of burnout on two subscales and low levels on one subscale of the MBI. Health behaviours such as smoking, alcohol consumption and exercise did not differ between the occupations. Midwives conducted breast self-examination and ate whole-wheat products more often, whereas MOAs utilized GP and cancer checkups more frequently and consumed more medication. Satisfaction with salary and overtime hours predicted burnout in both occupations. Burnout and smoking were the only overlapping predictors of the health status of midwives and MOAs. Further studies should consider differences between female-dominated occupations when designing appropriate studies on women's health. Increases in salary and reductions in overtime hours may be appropriate interventions for health promotion in these occupations.

Men working through mobile applications in Brazil: Reflections from occupational health

Work through mobile applications emerged as an alternative for many Brazilian men during the economic crisis and rising unemployment. However, these workers operate informally, without a formal employment relationship, leading to labor precariousness and a lack of workers' rights. Using a theoretical-reflexive, this study analyzes the intersection between occupational health, the platformization of work, and the specific challenges faced by male delivery app workers, especially during the COVID-19 pandemic. Reflective categories are divided into two thematic sections: "Labor insertion through mobile applications in Brazil and the algorithmic work model" and "men, health, and motorcycles: occupational health and male behavior in app-based delivery work." The study examines the expansion of this type of work in the Brazilian socio-economic context, the lack of security and labor protection for these workers, as well as the risks faced, particularly during the pandemic, within a male-centric culture.

Adherence To Healthy Lifestyle Among Medical Workers In Routine Practice And During The COVID-19 Pandemic Abroad

Introduction. A healthy lifestyle is a lifestyle aimed at preventing emergence and development of non-communicable diseases characterized by exclusion or reduction of behavioral risk factors. Adherence to the principles of healthy lifestyle among medical workers abroad is of great importance. Therefore, it is relevant to study foreign experience related to adherence to healthy lifestyle among medical professionals (doctors and nursing staff), both in routine practice and during the COVID-19 pandemic.
 Materials and methods. During a search for the keywords “healthy lifestyle”, “medical workers” and “pandemic” in the period from 2014 to 2023 conducted in the PubMed international database, more than a thousand of systematic reviews, meta-analyses and articles on relevant scientific and practical topics were found. Results of interest included occupational health and health behavior of medical workers. After the final selection and exclusion of the results that are scientifically and practically insignificant, 30 sources from 27 countries were included in the analysis. The authors assessed the quality of these reviews, meta-analyses and articles and obtained new summarized data on the topic.
 Results and discussion. The article presents analysis and summary of 30 systematic reviews, meta-analyses and articles published from 2014 to 2023 by authors from 27 countries. For this purpose, the results of an analysis of adherence to healthy lifestyle among medical workers, the relationship of lifestyle and health-related behavior; lifestyle, shift work and health; lifestyle and disease development in routine practice as well as during the COVID-19 pandemic were presented.
 Conclusion. The correlation of lifestyle and health-related behavior of medical workers; lifestyle, shift work and health; lifestyle and disease development in routine practice as well as during the COVID-19 pandemic were revealed. Optimizing recommendations suggesting necessary and appropriate measures to improve the adherence to healthy lifestyle among medical workers were elaborated.

Occupational Health and Safety Behavior in the Fisherman Group of Muara Tembulih Village, Ngambur District, Pesisir Barat

Background: Occupational health and safety is a right for workers in the formal and informal sectors, as well as for fishermen. Fishermen are very vulnerable to work accidents. This is caused by fishermen's lack of knowledge about occupational health and safety. As many as 80% of marine accidents are caused by human error and other causes are negligence by maritime transportation organizers and related agencies, as well as inadequate marine transportation safety equipment. Based on the background of this problem, this research was carried out to find out work health and safety behavior among fishermen groups in Muara Tembulih Village, Pesisir Barat Regency. Method: This research uses descriptive research with a qualitative approach. The independent variables in this research are fishermen's knowledge, attitudes and beliefs. The dependent variable of this research is the occupational health and safety behavior of fishermen groups. Result: The results of this research are that fishermen define occupational health and safety as traditional knowledge about safety when fishing, based on empirical experience passed down from generation to generation from their ancestors and combining knowledge obtained through government outreach. Fishermen in realizing occupational health and safety behavior with simplicity and knowledge are quite good, in bad weather conditions fishermen prefer not to go to sea due to the high risk. Fishermen are aware of the importance of occupational health and safety for fishermen, therefore fishermen bring personal protective equipment before going to sea as an alternative to bad conditions at sea. Including considering bad weather, fishermen prefer to return to their home villages for safety. Fishermen's actions in realizing occupational safety and health behavior from observations are still simple.

Relationship between compliance with the use of personal protective equipment (PPE) and occupational health and safety behavior (K3) on the performance of PT Enam Prakarsajaya Mandiri

This research aims to analyze the relationship between compliance with the use of PPE and K3 behavior on employee performance at PT. Enam Prakarsajaya Mandiri. This research uses primary data obtained through interviews and filling out questionnaires for 123 permanent and temporary employees at PT. Enam Prakarsajaya Mandiri were selected through a purposive sampling method using SPSS 25 to quantitatively measure compliance with the use of PPE, K3 behavior and employee performance in the company. The research results show that K3 behavior and compliance with the use of PPE have a significant effect on employee performance. Compliance with the use of PPE has a significant influence on employee performance and K3 behavior has a significant influence on employee performance. This research will be input for PT. Enam Prakarsajaya Mandiri to continue to be committed to improving K3 training and facility quality to achieve good K3 behavior and compliance with the use of PPE. Because high levels of K3 behavior and compliance with the use of good PPE will improve employee performance, which is the ticket to the success of all businesses.

Evaluation of occupational health and safety intervention for the waste and sanitation workers in Bangladesh during COVID-19

Waste and sanitation workers in South-Asian countries are vulnerable to injuries and diseases, including COVID-19. In Bangladesh, an intervention was implemented during COVID-19 to lower these workers' occupational health risks through training and PPE distribution.We assessed how the intervention affected their occupational health behaviors using a randomized cluster trial in 10 Bangladeshi cities, including seven intervention and three control areas. We conducted 499 surveys (Control-152, Intervention-347) and 47 structured observations (Control:15, Intervention:32) at baseline and 499 surveys (Control:150, Intervention:349) and 50 structured observations (Control:15, Intervention:35) at endline. To evaluate the impact of intervention at the endline, we used the difference in difference (DID) method.Compared to control, workers from intervention areas were more likely to have increased knowledge of using/maintaining PPEs (adjusted DID: 21%, CI: 8, 33), major COVID-19 transmission causes (adjusted DID: 27%, CI: 14, 40), and preventive measures (adjusted DID: 12%, CI: -0.6, 25), and improved attitude about using PPEs (adjusted DID: 36%, CI: 22, 49), washing PPEs (adjusted DID: 20%, CI: 8, 32). The intervention was more likely to improve workers' self-reported practice of taking adequate precautions after getting back from work (adjusted DID: 37%, CI: 27, 47) and changing/cleaning masks every day (adjusted DID: 47%, CI: 0.03, 94), and observed practices of maintaining coughing etiquette (DID: 20%, CI: 0.2, 40) at workplace and handwashing before wearing PPEs (DID: 27%, CI: 2, 52), after finishing work (DID: 31%, CI: -7, 69) & during work intervals (DID: 30%, CI: -33, 93). There was not much improvement in observed practices of mask use (DID: 1%, CI: -40, 42), handwashing before meals (DID: 2%, CI: -61, 65), and after toilet (DID: 7%, CI: -41, 55).This intervention has improved the knowledge, attitude and practice of the workers about critical occupational risk mitigation, which may be replicated in similar settings. Future interventions need to address occupational health-related injuries and health complications, introduce regular health checkups/insurance for the workers, create a balance between the quality and comfort of the PPEs and ensure a mechanism to ensure a regular supply of PPEs.

Trust and Occupational Safety Behavior Related to Decompressive Diseases on Bajo Ethnic Divers

The total area of Indonesian waters exceeds the land area, so the sea becomes one of the land community's livelihoods. Majority of the Bajo ethnic community work as traditional diver fisherman. This study examined trust community and their occupational safety and health behavior related to decompression sickness in Ethnic Bajo Divers. This type of research was qualitative, using an ethnographic study approach. Key informants in this study were ethnic Bajo divers who experienced and did not have paralysis. Data were collected through observation, in-depth interviews, documentation, sources, methods, and time triangulation. The beliefs and traditions of ethnic Bajo divers were related to safety and prevention. Decompression was before diving, asking for safety from the Almighty Creator by saying greetings and basmalah and praying before diving, which was a form of permission to The Guardian of the Sea. The Personal Protective Equipment that must be used were glasses (wooden/traditional glasses or glasses Ventara/modern). Decompression was understood as a disease cold with symptoms of cramps in the lower limbs obtained the result of diving for a long time at a certain depth to find seawater that was yellow like oil and very cold. Bajo tribe divers perform decompression treatment based on local wisdom and instill occupational health and safety behaviors and convince themselves by praying and saying basmallah before diving.

EDUKASI PENINGKATAN PENGETAHUAN DAN PERILAKU KESELAMATAN KESEHATAN KERJA NELAYAN TERHADAP ALAT PELINDUNG DIRI

Occupation, including fishermen, is one type of work that has potential hazards and risks of accidents and occupational diseases because fishing activities are carried out in the middle of the sea or along the coast. Fishermen can experience work accidents such as drowning, drifting, ship damage, injuries due to fish spines, low back pain, fever and others. Fishermen need personal protective equipment to reduce the risk of accidents and occupational diseases. The objectives of holding education to increase knowledge and behavior of fishermen's occupational health safety regarding personal protective equipment in fishermen settlements in Galang District, Batam City are: 1) increasing knowledge of occupational safety and health of fishermen regarding fishermen's personal protective equipment. 2) improve fishermen's occupational safety and health behavior towards personal protective equipment. 3) fishermen can use standard personal protective equipment.

Estratégias cognitivas e metacognição em terapia ocupacional para um paciente com COVID-19 longa: estudo de caso

Abstract Introduction The impact of COVID-19 on occupational and cognitive functioning deserves further exploration since clinicians have observed long COVID and neurological manifestations of COVID-19 long after the remission of respiratory symptoms. Patients with long COVID represent an underexplored population in need of quality occupational therapy interventions. Objectives (a) present an experience report on occupational therapy for assessment and intervention with this population in a hospital setting; (b) demonstrate how perceived occupational performance and health behavior can be improved by the adoption of cognitive strategies and strategies for changing habits. Method This was a single-case study of a long COVID patient in a hospital setting. A description of the framework for assessment and treatment is provided. The patient received a total of nine sessions focused on the use of cognitive strategies and metacognition. The data were analyzed descriptively. Results After exploring guided interventions, the client could create new habits and routines and have perceived occupational performance. Conclusion This experience report presents a framework for assessing and intervening in long COVID that highlights neurocognition. Prospective studies should evaluate if the effects of the proposed awareness assessment and treatment guidelines are reproducible in other settings and if this approach could be helpful for other COVID-19 survivors.

Relationship of Occupational Safety and Health Knowledge to The Occupation of Paramedical Occupational Accidents

Occupational health and safety is a fundamental issue. Work accidents, directly or indirectly, can cause losses to the company, among others, late completion of work, decreased productivity, and healing costs for employees. This study aims to determine the relationship between knowledge of occupational safety and health behavior with the occurrence of paramedic work accidents at UKI Hospital in 2018. This type of research is correlational, with a total of 30 samples. This study found a relationship between knowledge of occupational safety and health with attitudes and actions to prevent work accidents among nurses at UKI Hospital.
 Keywords: Occupational Accident, Occupational Health and Safety, Paramedic.

Status of Workers' Health Behavior and the Association between Occupational Characteristics and Health Behavior.

This study investigated differences in unhealthy lifestyle behaviors (ULBs) between workers and nonworkers and demonstrated the association of ULBs with occupational characteristics among workers. This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey from 2007 to 2019. For sociodemographic data, chi-squared tests were used to analyze categorical variables. Odds ratios (ORs) and 95% confidence intervals (CIs) for ULBs were estimated using Poisson regression models after adjusting for age, sex, educational level, and household income. The variables used were current smoking status, heavy drinking, and physical inactivity. Workers were associated with an increased risk of current smoking (adjusted OR (aOR) = 1.48, 95%CI = 1.41–1.56), heavy drinking (aOR = 1.79, 95%CI = 1.68–1.90), and physical inactivity (aOR = 1.07, 95%CI = 1.04–1.11) compared with nonworkers. Among workers, the differential risks of ULB according to occupational characteristics were as follows: skilled manual workers, self-employed workers, and workers working >40 h/week were at a higher risk of engaging in all ULBs than those in other occupational categories, paid workers, and workers working ≤40 h/week, respectively. Workers showed a higher risk of ULBs than nonworkers. The risk of ULBs differed according to occupational characteristics, highlighting the need for additional studies and detailed occupational health management.

Implementation Evaluation of a Cluster Randomized Controlled Trial to Promote the Use of Respiratory Protective Equipment Among Migrant Workers Exposed to Organic Solvents in Small and Medium-Sized Enterprises.

BackgroundWhile the effectiveness of several occupational healthcare interventions has been demonstrated, successful implementation of such programs among internal migrant workers (IMWs) in small and medium-sized enterprises (SMEs) has been limited. This study aimed to evaluate the implementation of a three-arm cluster randomized controlled trial promoting respiratory protective equipment (RPE) use among IMWs exposed to organic solvents in SMEs and to assess the association between participants' compliance and effectiveness of intervention.MethodsA total of 60 SMEs were randomly allocated to a low- or high-intensive intervention group, or a control group that did not receive any intervention. The low-intensive intervention group was subjected to both traditional and mHealth occupational health education. The high-intensive intervention group was subjected to the low-intensive group activities and peer education. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide implementation evaluation of this 6-months intervention. Generalized linear mixed models (GLMMs) were used to evaluate the effects of participants' compliance with the intervention on the primary outcomes, regarding the appropriate use of RPE.ResultsOf 4,527 potentially eligible participants, 1,211 individuals were enrolled, with a reach rate of 26.8%. Sixty of the 66 SMEs approached (90.9%) SMEs adopted the intervention. Fidelity to traditional education (100.0%) and mHealth intervention (97.5%) was higher than fidelity to peer education (20.0%). Peer leaders cited inconvenient time and unfamiliarity with peers as two major barriers to delivering peer education. Compared with the control group, IMWs who complied with the interventions in both groups were more likely to wear RPE appropriately [low-intensive group: adjusted odds ratio (aOR) = 2.58, 95% confidence interval (CI): 1.56–4.28; high-intensive group: aOR = 7.52, 95% CI: 3.72–15.23]. Most participants (95.8%) were satisfied with the program and 93.1% stated that they would maintain the use of RPE in the future.ConclusionsA multi-component occupational health intervention to promote the use of RPE among IMWs in SMEs was feasible and acceptable. Peer education had great potential to enhance the occupational health behavior of IMWs, and thus strategies to improve participants' adherence to this component warrant further investigation.Clinical Trial Registrationhttp://www.chictr.org.cn, identifier: ChiCTR-IOR-15006929.

Effects of Occupational Stress and Health Behaviors on Heart Rate Variability in Live-Fire Instructors.

This study aimed to identify the association between the healthrelated characteristics and the subscales of occupational stress of live fire instructors and heart rate variability (HRV). We conducted questionnaire survey on a general health checkup for 15 live fire instructors. Occupational stress and HRV parameters were measured to determine the association between health behavior, including smoking, drinking, exercise, and sleep-related disorders, and occupational stress of live fire instructors and HRV parameters using Spearman's rank correlation coefficient. Smoking, insomnia, and job insecurity, a subscale of occupational stress measurement, showed negative Spearman rank correlations with HRV. Insomnia, smoking, and job insecurity (due to occupational stress) among live fire instructors were associated with decreased HRV.

Occupational health and safety of multinational construction companies through evaluation of corporate social responsibility reports

Introduction: The aim of this paper is to examine Occupational Health and Safety (OHS) behavior in the construction industry through the assessment of Corporate Social Responsibility reports. The level of accident rates in the construction industry place OHS issues at the heart of their strategic management. Method: The assessment of OHS issues was made by drawing appropriate data from the Corporate Social Responsibility reports of 19 multinational construction companies published on a voluntary basis. Results: The findings show a low response rate by the companies sampled to the requirements of stakeholders for responsible organizational behavior and accountability for their consequences. Most of the companies sampled have only focused on a small number of OHS issues to assure the transparency of the information published such as OHS governance, accident and illness rates, training hours, third party assurance, and membership of externally developed OHS charters. Similarly, other important OHS issues seem to be less covered by the companies sampled such as the representation of total workforce in OHS committees, the percentage of high risk occupations, and OHS practices in the supply chain.

Factors Affecting Occupational Safety and Health Behavior in Welding Workshop Workers

Background:
 Accidents are generally caused by workers not applying a safety act in welding work, improper use of protective equipment, improper environmental regulation
 Objectives:
 This study aims to determine the factors related to occupational safety and health behavior in welding workshop workers.
 Research Metodes: 
 This research is a quantitative study with an observational approach using a cross sectional design. The research sample was 52 welding workshop workers in Suka Karya Village, Jambi City. The sampling technique was purposive sampling. The instrument used was a questionnaire. Data collection techniques by interview.
 Findings: 
 Bivariate results show that there is a relationship between knowledge (p = 0.000), attitude (p = 0.004) and occupational safety and health facilities (p = 0.003) with the behavior of implementing occupational safety and health among welding workshop workers in Suka Karya Village.
 Conclusion: 
 Occupational safety and health behavior in welding workshop workers is related to knowledge, attitudes, and facilities
 
 Keywords: occupational safety and health behavior

Impact of emotional intelligence on the stress and safety of construction workers' in Saudi Arabia

PurposeIn a country like Saudi Arabia, where the construction industry is witnessing an impressive growth in the post-oil era, it is important to examine the occupational health and safety behaviors of construction workers (CWs).Design/methodology/approachThe present study aims to investigate the impact of emotional intelligence (EI) on workers' stress and safety behaviors. Data were collected from CWs (n = 265) at a major construction site in the city of Jeddah. Two questionnaires comprising 25 and 32 questions were used to measure their EI and stress levels, respectively. Furthermore, structured interviews were conducted with the managers and supervisors to inquire about the safety behavior of their respective workers. Descriptive statistics, simple and companion regression were used for data analysis.FindingsThe findings indicate that EI plays an important role to enhance the safety behaviors of the CWs besides reducing their workplace stresses. Furthermore, workers' stress levels are found to negatively impact their safety behaviors, indicating that any reduction in occupational stress can reciprocally enhance their safety compliance. The findings are further discussed with the concerned stakeholders to recommend a seven-point therapeutic role of EI for the safety of CWs.Originality/valueResults of the study can be used by managers and supervisors of the Saudi construction industry to reduce workplace accidents and improve the productivity of their organizations.

Occupational Differences in Metabolic Syndrome Incidence Among Older Workers

This study investigates whether the incidence of metabolic syndrome (MetS), and its components, differs by occupational group among older workers (45-65 years) and whether health behaviors (smoking, leisure-time physical activity, diet quality) can explain these differences. We analyzed data from older workers (N=23 051) from two comprehensive measurement waves of the Lifelines Cohort Study and Biobank. MetS components were determined by physical measurements, blood markers, medication use, and self-reports. Occupational group and health behaviors were assessed by questionnaires. The association between occupational groups and MetS incidence was examined using Cox regression analysis. Health behaviors were subsequently added to the model to examine whether they can explain differences in MetS incidence between occupational groups. Low skilled white-collar (HR: 1.25, 95% CI: 1.13, 1.39) and low skilled blue-collar (HR: 1.45, 95% CI: 1.25, 1.69) workers had a significantly higher MetS incidence risk during 3.65 years follow-up than high skilled white-collar workers. Health behaviors reduced the strength of the association between occupational group and MetS incidence most among low skilled blue-collar workers (i.e. 10.3% reduction) as unhealthy behaviors were more prevalent in this occupational group. Similar occupational differences were observed on MetS component level. To conclude, MetS incidence in older workers differs between occupational groups and health behaviors only explain a small part of these differences. Health promotion tailored to occupational groups may be beneficial specifically among older low skilled blue-collar workers. Research into other factors that contribute to occupational differences is needed, as well as studies spanning the entire working life course.

Occupational Stressors and Safety Behaviour among Oil and Gas Workers in Kuwait: The Mediating Role of Mental Health and Fatigue.

This paper provides an examination of direct and mediated relationships among occupational stressors (responsibilities towards family and living environment), mental health (anxiety and depression), fatigue (physical and mental fatigue), and safety behaviour (safety compliance and safety participation). In this cross-sectional study, data were collected by means of a questionnaire among oil and gas workers (foreign employees working at a remote oil and gas field site located in Kuwait), during a two-month period (November–December 2018). Regression analyses (bivariate and hierarchical), carried out on 387 responses, were employed to test the links between occupational stressors, mental health, fatigue, and safety behaviour in the hypothesised model. The results provide support for the direct relationship in the model, in that both responsibilities towards family and living environment predicted safety behaviour participation. Further, the results provide partial support for the mediated relationships in the model, as mental health and fatigue were found to mediate the relationship of responsibilities towards family and living environment with safety participation behaviour. It is concluded that occupational stressors have a negative effect on safety behaviour, while mental health and fatigue can operate as risk factors. Given this, it is recommended that organisations need to enhance remote oil and gas workers’ safety behaviour by encouraging them to effectively balance their stress, mental health, and level of fatigue. This can be achieved by actions such as promoting spirituality, boosting workers’ resilience, providing recreational facilities and encouraging communications.

Metabolic syndrome incidence in an aging workforce: Occupational differences and the role of health behaviors

This study investigates whether the incidence of metabolic syndrome (MetS), and its components, differs by occupational group among older workers (45–65 years) and whether health behaviors (smoking, leisure-time physical activity, diet quality, and alcohol consumption) can explain these differences. A sample of older workers (N = 34,834) from the North of the Netherlands was investigated. We analyzed data from two comprehensive measurement waves of the Lifelines Cohort Study and Biobank. MetS components were determined by physical measurements, blood markers, medication use, and self-reports. Occupational group and health behaviors were assessed by questionnaires. The association between occupational groups and MetS incidence was examined using logistic regression analysis. Health behaviors were subsequently added to the model to examine whether they can explain differences in MetS incidence between occupational groups. Low skilled white-collar (OR: 1.24; 95 % CI: 1.12, 1.37) and low skilled blue-collar (OR: 1.37; 95 % CI: 1.18, 1.59) workers had a significantly higher MetS incidence risk than high skilled white-collar workers. Similar occupational differences were observed on MetS component level. Combinations of unhealthy behaviors were more prevalent among blue-collar workers. MetS incidence in older workers differs between occupational groups and health behaviors explain a substantial part of these differences. Health promotion tailored to occupational groups may be beneficial specifically among older low skilled blue-collar workers. Research into other factors that contribute to occupational differences is needed as well as studies spanning the entire working life course.

Changes in the Occupational Health and Safety Behavior in 21st Century Mining in Turkey

While striving to increase human well-being, new risks will continue to appear in return for this effort.Although, the technology offers innovations, it has also brought new challenges with it. The need for raw materials hasincreased, due to the effort of people to increase their luxury and quality of life. Thus, there have been revolutions inmining and mechanization has increased for more production. Although the number of employees decreased with theincrease in the number of machines, people who started working with the machines met new problems. Increasingmechanization in mining has created new dangers. Every mining activity where precautions are weak has also createdmajor problems for human health. With the emergence of the principles and increase in the application of occupationalhealth and safety, their problems have decreased and people have achieved a healthier living environment.