Policy Dialogue Research Articles

Quitting with pride: Differences in smoking behaviour across sexual identity groups in Ireland

Abstract Background As smoking prevalence reduces, smoking inequalities across population groups is emerging as a key challenge. Despite recognition of specific needs among members of the Lesbian, Gay, Bisexual, Transexual Plus (LGBT+) community, differences in smoking across sexual identity groups is uncharted in Ireland and the community is not represented in tobacco policy agenda setting. This study aimed to measure and compare the prevalence of smoking, quitting intention and quitting behaviour across sexual identify groups in Ireland. Methods Secondary analysis of the 2023 “Healthy Ireland” cross sectional survey of health status was conducted (n = 7,411). For the first time, this survey included a question on self-reported sexual identify, along with standard questions on smoking prevalence, quitting intention and quitting behaviour. Prevalence of smoking, quitting intention and quitting behaviour were calculated with 95% Confidence Intervals (CI) and compared across groups with Chi Square tests. Results In total, 2.3% (95% CI 2.0-2.7%) of respondents reported an LGB+ identity. Compared to those reporting straight identity, LGB+ respondents reported higher smoking prevalence (17.6% versus 21.4% respectively); intention to quit was similar across groups, however, LBG+ respondents also reported a higher prevalence of making at least one quit attempt in the previous 12 months (51.3% versus 78.0% respectively, p < 0.0001). Conclusions While this study highlighted tobacco-use as a health challenge for the LGB+ community in Ireland, it also identified an opportunity for tailored stop smoking approaches to support quit success. As a consequence, an innovative Fulbright-sponsored policy dialogue was convened between leaders in tobacco control, LGBT+ community leaders, health services and academia across Ireland and the USA to explore solutions, underlining the important role equity stratifiers and population surveillance play in agenda setting for public health. Key messages • Including sexual identity in the national population health survey enabled tobacco-use needs across sexual identity groups in Ireland delineated for the first time. • Equity-stratified population health surveillance informed a policy dialogue to better represent needs of LGBT+ community in public health agenda setting.

10.X.2. Strengthening primary health care through best practice transfer: the CIRCE-JA approach

Abstract Primary health care (PHC) is a fundamental component of resilient, strong, and sustainable health systems. The main aim of PHC is to address people’s health in a high-quality comprehensive system approach, ensuring person-centred and integrated care across their lifespan, which includes their physical, mental and social well-being. Following the COVID-19 pandemic, health systems’ strengthening has become a global public health and European public health priority, and an overarching objective of the EU4Health programme. In Feb 2023, the three-year Joint Action on the transfer of best praCtices In pRimary CarE (CIRCE-JA) was launched. Its overall objective is to effectively transfer and implement six identified PHC best practices (BPs) across EU Member States (MS), with scientifically robust evidence-based approach, to ensure sound transferability methodology. Critically, it aims to increase MS capacity to deploy innovative care models in PHC and to effectively support health system transformation at this level of care. CIRCE-JA is a collaborative effort with 14 MS participating, bringing together 48 entities, to initially transfer the identified BPs into 42 new implementation sites, whilst at the same time generate all the necessary tools to facilitate uptake and evidence-informed decision-making across all MS. This implementation is based on the alignment of key BP characteristics to meet the local healthcare needs and priorities and match them with national and regional policies. It aims to facilitate integration of public health priorities to PHC practice, and to support the reorganization of services, for strong health promotion focus, synergies with community care, and better coordination of care. During this session key aspects will be discussed using the Pecha Kucha style, to inform the audience about current progress and CIRCE-JA using short stories, also on EU policies and priorities, and the EU4Health support for PHC and public health integration. What is urgently needed at EU-level when it comes to health systems’ strengthening in the post-COVID-19 period and why is PHC critical in this respect? How can the CIRCE-JA developments inform the ongoing transfer and future efforts for the selected BPs in terms of a robust scientifically evidence-based approach? How does the policy dialogue CIRCE-JA is establishing locally, nationally, regionally, supports not only the JA’s sustainability, but all future implementation efforts for PHC? Finally, a brief interaction with the audience will take a place to allow attendees to discuss on key priorities and challenges in their own settings and practice, including the barriers and difficulties that they have initially identifies in the implementation efforts. The output of this interaction will also inform the initial steps towards the establishment of the final deliverable of CIRCE-JA, i.e., the European Primary Healthcare Observatory, to sit on the European Commission’s Health Policy Platform. Key messages • Health systems’ strengthening necessitates strong PHC. CIRCE-JA delivers state-of-the-art tools and brokers policy dialogue to achieve it across Europe. • Several barriers and issues that facilitate the transferring process have been identified in the first implementation of this European initiative. Speakers/Panelists Christos Lionis CSFM & HSR-PH Lab, Faculty of Medicine, University of Crete, Heraklion, Greece Ana M Carriazo Regional Ministry of Health and Families of Andalusia, Seville, Spain Alice Borghini National Agency for Regional Health Services AGENAS, Rome, Italy Radivoje Pribakovic NIJZ, Ljubljana, Slovenia

A pathway design framework for national freight transport decarbonization strategies

ABSTRACT National and international freight transport emissions represent about 40% of global transport emissions, with demand expected to triple by 2050, which will increase emissions further. However, to meet the 1.5°C climate goal, a rapid decrease in transport emissions is required, along with the achievement of zero emissions as soon as possible around mid-century. Given this context, long-term low-emission national development pathways provide a strategic instrument to align short-term action with long-term objectives and to reduce national freight transport emissions. However, current transport-energy modelling studies often exclude the structural and systemic mitigation options that influence the industrial production and supply chain structure, as well as modal and logistics choices, and instead focus mainly on the technological options related to road freight vehicles and fuels. In addition, such studies lack relevant policy and stakeholder-oriented explanations of the barriers and enablers associated with these options. In this paper, we introduce a new framework to design and compare long-term national and sectoral decarbonization pathways for freight transportation, facilitating the consideration of all decarbonization options and the organization of stakeholder-oriented policy dialogues. The development of this sectoral framework builds on the general Deep Decarbonization Pathways (DDP) framework and a first implementation in France. It is then applied and tested in three emerging countries: Brazil, India and South Africa and the results show that the linking of systemic and technological changes could reduce emissions per tonne-km by at least 60%, and up to 100% by 2050, while also reducing energy consumption and supporting national development.

The political economy of national health insurance schemes: evidence from Zambia.

Governments in low and middle-income countries (LMICs) are increasingly considering the introduction of national health insurance scheme (NHIS) as a strategy to achieve universal health coverage (UHC) targets. The literature has widely documented the technical challenges associated with implementing UHC policies in LMICs but much less is known about the political process necessary to pass UHC legislation. In this article, we document the political economy issues surrounding the establishment of the Zambia NHIS in 2018. We adapted a political economy framework incorporating, semi-structured interviews with diverse stakeholders and document analysis of policies, operational reports, and legislatures from 1991 and 2018. Our findings show the 26-year journey towards the establishment of the NHIS in Zambia involved a long sequence of policy dialogue, technical review and stakeholder engagement. Our interviews with key stakeholders suggest that the act was eventually passed due to strong political will and dominant leadership of the Ministry of Health. Passing the law required trade-offs between choices influenced by stakeholder pressures and recommendations from research and actuarial studies. Another equally critical factor was the high public support and legacies of past policies, such as the removal of user fees that had created quality gaps and inequities in the health system. Furthermore, global ideas about UHC and initiatives implemented by other countries also generated support for Zambia's NHIS. Overall, this study highlights the complex set of political economy factors that need to align in order for governments to be able to adopt health insurance in low-income settings. We show that political leadership and commitment to getting reforms passed is crucial. We also highlight how certain narratives about countries in the global health sphere can shape policies in other countries.

Tropical forest cover, oil palm plantations, and precipitation drive flooding events in Aceh, Indonesia, and hit the poorest people hardest.

Tropical forest loss and degradation in watersheds disrupt essential ecosystem services that regulate water flow, often causing devastating floods that impact agricultural productivity and impoverish downstream communities. Despite its importance, evaluations of the interconnectedness between the depletion of hydrological services and flooding lack an evidence-base in the Global South and, therefore, have little influence on policy dialogue. In this study, we focus on the forest-rich province of Aceh, Indonesia, using local and national newspaper articles to compile information on flood events between 2011 and 2018. We explored spatio-temporal flood patterns with a combination of climatic, topographic, and environmental factors. We compiled 2,029 reported flood events in mainland Aceh located in 20 of the 21 districts/cities, with a disproportionately high occurrence (71%) in four districts. The trend of flood events exhibited an increasing pattern between 2011 and 2018. Over this period, floods displaced ~158,000 people and damaged ~24,500 houses and ~11,500 ha of agricultural land. Our generalized linear mixed-effect model found that reported flood events were more likely to occur in areas with lower tree cover, more oil palm plantations, and higher precipitation. Areas with a lower human population density and higher poverty rates were found to be most susceptible to flooding events. Our findings highlight the critical link between forest preservation and flood prevention, and the irreplaceable role that forests play in ensuring the well-being of local communities, especially those affected by poverty. Our study underscores the importance of considering these interconnected factors in future land use and economic development plans and policies.

Competition policy and agent discretion: transatlantic regulatory cooperation in the digital economy

ABSTRACT Despite a framework of bilateral agreements governing cooperation in competition policy since 1991, the European Union (EU) and United States of America (US) established a new Joint Technology Competition Policy Dialogue in 2021, which was different from previous cooperation and separate from the transatlantic Trade and Technology Council. Drawing from the principal-agent literature, this article argues that the choice to establish the new Joint Dialogue can be understood as an exercise of discretionary authority by agents in different jurisdictions with similar preferences who responded similarly to the common external factor of digitalisation. Facing new and shared challenges arising from the digital economy, the EU and US competition authorities undertook a new effort at cooperation – the Joint Dialogue – through which regulatory agents at various levels can interact, exchange information and improve enforcement in a rapidly changing business environment.

Who Cares? Women entrepreneurs and the transition to the Canada-wide Early Learning and Child Care Agreement in Nova Scotia

The Canada-wide Early Learning and Child Care Agreements signed in 2021/2022 represent an unprecedented investment into child care across Canada, supporting the expansion of care spaces, reductions in parent fees, and increased wages for care workers. In the province of Nova Scotia, however, the new funding model faced considerable pushback from women entrepreneurs in the care field, who felt overlooked and bullied by the provincial government amidst the policy rollout. This paper evaluates the experiences of child care owners in Nova Scotia during the transition to the new funding agreement through a series of interviews with entrepreneurs. The paper posits that the consultation and communications between the province and care owners reified gendered power relations, particularly through the devaluation and exploitation of women's care work. Interviewees report feeling treated as “glorified babysitters” and experiencing significant mental health strains as a result of the policy negotiation with the province.

Christian perspectives on the regulation of posthumous medical data donation (PMDD): An empirical study

This article sets out the results of an empirical study exploring the intersection of religious views and perspectives and the regulation of post-mortem data donation (PMDD), particularly focusing on issues of consent and individual control. Through semi-structured interviews with practicing members of the Christian clergy of the United Kingdom, the study investigated the ethical and practical implications of integrating religious viewpoints into secular debates on data protection and privacy, using PMDD as a use case. The findings revealed a consensus among participants that religious perspectives, including Christian perspectives, can enhance the ethical robustness of PMDD regulatory frameworks by promoting values such as dignity, autonomy, and respect for individual preferences. However, the study also identified a possible gap in the systematic consideration of these views within existing regulatory practices pertaining to data protection and privacy. Pursuant to these findings, the article argues for the adoption of an "opt-out" consent mechanism, which balances public health benefits with individual rights, as a pragmatic approach to PMDD regulation. Additionally, the article highlights the potential for religious insights to enrich policy dialogues, ensuring that legal rules relating to data protection and information governance resonate with a broader array of societal values.

Populists in the Shadow of Unanimity: Contestation of EU Foreign and Security Policy

The arrival of populist political parties to power in several member states and the increasing politicisation of EU foreign policy has made intra-European consensus more difficult to reach in the past decade. This article examines the impact of populist contestation on EU foreign policy negotiations in the Council, a policy area governed by unanimity. This decision-making mode makes the policy especially vulnerable to the impact of contestation and, at the same time, gives power to those willing to use their veto. Drawing on the idea of unpopulist politics, this study shows how Hungary and, to a lesser degree, Poland have contested the established formal and informal norms (such as consensus-building or reflex coordination) through discursive and behavioural non-compliance. The “domestication” of EU foreign policy has meant that, in general, populists show less willingness to compromise and resort to non-decisions to demonstrate the EU’s weakness. However, there are exceptions, and it is possible to see variations in populist strategies when faced with similar challenges, as exemplified by the EU’s response to Russia’s war in Ukraine. By testing the scope conditions under which unpolitics might be activated, we show that the same crisis situation did not lead to a uniform response amongst populist governments. This is because both the nature of the crisis and perceptions of risk/gain were understood differently (and actively constructed as such) by populists in power. This finding emphasises the social, relational, and multi-level nature of unpolitics as a phenomenon.

New Evidence of the Impact of the National Drug Price Negotiation Policy on the Availability, Utilization, and Cost of Anticancer Medicines in China: An Interrupted Time Series Study.

The increasing global burden of cancer has become a significant challenge for public health. The Chinese government introduced the National Drug Price Negotiation (NDPN) policy with the goal of lowering the prices of innovative drugs and enhancing their accessibility. This study aims to evaluate the impact of the 2021 NDPN policy on the availability, utilization, and cost of anticancer medicines in China. Data was gathered from 1519hospitals between April 2021 and December 2022, with a focus on eight anticancer drugs affected by the 2021 NDPN policy. The availability, Defined Daily Doses (DDDs), and cost per Defined Daily Dose (DDDc) before and after the intervention were evaluated through interrupted time series analysis. The NDPN policy resulted in a substantial 5.10% increase in the availability of anticancer drugs (p < 0.001). Utilization also experienced a significant surge, with an immediate increase of 11,254.36 DDDs (p < 0.001) and a monthly increase of 1208.28 DDDs (p < 0.001) following policy implementation. The DDDc decreased by US$ 111.00 (p < 0.001) immediately after the policy. Disparities in regional drug utilization were evident, with higher usage in the eastern region. The 2021 NDPN policy has notably enhanced the availability and utilization of anticancer medications in China while reducing their cost, in line with the policy's objectives. However, continuous monitoring is essential to ensure sustained access and to tackle regional disparities in drug utilization.

Drafting a Cybersecurity Standard for Outer Space Missions: On Critical Infrastructure, China, and the Indispensability of a Global Inclusive Approach

Despite limited progress within international institutions, the need for articulating a regulatory framework for cyber operations in outer space is becoming a pressing concern. One precondition for regulation is to share cybersecurity and outer-space common terminology that can inform the negotiation of standards, policies and laws. While the UN Institute for Disarmament Research has recently issued a baseline policy glossary, binding technical definitions are missing, and the lack of a binding international cybersecurity regime adds to the obsolescence of a binding outer-space regime tracing back to half a century ago. As the IEEE SA embarks on the drafting of the first-ever technical standard for cybersecure-by- design outer-space missions, scoping and conceptual challenges abound. Technical standards are US-centred, non-binding, engineering-intensive exercises, where lawyers and Asian jurisdictions are only marginally involved; nevertheless, as China’s framework for cybersecurity is refined and its involvement in outer-space policing deepens, its disengagement from Western-driven standard-setting bodies appears unsustainable. Drawing on the specific challenge of defining what makes a cyber system ‘mission-critical’, I expose the necessity to examine how domestic cybersecurity laws from a diverse range of States identify ‘critical’ information infrastructure. Generalising therefrom, I advocate a jurisdictionally inclusive process that combines American supremacy in technical standard-setting for outer-space missions with Chinese normative contributions to cybersecurity regulation, including on data localisation and mandatory multilevel cyber-hygiene requirements. I further argue that involving legal experts from a diverse range of jurisdictions and sociolegal cultures may enhance the global reception of standardisation outputs, thus securing higher degrees of voluntary compliance therewith. This could foster cooperation and promote regional and global satellite cybersecurity.

Governance by Gaslight: The Reproductive Politics of the Two-Child Limit

Abstract In 2017, the UK government limited the number of children for a whom a low-income family could claim a means tested benefit (the “child element” of “Universal Credit”) to two. Since then, over 400,000 families—including 1.5 million children—have been affected by the “two-child limit.” Emerging research indicates that the limit has done little to influence fertility rates, nothing to influence workforce participation, and a great deal to increase financial hardship and poverty. Via a synthesis of existing research, and a critical analysis of formal policy dialogue, I explore the specifically reproductive politics of the two-child limit. I cast the limit as “successful” reproductive governance, a “technology of discipline” with complementary effects and rationales, which works by further marginalizing intersectionally marginalized women. In concluding, I argue that the state justifies this abject outcome via what has been termed “cultural gaslighting.”

How informality keeps multilateralism going: the role of informal groupings in EU foreign policy negotiations

How informality keeps multilateralism going: the role of informal groupings in EU foreign policy negotiations

Counting women? Gendered sustainability and inclusivity for an ocean accounting framework

ABSTRACT The oceans are increasingly pivotal in scholarly and policy dialogues focused on achieving inclusive economic and social prosperity. The Ocean Account Global Framework (2020) underscores oceans' role as essential for social and economic development, crucially contributing to human well-being and gender equality. With oceans holding significant economic potential, governments face mounting pressure to systematically account for ocean resources and their utilisation (Ocean Account Global Framework, 2020). This need is particularly acute given the evolving relationships between economic prosperity, inclusive development, social well-being, and oceans. However, a knowledge gap persists, impairing governments' ability to make informed and gender inclusive decisions about oceans and undermining long-term commitments outlined in the 2030 Agenda for Sustainable Development (Ocean Global Account Framework, 2020). This article examines ocean governance, focusing on gender-related aspects and integrating gender perspectives into the ocean accounting framework using a political economy lens, supported by environmental and gender political economy analyses.

Power Relations in Optimisation of Therapies and Equity in Access to Antibiotics (PROTEA) Study: investigating the intersection of socio-economic and cultural drivers on antimicrobial resistance (AMR) and its influence on healthcare access and health-providing behaviours in India and South Africa.

Across social structures within society, including healthcare, power relations manifest according to gender, socioeconomic status, race, ethnicity, and class influencing infection related healthcare access and health providing-behaviours. Therefore, accounting for sociocultural drivers, including gender, race, and class, and their influence on economic status can improve healthcare access and health-providing behaviours in infection prevention and control (IPC) as well as antibiotic use, which in turn helps mitigate the spread of antimicrobial resistance (AMR). This Wellcome funded research will investigate how and why the social determinants of health and economic status influence how people seek, experience, and provide healthcare for suspected or proven (bacterial) infections and how these factors influence antibiotic prescribing and use in South Africa (upper middle-income country) and India (lower middle-income country). The aim of this body of work is to, (1) define and estimate the sociocultural and economic drivers for AMR in different resource settings, (2) design, implement and evaluate context-sensitive IPC and antimicrobial stewardship (AMS) interventions, and (3) inform policy and strategy for AMR mitigation. The population will be healthcare workers (HCWs), patients, and their carers across acute medical and surgical pathways where IPC and antibiotic-related healthcare access and health-providing behaviours will be studied. Qualitative methods will include ethnographic research, semi-structured in-depth interviews, and focus groups with healthcare providers, patients and carers. Quantitative analysis of bedside observational data from hospitals and population level data on antibiotic use will study the various predictors of AMR using bivariable and multivariable regression analyses. The research will provide high-quality evidence on how social determinants intersect with health, social well-being, and vulnerability in IPC practices and antibiotic use. Using this knowledge we will: 1) design, implement, and measure effects of interventions accounting for these factors; 2) provide a toolkit for advocacy for actors in AMR, and healthcare to assist them to promote dialogue, including policy dialogue on this issue. This work directly benefits the target population and informs healthcare services and practice across the participating countries with potential for wider translation. The setting will be hospitals in South Africa (middle-income country) and India (lower middle-income country). The population will be healthcare workers (HCWs), patients, and their carers across acute medical and surgical pathways where IPC and antibiotic-related health-seeking and health-providing behaviours will be studied. These populations represent communities most affected by infections and AMR because existing interventions do not address a) differences in how surgical versus medical teams manage infections; b) the role of the wider social network of individuals on their decision-making, c) intersection of the social determinants of health including race, gender, socioeconomic deprivation with AMR.

Increasing the number of midwives is necessary but not sufficient: using global data to support the case for investment in both midwife availability and the enabling work environment in low- and middle-income countries

BackgroundMost countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries’ (LMICs’) midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration.MethodsUsing the most recent available data from publicly available global databases for the period 2000–2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality.ResultsIn LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10–15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country.ConclusionsA complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes.

Pandemic Impact, Support Received, and Policies for Health Worker Retention: An Environmental Scan.

The COVID-19 pandemic has brought additional strain to health workers in the Philippines, leading to a significant proportion of them leaving the workforce. The purpose of this study is to explore the impact of the pandemic on health workers, the support that they received and associated challenges; and identify relevant policies for better workplace conditions. An environmental scanning method was utilized. Particularly, a literature review and policy scan that were validated through key informant interviews with administrators and frontline health workers from selected urban and rural sites in the three main islands in the Philippines. These were framed into a background note to springboard the discussions during a national policy dialogue participated by representatives from key government organizations, professional organizations of physicians, nurses, and midwives, professional regulatory bodies, hospital administrators, frontline health workers, and donor agencies in the Philippines. Deaths, burn-out, mental health problems, lack of personal protective equipment and poor allocation of vaccines were reported in the early phases of the pandemic. Support varied across settings but included additional allowance, free meals, accomodation, transportation, training and psychosocial services. Furthermore, pre-pandemic issues such as as low salaries and heavy workload continue to be the main reasons for leaving the workforce or the country. The proposed solutions are as follows: (1) creating policies and strategies for appropriate production, recruitment, and retention of human resources for health; (2) allocating regular permanent positions for both the education and health sector; (3) augmenting and continuation of deployment programs; (3) expanding roles of nurses to push for advanced practice nursing; (4) providing fair compensation along with risk allowances, non-financial incentives, and expanded benefits; (5) supporting mental health wellness by providing an appropriate work-rest balance and safe work environment; (6) providing opportunities for professional development and scholarships with accompanying return-service agreement; and (7) strengthening the reintegration programs for returning overseas health workers. The pandemic has affected the well-being of health workers and disparities in support were reported due to longstanding workplace issues and policy implementation gaps. Stakeholder commitments require sustained monitoring while policies that are in place and yet to be developed demand stronger support from the government, members of Congress, the private sector, and other key decision-makers.

Access to essential and innovative anti-cancer medicines: a longitudinal study in Nanjing, China

PurposeTo evaluate the availability, cost, affordability of anti-cancer medicines in Nanjing, Jiangsu.MethodsA longitudinal tracking investigation study was performed to collect information about 24 essential anti-cancer medicines (EAMs) and 17 innovative anti-cancer medicines (IAMs) in 26 healthcare institutions in Nanjing from 2016 to 2020. The availability, cost, drug utilization and affordability of EAMs and IAMs were investigated.ResultsThe availability of EAMs showed no significant changes in Nanjing, but the availability of IAMs showed a significant increase in 2018 and 2019 and tended to stabilize in 2020. For EAMs, the DDDc(Defined Daily Dose cost) of LPGs (Lowest-Priced Generics) showed no significant changes, and the DDDc of OBs (Originator Brands) and IAMs significantly decreased. The DDDs(Defined Daily Doses) of EAMs (LPGs) showed a decreasing trend since 2016 and rose again in 2019. Overall, the DDDs of EAMs (LPGs) decreased by 25.18% between 2016 and 2020, but the proportion selected for clinical treatment remained at 67.35% in 2020. The DDDs of EAMs (OBs) and IAMs both showed an increasing trend year by year, with a proportional increase of 207.72% and 652.68%, respectively; but the proportion selected for clinical treatment was only 16.09% and 16.56% respectively in 2020. EAMs (LPGs) had good affordability for urban residents but poor affordability for rural residents; the affordability of EAMs (OBs) and IAMs was poor for both urban and rural residents.ConclusionsThere were no significant changes in the availability and cost of EAMs (LPGs), whose lower prices showed better affordability. Although their relative change in drug utilization showed a decreasing trend, they still dominated clinical treatment. Driven by the national drug price negotiation (NDPN) policy, the availability of IAMs was on the rise. It is necessary to further develop and strengthen policies for essential medicines procurement assessment to improve the accessibility of EAMs.

Media Narratives Beyond the Headlines: A Review on Global Media Coverage of the COP15 UN Biodiversity Summit

Global media narratives refer to how international news outlets frame and present stories, shaping public perception and discourse on significant events like the COP15 UN Biodiversity Summit. This includes the themes, tones, and emphases used by different media sources to convey the importance, implications, and outcomes of such global events. This study explores global media coverage and narratives during the COP15 summit in December 2022, aiming to analyze dominant themes presented by international media, identify differences in reporting approaches among major outlets, and evaluate the influence of these narratives on public awareness and policy discourse regarding biodiversity. Using content analysis, the research studies news from various outlets to identify and quantify key themes such as ecological urgency, economic implications, policy negotiations, and scientific discoveries. Comparative analysis highlights variations in coverage focus, tone, and depth, revealing how regional contexts and media ownership influence reporting styles. Findings indicate that while some media outlets prioritize policy negotiations and economic implications, others emphasize ecological urgency and scientific findings, leading to varied public and policy responses. This research underscores the critical role of media in shaping public understanding and influencing policy debates on biodiversity. By providing insights into effective reporting practices, the study aims to enhance the quality of environmental journalism and foster informed public and policy engagement with biodiversity issues, contributing to the broader discourse on environmental communication and the power of media narratives in addressing global environmental challenges.

Enhancing Urban–Rural Integration in China: A Comparative Case Study of Introducing Small Rural Industries in Huangyan-Taizhou

Strengthening urban–rural linkages (URLs) has been proposed by UN-Habitat within the framework of ‘Sustainable Development Goals (SDGs)’ to narrow down urban–rural differences via shaping new urban–rural relationships. Like URL, the aim of urban–rural integration (URI) has been promoted by the Chinese government since 2019 to address existing urban–rural divides. This concept underlines the ‘rural revitalisation’ strategy and emphasises a two-way flow of urban–rural development factors. Introducing and upgrading ‘appropriate’ rural industries is crucial to stimulate and facilitate the circulation of urban–rural development factors. This research studied three neighbouring villages, situated in urban–rural interface areas in Huangyan-Taizhou, China, each driven by different types of small industries supported by URI. It analyses the impact of small rural industries on the flow of development factors between urban and rural areas. The results showed that small-scale rural industries have been enhanced URL by decreasing urban–rural differences by creating new job opportunities to attract an in-flow population, increasing investments, and upgrading public services and infrastructure. Indigenous industries demonstrated lower profitability but exhibited greater resilience compared to industries linked to global production chains and rural tourism. Thus, this study demonstrates the imperative to carefully consider the opportunities and potential risks associated with pursuing strategies of URI through rural industry development. By providing empirical insights from URI projects in China, this study contributes to theoretical and policy dialogues concerning the concepts of both URL and URI by exploring the localization of SDGs. Furthermore, it offers valuable practical knowledge and experience for other global regions confronting similar challenges to urban and rural development.