ABSTRACT
Both the ever-complex international and subnational supply chains could relocate health burdens and economic benefits across India, leading to the widening of regional inequality. Here, we simultaneously track the unequal distribution of fine particle matter (PM2.5) pollution, health costs, and value-added embodied in inter- and intranational exports for Indian states in 2015 by integrating a nested multiregional input-output (MRIO) table constructed based on EXIOBASE and an Indian regional MRIO table, Emissions Database for Global Atmospheric Research (EDGAR), the Community Multi-Scale Air Quality (CMAQ) model, and a concentration-response function. The results showed that the annual premature deaths associated with PM2.5 pollution embodied in inter- and intranational exports were 757,356 and 388,003 throughout India, accounting for 39% and 20% of the total premature deaths caused by PM2.5 pollution, respectively. Richer south and west coastal states received around half of the national Gross Domestic Product (GDP) induced by exports with a quarter of the health burden, while poorer central and east states bear approximately 60% of the health burden with less than a quarter of national GDP. Our findings highlight the role of exports in driving the regional inequality of health burdens and economic benefits. Therefore, tailored strategies (e.g., air pollution compensation, advanced technology transfer, and export structure optimization) could be formulated.
Subject(s)
Air Pollutants , Air Pollution , Air Pollutants/analysis , China , Environmental Pollution , India , Mortality, Premature , Particulate Matter/analysisABSTRACT
Unprecedented and chaotic growth of cities results in reducing open spaces and water bodies, worsening infrastructure facilities and changes in ecological morphology. This unregulated growth of the urban population led to uneven distribution of urban amenities, facilities and healthcare services. Considering this, the study aimed to draw attention to the existing spatial pattern of healthcare facility centres as well as to find out the possible sites for the provision of healthcare facility centres in the municipal ward (micro-scale) of Midnapore town. This prototype study was conducted using Analytical Hierarchy Process (AHP) and Ordinary Least Square (OLS) evaluation model based on various criteria through Arc GIS environment. The findings indicate that the spatial distribution patterns of existing public healthcare centres were significantly dispersed. Weights based on a set of criteria were calculated by AHP and OLS algorithm and generated suitability evaluation maps classified from 1 (poor suitable) to 4 (most suitable). According to the employed criteria in this study unveil those existing hospitals and primary healthcare centres have not been located in the appropriate locations. The model is found to be valid for the given study area and there is no significant difference between AHP and OLS results. Further, it can be used for preparing the suitability map for the other areas with similar geo-environmental conditions for the proviso of healthcare services as well as will be most effective in preventing disease progression and reducing healthcare inequality on a large scale. Supplementary Information: The online version contains supplementary material available at 10.1007/s10708-021-10528-w.
ABSTRACT
Resumo Este estudo tem como objetivo analisar se o Programa Mais Médicos (PMM) contemplou as recomendações da Organização Mundial da Saúde (OMS) relacionadas ao aprimoramento da atração, do recrutamento e da retenção de profissionais de saúde em áreas remotas e rurais. Trata-se de um estudo descritivo, qualitativo, baseado em análise documental, no intuito de comparar se as recomendações publicadas em 2010 pela OMS foram contempladas na Lei 12.871/13, que instituiu o PMM. Ao total, foram sistematizadas 16 recomendações da OMS, para as quais o PMM atendeu a 37,5%. Entre as recomendações não contempladas, encontram-se a ausência de programas de desenvolvimento da carreira e de medidas de reconhecimento público. Algumas recomendações que não foram atendidas pela PMM já estavam sendo desenvolvidas, tais como o Programa Nacional de Bolsa Permanência para estudantes de nível superior e a inserção de diferentes profissionais de saúde no SUS (Estratégia Saúde da Família). O programa apresenta fatores inovadores, como a mudança curricular do curso de medicina e o serviço médico obrigatório, entretanto, poderia ter feito mais investimentos na categoria de apoio pessoal e profissional.
Abstract In order to examine whether Brazil's Mais Médicos (More Doctors) Programme (PMM) reflected World Health Organisation (WHO) recommendations for improved attraction, retention and recruitment of health workers in remote and rural areas, this descriptive, qualitative study drew on document analysis in order to compare the WHO recommendations published in 2010 with Brazil's Law No. 12,871/13, which instituted the PMM. Of the 16 WHO recommendations systematised here, the PMM met 37.5%. Recommendations not incorporated into the PMM include career development programmes and public recognition strategies. Although reflecting WHO recommendations and already in place elsewhere in the SUS prior to announcement of the PMM, the National Retention Grant Programme and multi-professional teams (as in the Family Health Strategy) were not implemented by the PMM. The programme contains innovative components such as a new curriculum for medical schools and compulsory medical service. On the other hand, the PMM could have invested more in personal and professional support.
