European Journal of Public Health最新文献

Through its activities and energy consumption, the healthcare sector contributes to environmental degradation and climate change. With rising healthcare demands, the adoption of sustainable models has become increasingly urgent. Circular economy (CE) principles-Reduce, Reuse, Recycle, and Recover-offer a strategic framework to minimize waste and resource use while enhancing system resilience. A narrative review was conducted using Medline (PubMed) and Web of Science, covering literature from January 2015 to June 2025. Studies were selected based on relevance to CE principles in healthcare, including case studies, reviews, and original research. The review identified diverse interventions aligned with CE principles, including reducing low-value care and energy consumption, optimizing surgical trays, promoting reusable medical devices, enhancing waste segregation, and recovering energy from non-recyclable waste. Case studies from various countries highlight both environmental and economic benefits, such as lower CO2 emissions, cost savings, and greater operational efficiency. However, challenges remain, including limited climate literacy, regulatory gaps, and insufficient leadership. Applying CE principles in healthcare can significantly reduce environmental impact while supporting high-value care and financial sustainability. Broader adoption requires systemic policy support, stakeholder engagement, and integration of environmental metrics into clinical and procurement decisions.

Waiting times for health care is a significant health policy concern across many health systems, which has been exacerbated by the COVID-19 pandemic. Long waiting times for non-emergency care generate health losses to patients because health benefits are postponed. They can increase the risk of mortality or morbidity and reduce patient ability to benefit from health care. Waiting times can also generate negative spill-over effects on labour market outcomes. For individuals in the working age, employed individuals might end up on sick leave and claim sickness benefits, or experience reduced productivity if they continue to work. Individuals looking for a job may find it harder to find employment or become economically inactive. We conduct a narrative review of the literature on the effect of waiting times on health losses and labour market outcomes. There is growing literature documenting the effect of longer waiting times on labour market outcomes. Although limited, the literature identifies potentially harmful effects in particular when patients are waiting for mental health services and orthopaedic treatment. The findings have implications for prioritization of patients on the list and for allocation of resources within the health sector and across sectors.

Amidst low trust in public institutions, policy makers and scholars have proposed using the health system to help rebuild trust in other institutions. One potential mechanism to do so is linking the health system with public programs, e.g. simple referrals, shared financing, or delivering social services via the health system. While other reviews have examined the technical aspects of such linkages, few have examined the political calculus involved. We conducted a narrative review of the academic and grey literature on the relationship between health and trust in public institutions, as well as political considerations when integrating health systems and social programs, including the attitudes, concerns, and constraints of beneficiaries, stakeholders (e.g. service providers), and political actors. For beneficiaries, attitudes about the health system are associated with attitudes about public institutions, and linking the health system to less popular public programs has been shown to increase engagement in the latter. However, unsuccessful handoffs and administratively burdensome social programs can alienate beneficiaries. Stakeholders are often eager to partner in linkages but can become frustrated by redundant roles and uncoordinated financing. For political actors, embedding social services in the health system may be logistically easier than maintaining standalone programs, but it may also result in weaker long-term public support. Thus, linking health systems and public programs can produce mutual "co-benefits" when done well. At the same time, policy makers must consider the political trade-offs inherent in the linkage. Future research should directly test whether these linkages causally impact broader social outcomes, such as political trust.

The Health in All Policies (HiAP) approach has been the main focus for intersectoral action for health and heath equity but has proved challenging as result of other political and economic priorities of governments and the multilevel nature of policymaking. This article explores the role of HiAP in changing politics and policy context. The article takes a critical appraisal on how HiAP has been conceptualized and used to compare concepts associated with HiAP. It assesses the limits and potential for the use and application of different concepts drawing from a realist evaluation in understanding why, how, and for whom and in what context they work for HiAP. Illustrative case studies focus on the substance and provide examples from work with Ministries of Finance, Employment and Education. HiAP can be seen as a flexible overarching approach, which provides scope for action through several concepts and practices for intersectoral work. The comparison shows that definitions matter to the practice of HiAP concerning priorities, ideological premises, and level of governance. Ministries of Finance are crucial for action on equity and social determinants of health. HiAP requires understanding of health policy priorities and competences and capacities in public health and health systems governance as well as in analysis of politics, power, and different contexts of policymaking under multilevel governance. While HiAP aims to ensure health priorities in decision-making of all policies, if and how this is realized, is a political choice.

Global and regional commitments to universal health coverage emphasize reducing financial hardship due to out-of-pocket payments for health care. Despite this, many countries continue to rely on user charges-either to raise revenue or reduce demand-especially under fiscal pressure. We conducted a narrative review of academic literature on the theoretical basis for and empirical effects of user charges in health systems. This was complemented by recent case studies from Slovenia, Estonia, and Cyprus, selected to illustrate diverse approaches to user charge policy under fiscal constraints. Common arguments in favour of user charges are that they can mitigate excess health care consumption and generate revenues. However, evidence suggests they often deter necessary care and lead to financial hardship, especially for low-income groups. Country case studies reveal varied approaches towards user charges in the context of fiscal pressure: Estonia increased co-payments despite prior efforts to improve financial protection; Slovenia eliminated user charges by introducing a flat levy to generate additional revenue; and Cyprus dramatically reduced its reliance on out-of-pocket payments by increasing public spending on health. Growing fiscal pressure may tempt countries to implement or increase user charges. However, doing so without adequate protective mechanisms can increase financial hardship, poverty and unmet health needs. Policymakers should prioritize pre-payment mechanisms and equity-oriented safeguards to ensure sustainable, fair and affordable access to health care. Continuous monitoring of financial hardship remains essential to inform policy decisions.

The health and care workforce crisis and gender inequalities are interconnected, threatening healthcare and equity. We turn this 'unhealthy' connection upside down, aiming to explore how health policy can create co-benefits for gender equality and how governance can support policy implementation. A conceptual approach on SDG3 'Health' and SDG5 'Gender Equality' co-benefits served our analysis. We applied a qualitative explorative approach to identify co-benefits; following a rapid scoping review of the literature, we focus on document analysis and an illustrative case study of artificial intelligence in the health and care workforce. The literature reveals an overall lack of attention to co-benefits in research. Policy documents pay some attention to co-benefits, but primarily consider the benefits for the healthcare sector rather than for gender equality. The case of artificial intelligence illustrates that technological innovations provide opportunities for change, but to create co-benefits, they need gender-responsive and equity-based policy approaches to enhance economically effective and socially fair transformations. We discuss how transformational leadership and gender-transformative governance approaches can support implementation of co-benefits policies. Strengthening the policy and implementation of co-benefits provides novel opportunities for improving gender equality and responding to the health and care workforce crisis.

Urban health is the study of how the physical, social, and cultural features of cities contribute to the unequal distribution of health, disease and overall well-being of urban dwellers. The widespread implications of climate change and other global environmental phenomena are increasingly recognized as major threats to urban health. Shifting from a 'Health in all Policies' to a 'Health for all Policies' approach, policies from different sectors are to be planned and implemented to achieve shared and specific goals. With the aim of considering how urban health interventions and policies interact across sectors, we selected three integrated urban health policies and interventions developed at various governance levels in different parts of Europe. We also offer guidance on how to establish fruitful collaborations with policymakers, stakeholders and citizens in the pursuit of healthier and more sustainable cities. Selected case studies were (i) the local clean air zone implemented in Bradford (UK), (ii) a regional urban renewal policy developed in Barcelona (Spain), and (iii) a European multi-city consortium for healthy and sustainable school meals. We were able to identify impacts beyond health and map their contribution to the UN's Sustainable Development Goals. Well-designed urban health research can address the multiple health, social and ecological challenges of our time by generating the evidence needed to design and evaluate urban policies and translating this evidence into population health and well-being.

This article examines how public procurement of pharmaceuticals can serve as a tool to advance both access to medicines and industrial development, in line with the Health in All Policies (HiAP) and Health for All Policies (HfIAP) agendas. We draw on four illustrative, purposefully selected cases-the pneumococcal Advance Market Commitment, emergency procurement of the Ebola vaccine, Operation Warp Speed for the accelerated production of coronavirus disease 2019 (COVID-19) vaccines, and Brazil's Partnerships for Productive Development. Through configurative analysis, we identify distinct procurement models and assess their contributions to health and industrial objectives. The analysis highlights several procurement models: anticipatory, reactive, emergency-driven, innovation-enabling, and capability-building. These cases demonstrate how procurement can generate co-benefits across Sustainable Development Goals (SDGs) 3 (health) and 9 (industry, innovation, infrastructure), while also revealing implementation gaps and structural constraints. Realizing the potential of procurement as a dual health-industrial tool requires linking it to capability-building, tailoring instruments to local and industrial contexts, and confronting structural asymmetries that limit national ownership. By treating procurement not as an administrative task but as an industrial strategy, governments can better operationalize HiAP/HfIAP and make progress toward more equitable and sustainable health innovation systems.