Vol. 3 No. 1 (2025)

Open Access

Article

Article ID: 2323

Evaluating the implementation of an integrated work health intervention among cleaners in Denmark: Challenges and lessons learned

by Vivian Rueskov Poulsen, Astrid Juhl Andersen, Ole Steen Mortensen, Margrethe Bordado Streymá, Mette Korshøj

Environment and Public Health Research, Vol.3, No.1, 2025;

Introduction: Work-related diseases and injuries represent a rising global health challenge, with 2.9 million deaths attributed to work-related causes in 2019. Work-related risk factors and diseases are unequally distributed across occupational groups, with cleaners identified as a vulnerable occupational group. Integrated approaches combining the prevention of disease and promotion of health in work health interventions have been developed. This process evaluation aims to assess the implementation of the Integrated Approach to Health, Wellbeing, and Productivity at Work (ITASPA) intervention. Methods: The ITASPA intervention was implemented at two workplaces among cleaners in Denmark. At each workplace, a committee of employees and line managers was formed to develop initiatives to prevent work-related injuries and diseases and promote workers’ health, safety, and well-being. Using the British Medical Research Council’s framework, this process evaluation assessed the implementation through reach, dose, fidelity, adaptations, mechanisms of impact, and contextual factors. Data from focus group interviews and field notes were utilized to evaluate the implementation. Results: A total of 91 cleaners provided data, and three workshops were held at each workplace. Lack of information about the intervention and motivation challenged the implementation. Furthermore, unwanted power dynamics were unintended consequences of the intervention. Contextual factors, such as many replacements, time pressure, and the absence of managers, challenged the implementation and fidelity. Conclusion: Integrated approaches to work health interventions among employees with short or no education can positively impact employees’ health, well-being, and safety if comprehensively implemented. However, attention should be given to unintended power dynamics arising from participatory approaches and the importance of management during implementation. Future interventions may benefit from increased attention to such factors to enhance long-term sustainability as well as realist evaluation approaches for more comprehensive evaluations of contextual factors. Trial registration: ITASPA was retrospectively registered at Clinicaltrials.gov on the 19 May 2023 (NCT05866978).

Open Access

Article

Article ID: 2652

Bridging health and environment: Clean fuel access and tuberculosis in India

by Skylab Sahu, Smrutirekha Sahoo

Environment and Public Health Research, Vol.3, No.1, 2025;

Air pollution, both outdoor and indoor, is a major health risk, contributing to diseases like respiratory infections, cardiovascular conditions, and cancer, particularly affecting vulnerable groups like children, women, and the elderly. Poor indoor air quality (IAQ) due to cooking, heating, and inadequate ventilation is a significant concern, especially in low-income countries where solid fuels like biomass and coal worsen pollution. Long-term exposure leads to chronic conditions such as Chronic obstructive pulmonary disease (COPD), while immediate effects include respiratory infections and headaches. IAQ also affects the spread of tuberculosis (TB), particularly in areas with poor healthcare. This study examines the link between access to clean cooking fuels and TB incidence in India, using data from 2000 to 2022. It explores whether improved access to clean fuels reduces TB rates, considering factors like health expenditure and community health workers. Descriptive statistics, correlation analysis, regression, and time series analysis were employed. The data reveals a steady increase in access to clean cooking fuels, from 22.6% in 2000 to 74.5% in 2022, with the Pradhan Mantri Ujjwala Yojana likely contributing. TB incidence declined from 322 cases per 100,000 people in 2000 to 199 cases per 100,000 in 2022. Regression analysis shows a strong inverse relationship, explaining 94.1% of TB variance. However, socio-economic issues like poverty and illiteracy remain barriers, hindering TB control. India aims to eliminate TB by 2025, targeting an 80% reduction in incidence. While progress has been made, improving IAQ with clean cooking technologies like Liquefied petroleum gas (LPG) is crucial. Policies should focus on subsidies, alternative energy solutions, and rural infrastructure to achieve TB elimination and sustainable development goals.

Open Access

Perspective

Article ID: 2361

Rich people have better health than the poor: Health equity in an unequal world

by Jean Woo, Gary Ka-ki Chung, Roger Yat-Nork Chung, Ning Fan, Eric TC Lai, Richard Lee, Hung Wong, Eng-Kiong Yeoh, Michael Marmot

Environment and Public Health Research, Vol.3, No.1, 2025;

Many accept as inevitable that the rich have better health than the poor; at the same time, many would view this as contravening social justice. This topic was discussed between experts from diverse disciplines at a colloquium on 15th November 2024 in Hong Kong, jointly organized by the Institutes of Health Equity of the Chinese University of Hong Kong and University College London. To address health equity, there need to be indicator(s) that consist of health data, disaggregated by age groups, gender, and measures of deprivation, that are regularly collected. Social determinants of health that give rise to health inequalities need to be documented, to enable measures to be developed to counter such inequalities in the presence of wealth disparities. Such measures include government policies covering health, social, and other areas such as housing, transport, urban planning etc. Civil society also has an important role in mitigating health inequalities, particularly in societies with a steep gradient in wealth, such as Hong Kong.

Open Access

Perspective

Article ID: 2120

Occupational diseases: The prototype of all syndemics?

by Sara De Matteis, Emily Mendenhall

Environment and Public Health Research, Vol.3, No.1, 2025;

Labour laws play critical roles in people’s lives but rarely are they associated with health risk factors or outcomes. Yet, labour represents, directly and indirectly, the key driver of our health, as dramatically confirmed by the COVID-19 pandemic. This viewpoint discusses how syndemic thinking can explain a link between labour laws and occupational health. Syndemics are synergistic factors among epidemics, which provide a structured way to think about what conditions emerge epidemiologically, interact in the body, and are driven by shared social, structural, political, or ecological factors. Thinking syndemically about these conditions can explain the ways in which legal determinants, such as safety, work hours, wages, and leave, may be associated with poor health, particularly among those lower in social hierarchies. Workplaces can be a critical space for social and financial mobility as well as an opportunity to intervene in the major risk factors that promote poor health.

Open Access

Brief Report

Article ID: 2244

Comparisons of cost-utility analyses for major diseases: A focus in the Australian context

by Alan Silburn

Environment and Public Health Research, Vol.3, No.1, 2025;

This article delves into the nuances of cost-utility analyses applied to prevalent health conditions, examining the distinctive approaches for lung cancer, ischemic heart disease, and depressive disorders in Australia. The study explores the impact of utility-based units such as Disability-Adjusted Life Years, Quality-Adjusted Life Years, and Potential Years of Life Lost in economic evaluations. Notably, variations in disability weights and their implications on comparability are scrutinized, providing insights into the economic burden and cost-effectiveness of interventions. Findings reveal nuanced evaluation techniques’ critical importance and contextual relevance in health economic assessments.