Curvature-aware urban terrain earthwork volume estimation: a multi-city remote sensing framework
Sakiru Olarewaju Olagunju, Huseyin Atakan Varol, Ferhat Karaca
Accurate estimation of earthwork material volume is essential for achieving circular and resource-efficient urban development, enabling material reuse in construction planning. Traditional survey techniques cannot efficiently cover large areas, while grid-based approaches often overlook terrain curvature. This study presents a novel and scalable framework for earthwork volume estimation across five cities over eleven years. We introduce a curvature-aware methodology using sub-meter digital terrain models (DTMs) derived from Maxar stereo imagery. DTMs were validated against commercial datasets (RMSE 1.12–2.10 m) and literature benchmarks. Our approach combines adaptive grid refinement with spline-based volume integration, yielding 20.6% lower error than grid-based methods. Pre-earthwork terrain surfaces were reconstructed using Natural Neighbor Interpolation (RMSE 0.06 m in Astana). Temporal analysis reveals diverse urban development trajectories, including volume decline in Astana, stable growth in Almaty and Porto, and seasonal drops in Prague. These findings support sustainable construction strategies through precise city-scale earthwork volume estimation.
Sky view factor analysis of street canyons and its implications for daytime intra‐urban air temperature differentials in high‐rise, high‐density urban areas of Hong Kong: a GIS‐based simulation approach
Liang Chen, E. Ng, Xipo An
et al.
Personal rapid transit and the future city with sustainable mobility
Jiaxiang Wang
The concept of personal rapid transit (PRT) has been proposed for over 70 years since 1953, and the practice of PRT has been advancing slowly worldwide. This paper analyzes advantages of PRT and applicable scenarios of PRT in the future city. The future city has a new functional structure, spatial form and public transportation system, and the era of autonomous driving is coming. This paper analyzes the reasons why PRT is suitable for future urban planning and design. With the advancement of various technologies and the decline of costs, through good multi-discipline planning and design, this paper focuses on how PRT can be perfectly integrated into the future urban space, architecture, landscape environment, and the road network. The PRT guideway could highlight the characteristics of future urban space landscape, avoiding existing visual invasion and other issues. As an important part of the public transport system in the future city, PRT can help achieve the goal of sustainable mobility once there are more practices. The next step for PRT is most likely to be the connection of urban medium- or large-carrying-capacity public transport. The paper takes Suzhou Taihu national tourism resort, China as an example for the recent expansion of PRT's practice.
Transportation engineering
Identifying and modeling creative tourism challenges in the city of Nain
Fatemeh poorbafarani, aboozar vafaei, Esmaeil Mazroui Nasrabadi
1. IntroductionToday, creative tourism is one of the most important ways to improve the economic status of cities, but despite the benefits of developing this model of tourism, its implementation is not easy and there are numerous challenges to its realization. In this regard, the city of Nain is one of the urban areas that, despite benefiting from various forms of tourism, namely historical, agricultural, natural, handicrafts and physical, and allocating a share of the city's economy to this activity, faces challenges in various dimensions in realizing creative tourism. Therefore, the present study aims to identify and model the challenges of creative tourism in the city of Nain, to form the basis for proper policy and decision-making by the authorities in this field, and ultimately to remove the obstacles to realizing creative tourism in the city.2. Research MethodologyThe research type is applied in terms of purpose and descriptive-analytical in terms of method. The statistical population of the research consists of two levels including officials, city managers and city tourism activists, and academic experts and specialists. The sampling method is judgmental and the sample size for the first group is 17 people in the form of semi-structured interviews based on theoretical saturation and for the second group, 10 people in the form of questionnaires. The data collection method is field-based and its tool is semi-structured interviews in the field of creative tourism challenges and a questionnaire developed by the researcher in the field of modeling creative tourism challenges. To design the interview protocol, after reviewing the relevant literature, the PESTEL technique was used to design questions. Pairwise comparisons between factors were used to design researcher-made questionnaires. Thematic analysis was used to analyze data in the stage of identifying creative tourism challenges and interpretive structural modeling (ISM) was used to model creative tourism challenges.3. Results and discussionThe results of the interviews revealed 39 challenges of creative tourism in the city, which were divided into 17 subcategories, including "presence of various types of pollution in the city's tourism space", "excessive use of the city's pristine and natural space", "ignorance of local customs and traditions", "lack of use of traditional elements in the recreation of urban spaces", "lack of motivation and willingness to invest", "weakness of government finances in supporting various tourism sectors", "lack of concerned managers in the tourism sector", "divergence of tourism sector managers and lack of teamwork", "lack of necessary tools for guidance and advertising", "lack of primary tourism infrastructure", "weakness of executive management of the tourism sector", "lack of training, preparation and accompanying the host community in tourism activities", "lack of necessary preparation for tourists to familiarize themselves with the culture of the local community", "lack of educational and specialized centers in the tourism sector", "lack of interactions and communications with tourism sector activists in all parts of the country and the world", "ignorance of the city's tourism capacities", "Lack of planning to implement traditional and local ceremonies continuously throughout the year" and 9 main categories including "Existence of environmental pollutants and damage to nature tourism", "Forgetting the original culture and identity of the city", "Lack of a sustainable tourism economy", "Lack of a unified policy and strategy in the field of tourism", "Lack of facilities, equipment and services in the field of tourism", "Lack of creative and convergent management", "Lack of culture and trust building for the local community and tourists", "Lack of specialized and practical training", "Lack of a comprehensive tourism package to offer" were categorized. Next, in order to more accurately analyze the challenges of the city's creative tourism, their interpretative structural model was drawn and the position of each challenge was examined in it.4. ConclusionThe present study has identified and modeled the challenges of creative tourism in the city of Nain. The results of the theoretical study of the research show that creative tourism is a type of tourism that distinguishes and develops the creative experiences of tourists and prioritizes sustainability. However, there have always been obstacles and challenges to the sustainability of this type of tourism, which include infrastructure challenges such as the lack of adequate and suitable accommodation and amenities, as well as a weak structure for creating jobs, inadequate education, lack of smart technologies, lack of guidelines, and inadequate training. On the other hand, comparing the research findings with theoretical foundations shows that Nain city is one of the urban areas that, despite benefiting from various forms of tourism and allocating a share of the city's economy to this activity, faces challenges in the field of creative tourism, including the lack of specialized training centers in various fields of tourism, a shortage of specialized personnel in the field of tourism, the lack of facilities and equipment necessary for the development of city tourism, lack of investment in various tourism affairs, and the weakness and incompetence of tourism sector managers. These challenges can hinder the path of creative and dynamic economic formation and ultimately the sustainable development of the city's tourism. Therefore, the results of the present study show that there are several challenges in the development of creative tourism in this city. The output of the structural model showed that the challenge of lack of creative and convergent management is the most important of all challenges; Because experts believe that the lack of creative and convergent management in the city of Nain has led to the lack of support from senior city managers for the tourism sector, the lack of alignment between executive institutions and the private sector in this area, the lack of a real and concerned custodian in the city's tourism sector, and the inability of executive managers to actualize the city's existing capacities and capabilities in the tourism sector.
Commerce, Human ecology. Anthropogeography
Research on the Characteristic Identification and Multidimensional Dynamic Evolution of Urban–Rural Fringe in Harbin, China
Jing Ning, Haozhi Ma, Yu Sun
et al.
The urban–rural fringe, serving as a frontier space and protective barrier for urban–rural factor circulation, is a complex area marked by significant human–land conflicts. Therefore, scientifically identifying and dynamically monitoring the urban–rural fringe is crucial for its integrated development and spatial governance. In this context, this paper constructs an information entropy model using land use data, combined with the central gravitational agglomeration method, to accurately identify the evolution of Harbin’s urban–rural fringe over the past 40 years. The research reveals that Harbin’s urban–rural fringe exhibits a distinct circling pattern, with spatial morphology changes characterized as “low-speed spreading—jumping expansion—internal dissimilarity”, allowing for improved identification of its three types: stable, expanding, and degrading. The study also tracks the scale of the urban–rural fringe in Harbin with three types of stable, expanding, and degrading urban–rural fringe. Drawing on previous research, we visualize the fringe area’s functional spatial positioning, showing its dominant function shifting from a production–ecological composite to a production–life–ecological coordinated function. Concurrently, the study’s findings, alongside Harbin’s socioeconomic development, indicate that the urban–rural fringe’s evolution is driven by economic, policy, and environmental factors. Based on the multi-dimensional research outcomes, we conclude that the evolution of Harbin’s urban–rural fringe can be divided into three stages: a slow gestation period (1980–1990), a rapid development period (1990–2010), and a stable reconstruction phase (2010–2020). In the initial phase, urban and rural development is minimal; during the second phase, the trend of urban expansion is significant, and the urban–rural fringe is rapidly shifted to the city; and in the latter stage, urban and rural elements are stabilized and coordinated, and urban and rural areas are realized to be developed and reconstructed as one. This paper provides a scientific basis for understanding the dynamic evolution of the urban–rural fringe in Harbin City and is an important reference for future territorial spatial planning and development.
Customer complaints management in South Africa: A quest for service excellence
Tebogo Mogotloane, Valery Louw
Background: The poor resolution of customer complaints in the domain of public service is often attributed to a lack of accountability, transparency, communication, leadership, competent personnel, and well-defined complaint-management policies.
Aim: This article examined the efficacy and efficiency of the processes and procedures used to carry out the customer complaints management policy within the public service.
Setting: The study focused on the Department of Employment and Labour in the Free State province.
Methods: A qualitative study design was adopted, with self-administered questionnaires used to collect data from 20 purposefully selected participants from the Department of Employment and Labour – Free State province.
Results: The research revealed several key findings. Firstly, there was a lack of consequences for subpar performance. Secondly, inadequate communication and coordination hindered the timely resolution of customer complaints, and minimal frontline staff training on the customer complaints management policy. Thirdly, it was discovered that a lack of capacity resulted in underreporting of complaints, which has a detrimental impact on how quickly and effectively customer complaints are handled.
Conclusion and contribution: The implications of this study, therefore, draw attention to redress mechanisms as a vehicle to turn around and improve public service delivery. The study recommends that the Department of Employment and Labour should consider increasing the capacity of staff in handling customer complaints, developing appropriate customer complaints management training manuals, and establishing a business unit or directorate that deals with customer complaints.
Political institutions and public administration (General), Regional planning
Optimization of time scheduling planning with the precedence diagram method (PDM) on the drainage construction project
Adde Currie Siregar, Noorkhayati Noorkhayati, Santi Yatnikasari
et al.
Jalan Pemuda 1 is one of the city roads located in the Samarinda region that often experiences flooding. Therefore, the construction of adequate drainage is necessary to address this flood issue. The construction of this drainage system is expected to effectively solve the flooding problems in the area. The project utilizes precast U-ditches as part of the drainage, replacing the less effective manual methods. The project site frequently experiences tidal fluctuations from the Karangmumus River, which triggers the floods. The U-ditch Precast has dimensions of 240 cm width, 180 cm height, and 10 cm length. Additionally, this research aims to analyze the time optimization in drainage channel construction projects using the Precedence Diagram Method (PDM). The critical tasks in the construction of the drainage channel project are also analyzed using the PDM method. In this research phase, the author chose the Precedence Diagram Method (PDM) not only to clarify the tasks but also to improve project management efficiency and effectiveness to achieve optimal results. The advantage of the Precedence Diagram Method (PDM) is that it does not require dummy or additional activities, simplifies the project network creation, and the interdependence between activities can be arranged without adding new tasks. The accelerated tasks include mobility work, reduced from 7 days to 2 days, and demobilization, reduced from 7 days to 1 day. The occupational safety and health management system (K3) is reduced from 7 days to 2 days, and utility tasks (PDAM, PLN, Telkom) are reduced from 7 days to 2 days. The initial project scheduling indicates a duration of 210 days, but with optimization, the project is completed in 196 days, resulting in a time savings of 13 days. This study provides insights into the effectiveness of the PDM method in addressing critical challenges in construction projects, with implementation leading to more efficient planning and timely project completion.
Urban form revisited—Selecting indicators for characterising European cities
N. Schwarz
Cosmopolis II : mongrel cities in the 21st century
L. Sandercock, P. Lyssiotis
Climate change response in Europe: what’s the reality? Analysis of adaptation and mitigation plans from 200 urban areas in 11 countries
Diana Reckien, Johannes Flacke, Richard Dawson
et al.
Comparison of gut bacterial communities of Hyphantria cunea Drury (Lepidoptera, Arctiidae), based on 16S rRNA full-length sequencing
Hui Gao, Sai Jiang, Yinan Wang
et al.
There are a large number of microorganisms in the gut of insects, which form a symbiotic relationship with the host during the long-term co-evolution process and have a significant impact on the host's nutrition, physiology, development, immunity, stress tolerance and other aspects. However, the composition of the gut microbes of Hyphantria cunea remains unclear. In order to investigate the difference and diversity of intestinal microbiota of H. cunea larvae feeding on different host plants, we used PacBio sequencing technology for the first time to sequence the 16S rRNA full-length gene of the intestinal microbiota of H. cunea. The species classification, β diversity and function of intestinal microflora of the 5th instar larvae of four species of H. cunea feeding on apricot, plum, redbud and Chinese ash were analysed. The results showed that a total of nine phyla and 65 genera were identified by PacBio sequencing, amongst which Firmicutes was the dominant phylum and Enterococcus was the dominant genus, with an average relative abundance of 59.29% and 52.16%, respectively. PERMANOVA analysis and cluster heat map showed that the intestinal microbiomes of H. cunea larvae, fed on different hosts, were significantly different. LEfSe analysis confirmed the effect of host diet on intestinal community structure and PICRUSt2 analysis showed that most of the predictive functions were closely related to material transport and synthetic, metabolic and cellular processes. The results of this study laid a foundation for revealing the interaction between the intestinal microorganisms of H. cunea and its hosts and provided ideas for exploring new green prevention and control strategies of H. cunea.
Urban Governance, Institutional Capacity and Social Milieux
G. Cars, P. Healey, A. Madanipour
et al.
196 sitasi
en
Political Science
Challenges of urban green space management in the face of using inadequate data
Marcin Feltynowski, Jakub Kronenberg, Tomasz Bergier
et al.
Urban Heat Island studies in South Asia: A critical review
Rajashree Kotharkar, A. Ramesh, Anurag Bagade
Abstract South Asian cities are home to nearly 15% of the world's urban population. These cities are experiencing rampant environmental deterioration, making them vulnerable to the impacts of climate change phenomenon, one of which is urban-rural temperature difference known as urban heat island (UHI) effect. While South Asian UHI research publications have tripled since 2000, a comprehensive overview of the experimental results, significant advancements and predominant directions in research is necessary to add clarity to the scientific understanding of tropical and subtropical urban climates and also, to aid city planning and policy-making. A review of 85 original research publications from peer-reviewed journals and conference proceedings in last five decades, covering 28 representative South Asian cities, revealed that Delhi, Chennai and Colombo were most frequently studied and satellite imagery based thermal mapping was used predominantly. Results from few significant studies have shown practical implications for energy use and management, human health, comfort and productivity, reducing air pollution and urban land-use planning. With similar patterns of urbanization, geographies and climate types prevailing across international borders, cities in South Asian region could mutually benefit from collaborative multi-disciplinary research efforts and knowledge sharing to competently respond to and manage the detrimental impacts of urban heat islands.
Experimental investigation of shear-extension coupling effect in anisotropic reinforced concrete membrane elements
Ratnasai Kosuru, Amlan Kumar Sengupta
Performance based analysis under seismic loads using the finite element method for wall-type reinforced concrete (RC) members in buildings and in important structures like liquid retaining structures, nuclear containment structures, offshore concrete gravity structures etc., necessitates the understanding of the non-linear behaviour of the constituent membrane elements. The current orthotropic formulation of the softened membrane model (SMM) can be strictly used only when the reinforcement is symmetric to the principal axes of applied stresses. When the reinforcement is asymmetric, shear strain is generated due to the normal stresses in the principal axes of applied stresses, which is referred to as shear-extension coupling. An anisotropic formulation is required to capture the generated shear strain. The current study quantifies the shear strain due to asymmetry in reinforcement, by testing panels under biaxial tension-compression using a large-scale panel testing facility. A model for the shear strain is proposed based on the tests data. The paper presents the experimental programme, important test results and the modelling of shear strain. Expression developed for the shear strain can be incorporated in the solution algorithm of the SMM for improved prediction of the shear behaviour of a membrane element. This further aids in accurate prediction of the seismic performance of the important structures mentioned earlier.
Engineering (General). Civil engineering (General), City planning
Urban spatial structure features in Qinling mountain area based on ecological network analysis-case study of Shangluo City
Xiaohui Yu, Yang Liu, Ziyu Zhang
et al.
Since the 20th century, the world is facing two major problems: the serious deterioration of the ecological environment and the accelerated decline of living quality of people residing in the urban environment. Urban development policies, ecological patterns, production and consumption modes have an important impact on global environmental changes that threaten the future living of mankind. The focus of urban space construction has also turned to the fields of ecological security, energy development, resource management and urban ecological virtuous circulation. Investigating urban spatial structure features from the perspective of urban metabolic system is important for ecological security and resource management. Shangluo urban space in Qinling area is used as the research object and an analysis system of urban spatial structure based on ecological network analysis is proposed in this study. First, an ecological network model of urban space was constructed from the research perspective of ecological network analysis and the system metabolic level was evaluated using metabolic scale, intensity, and efficiency. Second, the system structure of urban metabolic network and its functional relations were analyzed. On this basis, interactive relationships among different components in the metabolic system were explored via symbiosis index and symbiotic, competitive, predatory, and control relations. Meanwhile, the ecological network analysis method is used to construct an analysis system for urban spatial structure in the Qinling mountain area. Finally, the analysis system of urban spatial structure in the Qinling mountain area is applied to examine the urban spatial structure of Shangluo, Qinling Mountains, China. Results showed that resource utilization efficiency of Shangluo City presents a rising trend and the city is located in a strong structural center in the regional space. Predatory and control relations played a dominant role among ecological relations in the urban metabolic structure, and the urban space presented a clear uniaxially extended spatial structure. Sensitivity of internal environment was extremely evident, and the natural spatial structure was an important basis for urban space development in Shangluo. The urban spatial structure analysis system in this research is constructed with the three aspects of “metabolic level”, “ecological relationship” and “compartment weight” of the spatial structure information, which solves the problem that the conventional spatial structure analysis system is difficult to quantify the ecological network information, and it provides a new idea to explain the internal component interaction mechanism and spatial structure composition of the urban system. The results of this study can provide not only useful reference for urban spatial structure analysis of underdeveloped ecological capital areas in China but also a basis for sustainable development planning of urban spaces.
Engineering (General). Civil engineering (General)
Just Adapt: Engaging Disadvantaged Young People in Planning for Climate Adaptation
Anna R. Davies, Stephan Hügel
The visibility of young people in climate change debates has risen significantly since the inception of the Fridays for Future movement, but little is known about the diversity of positions, perspectives and experiences of young people in Ireland, especially with respect to climate change adaptation planning. To close this knowledge gap, this article first interrogates key emergent spaces of public participation within the arena of climate action in Ireland in order to identify the extent of young people’s participation and whether any specific consideration is given to disadvantaged groups. It then tests the impacts of workshops specifically designed to support disadvantaged young people’s engagement with climate change adaptation which were rolled out with a designated Delivering Equality of Opportunity in Schools school in inner-city Dublin, Ireland. We found limited attention to public participation in climate change adaptation planning generally, with even less consideration given to engaging young people from disadvantaged communities. However, positive impacts with respect to enhanced knowledge of climate change science and policy processes emerged following participation in the workshops, providing the bedrock for a greater sense of self-efficacy around future engagement with climate action amongst the young people involved. We conclude that what is needed to help ensure procedural justice around climate action in Ireland are specific, relevant and interactive educational interventions on the issue of climate change adaptation; interventions which are sensitive to matters of place and difference.
Political science (General)
Airbnb and Amenity: Is Short-Term Letting Reshaping How We Live in the City?
Laura Crommelin, Sharon Parkinson, Chris Martin
et al.
The popularity of short-term letting (STL) platforms like Airbnb has created housing and planning challenges for cities worldwide, including the potential impact of STL on the quality of life of nearby residents and communities. Underpinning this concern is an inherent tension in urban living between the rights and interests of individual residents and the collective rights and interests of neighbours. Through interviews with Australian Airbnb hosts, this paper examines how STL hosts navigate this tension, including how they frame their rights, how they seek to minimise impacts on neighbours, and how they perceive the role of regulation in balancing individual and community rights. In doing so, the paper contributes to both theory and policy debates about urban property rights and how ‘compact city’ planning orthodoxies are reshaping the lived experience of urban residents worldwide.
Land use, Economic growth, development, planning
Modernizing and expanding universal eye care coverage after VISION 2020
Megan Yu
Photo by Wesley Tingey on Unsplash
INTRODUCTION
On February 18, 1999, the World Health Organization launched VISION 2020 to eliminate preventable, treatable blindness by 2020.[1] Today, low-income nations continue to lack access to prevention-based eye care.[2] The leading causes of vision impairment in 2015 were cataracts and uncorrected refractive errors, particularly in low-income nations. Currently, 123.7 million people have uncorrected refractive errors and 57.1 million people have cataracts.[3] 826 million people have uncorrected farsightedness (presbyopia), most prevalent in rural areas among low-income countries.[4] These findings suggest there may be global disparities in access to eye care resources.
Preventable ocular impairment impacts quality of life immensely. For instance, people living with uncorrected refractive errors can have difficulty cooking, recognizing faces, and showering.[5] Cataracts can cause driving difficulties and increase risk of injuries.[6] Access to eye care is vital to performing activities of daily living. This paper discusses the factors that contribute to the immense burden of vision impairment among low-income nations, the impact preventable vision impairment has on societies, and some ethical issues and recommendations that should be considered when expanding eye care coverage.
ANALYSIS
I. Contributing Factors to the Vision Impairment Burden among Low-Income Nations
Resource Availability
A lack of trained ophthalmic professionals and equipment remains one of the greatest barriers to reducing the global prevalence of avoidable ocular impairment, especially in low-income nations.[7] Despite an overall increase in total ophthalmologists and optometrists, very few eye healthcare workers are available in rural settings.[8] Over 10 percent of the world’s blind population (4.8 million blind individuals) live in Africa, where there are not enough ophthalmologists to care for them.[9] Even if there were enough ophthalmologists worldwide, there are shortages in optometrists and other allied ophthalmic personnel critical to providing comprehensive eye services.[10] Approximately one ophthalmologist is available to address the needs of 446,000 individuals in sub-Saharan Africa.[11] There are drastic differences in the distribution of eye professionals among Anglophone, Francophone, and Lusophone Africa, with the greatest number of professionals available in Anglophone Africa.[12] Many low- and middle-income nations do not have sufficient ophthalmic equipment or infrastructure. Of about 120 healthcare settings in Africa, only 38 percent had an A-scan, a device essential for cataract surgery.[13] The majority of eye services in low-income nations are offered in secondary or tertiary hospitals, which are primarily located in urban areas, fueling the inequity in rural access to healthcare resources.[14]
Gender and Resource Accessibility
Many demographic factors affect accessibility to eye resources. In some low-income nations, women have lower cataract surgical coverage and poorer visual outcomes than men.[15] Many factors such as “limited financial decision-making power” for women and a lower likelihood for them to travel beyond their community contribute to the gender inequity.[16] Increasing socioeconomic disadvantage, poor health literacy, and lack of knowledge on healthcare resource availability also prevent individuals from accessing eye resources.[17]
Local Remedies
The presence of local remedies and unlicensed health providers, such as illicit drug sellers or spiritual healers, may divert individuals from ophthalmologists and cause delays in eye treatment.[18] Couching, which is an ancient treatment for cataracts, is still widely practiced in Nigeria.[19] It involves moving the cataractous lens from the visual axis into the vitreous cavity either surgically or through non-invasive methods, such as “repeated blunt trauma” to the eye or applying a plant extract topically.[20] Individuals living in rural regions are more likely to be couched rather than visit an ophthalmologist, and only 9.7 percent of those who were couched had a good outcome.[21]
Affordability
Individuals with lower socioeconomic status are less likely to seek eye resources. They cannot afford to forego earnings for their basic living needs, which can explain nonattendance at eye care appointments.[22] Costs involved in receiving eye care, transportation to appointments, and pharmaceutical interventions are common barriers to accessing eye resources. 50 percent of people in low-income nations live more than one hour from a city, making travel difficult for appointments.[23] Additionally, many adults do not have health insurance, which affects their ability to afford eye services. In Trinidad and Tobago, “private sector ophthalmologists provide 80 percent of all eye care services but less than 20 percent of the adult population has health insurance.”[24]
Acceptability
In some societies, eyewear is not accepted and wearing glasses is seen as a disability.[25] Indigenous populations are more likely to access eye services if they are culturally appropriate and integrated into their community-based health service.[26]
II. Impact of Uncorrected Vision Impairment on Societies
Uncorrected vision impairment has tremendous impact on societies. Apart from poor health, it causes increased social isolation, decreased employment, diminished educational opportunities, and increased morbidity.[27] Uncorrected refractive errors could result in a global productivity loss of US $202 billion annually; it would take US $28 billion to resolve this issue.[28] Up to 94 percent of individuals living with farsightedness in low-income nations remain uncorrected or under-corrected.[29] These findings highlight the need to propose radical solutions to achieve access to affordable corrective measures like eyeglasses and contact lenses.
III. The Ethical Imperative in Eye Care
Basic vision correction is life altering. Those in rural poverty in low-income countries should have access to glasses as a minimum standard of justice. Glasses could change someone’s ability to become educated, achieve job success, and reach a better standard of living. In wealthy countries like the US that do not have universal healthcare coverage, access to glasses is a priority even for the poorest people. An individual’s ability to autonomously achieve their own goals rests on the ability to correct simple vision problems. A lack of eyeglasses threatens autonomy and may require dependence on others for driving and reading. Uncorrected vision also limits job opportunities requiring manual tasks like farming, operating cash registers, managing small shops or businesses, and using computers and phones. For many women, eyeglasses are necessary for weaving, knitting, and sewing to incur income. Living without glasses could also lead to a progressive deterioration in mental health and an inability to engage in social and community activities.
Ophthalmologists, optometrists, and other eye health professionals have a professional obligation to serve the needs of their patients and engage in activities that promote public awareness of eye health issues. However, all doctors are not obligated to care for those in poverty in developing countries. Justice and autonomy should compel governments, with the help of global nonprofits and health organizations to act in the best interests of their communities, to avoid preventable morbidity, and to level the playing field, and allow each person equal opportunities. They should also support transparent, equitable allocation of eye care resources, and use more effective strategies than those implemented in the VISION 2020 initiative. Governments concerned with directing resources to communities equitably should consider eyecare necessary, distribute it fairly, and serve the marginalized.
To meet the needs of the community and fully incorporate eye care in national health strategic plans, governments of low-income nations should allow their citizens to participate in determining what eye health goals should be achieved. Respecting the community’s autonomy to engage in discussions would ensure vulnerable populations can voice their concerns regarding their access to eye care resources. Distributive justice should supersede cost-benefit analysis to ensure certain interventions or subpopulations are not neglected. While scarcity leads to allocation plans that prioritize certain interventions, distributive justice is achievable. To avoid prejudice against the elderly who tend to have vision problems, eyecare plans should not depend on subjective views of quality of life or remaining years. Providers should be able to stretch resources to cover even the most marginalized by using the most economical solutions such as eyeglasses rather than laser surgery to correct vision.
IV. Moving Forward to Achieve Universal Eye Care Coverage
Because most eye care delivery in low-income nations is offered at secondary or tertiary hospitals and is restricted to urban settings, providing incentives to rural eye practitioners and training locals to perform eye care is imperative.[30] Enhanced training of primary health staff, training eye health professionals that are not ophthalmologists, and promotion of regular eye exams and eye safety could be effective.[31] Countries should implement programs that destigmatize eyeglasses, improve health literacy, and integrate eyecare into primary care.
To address scarcity of resources, low-income countries should “shift from out-of-pocket payments toward mandatory prepayments with pooling of funds” and prioritize vulnerable populations.[32] The median out-of-pocket spending on health constitutes more than 40 percent of healthcare spending in low-income nations, placing a tremendous financial burden on many families.[33] These nations should estimate coverage costs they cannot meet even with pooled funds and appeal to nonprofits, the international community, and the physician community to meet the costs of basic care. Alternative financial sources, including “national insurance or performance-based financing” may be helpful.[34] Overall, health systems research is important to evaluate the global prevalence of preventable visual impairment, since there is dearth of data in this area.[35]
CONCLUSION
Visual impairment is still prevalent in low-income nations 21 years after VISION 2020 was launched. The global community and individual governments have an ethical responsibility to reduce the tremendous burden preventable visual impairment has on people in low-income nations. New approaches are necessary to provide affordable, equitable eye care coverage. While scarce resources call for difficult choices, by prioritizing those with correctable vision loss regardless of age or income and using the least expensive solutions (like eyeglasses), countries can achieve distributive justice. Individuals able to correct their vision problems can act autonomously to access more jobs, activities, and opportunities. While global organizations are needed for research, financing, and application, strategic plans should also involve all stakeholders within the healthcare system so local government agencies, healthcare providers, patients, and communities can come together to create a solution. Regulatory frameworks should elevate the standard of living by providing access to vision care that ensures autonomy, beneficence, and justice.
[1] World Health Organization, “Prevention of blindness and visual impairment,” 2020. https://www.who.int/blindness/partnerships/vision2020/en/.
[2] Healio, “Vision 2020 reaches landmark year”, January 2, 2020. https://www.healio.com/news/ophthalmology/20191226/vision-2020-reaches-landmark-year.
[3] World Health Organization website. https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment See also Flaxman, Seth et al., “Global causes of blindness and distance vision impairment 1990-2020: A systematic review and meta-analysis,” The Lancet: Global Health 5, no.12 (December 2017): e1221-e1234. https://doi.org/10.1016/S2214-109X(17)30393-5.
[4] Fricke, Timothy et al., “Global prevalence of presbyopia and vision impairment from uncorrected presbyopia,” Ophthalmology 125, no. 10 (October 2018): 1492-1499. https://doi.org/10.1016/j.ophtha.2018.04.013.
[5] Kandel, Himal et al., “Impact of refractive error on quality of life: A qualitative study,” Clinical & Experimental Ophthalmology 45, no. 7 (September/October 2017): 677-688. https://doi.org/10.1111/ceo.12954
[6] InformedHealth.org, “Cataracts: Overview”, October 10, 2019. https://www.ncbi.nlm.nih.gov/books/NBK390302/.
[7] World Health Organization, “World report on vision”, 2019. https://www.iapb.org/wp-content/uploads/world-vision-report-accessible1.pdf.
[8] World Health Organization, 2019, p. 36; World Health Organization, 2019, p. 37
[9] Gilbert, Suzanne et al., “Recruiting and distributing eye health workers,” Community Eye Health, 31, no. 102 (2018): 45-47; World Health Organization, Global Data on Health Impairments, 2010. https://www.who.int/blindness/GLOBALDATAFINALforweb.pdf
[10] World Health Organization, 2019, p. 37
[11] Graham, Ronnie, “Facing the crisis in human resources for eye health in sub-Saharan Africa,” Community Eye Health, 30, no. 100 (2017): 85-87.
[12] Graham, p. 87
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Medical philosophy. Medical ethics, Ethics
The linkage between globalisation and financial inclusion: Do inequality and institutions matter?
Malik Cahyadin
This paper examines the effect of the globalization threshold on financial inclusion in 40 selected countries during 2000-2018. A principal component analysis (PCA) and a static panel threshold (SPT) are utilized. There are three dimensions and one aggregation of financial inclusion indicators assessed by PCA, while the globalization threshold is estimated under static panel threshold regression. Findings/Originality: The findings exhibit six countries with strong financial inclusion and eight countries with weak financial inclusion during study periods. Furthermore, the threshold effect of globalization has a significant impact on the financial inclusion index. The robustness checking employs panel cointegration test exhibits that inequality and some institutions indicators have a significant impact on financial inclusion both in the short-run and long-run. The policy implication suggests that governments should increase the financial inclusion index level during the globalization period, decrease inequality, and improve institutions' quality.
Economic growth, development, planning, Regional economics. Space in economics