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Background Inequalities in obesity pertain in part to differences in dietary intake in different socioeconomic groups. Examining the economic, social, physical and political food environment of low-income groups as a complex adaptive system – i.e. a system of multiple, interconnected factors exerting non-linear influence on an outcome, can enhance the development and assessment of effective policies and interventions by honouring the complexity of lived reality. We aimed to develop and apply novel causal loop diagramming methods in order to construct an evidence-based map of the underlying system of environmental factors that drives dietary intake in low-income groups. Methods A systematic umbrella review was conducted on literature examining determinants of dietary intake and food environments in low-income youths and adults in high/upper-middle income countries. Information on the determinants and associations between determinants was extracted from reviews of quantitative and qualitative studies. Determinants were organised using the Determinants of Nutrition and Eating (DONE) framework. Associations were synthesised into causal loop diagrams that were subsequently used to interpret the dynamics underlying the food environment and dietary intake. The map was reviewed by an expert panel and systems-based analysis identified the system paradigm, structure, feedback loops and goals. Results Findings from forty-three reviews and expert consensus were synthesised in an evidence-based map of the complex adaptive system underlying the food environment influencing dietary intake in low-income groups. The system was interpreted as operating within a supply-and-demand, economic paradigm. Five sub-systems (‘geographical accessibility’, ‘household finances’, ‘household resources’, ‘individual influences’, ‘social and cultural influences’) were presented as causal loop diagrams comprising 60 variables, conveying goals which undermine healthy dietary intake. Conclusions Our findings reveal how poor dietary intake in low-income groups can be presented as an emergent property of a complex adaptive system that sustains a food environment that increases the accessibility, availability, affordability and acceptability of unhealthy foods. In order to reshape system dynamics driving unhealthy food environments, simultaneous, diverse and innovative strategies are needed to facilitate longer-term management of household finances and socially-oriented practices around healthy food production, supply and intake. Ultimately, such strategies must be supported by a system paradigm which prioritises health.

This study reviewed the municipal solid waste (MSW) composition, the management practices, and the use of life cycle assessment (LCA) tool for MSW management (MSWM) options in the various income group countries. LCA studies require inventory data, which is difficult to procure for any country including higher income group countries, and this issue gets compounded in low-income and lower middle-income group countries, which limits the implementation of LCA. This paper compared the use of LCA for MSWM between high-income and low-income group countries and also highlights the gap in using LCA for MSWM. A very limited number of LCA studies on MSWM were found for low-income group countries in comparison to high-income group countries. The study also provided a critical discussion on the challenges in applications of LCA in MSWM for better solid waste management in low-income and lower middle-income group countries. The study will help in taking up LCA studies in low-income countries to improve the overall MSWM efficiency.

Background The global COVID-19 pandemic has significantly impacted public health and socio-economic development worldwide. This study aims to investigate the effects of non-healthcare system interventions on the daily new cases of COVID-19 from January 2020 to October 2022. Methods With the aid of multilevel approach, we identified income group, region and country as stratification factors that affect the number of COVID-19 daily new cases. Data on COVID-19 cases collected by Johns Hopkins University were used, and policy implementation details were recorded through the Oxford COVID-19 Government Response Tracker dataset. To analyze the effects of national, regional, and income group factors on the number of daily new COVID-19 cases, we implemented three multilevel sequential mixed-effects models and applied restricted maximum likelihood to estimate the variance of random effects. Results Our results indicate a correlation between income group and the rise in intercepts of random effects in the multilevel sequential mixed-effects models. High-income countries recorded the highest intercept at 713.26, while low-income countries showed the lowest at -313.79. Under the influence of policies, the implementation of \"Canceling public events\" and \"International travel restrictions\" has been shown to significantly reduce the daily number of new COVID-19 cases. In contrast, \"Restrictions on gatherings\" appear to have the opposite effect, potentially leading to an increase in daily new COVID-19 cases. Conclusions In designing epidemic control policies, due consideration should be given to factors such as income group, as well as medical, demographic, and social differences among nations influenced by economic factors. In policy-making, policymakers should pay greater attention to policy implementation and people's responses, in order to maximize the effectiveness and adherence of such policies.

PurposeThe increasing growth of urbanisation, especially in developing countries, coupled with affordable housing leakages, may thwart achieving Sustainable Development Goal (SDG) 11 (sustainable cities and communities). Studies regarding affordable housing leakages and their aftermath to Goal 11 in one study are scarce in Malaysia. The study investigated Malaysia's low-cost housing (LCH) leakages and their aftermath to Goal 11 and proffered measures to achieving Goal 11 and its targets. The purpose of this paper is to address these issues.Design/methodology/approachThe researchers covered four of Malaysia's major cities via a qualitative approach. The study used 40 participants via semi-structured virtual interviews, and saturation was achieved. The study adopted a thematic approach for the collected data and honed them with secondary sources.FindingsFindings group Malaysia's LCH leakages into government/agencies/departments in housing, housing developers/building contractors and client/building owners' root causes in Malaysia's context. It shows a threat from Malaysia's LCH leakages to achieving Goal 11 and proffered measures to enhance achieving Goal 11. Achieving Goal 11 will strengthen and improve Malaysia's many SDGs accomplishments because of their link.Originality/valueApart from proffering measures to mitigate long-standing issues (leakages) in Malaysia's LCH delivery from achieving Goal 11, findings will stipulate the accomplishment of other SDGs related to housing delivery.

The declining trend in China’s fertility rate is very pronounced, and since 2023, the population has entered a phase of negative growth, significantly constraining economic development. At the same time, income inequality, which creates many problems, remains a serious issue. Existing research does not discuss the impact of income inequality on fertility rates in China currently. This paper depends on both macro and micro perspectives to examine the relationship between income inequality and fertility. We used the macro perspective to study the impact of urban-rural income inequality on the birth rate. The results show that the widening income gap between urban and rural areas will reduce the birth rate, but this effect declines with increasing of the birth rate; this negative effect is the strongest in the eastern region and the weakest in the western region. We used micro perspective to study the effect of the Gini coefficient on fertility motivation. It was found that for every one percent increase of the Gini coefficient, the fertility motivation decreased by about 0.08%, indicating that income inequality also impacts fertility behavior negatively. Comparing different income groups, income inequality has no impact on the fertility motivation of low-income groups, but has a significant negative and positive impact, respectively, on the middle and high-income groups. The mediating effect model shows that income inequality can negatively affect fertility behavior by reducing social trust and subjective well-being. Therefore, the empirical results from China suggest that income inequality negatively affects fertility behavior.

Modifying the food environment of cities is a promising strategy for improving dietary behaviors, but using traditional empirical methods to test the effectiveness of these strategies remains challenging. We developed an agent-based model to simulate the food environment of Austin, Texas, USA, and to test the impact of different food access policies on vegetable consumption among low-income, predominantly Latino residents. The model was developed and calibrated using empirical data from the FRESH-Austin Study, a natural experiment. We simulated five policy scenarios: (1) business as usual; (2)–(4) expanding geographic and/or economic healthy food access via the Fresh for Less program (i.e., through farm stands, mobile markets, and healthy corner stores); and (5) expanding economic access to vegetables in supermarkets and small grocers. The model predicted that increasing geographic and/or economic access to healthy corner stores will not meaningfully improve vegetable intake, whilst implementing high discounts (>85%) on the cost of vegetables, or jointly increasing geographic and economic access to mobile markets or farm stands, will increase vegetable intake among low-income groups. Implementing discounts at supermarkets and small grocers is also predicted to be an effective policy for increasing vegetable consumption. This work highlights the utility of agent-based modeling for informing food access policies.

Objective Multi-drug resistance (MDR) has notably increased in community acquired uropathogens causing urinary tract infections (UTIs), predominantly Escherichia coli . Uropathogenic E. coli causes 80% of uncomplicated community acquired UTIs, particularly in pre-menopausal women. Considering this high prevalence and the potential to spread antimicrobial resistant genes, the current study was conducted to investigate the presence of clinically important strains of E. coli in Pakistani women having uncomplicated cystitis and pyelonephritis. Women belonging to low-income groups were exclusively included in the study. Seventy-four isolates from urine samples were processed, phylotyped, and screened for the presence of two Single Nucleotide Polymorphisms (SNPs) particularly associated with a clinically important clonal group A of E. coli (CgA) followed by antibiotic susceptibility testing and genome sequence analysis. Results Phylogroup B2 was most prevalent in patients and 44% of isolates were positive for the presence of CgA specific SNPs in Fumarate hydratase and DNA gyrase subunit B genes. Antibiotic susceptibility testing showed widespread resistance to trimethoprim-sulfamethoxazole and extended-spectrum beta-lactamase production. The infection analysis revealed the phylogroup B2 to be more pathogenic as compared to the other groups. The genome sequence of E. coli strain U17 revealed genes encoding virulence, multidrug resistance, and host colonization mechanisms. Conclusions Our research findings not only validate the significant occurrence of multidrug-resistant clonal group A E. coli (CgA) in premenopausal Pakistani women suffering from cystitis and pyelonephritis but also reveal the presence of genes associated withvirulence, and drug efflux pumps. The detection of highly pathogenic, antimicrobial-resistant phylogroup B2 and CgA E. coli strains is likely to help in understanding the epidemiology of the pathogen and may ultimately help to reduce the impact of these strains on human health. Furthermore, the findings of this study will particularly help to reduce the prevalence of uncomplicated UTIs and the cost associated with their treatment in women belonging to low-income groups.

Background Cancer imposes a significant economic burden on patients and their families, often leading to catastrophic health expenditure (CHE) and impoverishment. This study assesses the financial strain faced by cancer patient households, particularly among lower-income populations, focusing on the catastrophic and impoverishing effects of cancer-related spending. Methods A cross-sectional study involving 430 cancer patients was conducted at six referral cancer centres across Malaysia from June to October 2022. Data on sociodemographic, out-of-pocket (OOP) cancer expenses, and household expenditure data were collected through face-to-face interviews. A three threshold levels were used to examine the CHE, with spending exceeding 10% of total household expenditure, or 25%, and 40% of non-food expenditure. The poverty headcount and gap were assessed by comparing pre- and post-OOP household income against the poverty line income (PLI). Multivariable logistic regression was used to identify determinants associated with CHE. Results The average total OOP costs were MYR4,388.65 (USD983.45) for early-stage cancers (Stages I-II) and MYR5,691.70 (USD1,275.45) for late-stage cancers (Stages III-IV). On average, OOP expenses constituted 17.4% of total household resources. The incidences of CHE at thresholds of 10%, 25%, and 40% were 67.2%, 48.8%, and 32.8%, respectively. Determinants significantly associated with CHE included age, ethnicity, cancer type, cancer stage, distance to cancer centre, household size, and household income. Pre-OOP, 52.6% of households were below the PLI, rising to 63.7% post-OOP, reflecting an 11.1% increase in the poverty headcount. The poverty gap widened, with a mean increase of MYR242.71 (USD54.39) between early- and late-stage cancers. Conclusions Although the public healthcare in Malaysia is highly subsidised, the lower-income households still face substantial CHE and poverty due to cancer-related OOP costs. Therefore, designing targeted policies and establishing comprehensive safety nets are essential to safeguard vulnerable households.

Understanding the financial well-being of lower-income group is a critical concern of any government as this group struggles most to meet up with their necessities. Despite the significance, little is known about financial well-being of low-income group. This study attempts to investigate the relationship between financial literacy, financial behaviour, financial stress, and financial well-being of B40 group in Malaysia. A total of 412 usable responses was derived from a survey in Klang Valley and analysed the data following partial least squares structural equation modelling (PLS-SEM) techniques. The results demonstrate that financial behaviour is the key antecedent followed by financial stress and financial literacy in predicting financial well-being. Hence, balancing between income and expenditure, managing financial stress, and increasing financial literacy would be necessary to assure financial well-being of lower-income group people. Governmental and institutional interventions are essential to equip the low-income group people with employment opportunities and financial knowledge to manage their basic living standards.

This paper analyses the impact of financial crises on the Sustainable Development Goal of eradicating poverty. To do so, we develop an adjusted Multidimensional Poverty Framework (MPF) that includes 15 indicators that span across key poverty aspects related to income, basic needs, health, education and the environment. We then use an econometric model that allows us to examine the impact of financial crises on these indicators in 150 countries over the period 1980–2015. Our analysis produces new estimates on the impact of financial crises on poverty’s multiple social, economic and environmental aspects and equally important captures dynamic linkages between these aspects. Thus, we offer a better understanding of the potential impact of current debt dynamics on Multidimensional Poverty and demonstrate the need to move beyond the boundaries of SDG1, if we are to meet the target of eradicating poverty. Our results indicate that the current financial distress experienced by many low-income countries may reverse the progress that has been made hitherto in reducing poverty. We find that financial crises are associated with an approximately 10% increase of extreme poor in low-income countries. The impact is even stronger in some other poverty aspects. For instance, crises are associated with an average decrease of government spending in education by 17.72% in low-income countries. The dynamic linkages between most of the Multidimensional Poverty indicators, warn of a negative domino effect on a number of SDGs related to poverty, if there is a financial crisis shock. To pre-empt such a domino effect, the specific SDG target 17.4 on attaining long-term debt sustainability through coordinated policies plays a key role and requires urgent attention by the international community.