Background: Microplastics (MPs;<5 mm) and nanoplastics (NPs;<1 μm) are emerging pollutants increasingly causing environmental and health concerns due to their widespread presence and poor biodegradability. Humans are exposed to these particles through ingestion, inhalation, and dermal contact. Methods: This narrative review explores the impact of microplastics on human health by assessing exposure pathways and organ-specific effects. Studies (2010–2024) from major databases were synthesized by polymer type, exposure route, and observed outcomes across key body systems. Results: Studies have reported that nylon microfibers impair respiratory health by releasing toxic compounds that inhibit epithelial cell differentiation, disrupt tissue repair, and suppress Hoxa5 transcription factor expression. Evidence also indicates that MPs alter nasal and gut microbiota composition, potentially contributing to respiratory, digestive, and immune disorders. Some studies suggest that exposure to sources such as clothing dryers can modify airway protection gene expression. Additionally, MPs disrupt cellular signaling pathways and have been observed to accumulate in male reproductive tissues, including the prostate and semen, raising concerns about infertility and prostate cancer risk. Conclusion: Further research is urgently needed to clarify the long-term health effects of MPs, particularly regarding gastrointestinal function and chronic disease. This review highlights that MPs enter the human body through multiple pathways and exert detrimental effects on various organ systems. Effective mitigation strategies and improved public awareness are essential to reduce exposure and protect human and environmental health.
Background: Wastewater irrigation is widely utilized to address water scarcity and enrich soil fertility, yet its impacts on soil carbon-nutrient cycling and environmental sustainability remain complex and multifaceted. Methods: In this systematic review of 89 peer-reviewed studies published between 2000 and 2025, we synthesized data on soil organic carbon (SOC), nitrogen dynamics, crop yields, and greenhouse‑gas (GHG) emissions (CO₂, N₂O, and CH₄) under various wastewater irrigation regimes. Results: The findings indicated that wastewater irrigation can boost SOC by up to 164% and increase soil nitrogen content by up to 152%, driving short-term crop‑yield gains of up to 56% through enhanced nutrient availability. However, prolonged application frequently leads to soil salinization, heavy‑metal accumulation, and elevated CO₂ and N₂O emissions, with several studies reporting eventual declines in yield over time. Conclusion: These results reveal a dual effect: immediate agronomic benefits counterbalanced by long-term environmental risks. Sustainable implementation requires advanced wastewater treatment, continuous soil monitoring, and optimized irrigation practices to mitigate negative impacts while preserving soil health and carbon sequestration potential. Future research should prioritize strategies that minimize GHG emissions and maximize nutrient retention to ensure long-term agricultural and environmental sustainability.
Background: Financial limitation is a challenge in allocating human resources to provide environmental health services as a public health need. This study aimed to compare the cost of manpower for environmental health services in public health centers in the current situation and scenarios based on local needs. Methods: A financial model including fixed and variable costs in providing human resources was used. Human resources costs in the current situation and scenarios based on the allocation of human resources considering local needs were analyzed and compared. The financial situation in the studied scenarios was analyzed using the Monte Carlo simulation. Results: The workforce capacity was 25.38 to 80.06% less than local demands. Also, in 25% of the studied rural health centers, the workforce capacity was 13.8 to 39.03% less than local demands. In addition, in 75% of the rural health centers, the capacity of the environmental health workforce was 13-138% higher than local demands. Based on the traditional human resource support model, increasing the capacity of the environmental health workforce in the studied area would require hiring equal to 84% of the current workforce capacity, which would increase human resource management costs by 60%. However, applying a proportional distribution model of the environmental health workforce led to a 14.42% reduction in human resource costs. Conclusion: Proportional distribution of the health workforce based on local demands is a necessity in human resource management to prevent occupational consequences such as burnout and administrative costs.
Background: BTEX compounds are the most significant VOCs due to their carcinogenic potential and severe adverse effects on human health and the environment. Their removal from polluted air is therefore essential. The present study aimed to review and compare photocatalytic methods for removing BTEX compounds from air. Methods: A comprehensive review was conducted by searching databases on Scopus, ScienceDirect, EBSCO, RSC, and PubMed from 2013 to 2024. A total of 245 articles were found, and 52 were finally reviewed, covering variables such as BTEX analysis methods, photocatalytic processes for their removal, their advantages and disadvantages, and the parameters affecting these processes. Results: According to the findings, non-destructive methods are not suitable for air pollution control because they cannot eliminate pollutants and rely solely on transport to remove them. Destructive methods such as thermal oxidation offer higher degradation efficiency (up to 95%), but are associated with high energy consumption and formation of by-products. Photocatalytic degradation has emerged as a promising, environmentally friendly, and energy-efficient approach for VOC removal. The use of semiconductor nanoparticles such as TiO₂, ZnO, and V₂O₅, along with modifications to the visible light absorption range, reduction in energy demand and regeneration, enhancement of photocatalyst stability, and increased degradation efficiency (up to 99%). Conclusion: Finally, the energy consumption and environmental compatibility evaluation confirmed that the doped photocatalysts not only offer superior performance but also comply well with the principles of green chemistry and sustainable environmental practices management.
Introduction: The oasis of Ouargla has economic, ecological, and social significance, and it has very significant groundwater potential. At the same time, it is facing conditions that may cause its degradation, even its disappearance. This study aimed to identify these constraints and propose an effective and sustainable solution to these problems. The second objective of this study was to propose an oasis production system which will enable the valorization of water resources, sustainable socio-economic development, and the preservation of the environment. Method: This is a descriptive and analytical study that was conducted using a survey and measurements of soil, irrigation water, and phreatic aquifer water. Results: The soils of the Ouargla Oasis are sandy in texture (85% sand) and very salty (electrical conductivity of 3.56 dS/m), and they have very low organic matter content (0.25% organic matter). The phreatic aquifer is very salty (electrical conductivity of 30.13 dS/m) and very shallow (96.16 cm deep). The date palm uses the uppermost layer, which it shares with a few other crops. The irrigation technique practiced is submersion with inefficient drainage. Conclusion: To preserve Ouargla Oasis against degradation by salinization and waterlogging of the soil, and in order to preserve water and increase farmers’ incomes, it is necessary to practice rational water management and crop diversification.
Introduction: Antibiotics are among the most persistent pollutants in aquatic environments, posing ecological and health risks. This study evaluated the degradation of tetracycline in aqueous solutions using ozone-based advanced oxidation processes (AOPs). Methods: Ozone (O3 ), O3/UV, and O3/H2 O2 systems were compared under varying operational conditions in a batch reactor. The effects of pH, oxidant dosage, and reaction time on degradation efficiency were assessed. Biotoxicity and biodegradability changes were monitored using E. coli inhibition and the BOD5/COD ratio. Results: The O3/H2 O2 system achieved the highest degradation efficiency (99.2%) and improved wastewater biodegradability (BOD5/COD=0.67). In contrast, single ozonation achieved 69.2% removal. The combination of ozone and hydrogen peroxide significantly reduced effluent toxicity, lowering E. coli inhibition by 6.34%. Conclusion: The synergistic O3/H2 O2 process demonstrated superior performance in tetracycline removal and detoxification, highlighting its potential as a sustainable and effective pre-treatment for pharmaceutical wastewater.
Introduction: Groundwater is a vital resource for agricultural, industrial, and domestic needs, especially in coastal regions where alternative water sources are limited. Assessing groundwater vulnerability is crucial to ensuring sustainable water management and mitigating contamination risks. Methods: This study evaluates groundwater vulnerability in the Puducherry region using the DRASTIC model, which incorporates hydrogeological parameters such as depth to the water table, net recharge, aquifer media, soil media, topography, impact of the vadose zone, and hydraulic conductivity. Geographic information system (GIS) techniques were employed to generate vulnerability maps, categorizing the region into low-, moderate-, and high-susceptibility zones. Additionally, land use and land cover (LULC) data were integrated with the traditional DRASTIC model to develop a modified risk assessment layer. The model was validated using nitrate and chloride concentration data. Results: The findings indicate that integrating LULC data with the conventional DRASTIC model provides a more comprehensive assessment of groundwater vulnerability. The modified analysis revealed that high-risk areas account for 26.64% of the study region, highlighting the significant impact of human activities on groundwater contamination. Conclusion: This research presents a robust framework for assessing groundwater vulnerability in coastal regions. The results underscore the need for targeted groundwater management strategies to protect water resources. The study provides policymakers with valuable insights for developing sustainable water management practices.
Introduction: Seasonal variation of physicochemical parameters and metal concentrations in water sources can affect the type and density of microorganisms. These microorganisms might include pathogenic bacteria, parasites, and viruses. This study aims to investigate contamination of Nile River water at Greater Cairo sites by examining the type of microbiome, physicochemical characteristics, and heavy metal concentrations. Methods: Nile water samples were seasonally collected and centrifuged, and their total DNA was extracted and amplified by polymerase chain reaction (PCR) for qualitative detection of eubacteria, eukaryotes, and adenoviruses. Heavy metals were analyzed in water samples using an atomic absorption spectrometer. Results: No adenoviruses were detected; 97.92% of the samples were positive for eukaryotes, 93.75% for Gram-positive bacteria, and 6.25% for Gram-negative bacteria. Although iron, cadmium, calcium, and copper concentrations were within permissible limits, lead and zinc exceeded the limits at certain sites, with maxima of 93.4 & micro;g/L and 100 mg/L, respectively. Principal component analysis indicated that eukaryotes and Gram-positive bacteria showed positive correlations with temperature and pH, and negative correlations with Zn, Cd, Ca, and Fe. On the other hand, Gram-negative bacteria were positively correlated with dissolved oxygen, and negatively correlated with temperature, pH, total dissolved solids, and Pb. Conclusion: Nile River water in Greater Cairo may be contaminated with pathogenic bacteria, parasites, and fungi. In addition, the physicochemical characteristics and metal pollution of Nile River water correlated with the microbiome type and density in the investigated sites.
Background: Groundwater in Iraq, particularly in the Kirkuk Governorate, is under increasing pressure from a range of challenges, including human activities and natural conditions. These factors have led to the presence of contaminants, posing a significant risk to public health and underscoring the urgent need for systematic monitoring and evaluation. Examining the connection between groundwater contamination and its impact on human health is vital for safeguarding public well-being and promoting environmental sustainability. Methods: This study focused on the southwestern region of Kirkuk Governorate to evaluate the suitability of groundwater for drinking purposes. Twenty groundwater samples were analyzed using water quality indices (Nemerow's Pollution Index and Weighted Arithmetic Index) and Geographic Information System (GIS) techniques. Fourteen physicochemical parameters were assessed. Spatial mapping and statistical data analysis were conducted to provide essential insights into water quality and its management. Results: The NPI-WQI findings categorized 50% of samples as "seriously polluted" (NPI > 3.5) and 50% as "moderately polluted" (NPI 1-3.5). The WAI-WQI revealed that 80% of samples were deemed "unsuitable for drinking" (WAI> 100), with the highest levels of pollution recorded in wells W14 (WAI = 712.275) and W20 (WAI = 413.676). Critical values surpassed allowable thresholds: TDS (7625 mg/L compared to the WHO limit of 1000 mg/L), EC (10,500 & micro;S/cm versus 400 & micro;S/cm), and turbidity (192 NTU against 5 NTU). Spatial maps indicated regional variations, revealing heightened pollution in central and southern areas. Conclusion: The study contributes valuable data for improving water resource management and protecting public health.
Background: The Environmental Protection Agency (EPA) sets the maximum allowable dose for thallium in drinking water at 0.002 mg/L, and notes that chronic exposure leads to hair loss, kidney damage, and liver and heart disorders, depending on the severity and duration of exposure. This paper aimed to remove thallium ions from aqueous solutions using sawdust as a low-cost adsorbent. Methods: White poplar wood sawdust was prepared and used as an adsorbent. The experiments were conducted in batch adsorption unit at different pH levels, contact times, agitation speeds, temperatures, initial concentrations, and doses of sawdust. Results: The maximum thallium removal efficiency was 92.12% conducted at pH 6, contact time 150 min, agitation speed 450 rpm, thallium initial concentration 90 ppm, temperature 25 degrees C, and sawdust dosage 6 g. Morphological tests showed that thallium ions exploited almost all active sites of sawdust, and the surface area decreased by about 95% after adsorption. FT-IR and SEM tests confirmed that sawdust contains various functional groups such as-OH and-COOH responsible for the adsorption. The isothermal and kinetic results exhibited a better agreement with Langmuir and intra-particle diffusion models, respectively. Thermodynamically, the adsorption was of negative Delta S and Delta G values at all temperatures, while Delta H was-176 kJ/mol. Conclusion: The study demonstrated that raw wood shavings can be used as an effective adsorbent to remove toxic thallium ions from contaminated aqueous solutions.
Conclusion: The intervention positively affected key behavioral constructs and improved waste segregation practices. Nevertheless, sustaining these behaviors may require additional structural support-such as municipal provision of necessary equipment and facilities-to overcome enabling barriers.
Introduction: Microplastic contamination poses significant challenges to aquatic life and human health. This study aimed to assess the presence, frequency, and characteristics of microplastics in the Blue Swimmer Crab (Portunus armatus), Banana Prawn (Penaeus merguiensis), Bivalve Mollusc Oyster (Amiantis umbonella), and Razor Shell (Solen roseomaculatus) from the coastal waters of Bandar Abbas, Persian Gulf, Iran, which provides a comprehensive analysis of microplastic contamination in these species within this area. Methods: Five research stations along the Bandar Abbas coast, representing varying levels of urbanity, were chosen for sampling. After collecting biological samples, we isolated microplastics using a digestion procedure and flotation method. The characteristics of microplastics, including shape, color, size, and type, were analyzed with microscopy and Fourier-transform infrared spectroscopy (FTIR). Matrix-spiked (MS) samples were prepared to validate method accuracy and recovery rates. Identified microplastic forms included fibers, fragments, and films, with fibers being the most common. Results: The particles were categorized into three size ranges: 0.45-25 pm, 25-250 pm, and 250-500 pm. Sixty-six percent fell within the 0.45-25 pm range, predominantly in black and blue colors. Common polymers included polyethylene, polypropylene, polyethylene terephthalate, polystyrene, and polyamide. The average microplastic frequency was 2.57 +/- 1.2, 4.9 +/- 1.95, 3.27 +/- 1.2, and 4.05 +/- 1.9 particles/g for Blue Swimmer Crab, Banana Prawn, Bivalve Mollusc Oyster, and Razor Shell, respectively. Correlation analysis indicated a significant positive relationship between microplastic frequency in soft tissues and body size. Conclusion: This study highlights the presence of microplastics in key marine species in Bandar Abbas waters, posing risks to aquatic ecosystems and human health.
Background: This study aimed to examine e-waste management in the woreda offices of Addis Ketema Sub-City, Addis Ababa City Administration, Ethiopia, and to determine the concentrations of heavy metals in computer printed circuit boards (PCBs). Methods: This cross-sectional survey was conducted among 368 employees from 14 woredas using structured questionnaires. Three samples of discarded computer PCBs were analyzed for Mn, Ni, Pb, Cd, and Cu using Flame Atomic Absorption Spectroscopy. Results: Most employees (74.2%) were not aware of e-waste management, 75% had not received training, and only 26.6% knew proper disposal methods. Although 81.5% recognized its environmental and health impacts, 70.4% did not believe e-waste harms human or environmental health. Logistic regression showed that training, educational status, access to collectors, and access to disposal sites were significantly associated with better awareness, attitudes, and practices (P < 0.05). Analysis of PCBs revealed mean concentrations (mg/kg) of Cu: 78,402.44 +/- 13.44, Pb: 5,821.08 +/- 11.29, Ni: 1,620.11 +/- 6.15, Mn: 120.72 +/- 2.19, and Cd: 0.1 +/- 0.09. The levels of Cu and Pb exceeded the Toxicity Threshold Limit Concentrations (2,500 and 1,000 mg/kg, respectively), indicating potential environmental and health risks. Administrative, economic, and socio-cultural challenges contributed to poor e-waste management in the sub-city's woreda offices. Conclusion: E-waste management in the sub-city is inadequate. Enhancing training, access to formal collection systems, and enforcement of regulations is essential to reduce the adverse impacts of hazardous e-waste on human and environmental health.
Background: Noise pollution poses a significant threat to urban health in Nigeria, yet the issue remains unaddressed. This study assessed noise exposure levels and their health impact among residents of Ikorodu, Lagos State. Methods: A cross-sectional design was used to collect data from 500 respondents across residential, commercial, and industrial areas. Noise levels were measured using calibrated sound level meters during morning, afternoon, and evening periods. Questionnaires were used to collect socio-demographic information and perceived health effects. Data were analyzed using descriptive statistics, one-way analysis of variance (ANOVA), and Pearson and Spearman correlation tests at a 5% significance level. Results: Demographic analysis showed that the majority of participants were aged 30-39 years (57.4%) and male (54.5%). Mean noise levels ranged from 65.5 dB in residential areas to 81.6 dB in commercial areas, exceeding WHO (55-70 dB) and LASEPA limits. The mean health-impact score was 3.52, reflecting a high level of perceived annoyance and discomfort. One-way ANOVA indicated significant differences in mean noise levels across areas (P< 0.001). Both Pearson and Spearman rank correlation analyses showed a strong positive correlation (P< 0.01) between noise level and health impact, indicating that as noise exposure increases, perceived health effects, including stress, headache, fatigue, and sleep disturbance, rise. Conclusion: The study concludes that noise pollution in Ikorodu exceeds safe limits and significantly affects residents' well-being. Strengthened noise-control regulations, periodic monitoring, and urban planning interventions are recommended.
Background: The industrial growth in recent decades has led to the production of significant amounts of industrial waste, leading to environmental and economic consequences, especially in developing countries. This situation has led to environmental pollution and health risks. In this study, the use of a smart industrial waste management system and its impact on waste management costs were investigated. Method: Industrial waste quantity was investigated through field studies and official data, and the results were used for a comparative cost-benefit analysis of the current situation with scenarios for using the smart waste management model in a standard financial model. Results: The results showed that the ratio of industrial waste production to the final product unit in the nonmetallic mineral, cellulose, food, textile, metal, and leather industries was 0.004, 1.88, 0.144, 0.027, 2.106, and 0.063%, respectively. The costs of industrial solid waste management in this situation were estimated at 11.42 USD/ton, which was reduced by 25.09% and 56.47%, respectively, through the use of two smart industrial waste management systems: a decentralized storage method and a centralized storage method. Conclusion: Due to increased efficiency in waste collection and transportation, the costs of smart industrial waste management are much lower compared to the conventional method. Smart industrial waste management is a necessity for developing countries with financial limitations.
Background: Given the global importance of addressing sedentary lifestyles and environmental challenges, this study aimed to explore the role of environmental awareness in encouraging participation in plogging-an eco-friendly physical activity-while examining the mediating influence of social responsibility. Methods: The research was both descriptive and correlational. The research sample consisted of 290 active ploggers selected through purposive sampling. Data were collected using a validated and reliable questionnaire in November and December 2024. The conceptual framework centered on three key constructs: environmental awareness, participation in plogging, and social responsibility. To assess the model's validity and test the hypotheses, structural equation modeling (SEM) was employed using AMOS 22. Results: Environmental awareness had a significant positive effect on both plogging participation and social responsibility. Additionally, social responsibility positively influenced plogging participation. The findings also indicated that environmental awareness indirectly affects plogging participation by influencing social responsibility. Conclusion: Overall, the study suggests that increasing awareness of environmental issues and fostering a sense of social responsibility can significantly enhance engagement in plogging as an eco-friendly form of physical activity. These insights could be valuable for developing strategies to promote healthier and environmental conservation.
Background: Stroke, a leading cause of mortality and disability worldwide, is influenced by both non-modifiable and modifiable risk factors, including air pollution. Arak, Iran, is one of the country's most industrialized and polluted cities. This study investigates the association between short-term and longterm exposure to major air pollutants-PM2.5, PM10, O-3, SO2, and NO2-and stroke morbidity. Methods: This prospective cohort study included all stroke patients registered in Arak between 2019 and 2022. Air pollutant concentrations were obtained from four monitoring stations, with short-term exposures defined as 1 week, 1 month, 3 months, and 6 months, and long-term exposures as 9, 12, 18, and 24 months. Data were analyzed using a time-series zero-inflated negative binomial regression model, adjusting for confounders including smoking and opium use. Results: Short-term (3-month) exposure to NO2, O-3, and SO2 was significantly associated with increased stroke incidence, while short-term (1-week) exposure to these pollutants showed a negative association. PM10 and O3 (6 months) and SO2 (1-3 months) also demonstrated significant associations. Long-term (2-year) exposure to PM10, NO2, and SO2 was strongly associated with stroke morbidity, whereas O-3 exposure showed an inverse relationship. PM(2.5 )was not significantly associated in the short term but showed a positive, though nonsignificant, association in the long term. Conclusion: Both short-term and long-term exposure to certain air pollutants are associated with stroke morbidity, with varying effects by pollutant and lag period. Reducing chronic exposure to PM10, NO2, and SO2 may help lower the incidence of stroke in high-pollution settings.
Background: This study aimed to determine the spatial assessment and risk assessment of three widely used pesticides, chlorpyrifos (CPF), malathion, and diazinon, in the tap water distribution network and surface water of Ardabil Province, northwest Iran. Methods: Sampling was conducted at 41 points in the water distribution network and 30 surface water points. Pesticide values were detected by gas chromatograph-flame ionization detector (GC-FID) after solid-phase extraction. Results: The ranking of pesticide compounds in tap water was CPF > malathion> diazinon. The mean concentrations of CPF, malathion, and diazinon in surface water were found to be 0.006, 0.013, and 0.003 mg/L, respectively. The highest pesticide concentrations were detected in the northeast region. CPF concentrations exceeded the maximum concentration level (MCL) in 7% of tap water samples. Conclusion: Based on USEPA standards, the average non-carcinogenic health risks from exposure to pesticides through water consumption remained within the acceptable limits, with a hazard index (HI) below 1 (HI < 1 indicates "acceptable risk" per USEPA). Sensitivity analysis indicated that CPF concentration and the exposure duration to malathion had the most significant influence on chronic daily intake (CDI) and potential noncancer health effects. Although pesticide levels in drinking water mostly stayed within safe limits, concentrations in the northern region exceeded permissible levels. Therefore, further efforts are essential to regulate pesticide contamination and reduce related health risks in the future.
Background: Exposure to 1,3-butadiene leads to an increase in the carcinogenic risk and other related diseases. This study aimed to assess the carcinogenic and health risks of exposure to ambient 1,3-butadiene emitted from various sources in Tehran. Methods: For this purpose, sampling and data analysis were done in 30 monitoring stations in Tehran in 2024. In addition, the contribution of motor vehicles to the emission of 1,3-butadiene was estimated by IVE and AERMOD. Also, the Carcinogenic Risk (CI) index and Health Quotient (HQ) were used to evaluate carcinogenic and non-carcinogenic risk affected by the current concentration and four other scenarios. Results: The results showed that the average of 1,3-butadiene concentration caused by motor vehicles and stationary sources was calculated to be equal to 2.1E + 1 and 7.86E + 1 mu g/m3, respectively. The detected concentration was 4 times higher than the estimated concentration, indicating a significant concentration of contamination. In the best scenario, the pollutant concentration was reduced by 48%. The carcinogenic risk in the current conditions and the best scenario was 7.48E-03 and 4.06E-03, respectively, which were still much higher than the acceptable level. Conclusion: Scenarios of reducing the pollutant concentration made the non-carcinogenic risk for adults below the acceptable level. Therefore, modifying fuel consumption patterns, reducing fossil fuel consumption by implementing energy-saving measures in buildings and supporting the increase in electric vehicles, and monitoring air pollution control systems in industries are the main suggestions of this study to reduce the health risks of 1,3-butadiene.
Background: The economic toll of health issues related to carbon emissions is substantial, accounting for a significant portion of national healthcare expenditures. This research addresses the lack of studies on healthcare service quality and the local effects of carbon emissions. Methods: This study employed spatial econometrics to investigate the direct and indirect effects of carbon emissions on the quality of health services across Iranian provinces from 2011 to 2021. This method was chosen for its ability to capture both within-province and between-province effects, which is crucial for developing robust health policies. The researchers created a comprehensive index for health service quality, incorporating input, output, and overall index, using the entropy method. Results: The findings indicate that CO2 pollutants negatively impact both the output and the overall health service quality index. Economic growth demonstrated a positive direct impact and a negative indirect (spillover) effect on both dependent variables. The divergent indicators of direct and geographical consequences of per capita output growth imply a multifaceted link between the two. This indicates that economic affluence in one province directly enhances the quality of its healthcare services. The quality of health services in nearby regions may suffer as a result. Moreover, the input index demonstrates a substantial positive effect, while inflation and inequality exhibit a detrimental effect on the quality of health services. Conclusion: The study's findings suggest that improving the quality of health services requires a multifaceted approach, encompassing not only direct healthcare investments but also broader economic and environmental considerations.
