This paper aims to study the gender inequality in the health impacts of energy poverty. Using the Chinese Family Panel Studies (CFPS) 2018 data, we examine the gender heterogeneous effects of energy poverty on residents' health. The empirical results indicate that energy poverty would increase the ratio of respiratory disease, hospitalization as well as the healthcare expenditure. The effects are moderated by housework time. Moreover, we explore the gender inequality of the health impacts and find that women's health is more severely impaired and the effect of gender inequality is heterogeneous between urban and rural areas. We further investigate the historical origins of intra-household division of labor and reveal that the root of gender inequality in the health effects of energy poverty is status inequality. The government should give the first priority to energy poverty alleviation through modern energy network construction. Providing the energy-deprived families with ventilation equipment and medical insurance should be considered as the next step. Finally, it is imperative to eradicate urban-rural dual structure and legislate to ensure gender equality in the whole society. Access to clean energy is not only indispensable to the human daily life but also necessary to people's health. According to International Energy Agency (IEA), despite extraordinary progress during the last two decades, more than 2.5 billion people lack access to clean energy for cooking worldwide, air pollution induced by the consumption of solid fuels and kerosene causes nearly 2.5 million premature deaths from illness every year in 2021 −17 goals to be achieved before 2030 by the United Nations (UN) based on sustainable development of humanity.This paper contributes to existing literature on the relationship between energy poverty and health status in following aspects. First, we investigate the nexus between energy poverty and health from the perspective of gender inequality. The empirical results demonstrate that women's health is more severely jeopardized than men's, shedding light on the analysis of gender difference in related studies. Second, by examining the moderating effects of housework time, we point out that the adverse effects of energy poverty on health are exacerbated by housework time, offering a new explanation how gender discrimination causes health inequality between men and women. Third, we study the heterogeneous effects of energy poverty on health across sectors and ages. Our findings point out that the gender inequality of energy poverty on health is diminishing with urbanization, development of economy and progress of social concepts. Finally, this paper incorporates historical perspectives into the causality between health status and energy deprivation and reveals that gender inequality mentioned above is attributed to status inequality, providing a new insight of mitigating health hazards of energy poverty.The remainder of this paper is organized as follows. Section Literature review reviews the relevant literature. Section Methodology describes dataset, variables, and statistical characteristics. Section Main Results reports the main empirical results. The last section summarizes the main conclusions and draws some policy implications. Article types.In general, energy poverty is defined as inaccessibility or unaffordability to sustainable modern energy for cooking or warming up –10. SoliGiven that women tend to spend more time on domestic activities like cooking and cleaning, females in energy-deprived families are inevitably exposed to harmful compounds produced by solid fuel combustion , 23. VieDespite the fact that energy poverty can endanger health status especially women's health, very little research has been conducted on gender inequality in terms of impacts of energy poverty on health. However, the gender heterogeneity of the interplay between energy poverty and health status plays a vital role in alleviating energy poverty and mitigating gender inequality.Considerable literature attributed gender inequality in health to economic status, social customs and law –30. ThanDue to disadvantages in labor market, women tend to be homeworkers and spend more energy and time domestic work , 35–37. Notably, the impacts of energy poverty on health are positive with the extent of indoor air pollution. Considering that cooking accounts for more than 80% of housework time in countries such as China and Italy , 38, 41,While a relatively new body of literature has revealed that cook-dominant housework is the major source of health hazards, and women tend to spend more time on domestic affairs, little attention has been paid to examining the moderating effects of housework time on energy poverty and health status. Nonetheless, the moderating role of housework time is probably the direct reason that results in the gender inequality of the health impacts of energy poverty.Regarding the reasons why females spend more time on housework than males, Boserup  emphasizHowever, the uneven division of housework is not so prevalent until human being enters into industrial age. As the production mode and the economic position of females have differed from agricultural civilization , 54, a lAlthough previous literature has suggested that social status inequality is the root of the disproportionate division of housework time, to our knowledge, none of studies have explored the nexus between social status and the gender differences of the health hazards of energy poverty. Furthermore, if intra-household division of labor changes with the evolution of urbanization, the conclusions of this paper will be of great significance to transition countries.With the aim of investigating the health effects of energy poverty, this study employed the ordinary least squares model (OLS) and the Probit model.healthi,i = 1, 2, 3, corresponding to respiratory, hospitalization and expenditure, respectively; poverty is energy poverty; is a set of control variables; α0 is the constant term; and ε1 is the corresponding error term.Where, the dependent variables are denoted by All the data was derived from the CFPS carried out by the Institute of Social Science Survey at Peking University in 2018. This survey is recognized as nationally representative which covers 14,223 families and 32,669 individuals from 25 out of 33 provinces and which is regarded as one of the richest micro-survey data in China. It collects detailed information about accessibility to modern energy. Moreover, the questionnaire also cover issues concerning respondent's health including diseases, treatment and healthcare expenditure, confirming that the data can shed light on the Chinese residents' energy poverty and health status. Additionally, the analysis objects for this research are limited to individuals over the age of 18. We precisely match the data of energy poverty at the household level with the data at the individual level by household numbers and get 27,407 valid samples.We use objective health to assess people's health status. To this end, respiratory diseases, hospitalization and healthcare expenditure are considered as dependent variables building on Lin et al.  and BukaOur independent variable is energy poverty. It is a binary variable that equals one if the respondent's family relies on solid fuels to cook and zero if otherwise. Previous literature mainly assessed energy poverty through accessibility, affordability and multidimensionality , 60, 61.According to The baseline regression results are reported in 2 and NO2, are higher in the north than in the south, especially when residential heating caused more serious smog pollution in the north in winter.The estimation results of control variables are also presented in Given the potential endogenous problems caused by unobserved variables and other factors, we selected the average provincial share of people in energy poverty  as an instrumental variable (IV) drawing on Zhang et al. . For oneWe used instrumental variable probit (Ivprobit) method to regress respiratory and hospitalization because both of them are binary variables; while we employed two-stage least squares (2SLS) method to expenditure because it is a continuous variable. The results of regressions are reported in After introducing the IV, the coefficients of poverty on respiratory, hospitalization and expenditure are all significant at magnitudes of 0.49, 0.63, and 1.56, respectively, suggesting that energy poverty still hamper residents' health in consideration of endogeneity. Meanwhile, the coefficients of Ivprobit and 2SLS regression are higher in comparison with Probit and OLS regression, indicating that the effects may be underestimated without considering endogeneity, which is consistent with the conclusion of Phoumina and Kimurab .As stated in the Introduction, air pollution induced by cooking, heating and other household activities is the dominant reason for residents' health hazards. Therefore, if the energy poor engage in housework for a relatively long time, it will undoubtedly increase their frequency and quantity of toxic gas and particle inhalation, and health status will be harmed more severely. Hence, it is reasonable to assume that housework time plays a moderating role in the effect of energy poverty on residents' health. In order to test this hypothesis, this paper sets up the following econometric modelhealthi, i = 1, 2, 3, corresponding to respiratory, hospitalization and expenditure, respectively; poverty is energy poverty; time is housework time; poverty*time is the cross term of energy poverty and housework time.Where, the dependent variables are denoted by respiratory and hospitalization. Moreover, the coefficients of poverty in in columns (2) and (4) are 0.42 and 0.57, both significant at the level of 1%, suggesting that the moderating effect is positive. In other words, housework time can increase the likelihood of residents suffering from respiratory diseases and hospitalization in energy-poor families. For individuals suffering from energy poverty, the longer they spend on housework like cooking and heating, the more toxic gases and particles they inhale, the severer damage their respiratory tracts suffer. In addition, hazards to respiratory tracts will endanger other parts of body. Hospitalizations are necessary if the condition worsens over time.As presented in As stated in section Moderating effect, the health impacts of energy poverty are moderated by housework time. Considering traditional gender role—men being the breadwinners and women being the homemakers—in the division of housework in China, the time of females engaging in housework is much longer than that of males, which may lead women to suffer from more indoor air pollution and severer impacts on health status. Therefore, we adopted the following equation to examine whether the gender inequality exists in the health effects of energy poverty.healthi, i = 1, 2, 3, corresponding to respiratory, hospitalization and expenditure, respectively; poverty is energy poverty, poverty*female is the cross term of energy poverty and female. The results are shown in Where, the dependent variables are denoted by poverty*female to regress with respiratory, hospitalization as well as expenditure respectively. The results are reported in poverty are all significant at magnitudes of 0.32, 0.41, and 1.31, while the coefficients of poverty*female are all significant at magnitudes of 0.32, 0.44, and 0.62. The results reveal that female plays a positive moderating role in the nexus between energy poverty and the three proxies of health. In other words, females who suffer from energy poverty have a higher tendency to experience respiratory diseases and hospitalization as well as spend more on healthcare. Females are traditionally considered as the homemakers and devote more to the domestic work such as cooking and heating. On the contrary, males are usually considered as the breadwinners and pay less attention to homecare. Consequently, the frequency and quantity of toxic gases inhaled by females due to cooking, heating and other chores are higher than that of males, which results in the gender inequality in terms of health impacts of energy poverty.We introduced the cross item *female are significantly positive, suggesting that there is a positive moderating effect of female on the impacts of energy poverty on hospitalization and healthcare expenditure. In other words, gender inequality in terms of health impacts of energy poverty do exist in rural areas. Females in rural areas are considered as the homemakers and devote more to the domestic work such as cooking and heating, they are more likely to be impacted by energy poverty and experience higher rate of hospitalization as well as spend more on healthcare. However, as shown in columns (7) to (9), the coefficients of poverty are significantly positive while the coefficients of poverty*female are not significant, suggesting that this is no moderating effect of female on the nexus between energy poverty and health. In other words, gender inequality in terms of health impacts of energy poverty do not exist in urban areas. Compared with rural women, the status of urban women has been promoted to a large extent with the improvement of their economic status. Accordingly, intra-household division of labor becomes relatively equal in urban areas. Ultimately, gender gaps in the health impacts of energy poverty will be narrowed  to (6) present the regression results of rural residents' health. The coefficients of poverty and povertynarrowed , 68.*female are not significant, indicating that there is no moderating effect of female on health. Columns (4) to (6) present the regression results of middle age residents' health. The coefficients of poverty and poverty*female in columns (5) and (6) are significantly positive, suggesting that there is a positive moderating effect of female on the impacts of energy poverty on hospitalization and healthcare expenditure. The results of the old subgroup are similar to those of the middle-age group. Firstly, more and more young women become breadwinners with the rapid development of economy due to reform and opening policy since 1978, their housework time may decrease after getting equal economic status. In addition, development of economy also accelerates the progress of social concepts of gender equality, calling upon men to share housework with women.We further classified the samples into young subgroup (from 18 to 39 years old), middle-age subgroup (from 40 to 59 years old) and old subgroup (over 60 years old) to examine the heterogeneity across ages. The results are reported in Section Gender inequality reveals gender inequality in the health impacts of energy poverty. Given that status inequality is the dominant reason for gender differences in housework time, we further examined the nexus between status inequality and housework time. We adopted the following model to identify the effects of status inequality on housework time.time is housework time; inequality is status inequality. Additionally, in view of the significantly negative relationship between housework time and job, we add variable job into control variables.Where, inequality is not significant in consideration of control variables, indicating that status inequality doesn't increase the housework time in the whole society. As presented in columns (2) and (5), the coefficients of female subsample are significant in consideration of control variables, suggesting that status inequality increases the housework time of females. Columns (3) and (6) report the regression results of male subsample, the coefficients are not significant no matter whether control variables are introduced or not, suggesting that status inequality doesn't increase the housework time of males. Our findings point out that status inequality increases the housework time of females significantly, but it does not have the same effect on males. On the one hand, status inequality leads to disproportionate division of housework time, and women take more responsibility for domestic affairs owing to the relatively low economic status. On the other hand, the uneven intra-household division of labor may be reinforced by social customs and cultural norms.Because of the 9-year compulsory education system in China, parents do not have to pay for their children's education until high school. On the basis of Li et al. , we seleWe select respiratory, hospitalization and expenditure as dependent variables in above empirical analysis, and all measured health from the perspective of objective health. As a comparison, we use subjective health to assess health status in this section . SpecialUsing solid fuels for household chores will generate indoor air pollution and threaten the health of residents, while the disproportionate division of labor within the family may lead to gender inequality in the health hazards of energy poverty. Using CFPS 2018 dataset, we studied the gender inequality in the health impacts of energy poverty. First, we examined the causality between energy poverty and health status and the moderating effects of housework time. Then, we analyzed the gender inequality in health impacts of energy poverty and heterogeneous effects of energy poverty on health across sectors and ages. Finally, we further investigated the nexus between social status inequality and housework time.Our results reveal that energy poverty increases the odds of respiratory diseases, hospitalization as well as the health expenditure of the residents. In addition, housework time plays a moderating role in the causality between energy poverty and health. The more time energy-poor groups spend on housework, the worse their health will be. As a result, women are more susceptible to indoor air pollution since they usually devote more to domestic chores than men. However, the gender inequality of energy poverty on health is weakening with urbanization. Further analyses indicate that the root of gender inequality in the health impacts of energy poverty is status inequality.Although considerable literature focused on gender inequality in health impacts of energy poverty, this paper distinguishes itself from existing literature in following ways. Firstly, compared with previous studies , 70–72, Findings from this paper will contribute to policy formulation. In the context of the developing countries like China, the study suggests that policymakers should attach great importance to energy poverty alleviation. On the one hand, the government should invest more in modern energy infrastructure systems and clean energy technology to ensure that the energy-poor households could have access to modern energy. These initiatives should pay more attention to rural and underdeveloped areas since most of those areas are off-grid. On the other hand, subsidies on clean energy and related appliance energy consumption for energy-poor households should also be taken into consideration.The government should also improve the kitchen ventilation system of energy-poor families because cooking accounts for most of the housework time and plays a vital role in indoor air pollution. It is necessary to provide the energy poor families with cleaner stoves, chimneys, smoke lampblack machines and other ventilation equipment by subsiding so as to decrease the frequency and quantity of toxic gas and particle inhalation and thus alleviate the hazards of indoor air pollution.Moreover, it is important to eliminate the urban-rural dual structure. The breakdown of the urban-rural dual structure will be conducive to labor migration from rural to urban areas and providing more job opportunities for rural women. As a result, the social status of rural females will be promoted with the improvement of economic status, further leading to the relatively even intra-household division of labor and facilitating the gender equality.In addition, energy-poor households are likely to have lower health status, which may force them to spend more on healthcare and push them into the vicious circle of poverty. To avoid this trend, social security system for energy-poor households through medical insurance should be enhanced. Diseases related to energy poverty, such as chronic obstructive pulmonary diseases (COPDs) and cardiovascular diseases should be incorporated in the medical insurance. Moreover, the government should also focus on screening and treating these diseases for housewives as they are more likely to expose to indoor air pollution.Finally, the government should also legislate to ensure gender equality between men and women in the whole society. In addition, the role of women's rights protection organization and mass media should not be neglected. Social norms that men being the breadwinners and women being the homemakers in the division of housework can probably be changed in a subtle way as time passes by.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.ZZ: conceptualization, methodology, software, and resources. YL: investigation and writing—original draft. XM: data curation and software. HY: visualization, validation, supervision, and writing—review and editing. All authors contributed to the study conception and design.


This study described two companies’ financial compensation programs for semiconductor workers with suspected work-related diseases (WRDs) and discussed the major related issues. The key contents of the programs found on the websites opened by two semiconductor companies (Samsung and SK Hynix) were cited. In order to select the suspected WRDs for the FSC, all available epidemiologic studies related to health problems conducted in the semiconductor industry were reviewed. Most program contents are similar, although the amount of financial compensation and a few types of disease available for compensation differ between the companies. The group of cancer, rare disease, childhood rare disease among children born to semiconductor workers (hereafter selected diseases among offspring), and fetal loss, including spontaneous abortion (SAB) and stillbirth, were considered for compensation. An employment duration of longer than one year on a semiconductor production line is required for FSC for cancer or rare disease. The FSC for SAB and offspring disease require a period of employment longer than one month, either before three months prior to conception or between conception and childbirth. The maximum amount of compensation per type of cancer and rare disease was fixed based on the medical treatment fee. The FSC programs of the two companies have been operated successfully to date. These programs are arguably considered to contribute to resolving the conflict between companies and workers with WRDs. Workers in semiconductor wafer fabrication and packaging in the semiconductor industry have the potential to be exposed to a broad number of chemicals involved in the related manufacturing processes, which have been changing dramatically over the years with the rapidly advancing technology applied in this industry. Potentially hazardous chemicals such as metals, photoactive chemicals, organic solvents, acids, and toxic gases are used in the semiconductor industry in a wide variety of combinations and workplace settings, resulting in additional by-products. Over the past decade, there has been speculation that semiconductor operations and the related working environments and jobs, especially before the 2000s, may be related to the risk of various types of cancer, rare diseases, and reproductive toxicity. However, this has not been clearly examined .Controversy over health risks among semiconductor workers began growing in 2007 when a female semiconductor worker aged 22 died from leukemia. Her case was initially denied by the Korea Workers’ Compensation and Welfare Service (KWCWS), but it was later awarded compensation as an occupational disease by the administrative court. Since then, a number of former semiconductor workers and groups representing the alleged victims have continued to claim for over a decade that their chronic diseases, including certain types of cancer and rare diseases, were caused by semiconductor operations and jobs.Various actions have been taken to resolve the social dispute originating from the chronic health risks, including cancer, faced by semiconductor workers. Several studies have been undertaken to examine occupational factors that may be associated with health risks among semiconductor workers ,3,4. No From 2016 to the present, two semiconductor companies and one display manufacturing company in the Republic of Korea (Korea) have developed financial support compensation (hereafter referred to as FSC) programs to provide financial support to workers suffering from cancer, rare diseases, reproductive diseases, and selected diseases among their offspring, if minimal job profile requirements are satisfied. They have operated similar FSC programs that vary in detail, such as the year started, amounts of financial support, and types of disease compensated. This study aimed to describe the two semiconductor companies’ FSC programs for semiconductor workers and to discuss major issues, including the background, implications, and scientific basis for the FSC programs. In order to provide a scientific basis for the FSC program, we cited the key results of epidemiological studies conducted on the semiconductor industry examining the risk of cancer, rare diseases, and reproductive health problems.A semiconductor company manufactures both wafer fab and chip packaging. The fab for integrated circuits or chips is processed separately in the so-called fab clean rooms (hereafter referred to as a production line). Integrated circuits are fabricated onto a silicon wafer through a series of repetitive processes composed of four main operation groups. The principle of semiconductor operations and the major health hazards, including various classes of chemicals and electromagnetic fields generated in these operations, has been comprehensively described elsewhere ,6,7.This study introduced the FSC programs operated by two semiconductor companies (Samsung and SK Hynix) that provide financial support to semiconductor workers who have suffered WRDs such as cancers, rare diseases, and reproductive health problems (hereafter referred to as a suspected WRD). These programs are independent of the national compensation program operated by the Korea Worker’s Compensation and Welfare Service under the IACIA. The key contents of the programs available on websites provided by the two companies for the registration are summarized and described ,9.Suspected WRDs for the FSC were selected based on the examination of the following review process or other sources. Firstly, types of cancer, reproductive health problems, and rare diseases for which increased risks have been found in the semiconductor industry were included in the group of diseases for the FSC. All epidemiologic studies conducted in silicon wafer fab operations in the semiconductor industry were collected through an extensive literature review of articles reported from 1988 through the end of 2015 without limitation on the study period. The keywords used in the literature search were “semiconductor operations”, “wafer fab operation”, and “clean room environment”, singly and in combination. All types of cancer, rare disease, and reproductive toxicity that were evaluated at least once as significant were selected for the FSC. Secondly, types of cancer and rare diseases already compensated by either KWCWS or the administrative court were also included in the FSC. A few types of cancer and rare diseases examined in epidemiological studies or investigations conducted in their plants were included for the FSC programs, which differ slightly between companies.A formula combining job and disease factors for calculating the amount of the FSC was developed by the type of diseases compensated. The maximum amount of the FSC per type of diseases was first fixed based on the associated medical treatment fee. Job factors that influence the development of suspected WRDs in semiconductor production lines and also disease factors related to the burden of treatment expense were also identified and combined to calculate the FSC amount. A contribution fraction by job and disease factors was developed and applied to the total FSC amount. The formulas combining disease and job factors were created in order to avoid any prejudice through quantitative evaluation on the contribution to the development of a suspected WRD.A Financial Support Compensation Committee (FSCC) has been created by each company comprised of fewer than ten external occupational health professionals and lawyers. The number by type of professional and operation methods differs between companies. They have been operated entirely independent of the companies as well as the KWCWS. The key roles of the committees are to evaluate whether applicants are eligible for the FSC programs, calculate the FSC amount based on the designated formula combining several job and diseases factors, and determine the FSC amount to each company and applicants. As soon as a company receives the FSC results from the FSCC, it sends the amount of the FSC directly to the applicant .Most of the components of the programs, including the type of the suspected WRD, requirements for registration, and principles and methods for the FSC, are nearly the same . HoweverCertain types of cancers, reproductive health problems, and rare diseases were included as the suspected WRDs candidates for the FSC. The types of cancer, rare diseases, and reproductive health problems that have been found to be significant in epidemiological studies published in international journals were first selected for the FSC, regardless of the consistency among the literature or the type of studies  3,10,1111,12,13.The types of reproductive health problems evaluated to be significant in the semiconductor industry were spontaneous abortion (SAB) ,18,19,20Leukemia, brain cancer, ovarian cancer, and multiple sclerosis were rejected as occupational diseases by the KWCWS but were later awarded compensation by the administrative court , even thThe requirements for which semiconductor workers can register with the FSC program were decided by the type of the suspected WRD . The minThe amount of the FSC was designed to be smaller than that provided by the KWCWS but greater than the required medical treatment for the suspected WRD involved. The maximum amount of the FSC per type of cancer and rare disease was first fixed based on medical treatment fees by disease . SeveralThis study described the FSC programs that are being supported by two semiconductor companies for semiconductor workers with cancer, rare diseases, reproductive health problems, and selected diseases among their offspring. All countries have compensation-based surveillance systems and/or non-compensation-based surveillance systems, or both, to recognize occupational disease under a social welfare act or other pertinent regulations . As far It is well-known that the semiconductor industry involves rapidly shifting technologies and drastic changes in chemical use, processes, and technology, multiple exposures, and more, making it difficult to examine the hazardous agents or jobs causing chronic health risks. Most semiconductor workers suffering cancer and rare diseases in Korea have been denied national compensation because it is difficult for them to prove the association between various types of chronic disease and past exposure from a rapidly changing work environment and process.Before the FSC programs were introduced by the two semiconductor companies , former Firstly, these FSC programs are considered to have contributed to resolving a social dispute that lasted for more than a decade. Since the operation of these programs, no social conflict related to the causality of the semiconductor environment in terms of WRDs has been reported. All semiconductor workers who receive FSC from the companies are still allowed to apply to the KWCWS.Secondly, semiconductor workers with several rare diseases, including cancer and selected diseases among their offspring, can be financially assisted by the companies if certain minimum-period job history on a production line can be demonstrated. Most types of rare diseases and reproductive and diseases among offspring are unlikely to be awarded compensation by the national program in many countries, even though they are work-related to some extent. Korea has listed 12 types of WRDs allowed compensation under the Industrial Accident Compensation Insurance Act (IACI) . OccupatThirdly, the two semiconductor company’s FSC programs have impacted the process of evaluating the causality of a job or environment with cancer and rare disease as required by the KWCWS. Since 2018, the KWCWS has decided to not require further epidemiological investigation for semiconductor workers who have eight types of disease, leukemia, aplastic anemia, ovarian cancer, NHL, breast cancer, lung cancer, and multiple sclerosis, because they were either compensated by the KWCWS or the administrative court as an occupational disease . The comFourthly, it is meaningful that contractors involved inside the fab and chip production line inside the companies are compensated even though they are not directly employed by the parent company . There hFinally, the semiconductor companies can use the results from the FSC programs not only to identify new/emerging work-related health issues, but also to provide a signal that will initiate interventions and prevention efforts. These FSC programs should have a strong link with workplace prevention efforts, such as direct workplace interventions aimed at protecting co-workers or removing workplace risk factors and different forms of primary and secondary prevention.This study faced clear limitations due to the lack of data on both the details of the FSC results and the formula applied to calculate the individual FSC amount. We have accessed some of the results released at different times by the two companies through the media. Samsung’s FSCC reported that its program had compensated a total of 458 semiconductor workers, including contractors, , as of the end of May 2020, about two years after Samsung started the program in January 2018 . A totalThe FSC programs supported by the two semiconductor companies have been operated successfully to date. The group of cancer, rare disease, offspring rare disease among children born to semiconductor workers, and fetal loss, including SAB and stillbirth, were considered for FSC. Semiconductor workers who suffered from a suspected WRD can be financially supported and compensated if they satisfied the minimal job-associated requirements and type of diseases. To date, no social conflict related to the causality of the semiconductor environment in terms of WRDs has been reported. These programs have contributed to resolving the conflict between the companies and semiconductor workers with the suspected WRDs. Large companies need to consider the experiences of the two semiconductor companies’ FSC programs not only to resolve similar conflicts with workers suffering from WRD, but also to provide workers with a welfare program within a company.


To realise the opportunity to have a country with well-educated midwives of high academic standard, and, at the same time, promoting gender equality and equity we need to protect and invest together in midwives. This paper provides the foundation for a revitalised discussion on midwives’ role for women and child health in the 21st century. The full Swedish Midwifery report was published in October 2021. The UN Millennium Declaration and the Millennium Development Goals (MDGs) were adopted in 2000, and global efforts were made to achieve the eight goals agreed upon for the first 15 years of the new millennium. These efforts became the foundation for the development of the Sustainable Development Goals (SDGs) adopted by the leaders of the world in 2015. Sweden responded to the international agenda for global development by translating it into national policy. One priority in working toward achieving the MDGs was the empowerment of women. Sexual and reproductive health and rights, the promotion of gender equality, and addressing the imbalance of power are subjects that must be taken into account in implementing the MDGs. Advancing the United Nation’s 2030 Agenda in Sweden might call for letting the past shed light on the futureby looking at the history of midwifery in Sweden.Already in 1886, Swedish midwives had organized themselves into a joint union, the Swedish Midwifery Association . Three cThrough a collaboration between the Swedish Institute for Global Health Transformation (SIGHT) and the Swedish Association of Midwives, a review of the role of midwifery in the implementation of the UN 2030 Agenda in Sweden resulted in The Swedish Midwifery Report 2021.https://sight.nu/swedish-network-for-midwifery/The initial initiative leading to this report comprised round table discussions on the Role of the midwife in Global Health. These were organised by the Swedish Association of Midwives, through its International Council and were hosted at the Swedish Ministry for Foreign Affairs (MFA) in 2018 and 2019. This led to the formation of the Swedish Midwifery Network in 2020. The purpose of this network is to bring together actors who together can increase the impact of Swedish models on on Global Health.The Swedish midwife works at all levels in a hub-and-spoke health-care system that consists of network with a tertiary level hospital in the center, referred to as a hub, a hospital thatoffers a full array of services. This hospital is complemented by secondary health facilities referred to as spokes. These offer more limited-service referring women and children in need of more specialised services to the hub for treatment and care . ContinuThe development of the role of the midwife in Sweden – From traditional birth attendants to licensed midwives with an academic degree, a process that led to progressprofessionalization and academisation of the Swedish midwife.Sweden’s response to the SDGs relevant to Swedish midwifery practice – a) SDG 2 Zero Hunger. Without adequate and sustained investments in good nutrition for girls, women, and children, the SDGs will not be realised. Malnutrition will represent an often invisible impediment to the achievement of good health (SDG 3). Malnutrition not only from a lack of sufficient nutritious food, but also from a host of intertwined factors linking empowerment of women and families, health during pregnancy and childbirth, care for the newborn, breastfeeding, complementary food counseling to parents, clean water supplies, sanitation and hygiene with access to food and resources. b) SDG 3 The goal of SDG 3 is to ensure healthy lives and promote well-being for all ages. The associated targets include reducing the global maternal mortality ratio and ending preventable deaths of newborns and children. Having access to a midwife is beyond doubt the single most important factor in reducing mortality and morbidity among women and children worldwide [SDG 4 Quality Education, the first education programme for midwives in Sweden started in the 1700s. Today all midwifery education programmes in Sweden, and the full masters programme are based on a ‘midwifery discipline’ labeled ‘sexual, reproductive and perinatal health’ or similar. These can serve as a model d) SDG 5 Gender equality. Gender equality empowers all women and girls. Gender equality is a necessary foundation for a peaceful, prosperous, and sustainable world and leads to economic growth and development. In October 2014, Sweden became the first country in the world to launch a feminist foreign policy. This means applying a systematic gender equality perspective throughout the whole foreign policy agenda. The policy work is organised around rights, representation, and resources. It is based on the premise that gender equality is not just a women’s issue – it benefits everyone. As a means of the feminist policy Sweden has campaigned for women’s and girls’ sexual and reproductive health and rights, and greater access to midwives worldwide. In Sweden, the total per capita cost for health care is 20% higher for women than for men . When excluding health care for reproduction and sex-specific morbidity from total health care cost, the cost difference between women and men declines to 8%. A separate budget track for reproductive health would facilitate the investment in midwives, being the profession that meets most of the reproductive needs. The total cost for care received in connection with reproduction and sex-specific morbidity is estimated to be 7.7% of the total health care budget [SDG 16 Promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build effective, accountable, and inclusive institutions at all levels. The tax-funded, free-of-charge, and evidence-based health care system in Sweden is a prerequisite for the high attendance to maternal and child health care and the public trust in the system. According to Swedish health care reports, almost 100% of pregnant women utilise their right to ANC services. The routine of midwives reporting the birth of every child helps the delivery of birth certificates and has been in use for more than 200 years, placing Sweden as the country with one of the oldest and best functioning birth registration systems in the world. The Swedish model should be considered for use wherever possible. A birth certificate should be issued for every person born within a single country, and some form of data on every individual, no matter where they are born, should be kept in appropriate registers because such data finds extensive use in medical research. The feminist foreign policy and the collaboration between strong institutions constitutes a solid ground for midwives as well as other health care providers. f) SDG 17 Partnerships for the goals describe the cooperation and partnerships with national and international civil society, multilateral organisations, public agencies, and the private sector. Sweden works for sustainable development and helps create conditions for people living in poverty and oppression to improve their living conditions nationally and internationally. For over 30 years, Sweden has been supporting the education of and accessibility to midwives in low- and middle-income countries. The unique tradition and experience of more than 300 years of midwifery in Sweden underpin Sweden’s capacity-building support.alth SDG . Malnutrorldwide . MidwiveThe Swedish Midwifery report describes the history of midwifery in Sweden, a history that can be presented as consisting of three main partsEfforts should be made to identify the nature of interlinkages between the SDGs and various elements of midwifery. In addition efforts should be made to PROTECT midwives’ rights, to continue academisation of the profession, provide decent work, and practice environments. INVEST in midwifery leadership to accelerate the implementation of the 2030 Agenda. TOGETHER, we all have a role to play to ensure that midwives are supported, protected, motivated, and equipped to always deliver safe health care.


Antibodies constitute a major component of serum on protein mass basis. We also know that the structural diversity of these antibodies exceeds that of all other proteins in the body and they react with an immense number of molecular targets. What we still cannot quantitatively describe is how antibody abundance is related to affinity, specificity, and cross reactivity. This ignorance has important practical consequences: we also do not have proper biochemical units for characterizing polyclonal serum antibody binding. The solution requires both a theoretical foundation, a physical model of the system, and technology for the experimental confirmation of theory. Here we argue that the quantitative characterization of interactions between serum antibodies and their targets requires systems-level physical chemistry approach and generates results that should help create maps of antibody binding landscape. Our immune system is responsible for more than protecting us from pathogens. It also regulates the removal of our own molecules and cells once these are losing function due to ageing, attrition, or infection. It maintains a healthy balance with the myriad of microbes and viruses present in our bodies . To carrAntibodies are present in three main forms in blood: as part of a receptor complex, the B-cell antigen receptor (BCR) or membrane immunoglobulin (mIg), with cellular signaling capacity ,7,8; in Based on the form of antibody they express, there are three categories of B cells: (1) resting naïve B2 lymphocytes and memory B cells (MBC) display BCR but do not secrete Abs; (2) activated B1 cells, pre-plasmablasts, lymphoblasts express both surface and secreted Ab; (3) plasma cells, such as short-lived plasma cells (SLPC) and long-lived plasma cells (LLPC), only secrete antibodies. The second and third group together is also called antibody secreting cells (ASC). In accordance with these categories, these cell types function as antigen (Ag) sensors, as both sensors and effectors and as effectors only . A feedbFrom the medical and biological perspective, the humoral immune response takes place in various anatomical locations of the host: lymph nodes, spleen, bone marrow, blood, or periphery. The specialized structure of these tissues contributes to the development, differentiation and activation of B-cells and antibody secreting cells ,21,22. NThis interaction space can be thought of as a coordinate system of chemical potentials. Chemical potential here refers to the ability of the system to contribute to the generation of Ab-Ag complexes. An Ab with given specificity can be identified by a vector pointing towards a given direction in the landscape of molecular targets . The cheDuring an immune response, naïve and memory cells of the adaptive immune system are activated, expanded, and differentiated . B cellsAs the stimulus is cleared by the immune response, most effector cells die and only memory cells remain. This corresponds to a retraction and reorganization in configuration space. It is important to note that the new boundary of the system is established by the negotiation between the host and the intruder: very harmful intruders will tend to leave a long-lasting and high affinity imprint, while softer attacks will have weaker effects ,33. ReguThe immune system is never totally at rest. It is the dynamism, the constant restructuring of this landscape by antigenic stimuli that maintains system architecture and adjusts the configuration space to the molecular environment. Therefore, whilst the overall hierarchy is expected to be governed by the laws of physics, shifting, and changing, locally active sites respond to the biological needs of the system.Understanding the underlying hierarchy and architecture of the network of antibodies has an immediate practical use: the design of serological assays with results that characterize this network. Current serological assays are standardized according to medical purposes, with the aim of establishing optimal cut-off values for diagnostic accuracy. The units obtained this way do not allow any kind of comparison of results, even for the identical antigen when different platforms are used, or different antibody isotypes are measured. The units are standardized but arbitrary with no biochemical meaning .By using the configuration space model, we can identify the parameters that are required to describe such a system. Considering that serum antibodies are mixtures of molecules with a wide range of affinities against antigenic targets and a wide range of concentrations of each molecule, it is reasonable to assume that these parameters need to be estimated. We can probe this space by measuring the formation of antigen–antibody complexes in immunoassays and map the space by applying mathematical functions that model physical properties of the system.The logistic function  describes population growth with an exponential growth limited by maximum capacity of the system. The logistic function is the solution of the logistic differential equation, which describes rate of change against a given variable. While originally it was introduced for modeling growth in time, it is also used for modeling chemical reactions and antibody–antigen binding reactions . In immuN is the number of entities and K is the capacity of the system for such entities, and r is the rate of exponential growth, asFor a reaction where we increase Ag concentration and follow the concentration of bound Ab , we can rewrite the logistic differential equationxt S1 of ), which We can simplify this expression by using the relative thermodynamic activity of antigen under equilibrium conditions. This activity is characterized by the thermodynamic activity coefficient of antigen By normalizing, i.e., with The explicit solution of this differential equation is the function known to immunologists as the four-parameter logistic function or 4PL see  with a lAg]i is one of the parameters. This differential equation implies that besides the activity coefficient of antibody and the rate parameter, the rate of generation of bound antibody while increasing log(Ag), is determined by a power of the activity coefficient. The exponent in the power expression However, while the 5PL is the solution of a modified differential equation, it is less suitable for the description of a system’s behavior because of its parametrization. First order differential equations define relationships between functions representing physical quantities and their derivatives, the latter representing rates of change of the physical quantity. In an immunoassay, the physical quantity is the amount of antigen–antibody complex (or bound antibody) formed during the assay once equilibrium is reached. The rate of change in this quantity, while changing reaction conditions by titrating antibody or antigen, is the derivative of the function that relates the amount of complex formed to the logarithm of the titrated component. We proposed the use of the generalized logistic model (GL) or Richards growth model ,41 instetal pool .i and the other is the limiting activity coefficient  or would unnecessarily remove antibodies and antigen . The overall balance can be kept if the immune system tunes clearance to match affinity by switching isotypes to enhance FcR binding and complement activation when affinity increases. This harmonization shapes the binding landscape, which is modeled by the proposed configuration space.The equation we propose addresses serum antibody measurements and thereby systemic immune responses. Because lymphatic circulation drains into the blood via sites of lymphocyte differentiation and activation, the lymph nodes and systemic immune responses have access to practically all antigens in the host. The other way round, antibodies in the bloodstream also reach lymphoid organs. It is in the lymphoid organs that affinity maturation takes place and adjusts distribution of affinities. Otherwise, at sites where the flow of immune complexes is unidirectional (out of the host), like mucosal surfaces, we do not expect to have direct effects on the equation. Consequently, we also do not expect that the systemic configuration space model is applicable to mucosal surfaces.The key message of our article is that the binding landscape of serum antibodies cannot be approached as the simple sum of individual, independent interactions. The word binding is rather meaningless unless we identify conditions and quantify interaction energy. Blood plasma is crowded with macromolecules, with a significant contribution from circulating antibodies. The conditions are therefore defined by the composition of antibodies by the intricate cross-reactivity network of antibodies, their structures, and concentrations. Most of the immunological studies have been directed towards defining how an active immune response happens. Molecular biology helped us clone, sequence, and recombinantly express monoclonal antibodies. Structural biology allowed the characterization of antibody structures in detail. Now it is time to organize this information into a complex biological system. We propose that instead of examining the active phase of an immune response, the characterization of landscape of serum antibody binding in steady state is a better goal from the point of view of physics.The ability to quantitatively characterize and map serum antibody binding to vast collections of antigens can open several possibilities. Via the standardization of simplex measurements, we could generate comparable binding data from quantitative immunoassays and integrate that into epitope databases. Epitope databases would develop into quantitative databases in terms of incorporating binding strength data. By generating antigen arrays with whole molecule antigens, peptides, and modified random peptides suitable for binding strength quantitation, we can attempt to create complete maps of serum antibody binding landscape. By the selective detection of isoforms IgG, IgA, IgM, and IgE, a further dimension, related to biological effects, can be introduced into the database. In the long term, such quantitative maps of individual’s Ab interaction spaces should become the foundations for immunodiagnostics and therapeutics as well. Our model provides a theoretical framework of systems-level physical approach to the functioning of adaptive immunity. Experimental testing will be necessary to see how and when and with what accuracy the model can be applied to map the antibody landscape of a living organism, especially with regard to the relationship of MBC and secreted antibodies, the effects of antigen and antibody multivalency, and the possibilities of merging quantitative binding data with BCR repertoire sequencing.


This study empirically examines the incidence and earning effect of educational mismatch in the labor market of Pakistan. Microdata obtained from the labor force survey for the years  is used for the analysis. The realized match approach is used to measure the required level of education, and the augmented mincerian model is used to determine the potential earning effects associated with the educational mismatch. The study found a considerable incidence of under-education and over-education in the labor market. Results show a positive return to under-education and over-education. However, the return to the required level of education is significantly higher than both the under-education and over-education. The educational mismatch can have certain negative ramifications for individuals, such as job dissatisfaction, skill depreciation due to lower access to further education and training activities, lower labor productivity, underutilization, as well as wage penalty –4. It caDeveloping countries (such as Pakistan) have specific labor market characteristics that might influence educational mismatch on income. Pakistan belongs in the lower-middle-income country group (World Bank classification) with an emerging market and developing economy (IMF). The analysis of educational mismatch and its impact on earnings in the labor market of Pakistan can be interesting for several reasons.First, the country’s higher education sector has observed significant structural changes in the last two decades. Recent statistics show that over 209 public and private sector higher education institutes are producing around 500,000 university graduates each year. However, with the expansion in higher education, there appears to be the paradox of graduate unemployment. The educated unemployment (higher education and diploma) has increased significantly from 6.52% in 2003–2004 to 18.82 in 2017–2018. Second, with an average labor productivity growth rate of about 1.5%, Pakistan is positioned at the bottom of the lowest labor productivity rate in the region; while countries such as India, Sri Lanka, Bhutan, Vietnam, and Bangladesh have all witnessed strong labor productivity growth during the same period, even though the average annual hours of work by persons employed in Pakistan are almost equal to the average annual hours of work in India, Bangladesh, and Sri Lanka.There is a general agreement that job-education mismatch would have a detrimental impact on productivity. Evidence suggests that employing workers in a position that requires less educational qualification than what the workers actually possess is potentially counterproductive , as it mApart from that, young people have a significantly strong desire to leave the country. World Bank’s statistics from the Migration and Remittances Factbook 2017 show that Pakistan stood third in South Asia (after India and Bangladesh) and sixth globally  for human capital mobility. The statistics from the Pakistan Bureau of Emigration and Overseas Employment and the Pakistan Economic Survey (various issues) show that Pakistan’s stock of immigration rose (those seeking employment abroad) from one million in 1981 to 8.77 million by December 2017. This scenario is unlike the countries such as New Zealand, where the departing highly skilled labor is being substituted by highly qualified individuals from many other countries;  referredA very few studies related to educational mismatch can also be found in Pakistan –9. HowevThe rest of the paper is organized as follows: Section 2 contains a brief review of theoretical and empirical literature related to educational mismatch and its impact on earnings, followed by a detailed description of data and methodology in section 3. Section 4 presents the findings of this study, followed by the conclusion and recommendations in section 5.The neo-classical model of human capital theory  suggestsThe signaling theory  states tThe Career mobility theory  can be cAssignment theory  holds thThe empirical literature on the impact of educational mismatch and earnings has emerged with the seminal work of , who proIt has been well established in the literature that every occupation requires a certain level of education , 25. OveSimilarly, individuals with a lower than required level of education for occupation are classified as undereducated. Several empirical studies on the incidence of educational mismatch found heterogeneous results for developing countries , 28 founIn analyzing the Egyptian labor market,  also fouIn the case of Pakistan, some researchers have focused on the issue of education mismatch and its impact on earnings in Pakistan; however, most of the previous studies are very descriptive in nature and limited in scope; see, for example, –40. In hThere is a large body of literature on the gap between the actual level of education attained by workers and the job’s required level of education. Using the worker’s current job and level of attained education, these studies provide three measurements defined as years of over-education, required-education, and under-education. However, existing economic literature shows several methods for measuring these variables. These measurement methods can be categorized into two major groups: subjective and objective methods. The former includes (1) indirect self-assessment, according to which the workers are asked about the required education for a specific job. Then the worker’s attained level of education is compared with the job’s required level of education. (2) direst self-assessment; according to which the workers are asked directly whether they are over or undereducated for their current jobs.The educational mismatch can also be assessed based on the objective method: (1) using the Job Analysis (JA) approach. Professional job analysts compute the academic requirements for specific occupations by grading each occupation to determine an individual’s required education and comparing it with their actual education level. (2) by realized match approach, which can be classified into two categories. The first is by calculating the mean and standard deviation of the education level of individuals as the required level of education for a specific group of occupations . The indBecause of the data limitations, it is not possible to use the subjective methods method in this study. Therefore, this study is based on realized matched approach, and following , 28, 42,This study is based on three waves of the Pakistan labor force survey for the years 2013–2014, 2014–2015, and 2017–2018). The labor force survey conducted by the statistical bureau of Pakistan is a cross-sectional survey that provides microdata incorporating annual estimates of detailed labor market characteristics. The survey is being conducted either annually or every second year. The sample for this study includes the civilian labor force working-aged between 15–65 working full time in different sectors of the economy. The sample is limited to regularly paid employees with at least 35 weekly work hours. Own account workers and those with less than 35 weekly hours of paid work are excluded from the sample. A complete list of variables is given in Table A1 in Mapping of education qualification of Pakistan based on the International Standard Classification of Education (ISCED) is used to account for the actual level of education obtained by the individuals. Further, occupational categories (excluding Armed forces) based on ISCO-08 have been used to classify the level of required education (RE), over-education (OE), and under-education (UE) for each worker working in a specific occupational group.Given the specific nature of the labor force survey, the data are pooled together for analysis. The required level of education (re) is estimated at occupation level, and the variables are pooled across years by gender.There are mainly two approaches used to determine the impact of educational mismatch on income. While both methods use a modified mincer earning function for analysis, the first approach uses the dummy variables to represent over-education and under-education. The second approach based on  breaks tWhere AE is the level of attained education, RE is the required level of education for a specific occupation, OE is the amount of education acquired by an individual that exceeds the required level of education in a particular occupation, and UE is the amount of education attained by an individual that is less than the required level of education in an occupation. OE will be zero for undereducated and correctly matched individuals. UE is zero for over-educated and correctly matched individuals. To calculate the level of over-education and under-education, the Eq  can be rAfter inserting the over-education, under-education, and required level of education in mincer wage equation, the augmented equation takes the following form:In Eq , the logThe distribution of mismatch across years of working experience  shows thStatistics of educational mismatch across occupational groups  reveal tFirst, the basic mincer model of returns to education attained by male and female workers in Pakistan is estimated. It is worth noting that, when dealing with pooled or panel nature of data, the data set may have characteristics that are shared between members of a group but differ across groups , known as fixed effects , 44. ThuThis section presents the estimates of ORU specification based on Eq . Table 6ORU specification provides better estimates of the return to education than the standard mincerian earnings equation . Column An attractive feature of this ORU specification is that it fits in the Human capital, job competition, or assignment model. It allows testing for three different hypotheses by applying different restrictions as:Eq  implies Similarly, H2 and H3 are also rejected, indicating that the job market of Pakistan can be explained by the assignment model. These findings are in line with numerous previous studies, such as , 46–48. The analysis presented in this study aims to identify the relationship between earnings and each year of over, required, or under-education. It is important to acknowledge that several unobservable individual characteristics can endogenously influence the returns to over, required, or under-education. However, because of data limitations, the analysis presented in this study cannot distinguish the extent to which the unobservable factors, such as unobserved ability, productivity, and other skills relevant for the labor market, can influence the returns to over, required, or under-education. Nevertheless, using the standard modeling approach, this study presents the extent of educational mismatch in the labor market and the potential earnings differentials associated with it.Given the Population structure of Pakistan, an important aspect worth further consideration is the effect of educational mismatch on the income of various age groups. The educational mismatch has become one of the major challenges in labor market policy in recent years. This paper investigates the effect of educational mismatch on earnings in the labor market of Pakistan. Based on the Labor force survey of Pakistan, the results provide an insight into educational mismatch and its effect on earning distribution for the employed labor force across genders and occupations. The findings of this study show that both over and under-education persist in the labor market of Pakistan. These findings are similar to previous literature dealing with developing countries such as Vietnam  and the Even though this study is limited to vertical educational mismatch, it has important implications for the labor market of Pakistan as it provides detailed information about the incidence of vertical educational mismatch and the earning penalties associated with that mismatch.The findings of the study lead to the following policy implications and recommendations:The incidence of educational mismatch highlights that: (1) the education system is not coping with the right demands of the labor market, and; (2) the labor force also lacks accurate information about the job market. It is imperative to introduce an organized information system that provides more accurate information about the employment patterns, skills, and education in demand in the labor market and improves the matching process. For the female labor force, it is also important to address the socio-cultural barriers and labor market discrimination. There is also a need to raise incentives to improve the job search intensity. And to overcome the negative effect of under-education, upskilling through on-the-job training to increase productivity is of utmost importance to raise the earnings level of workers.S1 Appendix(DOCX)Click here for additional data file.


The Chinese central government proclaimed a mandatory or demonstration waste separation policy in some cities or counties to manage the increasing amounts of generated waste since 2017. Many cities and regions have also begun to build waste separation management systems and institutions, and community managers have created waste management rules and provided separation management services under the guidance of local government. However, little is known about how these policies or services have performed and the degree of residents’ satisfaction, especially regarding the central government. Therefore, the purpose of this study was to analyze the consequence of these policies using residents’ community and national satisfaction levels with solid waste management services (SWMS) and their determinants. An online survey in 2021 showed that the overall satisfaction levels of communities and national SWMS are similar, but the differences between rural and urban regions are significant. Residents’ satisfaction with community SWMS in urban regions was higher than national satisfaction, and the results in rural regions was contrary. The determinants of community and national satisfaction were also different and varied by region. To improve satisfaction, the government need to standardize basic management systems in different types of regions, gradually improve management services and institutions in rural areas and non-pilot cities and provide special services or facilities for less healthy residents. With the rapid development of society and the economy in China, the domestic waste volume has increased rapidly—China became the largest municipal waste generation country in the world, outperforming the United States, in 2004 ,2. The dDifferent levels of local government have carried out this policy based on the residents’ participating willingness and community facilities, while the central government enacted a mandatory waste separation policy or waste demonstration programs; thus, residents may have different perceptions about the waste services or policies of central and local government ,15,16. TMany studies focus on residents’ satisfaction with SWMS from local government in rural or urban regions before a mandatory or demonstration policy, but there is a lack of evaluations about the satisfaction with national policy or services and the central–local and urban–rural comparison ,50,51,52There were some research works about the differentiation of hierarchical satisfaction about public services or environmental services that include SWMS ,55,56,57The factors that impacted satisfaction when applied to solid waste separation collection, management or treatment services in the previous studies include many items ,55,56,57Based on the literature review above, the following hypotheses are proposed: H1. Satisfaction with national SWMS is higher than community SWMS, and the difference is not large among regions and cities. H2. Residents’ socioeconomics characteristics have a significant impact on community and national satisfaction level. Income and education have a negative impact on community and national satisfaction levels. Age has a positive impact on community and national satisfaction levels. H3. Environmental perceptions have a positive impact on central-local satisfaction. H4. The situation of solid waste management has a positive impact on community satisfaction and no impact on national satisfaction. H5. There is a significantly positive correlation between waste institutions and community and national satisfaction.This study is the first paper using the country-wide data to explain and compare the difference of central–local satisfaction using the ratings of national and community satisfaction with SWMS and analyze the determinants in China. This can creatively give researchers and service providers a general view about the effect of services and institutions on community and national satisfaction and the implementation pathway of waste separation policy. This paper has three specific aims: (1) to describe the differences between community and national satisfaction levels, especially in rural and urban regions and non-pilot and pilot cities; (2) to describe and compare the relationship between solid waste management services and institutions and the community and national satisfaction levels with SWMS in different regions; (3) to analyze the factors that determine satisfaction with SWMS at the community and national level. The structure of the paper is as follows. We designed questionnaires and conducted an online survey about SWMS using Jinshuju, which is an application program developed by ThoughtWorks. We then trained six undergraduates and two graduate students as the seed investigators to post the questionnaires. The participants needed to meet four basic conditions: (1) 18 years old and above; (2) they could finish the survey using Wechat; (3) they could only submit the answers through the same IP address once—any further attempts were restrained by Jinshuju; and (4) voluntary participation. Before the formal investigation, we carried out a pilot survey to test the questionnaire’s rationality and validity and improved the questions. For this, the seed investigators sent the survey questionnaires to recognized friends or relations individually or sent it to members of different groups using the method of group sending of Wechat. We did not publish the questionnaire in our circles of friends to avoid transmitting it optionally and to ensure the quality and availability of the data. After the survey, we randomly sent a small remuneration to the participants as an incentive to enhance the response rate for the questionnaires . Ten perIn order to explore the diversity and determinants of satisfaction for the actual service providers—community managers and policy makers—and national governments with SWMS, we first used the satisfaction with community and national SWMS as the dependent variables. The questions were “are you satisfied with the situations of community SWMS?” and “are you satisfied with the situations or policy of national solid waste separation management services?”, and the answer scoring was based on a five-point Likert scale. Second, based on the literature in Third, the institution systems included setting and enforcing waste separation rules, undertaking advertising programs and setting and receiving waste management fees at the community level. From the residents’ perspectives, the institutions should be effective when rules are enacted and advertised; then, the residents can obtain the information about SWMS and possibly engage in waste separation collection behavior. We also asked the participants about waste management fees at the community level. If the community had waste separation management rules, waste separation advertisement and waste management fees, this was coded as 1; otherwise, this was coded as 0.Finally, we surveyed the environmental perceptions and the socioeconomic factors. The environmental perceptions included knowing about solid waste law and the pilot city list for waste separation and environmental activity. In addition, we collected socioeconomic characteristics data, which included gender, age, education, health and income. These variables and their definitions are also shown in i indicates the satisfaction level of resident i with SWMS, which includes satisfaction with community and national SWMS, and Sei indicates whether the community where resident i lived provides SWMS . When a community provides SWMS, then Sei is equal to 1; otherwise, it is equal to 0. Ini is the community institution, which includes waste separation rules, waste management fees and advertising. When a community has these institutions, then Ini is equal to 1; otherwise, it is equal to 0. Ri represents the region information of the communities, including region and pilot city, which are both dummy variables. In detail, region consists of the urban region, which is coded 1, and the rural region, which is coded 0; a pilot city is coded 1 and non-pilot city is coded 0. Eni is environmental perception, which includes environmental activity, knowledge about the environment law and the pilot city list. Xi is a vector describing the characteristics of a resident, including age, education, gender, health and monthly household income. Their definitions and values are shown in 1, β2, α1, α2 and α3 are the coefficients to be estimated. εi is the error term. In addition, we use the Probit model to evaluate the impact on SWMS of all socioeconomic and environmental knowledge variables and community institutions in We used both descriptive and multivariate analyses to evaluate the determinants of community and national satisfaction with solid waste management services. Based on the sequential dependent variables, we constructed an Ologit (Ordered Logit) regression model to analyze the determinants of satisfaction with SWMS and compare the differences between community and national satisfaction. Some studies considered that the situation of SWMS in China is simply decided by the local government or community managers based on the community status and national policy, rather than being mainly affected by the residents ,79,80,81The descriptive statistics for all variables are shown in Only 28% of residents reported that their communities provided waste separation collection facilities, and 62% of residents reported waste separation collection behaviors, so we found that most separation work is conducted by the waste separation workers. Because many residents, at about 443, did not know whether waste is transported, of all residents who knew this, 87% of the residents reported that the community had waste transportation services. Furthermore, waste recycling in 59% of communities was the main waste disposal method. In terms of community institutional actions, 64% of communities had seen advertisements that gave them waste-related knowledge, 56% of communities had rules about waste in the community, and 53% of communities collected a waste management fee.In the sample, 70% of residents lived in urban regions and 49% lived in a pilot waste separation city. Overall, residents’ community and national satisfaction levels with SWMS were neutral, because the average values were 3.18 and 3.15, respectively.Concerning the situation of SWMS, we found that the overall supply level provided was lower in China than other countries according to the literature ,14,42. TWe compared waste management institutional policies in urban and rural regions and found that there was no difference in the waste rules. However, the level of advertising promoting waste management was significantly different between rural and urban regions, but the gap was relatively minor. In fact, advertising about waste management in China was high, and this score was higher than that for waste rules. When services and institutional activities in different regions were compared, the largest divergence appeared for the waste management fee, which was only charged in 24% of communities in rural areas and was 42% lower than in urban regions. On the contrary, among cities, the largest difference was in waste advertisement and waste rules, and the lowest difference was found for the waste fee. This suggested that services and institutions in non-pilot cities are equally inadequate in rural areas and lower than in pilot cities.Overall, the satisfaction levels for community and national waste services are similar, as shown by the total sample in In order to describe the relationship between SWMS and satisfaction in the rural and urban regions, we showed that the satisfaction level of residents in the community providing and not providing SWMS and institutions in Because there are different impacts on satisfaction between urban and rural regions, we analyze these regions separately. With the status of SWMS, we found that when residents reported that their community provided waste separation collection behavior and waste recycling services in rural areas, they expressed higher satisfaction with community SWMS than without these services. The satisfaction with national SWMS was mainly determined by the waste separation behavior. In urban regions, all SWMS had a positive impact on the satisfaction with community SWMS, but only waste transportation and waste recycling gave a similar result to the satisfaction with national SWMS. The reason may be that waste separation facilities and collection behavior are provided by the communities, but waste transportation and waste recycling are provided and invested in by the local or national government in urban areas. Whether in rural or urban regions, waste advertisement and waste rules both impacted the satisfaction with community and national SWMS. Only in urban regions did residents for whom no waste fee was charged in the communities reported that they had significantly higher satisfaction.When we made a comparison between non-pilot and pilot cities, as shown in Using the Ologit regression model, we analyzed the determinants of community and national satisfaction with SWMS from four aspects—socioeconomic characteristics, environmental perceptions, situation and institutions of SWMS—using the Ologit model in Similar to the description statistics in Regarding the status of waste management services category, the results for the total sample in Model 2 of With regards to the institutional nature of SWMS, waste management rules were the main factor affecting the community satisfaction rating in rural regions, which did not change after adding the situation of SWMS in Model 4, which was similar to the descriptive statistics. However, in the total and urban regions, the waste fee was the main factor. There was a varied result for the different samples after adding the situation of SWMS in Models 2, 4 and 6 of In terms of the socioeconomic characteristics of the residents, the health of the residents had a significant impact on community satisfaction rating at the 0.001 level. When health increased by one level, satisfaction increased by 39.4%, 44.7% and 35.0% for the total, rural and urban samples, respectively (Models 2, 4 and 6 of Columns 3, 5 and 7, With the differences in the comparative analysis in With regards to the status of SWMS, waste recycling services were the only variable that affected satisfaction with national waste management services, and it only affected the satisfaction ratings in the total and urban samples, which is different from the results suggested by the descriptive statistics in In the waste services institutional policy category, the introduction of waste rules significantly improved satisfaction with national waste services in any samples; no impacts changed after adding the situation of SWMS in Models 8, 10 and 12, which is similar to the descriptive results in In the socioeconomic characteristics of residents category, health was positively related to national satisfaction with SWMS, but education and income were negatively related to satisfaction. When residents’ health increased by one level, satisfaction increased by 27.7% and 23.7% for the total and urban samples, respectively (To enhance the reliability of the results, we performed a robustness test using the Oprobit and OLS regression model, and the results are shown in This paper compared the difference between central and local satisfaction using community and national satisfaction with SWMS and showed their determinants. Overall, the satisfaction with community SWMS in the total sample is similar with national SWMS, but the satisfaction with community SWMS in rural regions is lower than national SWMS, and the situation is contrary in the urban regions. The result in rural regions is the same as precious studies about environmental services, medical services and public services, showing that the satisfaction with policy implementers is lower than that with policy makers based on the strong relationship between government trust and satisfaction ,83,84. HConcerning the community satisfaction with SWMS, the most important determinant is the status of SWMS, especially in the urban regions. Hence, community waste services are very important, and the higher the possibility of providing SWMS, the higher the community satisfaction in the total sample and urban sample. However, in urban regions, the waste fee decreased the community satisfaction. In rural regions, only waste recycling services and waste rules mainly affected the satisfaction. The possible explanations include two aspects. On the one hand, in terms of the process of making policy, the basic work for local government or communities is to provide public services with flexible implementation methods that are adapted to social and economic development levels below the mandatory or exemplary policy ,64,65. TRegarding the national satisfaction with SWMS, the main factor is the community rules of SWMS. This was verified by other previous studies  and pracConcerning socioeconomic characteristics and environmental perception, health is the most important factor for community and national satisfaction—the reason may be that a healthy resident has greater wishes to change the dirty and messy environment. In additions, the residents’ health condition is also a very important factor that increased satisfaction for all samples, because healthy residents can use the waste management services, including separating waste, throwing waste into the waste separation facilities and learning the waste transportation and disposal services ,96. IncoAlthough this paper gives a new idea about how to make a comparison of the central–local satisfaction with SWMS, limitations of this paper also exist and include four points. First, the paper is simply exploratory research about satisfaction with SWMS in China, and the result only affects the general situation and is not representative for the overall situation in China, because the sample is not randomly selected and not a nationally representative sample. Second, the result simply shows the correlational relationship between SWMS and satisfaction and does not give the precise causal relationships regarding the effect of satisfaction with SWMS. Third, the study may have some selection and reporting bias. Although the sample included 185 cities in China, we used the seed investigators to send the questionnaires and did not randomly select the sample, so there was some selection bias in the sample. In the questions regarding the situation of SWMS, some residents did not know the answers for the SWMS, so there was some reporting bias due to the lack of residents’ knowledge about local waste management services. Fourth, the results of this paper are based on the data in China, so we cannot precisely compare the result to other countries, though the results may be adaptable to other countries because of the characteristics of public services.The results showed that the differences in central–local satisfaction with SWMS in the total sample were almost non-existent, but in the different regions, the results were varied. The community satisfaction with solid waste management services in urban regions was greater than national services or policy, but resident satisfaction with national waste services in rural regions was higher than community services. The main determinants of community satisfaction were waste management services and waste management fees, and the national satisfaction is impacted by waste recycling services and waste rules and advertisements. However, the factors affecting community and national satisfaction differed depending on the sample type. In rural regions, waste recycling services and waste rules affected community services satisfaction, whereas only waste rules affected satisfaction with national waste services. In urban regions, all waste management services and waste fees had significant impacts on satisfaction with community services, but only waste recycling services and waste advertisements and rules increased satisfaction with the national waste management services.We propose several suggestions for improving waste management services, institutional policies, and systems. First, the local government or communities should continue to establish and invest in waste management facilities’ coverage in rural and urban areas. They should also strengthen the supply of comprehensive waste management services, especially the supply of waste treatment services and encourage the recycling and reuse of waste and thus improve satisfaction at the community and national levels. In urban regions, the integrality of waste management services in pilot and non-pilot cities should be constantly improved, which will increase waste management capacity and efficiency. Second, with regards to institutions, the government should at first increase the establishment of waste management institutions in communities across rural and urban regions, which will increase satisfaction with community and national waste services and should improve their performance. At the same time, the government should increase its advertising efforts and charge reasonably priced waste fees for better waste management services. Third, especially in the aging society, some facilities or services that are convenient for less healthy residents could be considered in waste management systems to optimize waste management systems and services, which should increase satisfaction. For example, the government could add a number of waste separation facilities and design a lower trash can. Fourth, the local government or community should increasingly advertise the waste management systems and deepen the knowledge of waste, not only guiding how to separate waste but also leading the community residents to visit the waste transportation and disposal services.In the future, studies should be developed and directed in terms of the following four aspects. The first is continuing to explore the impact of the quality of waste services on satisfaction in the different regions, which can steadily improve the performance or satisfaction with waste management services. Second is performing a comprehensive survey about the knowledge and utilization of waste management services in China; then, some intervention methods can be designed to increase the knowledge level of services and institutions of residents and increase the waste separation behavior. Third is to enhance the studies about new advertising methods about waste information or institutions and services targeting different residents, especially older people, such as “Internet + Time”, new media, short videos and regularly disseminating the knowledge daily. Fourth is comparing the similarities and differences of SWMS policies and services among different countries because of the different cultures and institutions and comparing the satisfaction with different public services, which may vary with the characters, subjects and patterns of providers.