Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world’s rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.

This paper explores the daily risks of households with respect to dimensions of inadequate water access and supply (quality, quantity, continuity and affordability). We describe how perceptions of risk are shaped and how households seek to reduce possible health impacts and potential economic losses through aversion behaviours. To this end, households’ activities relating to water storage, treatment and usage, together with water source preference, were analysed using a qualitative approach. We developed a framework that describes actual risk, risk perceptions and aversion behaviours. Risk perceptions and the adoption of aversion behaviours of varying frequency and intensity are based on a complex interaction between personal and shared experiences that relate to water supply dimensions, socioeconomic characteristics, and social networking. Moreover, we discuss household risk management strategies and provide some recommendations aimed at improving future approaches to the study of aversion behaviours.

Access to inclusive sanitation for people with disabilities (PWDs) remains a global challenge, including in Indonesia, where 10–15% of its population is disabled. Inclusive sanitation facilities can be achieved when PWDs are involved in the sanitation-related decision-making process, e.g., designing toilet that meets their needs. This study aims to investigate the situation of the sanitation facility in houses of PWDs and understand knowledge, attitude, and practices related to PWD participation in sanitation programs using a case study in two provinces in Indonesia: Nusa Tenggara Barat and Nusa Tenggara Timur. Quantitative data were taken from 129 PWD households, and qualitative data were from in-depth interviews with relevant stakeholders. The latter was presented in a causal loop diagram. Less than 5% had inclusive sanitation at home, mainly due to no supportive tools and bins. The knowledge levels related to sanitation and PWDs participation in sanitation programs were relatively low. Economic condition was one of the barriers for PWDs to participate in the sanitation program. Statistical analysis found that a higher household head education level was associated with a more positive attitude and higher PWD participation in sanitation programs. Although Indonesian law supports PWD participation, the implementation remains a challenge. This study also underlines the need for capacity building in facilitating PWDs’ involvement in sanitation programs and community meetings. Finally, barriers to PWD participation can come from different levels and actors, e.g., the family, the community, the district level, and the PWD itself, indicating the need to involve actors at all levels to enhance PWD participation in the sanitation program that leads to inclusive sanitation facilities for all groups.

Rapid tourism growth can place unprecedented strain on water resources and reduce access for local communities. This study explored the state of Inclusive water, sanitation and hygiene (WASH) in the tourism sector and local communities of Labuan Bajo, one of Indonesia's ‘super-premium’ tourism destinations. The formative research applied an Inclusive WASH-at-Work framework; data were collected using a case study methodology through semi-structured interviews (n = 20) and focus groups (n = 6) with government, tourism and community stakeholders. The findings identified growing tensions over inequitable water service levels and WASH access. Significantly, reported negative impacts were disproportionately experienced by women and girls, elderly and disabled members of the community, who suffer most from inadequate WASH facilities in hotels, public settings and their homes. Governance of and capacity constraints around WASH management highlighted the value of Inclusive WASH solutions to overcome the challenges Labuan Bajo faces as a rapidly developing tourism destination. Critically, solutions must be locally-driven, build local capacity and open pathways to collaboration between the community and decision-makers in the national government, provincial government and private tourism sector. Enhanced stakeholder collaboration and increased private sector contributions are needed to ensure a more equitable distribution of tourism benefits to underpin WASH and destination sustainability.

Forestry workers play a crucial role in implementing forest management programs, but their outdoor work exposes them to rising temperatures caused by global climate change, which poses potential health risks related to heat. This study specifically investigates the relationship between knowledge of heat-related issues, risk perception, and precautionary behavior among Indonesian forestry workers and paddy farmers in response to the escalating workplace heat exposure. Developing effective precautionary behavior is essential for preventing heat-related health disorders and promoting health protection programs. To investigate the association of the latent variables comprehensively, structured interviews were conducted with two occupational groups of outdoor workers, comprising 210 forestry workers and 215 paddy farmers. The findings indicate that increasing knowledge about heat-related issues promotes precautionary behavior, and risk perception acts as a mediator between knowledge and behavior. Additionally, the study highlights that the emotion of “dread” intensifies the perceived risk and predicts positive behavior changes. To enhance heat-related knowledge, exploring the potential use of a “fear” tone is important. In conclusion, comprehensive strategies should be implemented to promote precautionary behavior among forestry workers, particularly manual laborers, who are more vulnerable compared to farmers.