Harmonizing digital trade for sustainable stride: Unveiling the industrial pollution reduction effect of China's cross-border E-commerce comprehensive pilot zones.

As a key export-oriented economy, China faces significant challenges to its green economic development due to industrial pollution. While digital trade is crucial for sustainable development, its impact on industrial pollution has not been studied. This paper addresses this gap by adopting prefecture-level data from 2005 to 2021 and using a staggered difference-in-differences model to assess the impact of comprehensive pilot zones policy of cross-border e-commerce (CBEC) on industrial sulfur dioxide pollution. The findings indicate that CBEC significantly reduces industrial sulfur dioxide emission intensity, with the effect growing stronger over time. The effect is particularly notable in eastern and western regions, large cities, cities with underdeveloped digital infrastructure, and cities with lower pollution. Mechanism analysis reveals that CBEC lowers industrial emission intensity by driving structure upgrading, fostering green innovation, and advancing digital transformation. This paper emphasizes that the government can expedite the green transformation of the economy by integrating digital trade with industry.

The role of geographic distances in green industrial pilot policies evaluation: A sustainability transition perspective.

Green industrial policies (GIPs) aim to promote the adoption of green technology within a sustainability framework. While previous evaluations of GIP have focused more on the policy itself and the impacts within the policy boundaries, this paper further introduces the geographical factor to analyze the impact of different spatial geographic distances on implementing GIP. By integrating geographic distances into a spatial difference-in-differences analysis to assess the effects of municipal green industry policies (referred to as green industry pilot policies in this paper) enacted in 11 cities in China from 2006 to 2010, we find that these policies not only improve environmental and economic outcomes in targeted regions but also have spillover effects that may affect neighboring areas negatively, highlighting the importance of geographic considerations. The effectiveness of green industrial policies varies across cities, influenced by local socio-technical systems and regional characteristics such as infrastructure and information technology. These findings suggest that policy impacts are complex and multifaceted, requiring a comprehensive understanding of geographic interdependencies. By incorporating geographic factors, this research contributes to sustainability transition theory by offering insights into the spatial and temporal dynamics of socio-technical systems. The results underscore the need for policymakers to consider spatial-temporal aspects and potential secondary effects on adjacent regions when designing and implementing green industrial policies.

Do China's ecological civilization advance demonstration zones inhibit fisheries' carbon emission intensity? A quasi-natural experiment using double machine learning and spatial difference-in-differences.

China's National Ecological Civilization Demonstration Zone (NECDZ) policy has a significant role in ensuring national ecological security, and it is essential to investigate how the NECDZ policy affects the carbon emissions intensity of fisheries (CEIF) to advance China's commitment to reducing carbon emissions. This study evaluates the CEIF in 30 Chinese provinces from 2007 to 2021 using ecological civilization demonstration areas as a quasi-natural experiment and double machine learning (DML)to examine the impact and internal mechanisms of NECDZ implementation on the CEIF. We also explore spatial spillover effects using a spatial difference-in-differences approach. The results reveal that NECDZ implementation has a significantly negative impact on the CEIF and this effect continues over time. NECDZ policy potentially affects the CEIF through technology development, industrial structure improvement, and reduced energy consumption. Further investigation reveals that NECDZ implementation has spillover effects and inhibits the CEIF in surrounding regions. Therefore, it is essential to focus on developing the NECDZ policy to enhance fisheries' industrial structure, encourage low-carbon innovation in fishery technologies, and increase energy consumption efficiency. This could be supported by facilitating exchanges and cooperation with other areas, considering regional disparities, and assigning common but distinct responsibility for reducing the CEIF.

The Ambulatory Diabetes Outreach Program (ADOP): Rigorous Evaluation of a Pharmacist and Nurse-Led Care Model.

BACKGROUND: Although several systematic reviews found that ambulatory diabetes mellitus (DM) interventions involving pharmacists generally yielded better outcomes than the ones that did not, existing studies have limitations in rigor and study design. OBJECTIVE: To examine the intention-to-treat effects of the Ambulatory Diabetes Outreach Program (ADOP) on participants' A1c values and healthcare utilization over a 52-month follow-up period. DESIGN: Difference-in-differences with staggered adoption. Specifically, we employed the Callaway and Sant'Anna's "group-time average treatment effect" estimator using not-yet treated as controls adjusting for patient's age, BMI, sex, race, comorbidity, payor, and socio-economic status. PARTICIPANTS: All patients with at least one ADOP treatment encounter from July 2017 to October 2021, regardless of program completion or length of exposure to the program. INTERVENTION: ADOP, a collaborative population health program led by pharmacists and nurse specialists to provide individualized type 2 DM management and education within a large and diverse health system. MAIN MEASURES: Patients' A1c values and healthcare utilization, including inpatient admission, inpatient days, and numbers of visits to the emergency department, urgent care, and primary care in recent 6 months. KEY RESULTS: ADOP participation was associated with an overall average reduction of 1.04 percentage points (95%CI - 1.12, - 0.95) in A1c level. Similar A1c reductions were also observed in the subgroups by sex and race/ethnicity. An average of 2 months were required to reach the overall average effect, which persisted over 4 years. Compared to the respective utilization levels pre-intervention, participants also had average reductions in inpatient admissions by 32.4%, inpatient days by 81.6%, visits to the emergency department by 21.6%, and primary care by 17.9%. CONCLUSIONS: The results suggest that a collaborative model of pharmacist and nurse-led type 2 DM intervention was effective in improving A1c outcomes and reducing healthcare utilization in the long term.

Can green finance policy promote green innovation in cities? Evidence from pilot zones for green finance reform and innovation in China.

As a green finance policy, the establishment of pilot zones for green finance reform and innovation (PZGFRI) is of crucial importance to green innovation. This study employs panel data at the city level from 2011 to 2019 to explore the impact of the PZGFRI policy on green innovation in cities by constructing the Difference-in-Differences model. The results indicate that the PZGFRI policy significantly improves overall green innovation in cities. We test the mechanisms at the city level and find that the PZGFRI policy achieves green innovation improvement by improving capital support and research and development input, and this effect could be weakened when pollution intensity in cities is high. There is heterogeneity in different regions, cities of different economic development levels, and environmental regulation strength in the green innovation improving effects. These results suggest that the government should continue to promote the development of green finance and increase regulatory efforts to realize the enhancement of green innovation. This study can not only provide the Chinese government with more focused suggestions on green finance development of macro-policies but also give important references for other developing countries on green finance development.

The carbon emission reduction effect of green fiscal policy: a quasi-natural experiment.

Carbon emission reduction is crucial for mitigating global climate change, and green fiscal policies, through providing economic incentives and reallocating resources, are key means to achieve carbon reduction targets. This paper uses data covering 248 cities from 2003 to 2019 and applies a multi-period difference-in-differences model (DID) to thoroughly assess the impact of energy conservation and emission reduction (ECER) fiscal policies on enhancing carbon emission (CE1) reduction and carbon efficiency (CE2). It further analyzes the mediating role of Green Innovation (GI), exploring how it strengthens the impact of ECER policies. We find that: (1) ECER policies significantly promote the improvement of carbon reduction and CE2, a conclusion that remains robust after excluding the impacts of concurrent policy influences, sample selection biases, outliers, and other random factors. (2) ECER policies enhance CE1 reduction and CE2 in pilot cities by promoting green innovation, and this conclusion is confirmed by Sobel Z tests. (3) The effects of ECER policies on CE1 reduction and the improvement of CE2 are more pronounced in higher-level cities, the eastern regions and non-resource cities. This research provides policy makers with suggestions, highlighting that incentivizing green innovation through green fiscal policies is an effective path to achieving carbon reduction goals.

Balancing the scales? Evaluating the impact of results-based financing on maternal health outcomes and related inequality of opportunity in Zimbabwe.

This study evaluates the impact of results-based financing (RBF) on maternal health outcomes and the inequality of opportunity (IOP) in these outcomes in Zimbabwe. We employ a difference-in-differences approach that leverages the staggered implementation of the programme across 60 districts, exploiting temporal variation in the introduction of RBF and individual-level variation in birth timing. Our analysis uses nationally representative, pooled cross-sectional data from the 2005/2006, 2010/2011, and 2015 Zimbabwe demographic and health surveys. Employing the extended two-way fixed effects (ETWFE) estimator to address biases associated with staggered rollouts, we find significant positive effects of RBF on maternal health outcomes. The programme is associated with an increase in the number of prenatal care visits by 0.185 units (p < 0.01), first-trimester care by 7.7 percentage points (pp) (p < 0.01), facility births by 8.6 pp (p < 0.01), and professional delivery assistance by 3.4 pp (p < 0.01), while reducing C-section rates by 1.3 pp (p < 0.01). Additionally, RBF is associated with reductions in IOP in prenatal care visits, early prenatal care, facility births, and professional delivery assistance by 3.8, 1.3, 8.4, and 4.9 pp (p < 0.01), respectively. These findings underscore the potential of RBF to enhance maternal health outcomes and promote health equity. Integrating equity considerations into health system strengthening initiatives is essential. Policymakers should ensure that health interventions improve access and balance opportunities across various socio-economic and demographic groups. This evidence suggests that RBF schemes can improve access to and equity in healthcare services, particularly in low-income settings such as Zimbabwe.

Does contracting family doctor promote primary healthcare utilization among older adults? - evidence from a difference-in-differences analysis.

INTRODUCTION: In 2016, the Chinese government officially scaled up family doctor contracted services (FDCS) scheme to guide patients' health seeking behavior from tertiary hospitals to primary health facilities. METHODS: This study evaluated the overall gate-keeping effects of this scheme on healthcare utilization of rural residents by using a difference-in-differences (DiD) design. The analysis was based on Shandong Rural Elderly Health Cohort 2019 and 2020. Participants who contracted FDCS in second round and were not contracted with a family doctor in the first round were regarded as treatment group. In total, 310 respondents who have used medical care were incorporated for final study. RESULTS: Participants who contracted FDCS (treatment group) experienced a significant decline in the mean level of first-contact health-care facilities, decreasing from 2.204 to 1.981. In contrast, participants who did not contract FDCS (control group), showed an increasing trend in the mean level of first-contact health-care facilities, rising from 2.128 to 2.445. Our results showed that contracting FDCS is associated with approximately 0.54 extra lower mean level of first-contact health-care facilities (P = 0.03, 95% CI: -1.03 to 0.05), which suggests an approximately 24.5% reduction in the mean first-contact health-care facility level for participants compared with contracted FDCS than those who did not. CONCLUSIONS: The study suggested primary healthcare quality should be strengthened and restrictive first point of contact policy should be enacted to establish ordered healthcare seeking behavior among rural residents.

The association of increased SNAP benefits during COVID-19 with food insufficiency and anxiety among US adults: a quasi-experimental study.

OBJECTIVES: The COVID-19 pandemic and subsequent policy response to mitigate disease spread had far-reaching impacts on health and social well-being. In response, the Supplemental Nutrition Assistance Program (SNAP) underwent several pandemic-era modifications, including a 15 % monthly benefit increase on January 1, 2021. Research documenting the health effects of these SNAP modifications among low-income households and minoritized groups who were most impacted by the economic fallout during the first years of the pandemic is lacking. We aimed to estimate the health effects of the 15 % SNAP benefit increase in January 2021, among SNAP-eligible US households. DESIGN: We estimated the effects of the SNAP increase on food insufficiency, mental health, and financial well-being using a rigorous quasi-experimental difference-in-differences (DID) analysis. SETTING: August 19, 2020, to March 29, 2021. PARTICIPANTS: Participants were drawn from the national US Census Bureau Household Pulse Survey waves 13-27 (n 44 477). RESULTS: Compared with SNAP-eligible non-recipients, SNAP-eligible recipients experienced decreased food insufficiency (-1·9 percentage points (pp); 95 % CI -3·7, -0·1) and anxiety symptoms (-0·09; 95 % CI -0·17, -0·01), and less difficulty paying for other household expenses (-3·2 pp; 95 % CI -4·9, -1·5) after the SNAP benefit increase. Results were robust to alternative specifications. CONCLUSIONS: Expansions of federal nutrition programmes have the potential to improve health and financial well-being. This study provides timely evidence to inform comprehensive safety net nutrition policies during future economic crises and public health preparedness response plans.

Effect of the national integrated demonstration area for the prevention and control of noncommunicable diseases programme on behavioural risk factors in China: a synthetic difference-in-differences study.

Background: The government-led community-based Chinese National Integrated Demonstration Areas for the Prevention and Control of Noncommunicable Diseases programme was launched in 2011, but no rigorous impact evaluation has been conducted to date. We aimed to evaluate the causal effects of this programme on behavioural risk factors. Methods: We used data from the latest five waves of the China Chronic Disease and Risk Factor Surveillance. The primary outcome is a behavioural risk score combining current smoking, passive smoking, drinking in last month, regular exercise, body mass index, and waist circumference. We applied the synthetic difference-in-differences method and constructed synthetic controls from the non-demonstration areas with the outcome. The average treatment effects on the treated were estimated for overall effect and by short- (1-2), medium- (3-4), and long-term (6-7 years) effects. Findings: We identified 26 demonstration areas (N = 72,193) and 100 non-demonstration areas (N = 275,397). Participants in the demonstration areas had higher education and income levels and different pre-implementation trends than non-demonstration areas. Using synthetic controls instead of non-demonstration areas reduced these pre-implementation differences. Compared to the synthetic controls, declines were observed in current smoking (-1.78% [-4.51%, 0.96%]), passive smoking (-8.09% [-14.27%, -1.90%]), and drinking in last month (-4.04% [-8.75%, 0.67%]) but not in the other factors. Behavioural risk score declined by 1.05 short-term (95% CI: -1.84, -0.26), 1.15 medium-term (95% CI: -2.08, -0.22), 2.82 long-term (95% CI: -4.79, -0.85), and 1.54 overall (95% CI: -2.51, -0.56). Interpretation: The programme improved behavioural risk scores, primarily through reductions in the prevalence of smoking and drinking, and the effect was long-lasting. Our findings provided empirical evidence for utilizing an integrated prevention and control strategy to fight against NCD in China and other countries facing similar challenges. Funding: The China National Key Research and Development Program (2018YFC1315304 and 2017YFC1310902); National Natural Science Foundation of China (81872721).

US trade policy and public health: heterogeneous effects from the North American Free Trade Agreement.

OBJECTIVE: To investigate the causal link between the North American Free Trade Agreement (NAFTA) unrestricted sugar trade agreement signed in 2008 between the USA and Mexico and the diabetes prevalence across all fifty US states. DESIGN: A quasi-experimental research design to investigate the causal effect of the NAFTA unrestricted sugar trade agreement on diabetes prevalence. Our study utilises a comprehensive panel dataset spanning from 2000 to 2016, comprising 1054 observations. To conduct our analysis, we applied both the difference-in-differences and event-study methodologies. SETTING: All the states in the USA. PARTICIPANTS: The fifty states in the USA. RESULTS: After the enactment of the NAFTA sugar trade agreement between the USA and Mexico in 2008, most states witnessed an increase in diabetes prevalence. The annual impacts displayed significant variation among states, with percentage increases spanning from 0·50 to 2·28 %. CONCLUSIONS: States with a higher percentage of their population living below the poverty line, a larger Black resident population and a lower proportion of high school graduates had more significant increases in diabetes prevalence attributed to the NAFTA sugar trade agreement.

Does the pilot trading of carbon emission rights cause domestic or international pollution transfer?

The implementation of a carbon emission trading pilot policy has a positive impact on sustainable development but may lead to pollution transfer by enterprises, thereby affecting sustainability. In this study, based on the panel data of Chinese-listed companies from 2007 to 2017, the carbon emission trading pilot policy was treated as a quasi-natural experiment and the Difference-in-Differences model was used to analyze whether these companies engaged in pollution transfer under the policy shock. The results indicated: first, carbon emission trading pilots lead to pollution transfer within mainland China but not across international borders; second, the power and aviation industries exhibited significant pollution transfer phenomena, and the policy also encouraged pollution transfer by non-green transformation enterprises; third, regional heterogeneity further showed that the central region showed no signs of pollution transfer and instead experienced pollution inflow, while the eastern region exhibited significant pollution transfer. Therefore, in designing policy, we should fully consider the phenomenon of enterprise pollution transfer, promote technological innovation, and ensure that carbon emission trading policies achieve emission reduction goals and promote sustainable development.

Effect of smart city construction on an urban transition to a low-carbon economy: evidence from China.

China is currently in a new era of an urban transition to a low-carbon economy and digital economic development. Smart cities, as an advanced form of information-based urban development, may be the key to the urban transition to low-carbon emissions. This paper examined the effect of smart city construction (SCC) on urban low-carbon transitions and its transmission mechanisms in China from the dual perspectives of reducing urban total carbon emissions (TCE) and improving urban total-factor carbon emission efficiency (TFCEE). Utilizing a multi-period difference in differences (DID) method, this study was conducted based on panel data of 245 Chinese prefecture-level cities from 2003 to 2021. The results demonstrated that SCC both reduced TCE and enhanced TFCEE. The effects of SCC were stronger in cities with more stringent environmental regulations. SCC achieved the dual effect of reducing TCE and enhancing urban TFCEE by promoting green technological progress and a low-carbon transformation of city residents' lifestyles. Moreover, optimization of the industrial structure was also a transmission mechanism for SCC to improve TFCEE. These conclusions provide an empirical basis for the SCC to empower low-carbon transitions of cities and help countries in different regions to transform the extensive urban development mode and promote urban low-carbon economic development.

Can the implementation of the smart city pilot policy improve the social adaptive health and mental health of middle-aged and elderly people? Evidence from China.

With the accelerating pace of population aging in China and the implementation of the smart city pilot policy, whether the middle-aged and elderly population can integrate and adapt to this "smart" society has become an urgent problem that needs to be solved. In this context, exploring the impact of smart city pilot policies on the social adaptation health and mental health of middle-aged and elderly people has become a top priority for China to implement a national strategy to actively respond to population aging. Thus, based on panel data from the China Health and Retirement Longitudinal Study (CHARLS) for the years 2011, 2013, and 2015, this study employs the difference-in-differences (DID) method to investigate whether the smart city pilot policy can improve the social adaptive health and mental health of middle-aged and elderly people and to explore in depth the mechanism of its influence. The study finds that compared with non-pilot cities, the social adaptive health and mental health of middle-aged and elderly people in smart cities improve by 0.6% and 2.2%, respectively. The mechanism effect study shows that the smart city pilot policy can improve the mental health of the middle-aged and the elderly through the use of Information and Communication Technology (ICT) and the enhancement of human capital. Furthermore, for the social adaptive health of middle-aged and elderly individuals, the smart city pilot policy can only make improvements through the enhancement of human capital. Heterogeneity analysis shows that the effect of smart city pilot policies on social adaptive health is more pronounced in the middle-aged group than in the elderly group.

Can Information About Negative Age-Related Stereotypes Improve the Employment Chances of Older Unemployed Workers?

With increasing age, it becomes more difficult for unemployed workers to find a new job. Due to age-related negative stereotypes, employers typically prefer younger applicants. This study analyzes a marketing campaign of a local employment agency in Germany that drew attention to the problem of negative age-related stereotypes and highlighted the high value of older workers. The goal of the campaign was to increase the hiring rate of older unemployed. Using comprehensive register data and applying a difference-in-differences approach, we find that the information conveyed through the campaign (via banners, interviews, job fairs, and informational brochures) did indeed change firms' hiring behavior. The intervention increased the employment rate of workers aged 50 to 59 with unemployment experience by approximately 3 percentage points. The positive employment effects of the campaign appear to be somewhat more pronounced for women than for men. We conclude that an information campaign to overcome age-related negative stereotypes might be an appropriate measure to highlight the value of older workers and increase their employment chances. In the context of the demographic change, therefore, an information campaign might help to fight against a shrinking workforce and an impending shortage of skilled labor.

The impact of environmental protection tax on the health of middle-aged and older adults: evidence from CHARLS data in China.

Introduction: With the aging population, the relationship between human health and the ecological environment has gained increasing attention. In China, it is imperative to evaluate the policy effects of the Environmental Protection Tax (EPT) on improving the ecological environment and enhancing the health of middle-aged and older adult people. Methods: This study, based on data from the China Health and Retirement Longitudinal Study (CHARLS), employs a Difference-in-Differences (DID) model to assess the health effects of the EPT policy. Results: The findings indicate that the EPT policy significantly improves the health of middle-aged and older adult individuals and reduces the prevalence of chronic diseases. The EPT policy affects the health of middle-aged and older adult through two main mechanisms: emission reduction and psychological effects. These are evidenced by reductions in PM10 particle concentration and sulfur dioxide emissions, improvements in public sleep quality and memory, and significant changes in environmental awareness and concern. Discussion: Heterogeneity analysis reveals differences across urban and rural areas, age groups, and education levels. Following the implementation of the EPT policy, there are notable improvements in reduction of chronic diseases among rural residents, self-rated health among urban residents, and overall health among the older adult and individuals with a junior high school education or lower. The study's results confirm the importance of environmental policies in promoting public health, providing a reference for the refinement of the EPT system, and offering insights for environmental pollution control in developing countries.

Can environmental protection tax alleviate the mismatch of financing and investment maturities of heavily polluting enterprises?

The gradual implementation of environmental protection tax policies has incentivized enterprises to engage in green production, effectively promoting China's accelerated achievement of the "dual­carbon" goal. Although environmental protection tax has an important impact on the investment and financing decisions of heavily polluting enterprises (HPE), few studies have focused on the relationship between environmental protection tax and mismatch of financing and investment maturities. In this paper, we consider China's environmental protection tax reform as a "quasi-natural experiment", and utilize the data of A-share listed companies from 2013 to 2022, and use a difference-in-differences (DID) model to assess the impact of this policy on the degree of mismatch of financing and investment maturities of HPE. The study shows that the implementation of the environmental protection tax policy (EPTP) significantly reduces the investment and financing maturities mismatch of the HPE, but this effect "fails" in the high tax rate area, and the policy is difficult to reverse the financing difficulties of the enterprises with a large degree of their own investment and financing maturities mismatch. The mediation mechanism test proves the EPTP acts on the mismatch of financing and investment maturities through two paths: alleviating the financing constraints faced by enterprises and increasing external supervision pressure; the impact of the policy has a time-differentiated effect, which is weakened year by year.

Carbon Abatement and Leakage in China's Regional Carbon Emission Trading.

Emission trading schemes (ETS) are increasingly becoming a popular policy instrument to balance carbon abatement and economic growth. As a globally unified carbon pricing system has not yet been established, whether regionally operated ETSs cause carbon leakage remains a major concern. Taking China's regional pilot ETSs as a quasi-natural experiment, the study uses the spatial difference-in-differences method to examine how regional ETSs affect carbon emissions in and outside cities of policy implementation. Our analysis finds that China's regional ETS policy contributes to a 6.1% reduction in urban CO2 emissions and a 6.6% decline in emissions intensity in regulated cities, causing carbon leakages that increase CO2 emissions in neighboring cities by 1.7% on average. Our finding further suggests that regional ETSs mitigate local CO2 emissions through outsourcing production, improving energy efficiency and decarbonizing energy structure, whereas the outsourcing of industrial production drives up CO2 emissions in adjacent cities. Moreover, the performances of regional ETSs vary largely by socioeconomic context and mechanism design. China's regional ETSs reduce CO2 emissions more effectively in central and industrial cities but with more severe carbon leakage, while rigorous compliance mechanisms and active market trading help deepen carbon abatement and alleviate carbon leakage.

Green finance pilot policy and corporate environmental social responsibility: empirical evidence from China's green finance reform and innovation pilot zones.

The establishment of green finance reform and innovation pilot zone (GFRIPZ) is a pivotal strategy for harmonizing the twin goals of economic prosperity and environmental preservation. By applying panel data on Chinese A-share listed firms from 2011 to 2022, this study examines the influence of China's green finance pilot policy on corporate environmental social responsibility (ESR) using a difference-in-differences (DID) model. The study's findings indicate that the green finance pilot policy promotes corporate environmental social responsibility. The results remain robust after a series of robustness tests. Moreover, mechanism analysis reveals that the pilot policy promotes firms' ESR through three key channels: financing constraints, green innovation, and corporate governance mechanisms. Additionally, analyst attention can positively moderate the promotional effect of the green finance pilot policy on corporate ESR. Furthermore, this study reveals that the green finance pilot policy's impact on corporate ESR is more pronounced among large-scale firms and firms operating in regions characterized by stringent environmental regulations and greater marketization. The empirical findings present evidence for enhancing ESR through the implementation of the green finance pilot policy in China and offer insights for refining the green finance system.

Air pollution, viral spread and health outcomes evidence from strikes in France.

To evidence the impact of air pollution on the health of urban populations, several studies use natural experiments that shift commuting from public transport to cars (or vice-versa). However, as public transport use declines, reduced interpersonal contact may lead to slower virus spread and thus lower respiratory morbidity. Using a difference-in-differences strategy, we show that respiratory hospitalisations are both positively affected by air pollution and negatively affected by viral spread following partial unavailability of public transport due to strikes in the ten most populated French cities during the period 2010-2015. Our results are in line with studies in other countries that have found a significant increase in urgent respiratory hospitalisations following a public transport strike, most likely due to car pollution, but we also find a detectable interaction with viral spread, which should not be overlooked when interpreting these studies.