The research team, led by Simbarashe Chinyowa of the University of Zimbabwe together with colleagues at the University of Cape Town and the University of California San Francisco, interviewed thirteen recently diagnosed colorectal cancer patients and thirteen of their caregivers. The participants were recruited consecutively from five major hospital sites across the country, including Parirenyatwa Group of Hospitals and Sally Mugabe Central Hospital in Harare, Chitungwiza Central Hospital, and Mpilo Hospital and the United Bulawayo Hospitals in Bulawayo. All of the patients were symptomatic and had been admitted either electively or as emergencies for colorectal surgery. Crucially, the study included four patient-caregiver dyads, allowing the researchers to compare how the same diagnostic journey was experienced by both the person with cancer and the family member supporting them.

The interviews were audio-recorded, transcribed and translated into English, then analysed using inductive coding guided by the Model of Pathways to Treatment, a well-established framework that divides the diagnostic journey into distinct intervals: the time before a patient recognises something is wrong, the time before they seek help, and the time between first presenting to the health system and receiving a definitive diagnosis. This structure allowed the team to pinpoint exactly where in the journey delays occur and what factors either accelerate or obstruct progress at each stage. Ethical approval was granted by the Joint Research Ethics Committee for the University of Zimbabwe Faculty of Health Sciences and Parirenyatwa Group of Hospitals and by the Medical Research Council of Zimbabwe, and all participants gave written and verbal consent.

The first interval, known as the appraisal interval, turned out to be shaped by powerful psychological and cultural forces. Many patients normalised their symptoms, interpreting rectal bleeding, changes in bowel habits or abdominal discomfort as ordinary complaints that did not warrant medical attention. A widespread belief in the body’s capacity to heal itself encouraged a wait-and-see approach, while some participants described a perceived futility of treatment, a fatalism that suggested even a diagnosis would change little. These beliefs kept people away from clinics during the critical early window when colorectal cancer is most treatable. The researchers found that this phase of the journey, before any contact with the health system, could consume enormous amounts of time, silently allowing tumours to progress.

What finally pushed patients to seek help was often the arrival of alarming symptoms that could no longer be ignored, or the persistence and worsening of symptoms over time. Social networks also played a decisive role: family members, friends and neighbours who noticed something wrong and urged the patient to visit a health facility frequently tipped the balance toward action. This finding underscores a recurring theme in the study, namely that in the Zimbabwean context the diagnostic journey is rarely a solo undertaking. It is a family project, shaped by collective decision-making, shared resources and, in many cases, the appointment of a designated caregiver who accompanied the patient through every stage of care.

Once patients decided to seek help, a second set of obstacles emerged. The most prominent were financial: many participants simply lacked the money to pay for consultations, transport, investigations or the medications needed along the diagnostic pathway. Logistical barriers compounded the problem, particularly when the nearest facility offering colorectal services was far from home. The study notes that these burdens were amplified by distance, meaning that patients in rural or remote areas faced a double disadvantage of higher travel costs and longer journeys. In a health system where patients frequently must fund much of their own care out of pocket, the ability to reach a hospital and pay for a colonoscopy can be the difference between early detection and a late-stage emergency admission.

Family support emerged as the single most important facilitator during this help-seeking interval. When relatives could contribute money, provide transport or accompany the patient to appointments, the journey moved forward. The designation of a caregiver who acted as a chaperone during all health-related visits proved especially valuable, ensuring that patients who were unwell, unfamiliar with the system or unable to advocate for themselves still made it to the right place at the right time. The researchers argue that this caregiving role is an underappreciated asset in cancer control, one that health systems could deliberately support rather than leave to chance.

The third phase, the diagnostic interval between first presentation and confirmed diagnosis, revealed systemic weaknesses inside the health facilities themselves. Services for colorectal cancer are heavily centralised in a handful of hospitals, forcing patients to travel long distances for specialist assessment and endoscopy. High costs persisted at this stage as well, and inefficient consultation scheduling meant that appointments were delayed or lost. Misdiagnoses added further delay, with some patients initially treated for other conditions before the cancer was recognised. Each of these barriers added weeks or months to a journey that had often already stretched over a year, pushing patients closer to the advanced presentations that dominate colorectal cancer care in the region.

Yet the study also documents what good care looks like when the system functions. Participants reported positive experiences when there was strong rapport between patient and doctor, when healthcare workers were knowledgeable about colorectal cancer, and when clear referral prompts and pathways were provided. Notably, social welfare department support proved vital to the successful diagnosis of several participants, helping to cover costs that would otherwise have halted the journey entirely. These facilitators, the authors suggest, are not expensive to replicate: training frontline clinicians to recognise red-flag symptoms, streamlining referral pathways and strengthening social welfare mechanisms could all shorten the diagnostic interval substantially.

The study’s conclusions point in two directions at once. From a public health education perspective, the findings argue for campaigns that counter symptom normalisation and the belief in body self-healing, teaching communities that rectal bleeding and persistent bowel changes demand medical attention. From a health system policy perspective, they call for decentralising diagnostic services, reducing costs, improving scheduling and building formal support for the caregivers who already carry so much of the load. With colorectal cancer incidence climbing steadily in Zimbabwe and across sub-Saharan Africa, and with most patients still diagnosed too late for curative treatment, the voices of these twenty-six patients and caregivers provide a rare and valuable roadmap, showing precisely where the journey to diagnosis breaks down and, just as importantly, what keeps it moving.

Subject of Research: Barriers and facilitators to timely colorectal cancer diagnosis in Zimbabwe

Article Title: Barriers and facilitators to colorectal cancer diagnosis in Zimbabwe: a qualitative study

Article References: Chinyowa, S., Chitukuta, M., Katsidzira, L., Chirenje, M. Z., Muguti, G., & Moodley, J. (2026). Barriers and facilitators to colorectal cancer diagnosis in Zimbabwe: a qualitative study. BMC Cancer. https://doi.org/10.1186/s12885-026-17064-1

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17064-1

Keywords: colorectal cancer, Zimbabwe, cancer diagnosis, qualitative research, caregivers, health systems, sub-Saharan Africa, patient pathways, diagnostic delay, health communication, cancer screening, social welfare

The study, published in the journal Discover Animals by David C. Cook of the University of Western Australia and Murdoch University, Christina Siettou of University College London, and Rob W. Fraser of the University of Kent, takes an unusually broad view of what is at stake when dog populations are mismanaged. Rather than counting only the costs of kennels and collection services, the researchers define social welfare as the combined well-being of all individuals in society, including both the intrinsic and instrumental value of animals themselves. When free-roaming dogs go unmanaged, the losses ripple outward: wild dog attacks generate medical and veterinary bills, overcrowded shelters impose mental health costs on staff, and rising euthanasia rates create moral distress and opportunity costs for veterinarians and nursing workers. The framework explicitly extends the traditional economic view, in which social welfare depends solely on human well-being, to incorporate the welfare of the animals as well.

To capture the dynamics of the problem, the team constructed a dynamic systems model describing three interacting subpopulations: owned dogs, shelter dogs, and dogs held by registered commercial breeders. Animals move between these groups through purchases, adoptions, and relinquishments, and each subpopulation changes over time through births, deaths, and transfers. The model was simulated over ten years using ordinary differential equations solved numerically in the R programming environment with the deSolve package. Crucially, the flows between populations respond to price. The demand for puppies from breeders and the demand for shelter adoptions are both governed by a price elasticity of demand, assumed to be negative at -0.5, meaning that taxes on breeder purchases or subsidies for shelter adoptions can shift where prospective owners acquire their dogs.

Social welfare enters the model through two channels. Direct losses accrue at a constant rate for every shelter dog euthanised, while indirect losses capture the stress animals endure in crowded facilities, specified as rising at an increasing rate as the shelter population approaches its carrying capacity. Both loss streams are discounted over time using a continuous discounting factor. The researchers set hypothetical values of £50 per euthanised dog and £5 per shelter dog for these parameters, and a sensitivity analysis later confirmed that these two assumptions were the most influential in the entire model, shifting estimated welfare losses by roughly 25 percent when varied by 50 percent.

Against a base case reflecting the status quo, the team simulated five hypothetical policies. Two of them produced sobering, even counterintuitive results. Increasing shelter capacity, simulated as a one-off expansion of the shelter carrying capacity, actually made social welfare slightly worse than doing nothing, producing a cumulative loss £0.6 million greater over ten years. The reason lies in the biology of stress: events that are novel, unpredictable, or outside a dog’s control, such as entering a shelter, trigger the fight-or-flight response and the release of cortisol. Short-term cortisol surges boost energy, but prolonged elevation impairs the immune system and produces anxiety and abnormal behaviours. More kennel space means more dogs housed in stressful conditions, and the model links that directly to greater welfare loss. Increasing the euthanasia rate by roughly 50 percent fared far worse, adding £8.6 million to cumulative social welfare losses compared with the status quo, the poorest result of any scenario.

The economic instruments performed better. A £200 fixed-rate tax on dogs purchased from breeders reduced demand for breeder dogs but left shelter numbers largely unaffected, producing only a negligible change in welfare. A £100 subsidy for shelter adopters, modelled on the German practice of waiving the annual dog tax for shelter adoptions, cut the shelter population by 11,360 dogs after ten years relative to the status quo and reduced cumulative welfare losses by £3.9 million. In the baseline scenario, representing current policies, cumulative social welfare losses over the decade totalled roughly £40.4 million, with annual losses reaching about £5.3 million by year ten.

The clear winner, however, was the DNA database scenario inspired by Greece’s newly legislated framework. Greece, which manages one of the highest per capita free-roaming dog populations in the world, combines compulsory microchipping and registration, a prohibition on euthanasia, strict breeding laws, and mandatory sterilisation with an opt-out route. Owners who decline to sterilise their dogs must submit DNA samples to a national database, meaning any unaltered animal is recorded and its offspring traceable, holding owners accountable for contributing to the future stray population. Non-compliance carries fines ranging from €1,000 for owners who fail to neuter or submit samples to €3,000 for breeders who fail to report or register breeding animals, with enforcement spread across municipal and national police, customs authorities, the coast guard, and forestry services.

In the UK simulation, the DNA policy was represented by raising the effective price of breeder dogs, since breeders pass on the £130 cost of DNA sampling to consumers, lifting the average price from £930 to £1,060; by lowering the natural growth of the owned dog population, as owners sterilise pets to avoid future penalties; and by reducing the relinquishment rate, since sterilisation is associated with fewer surrenders. After ten years, this scenario left 34,000 fewer dogs with breeders, 41,500 fewer dogs in shelters, and 26,210 more owned dogs than the status quo, improving social welfare by £7.3 million cumulatively, or about £1.4 million per year by the end of the simulation. Even when the researchers halved the policy’s simulated effectiveness to reflect widespread non-compliance, it remained the best-performing option, though the cumulative benefit fell to £3.4 million.

The sensitivity analysis revealed which assumptions mattered most. Beyond the two welfare loss parameters, results were sensitive to shelter carrying capacity, the initial shelter population of 250,000, and the euthanasia rate of 10.4 percent drawn from published UK data. Reducing shelter capacity by half produced a 33 percent change in welfare loss, while halving the euthanasia rate lowered losses by 20 percent. Importantly, the researchers note that provided the direct welfare loss per dog euthanised exceeds the indirect welfare loss per shelter dog, which they consider reasonable, the ranking of policies does not change, and the DNA database remains the welfare-maximising choice. The authors acknowledge that the absolute magnitudes are indicative rather than definitive, since the welfare loss values are plausible estimates rather than figures elicited through quantitative research, and they call for future studies to enable a full benefit-cost analysis.

The findings carry an urgent contemporary resonance. In 2024, the government of Türkiye adopted legislative amendments likely to lead to large-scale euthanasia of shelter dogs due to overpopulation, provoking public outcry. The model offers a quantitative warning about such approaches: raising the euthanasia rate from its base of 10.4 percent to 100 percent drove simulated social welfare to minus £135.6 million, a societal loss more than double the status quo. The study also documents the well-established toll that euthanasia takes on the people who perform it, from compassion fatigue to perpetration-induced traumatic stress among shelter and laboratory staff. Against that backdrop, the authors’ central recommendation is straightforward: the UK government should consider a dog-overpopulation policy modelled on Greece’s, because its superiority proved robust both to alternative parameter values and to imperfect compliance. Compulsory microchipping, introduced across the UK by 2016, has already been undermined by owners supplying incorrect or outdated contact details, a cautionary tale about enforcement that any DNA-based successor would need to confront head-on.

Subject of Research: Economic modelling of dog shelter policy reform and social welfare in the United Kingdom

Article Title: Social welfare implications of policy reform for dog shelters in the United Kingdom

Article References: Cook, D. C., Siettou, C., & Fraser, R. W. (2026). Social welfare implications of policy reform for dog shelters in the United Kingdom. Discover Animals, 3(1), Article 99. https://doi.org/10.1007/s44338-026-00258-z

Image Credits: AI Generated

DOI: 10.1007/s44338-026-00258-z

Keywords: dog shelters, animal welfare, social welfare, DNA database, dynamic systems model, euthanasia, sterilisation, policy reform, United Kingdom, Greece, shelter overcrowding, pet overpopulation

The timing, the authors argue, is critical. Looking ahead to the 2026 to 2030 five-year plan period, innovation, resilience and social well-being are central priorities, and philanthropy is likely to be expected to fill growing gaps in social provision as the economic model evolves. Several forces are converging at once: the political salience of the common prosperity agenda, rapid population ageing, the integration of charitable giving into digital platforms, generational shifts in giving behaviour, and an often uneasy relationship among elite donors, grassroots communities and the party-state. As the state confronts the limits of its capacity to deliver comprehensive welfare to an ageing population, the question of who supplies, organizes and legitimates the resources that close those gaps becomes both an analytical puzzle and a governance problem.

The sector displays remarkable vitality on one hand. Digital platforms such as Tencent’s 99 Giving Day facilitate millions of micro-donations; community foundations address local needs ranging from elderly care to environmental protection; tracking systems now monitor large numbers of donations exceeding one million RMB; and the establishment of the Central Social Work Department signals heightened governmental investment in social service and nonprofit infrastructure. Yet significant constraints persist. China ranked near the bottom of global giving indices throughout the 2010s, reflecting limited traditions of mass philanthropy, and economic uncertainty has prompted some of the wealthy to move assets abroad rather than give domestically. The vitality and the constraints are inseparable from a political order in which civic action is framed through the party’s relationship with the masses rather than primarily through citizens’ legal or communal rights. The key question, the editors insist, is not whether civil society exists in China, but what form it takes, whose purposes it serves and on what terms association and accumulation are permitted.

Elite giving presents a genuine and unresolved dilemma. In the United States, wealthy families are the primary source of philanthropic funding; in China, private giving is frequently animated by political ties or corporate strategy, and uncertainty about the business environment now pulls in the opposite direction, with some affluent individuals relocating wealth, and sometimes themselves, beyond China’s borders. Whether economic uncertainty will encourage giving as a demonstration of commitment to shared national goals, or simply encourage exit, remains open. So does a structural question: whether the sector’s future will be elite driven, as in many jurisdictions, or increasingly bottom-up, characterized by the micro- and nano-philanthropy populating the literature. The editors view these trajectories as potentially complementary, noting that rising inequality concentrates resources among the wealthy, many of them educated abroad and inclined to deploy philanthropy as influence, even as community foundations attract growing attention as mechanisms for addressing challenges such as eldercare within neighbourhood governance ecosystems. The long-standing hypothesis that civic association drives democratization finds little support in the Chinese case; the inequalities that elite philanthropy can entrench are, they argue, the more pressing concern.

The state’s hand is decisive in ways that differ sharply from liberal democratic settings, where nonprofits draw funding chiefly from private donors and independent foundations. In China, a substantial share of resources flows from the government or government-affiliated foundations, with one nationwide survey finding government funding to account for roughly half of annual revenue among the social service organizations sampled, with profound implications for organizational autonomy. Demography sharpens the stakes: as society ages, the question becomes whether even a peaceful, growing state can comprehensively support its population, and if not, where the resources for healthcare and eldercare will come from should elites withdraw. Moreover, state investment does not automatically translate into sectoral flourishing. Officials staffing new bodies such as the Department of Social Work often arrive from elsewhere in the party apparatus without a background in social work, so directives can appear disconnected from professional practice. The effectiveness of new institutions will depend on professional capacity that cannot be conjured by administrative fiat.

Incentivizing ordinary giving remains difficult. Tax deductions exist but function inefficiently, benefiting mainly major donors, while recognition and reciprocity loom large: exemplary donor designations are valued for their own sake, and donations and volunteer hours are increasingly linked to welfare systems, including accelerated access to urban residency permits and city-level points or social credit schemes integrated with digital platforms. These mechanisms constitute a reciprocal return pathway to participation; the alternative, giving for self-realization, is harder to cultivate at present. Generational variation complicates any single prescription. Younger cohorts are more inclined to give financially yet, by some accounts, more likely to engage through discussion than donation. The familiar assumption that early volunteering seeds later monetary giving finds little empirical support, and cross-national evidence shows a curvilinear relationship between resources and participation, suggesting that a philanthropic culture can be cultivated locally largely irrespective of wealth, provided the principal obstacle, securing a first donation, can be overcome.

Digital finance is among the most distinctive features of Chinese philanthropy. For younger generations, mobile giving has become normalized, and the scale, reach and everyday integration achieved by platforms such as 99 Giving Day are difficult to match elsewhere. That very ease, however, raises a question about meaning. Practitioners often assume their task is to make giving as frictionless as possible, but if giving becomes nearly automatic, the warm glow effect that ordinarily accompanies a charitable act may attenuate, much as tipping has become an expectation detached from any judgement of service. There is also a related paradox: many who voice support for a cause online do not in fact donate, preferring to build communities of discussion, so digitalization can produce detachment even amid intense connection. Crucially, these information flows do not run through neutral infrastructure. The state designates the platforms on which charitable fundraising may lawfully occur and folds disclosure, fund flow and project execution into platform-based monitoring, so the very channels that make giving frictionless are also the channels through which it is observed.

Underlying these debates is a question easy to defer and difficult to answer: what is philanthropy ultimately for? One compelling framing is resilience, the diversification of the sources of support available to communities when both state spending and business activity retreat. Yet even resilience invites scrutiny, for community resilience and the resilience of a particular political order may be served at once. Official discourse consistently frames civic energies as a contribution to long-term social governance, and a substantial literature on the administrative absorption of society describes how organized social actors are drawn into party-led structures. The affective sources of giving matter too: practitioners report that people give out of connection to a mission and a sense of responsibility cultivated through sustained community work, which raises a provocative hypothesis that a rise in individual philanthropy under a strong state might itself signal a perception that the state is falling short of its duties.

The five studies assembled in the special issue ground these debates empirically. Hu and Dong compare national nonprofit policy across the New Century of 2002 to 2012 and the New Era from 2013 onward, drawing on a corpus of laws, ordinances and directives issued between the early 1990s and 2026. They find substantial change in organizational establishment, monitoring, government funding, charitable fundraising, overseas funding, party building and policy advocacy, but comparatively little in business activities and tax deduction. The overall movement, they argue, is from deliberative state control to directive state incorporation, with the New Era intensifying and systematizing tools that originated earlier rather than inventing them. Bi, Shen, Yan and Liu reconstruct China’s donation network from 2016 to 2023 using nationwide annual-report data, analyzing 34,325 valid donor ties involving 5,123 recipient foundations, and find a business-led but multi-actor field clustering into broker hubs, reach hubs, core receivers and peripheral receivers, with membership closely associated with organizational age, fundraising qualification, board size and staffing.

The remaining contributions extend the picture from mechanism to microfoundation. Yin and Miao develop an information-impact model of digital philanthropy through three longitudinal cases, specifying scale expansion, precision deepening and agile reshaping mechanisms that synergize into a self-reinforcing flywheel for social impact. Han and Hong examine how the All-China Women’s Federation and the nonprofit sector coproduce women’s organizations, drawing on 180 federation-endorsed projects from 2023 to 2025, and show that coproduction operates through institutional incorporation, discursive role alignment and gendered coproduction for affective governance, transforming women’s emotional labour into a resource for state legitimacy while opening limited spaces for negotiation. Sindila, Zhan and Jin offer a process model of nonprofit resilience organized around anticipation, coping and adaptation, driven by slack resources, entrepreneurial judgement and frontline delegation, and reframe mission drift as adaptive mission re-specification. Taken together, the editors conclude, the contributions caution against monolithic characterizations of Chinese philanthropy and reveal the heterogeneity and agency that persist within a distinctive state-society relationship whose future over the coming decade remains genuinely uncertain.

Subject of Research: The evolution of philanthropy in China under state regulation, digital innovation and demographic change

Article Title: The future of philanthropy in China: navigating state, society and digital innovation

Article References: Hildebrandt, T., & Hasmath, R. (2026). The future of philanthropy in China: navigating state, society and digital innovation. Global Public Policy and Governance. https://doi.org/10.1007/s43508-026-00156-w

Image Credits: AI Generated

DOI: 10.1007/s43508-026-00156-w

Keywords: Chinese philanthropy, civil society, digital giving, state-society relations, nonprofit governance, common prosperity, social welfare, community foundations, 99 Giving Day, nonprofit resilience, gendered governance, party-state