Dynamic reward-penalty incentives and occupational health governance: an evolutionary game analysis with public health implications

Introduction: Occupational health risks remain a significant public health concern in environmentally intensive industries, where inadequate regulatory enforcement and weak enterprise compliance can result in persistent workplace health hazards and potentially preventable long-term health burdens for workers. Understanding how environmental regulatory incentives influence enterprise occupational health management is essential for improving occupational health governance and generating public-health-relevant benefits. Methods: This study developed an evolutionary game framework to examine the strategic interactions between local regulators and enterprises under environmental regulation, with a focus on occupational health governance. By comparing static and state-dependent reward-penalty incentive structures, the model explored how different regulatory designs shaped enterprises' investment in occupational health protection over time under imperfect monitoring. Results: The analysis showed that static reward-penalty schemes were insufficient to sustain long-term active occupational health governance. In contrast, dynamically adjusted penalty mechanisms were more effective in promoting proactive enterprise investment in occupational health management and stabilizing long-term occupational health governance. The findings further indicate that enterprise behavioral responses are highly sensitive to not only the structure and intensity of regulatory incentives, but also the monitoring probability that passive governance can be detected under strict supervision. Discussion: These results highlight the importance of incentive design in linking environmental regulation with occupational health governance under imperfect monitoring. By demonstrating how regulatory incentives can improve occupational health governance and strengthen worker health protection in high-risk industrial settings, this study provides policy-relevant insights with broader public health relevance.