Public health research & practiceEmma Cox, Tiffany Tsoukalas, Sophia Parada, Sarah Dennis, Pippy Walker, Gideon Meyerowitz-Katz, Victoria Silvestro, Stephen Colagiuri, Alice A Gibson
OBJECTIVES AND IMPORTANCE OF STUDY: The aim of this scoping review was to: (1) consolidate the barriers and enablers to allied health service use for type 2 diabetes (T2D) management, and (2) identify knowledge gaps and priorities to inform future research and policy development. METHODS: This scoping review has been reported in accordance with the PRISMA for Scoping Reviews guidelines. Electronic databases, including Medline, Scopus, Web of Science, INFORMIT, and Cumulative Index to Nursing and Allied Health were searched from 1 January 2005 to 18 April 2025 for relevant articles. Peer-reviewed articles investigating barriers and enablers to allied health service use for T2D management in Australia were included. Barriers and enablers influencing: (1) patient utilisation of services, (2) General practictioner (GP) referral to services, and (3) allied health practitioners' delivery of services were extracted and categorised according to the Theoretical Domains Framework (TDF). RESULTS: A total of 44 articles (43 studies) were included. A total of 32 themes were identified across 11 TDF domains. Key barriers to service use included limited available services, workforce shortages, long wait lists, high out-of-pocket costs, a lack of GP referral, and limited patient and GP awareness of the role and value of allied health services. Enablers included person-centred care and culturally tailored service delivery. The Medicare Chronic Disease Management scheme was identified as both an enabler (facilitating use of and referral to services) and a barrier (limiting utilisation and delivery of services due to inadequate rebates and session caps). Few studies examined differences in barriers and enablers by age group or sex. CONCLUSIONS: This review identifies opportunities to strengthen multidisciplinary primary care management of T2D. Barriers and enablers to allied health service use are multifaceted, and addressing them will require targeted policy action, including workforce investment, a redesign of the Medicare Chronic Disease Management scheme, new integrated models of care and enhanced practitioner training. Future research should explore sociodemographic disparities in service use to inform equitable service delivery.
International nursing reviewBeatrice Albanesi, Riccardo Casciaro, Elena Casabona, Alessio Conti, Paula Alite-Cerezuela, Samuel Cooke, Ros Kane, Nikoletta Karavani, Venetia-Sofia Velonaki,…
AIM: This review aimed to map the available evidence on nurses' engagement in healthcare policy-making and to identify the foundational concepts that shape this engagement. BACKGROUND: Nurses represent the largest professional group in healthcare systems and hold a central position in responding to population health needs. However, they remain underrepresented in policy-making arenas. Their engagement is increasingly recognised as essential for building equitable, responsive and patient-centred healthcare systems, yet it is limited by insufficient policy education, restricted access to decision-making spaces, and the absence of a guiding conceptual framework. METHODS: This scoping review was conducted using established methodological guidance for evidence mapping. A Pragmatic utility approach informed the conceptual analysis, allowing the available literature to be examined in relation to the usefulness, clarity, and applicability of concepts describing nurses' policy engagement. SOURCES OF EVIDENCE: A systematic search of peer-reviewed databases was complemented by manual searches of reference lists. Eligible sources examined nurses' engagement, participation or influence in healthcare policy-making across clinical, organisational, professional, or governmental contexts. DISCUSSION AND CONCLUSION: Nurses' engagement in policy-making was described through interrelated antecedents, attributes, and outcomes. Individual factors and professionalism were important antecedents, but engagement was strongly shaped by contextual conditions, including organisational support, opportunities for collaboration, and access to policy spaces. The findings suggest that policy participation is relational and depends on the ability to translate nursing expertise into policy-relevant messages. Engagement was associated with enhanced advocacy, exposure to positive role models, and education and information seeking, which may reinforce further participation. IMPLICATIONS FOR NURSING PRACTICE: Nursing organisations, educators, and leaders should strengthen policy and advocacy education, mentorship, leadership development, and opportunities for nurses to participate in policy-related activities. IMPLICATIONS FOR HEALTH POLICY: Health systems should create organisational mechanisms that provide protected time, formal recognition, and access to policy forums, enabling nurses to contribute more effectively to policy decisions.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationElizabeth Edwards, Tsun Lok Morris Tsang, Priya Iyer
Hospital malnutrition remains highly prevalent in Australia and contributes to poorer clinical outcomes and increased healthcare costs. Hospital nutrition standards play a critical role in ensuring nutritionally adequate menus and supporting patient intake. While Australian jurisdictions have developed hospital nutrition standards, the extent of their consistency and alignment with national and international evidence-based guidelines has not been systematically examined. This scoping review aimed to identify and compare existing hospital nutrition standards across Australia and assess their alignment with the Australian Dietary Guidelines (ADG) and European Society for Clinical Nutrition and Metabolism (ESPEN) hospital nutrition guidelines. Guided by JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, grey literature searches were conducted across government websites, national repositories, and targeted Google searches. Twelve documents met inclusion criteria, including six nutrition standards and six supporting documents. Directed content analysis guided by ADG and ESPEN deductive frameworks was used to extract and compare data across jurisdictions. Findings showed strong alignment with the ADG, particularly in five food group provision and macronutrient targets. Alignment with ESPEN guidelines was more variable. All jurisdictions met minimum energy and protein targets and offered patient menu choices; however, inconsistencies were observed in therapeutic diet provisions, macronutrient distribution, food service considerations, adaptations for diverse patient groups and monitoring practices. Hospital nutrition standards in Australia are fragmented. Developing a unified evidence-based standard integrating ADG principles with ESPEN hospital nutrition recommendations could enhance consistency, quality, and equity in hospital nutrition care.
The Journal of school healthChakkraphan Phetphum, Orawan Keeratisiroj, Supanee Boonyom
BACKGROUND: Thailand has one of the strongest tobacco control frameworks in Southeast Asia, including comprehensive smoke-free laws and a ban on e-cigarettes. However, implementation of smoke-free school policies remains uneven across diverse educational settings. This study examined the contextual and governance dynamics shaping implementation and sustainability across school types. METHODS: A qualitative study was conducted using 14 focus group discussions (FGDs) across 14 provinces. Participants (n = 122) included school administrators, teachers, and provincial tobacco control stakeholders. Data were analyzed using reflexive thematic analysis to identify key governance conditions influencing implementation. RESULTS: Six interrelated themes emerged: institutional diversity, structural constraints, enforcement gaps, multi-level enablers, sustainability challenges, and field-driven recommendations. Implementation gaps were driven less by policy absence than by differentiated governance conditions. Hybrid authority structures, leadership turnover, digital diffusion of e-cigarettes, and geographic monitoring disparities constrained enforcement capacity. While teacher networks and provincial endorsement enhanced legitimacy, sustainability depended on institutional embedding rather than individual leadership. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Uniform national standards require context-sensitive implementation strategies. Embedding smoke-free criteria within evaluation systems, institutionalizing peer networks, and addressing geographic inequities are critical to strengthening sustainability and equity. CONCLUSIONS: Strong legislation alone is insufficient; tailored governance approaches are essential to achieve equitable and durable implementation.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationKrystal L Hodge, Caitlin Kownacki, Kaitlyn Streitmatter, Rebecca L Hagedorn-Hatfield, Karah Mantinan, Jennifer McCaffrey
BACKGROUND: As community nutrition education programs have expanded to include policy, systems, and environmental (PSE) initiatives to increase access to nutritious food and safe physical activity, the impact of these efforts on the consumption of healthier foods and physical activity levels is not clear. Research shows the effectiveness of PSE changes on individual-level behavior in controlled environments and in other public health disciplines. However, more evidence and guidance is needed to show the impact of PSE interventions in practice on individual-level nutrition and physical activity behaviors. The PSE Intervention and Evaluation Framework (PSE-IEF) was developed to explain the process by which implemented PSE activities may result in behavior changes within the priority audience. METHODS: Framework development involved a review and Theory of Change mapping process of a list of PSE changes used in the Supplemental Nutrition Assistance Program- Education (SNAP-Ed) Program, an environmental literature scan to identify relevant theories and related factors, and an expert review. The environmental scan examined how PSE changes are conceptualized as drivers of behavior change and how their impacts are measured at the individual level. Sources were identified through database searches, grey literature review, and citation tracking, with inclusion limited to U.S.-based, English-language documents published in the past 10 years. Twelve frameworks or theories were reviewed for their focus on individual behavior, ability to capture behavior change over time, and recognition of individual choice in when or whether change occurs. The PSE changes theory of change mapping results were reviewed for alignment with the selected framework and applied to a logic model for PSE implementers. Forty-five practitioners reviewed the framework for relevance, comprehensiveness, and comprehensibility, with revisions made iteratively until no substantial changes to structure or content were received. RESULTS: The final PSE-IEF describes how PSE programs are implemented at the organizational level and how they might impact the target audience at the individual level. To see outcomes at the individual level, organizational level activities must be completed, including staff awareness, engagement, action and maintenance activities to produce PSE outputs available for target audience use. Precaution Adoption Process Model stages of awareness, engagement, decision, action, and maintenance describe the responses at both the organizational and individual level over time. CONCLUSIONS: The resultant framework can be used to guide PSE intervention and evaluation in community-based programs and to increase the evidence base illustrating the impact of PSE interventions on individual behavior and health.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationSarah Browne, Aoife Dooley, Eamon Lovett, Aisling Ní Fhionnghalaigh, Aideen O'Neill
BACKGROUND: The quality of food environments in secondary schools in the Republic of Ireland (ROI) varies depending on local practices. Funding for free hot school meals recently increased significantly with phased implementation and priority for universal access in primary schools and among 'disadvantaged' status schools at the secondary level. Engagement with students, in the context of rapidly changing school food policies, is lacking. This study explored students' views about the food environment in secondary schools using a system-based approach and identified student priorities for actions and policies to support school food environments that are healthy for people and planet. METHODS: A cross-sectional qualitative study design using participatory methods was used. Public secondary schools were recruited in 2023 and 2024. Fourth year students volunteered to participate in one CO-CREATE Dialogue Forum per school on the idea: How to make our school food environment better for our health and the planet? Data were analysed using content analysis. The systems-based action scales model was applied to categorise students' recommendations for a desired system. RESULTS: Sixty-two students (55% female) aged 15-17 years in eight schools (including four schools designated 'disadvantaged' status) participated in dialogue forums. Issues with time, space and mealtime infrastructure were reported by students. Dissatisfaction with food quality and lack of variety were reported by some. Practices that identify students accessing free school meals risk perpetuating stigma. Food and packaging waste and catering for diverse food cultures and health needs were students' primary concerns from a planetary health perspective, with a small minority suggesting more plant-based food options. Limited opportunities to influence school food were reported. In the desired system, food choice, taste and quality, food and packaging waste, adequate spaces to eat and socialise, improved break-time logistics (e.g., food ordering system, time available, queue systems), and structures for participation and influence were priorities for students. CONCLUSION: The CO-CREATE Dialogue Forum was an effective method for exploring school food, with students demonstrating systems thinking ability in considering a range of factors shaping their environments. Their ideas and solutions are important to inform policy and practice at local school, public health and government levels.
PloS oneJuliana de Paula Matos, Breenda Lorranny Santos Gonçalves Araújo, Mariana Ribeiro, Laís Amaral Mais, Paula Martins Horta
Front-of-pack nutrition labeling (FoPNL) and restrictions on food advertising are regulatory strategies to support informed dietary choices and reduce exposure to unhealthy food. These measures are often integrated through a policy package, that employs a Nutrient Profile Model (NPM) for the classification of food. In Brazil, however, these policies remain fragmented, and current food advertising regulations do not fully cover all channels, particularly digital media. This study applied the NPM adopted in Brazil's FoPNL (RDC No. 429/2020 in conjunction with IN No. 75/2020, hereafter RDC 429) and those proposed by the Pan American Health Organization (PAHO) for identifying foods subject to advertising restrictions on social media posts directed at children and adolescents. The sample included posts from ultra-processed food brands/products on Instagram (n = 623), TikTok (n = 257), and YouTube (n = 114). Both NPM were applied to assess non-compliance at the food-item level and at the advertisement level (considering posts containing at least one non-compliant food). At the food-item level, 61.28% of products exceeded at least one item of RDC 429, with the highest prevalence on TikTok (72.63%), while 93.86% were non-compliant according to PAHO, reaching 100% on TikTok and 98.5% on YouTube. At the advertisement level, 49.53% of posts contained at least one non-compliant food under RDC 429, and 74.13% under PAHO, with YouTube showing the greatest potential for restriction (62.16% RDC; 99.10% PAHO). Both models are feasible for regulating digital food advertising: the PAHO provides a robust framework, while RDC 429 offers a strategic starting point given its current implementation in Brazil.
Global health actionDilara Canbay Özdemir, Melike Karabulut Özer
Despise the existence of numerous community-based health literacy interventions worldwide, our understanding of their impact on equity and the influence of national policy frameworks and implementation considerations remains limited. This narrative review aims to conduct a comparative analysis of community-based health literacy programs and national policy frameworks post-2020, with a focus on implementation characteristics, system-level integration, and implications for equitable public health initiatives. Effective interventions across various countries exhibited three key action-relevant features: integration into national prevention and broader primary care strategies; utilization of hybrid delivery models combining digital technology with in-person contact; and active targeting of socioeconomically disadvantaged groups. Government-led models demonstrated superior scalability and sustainability, whereas community-based models enhanced outreach to marginalized populations. However, the majority of programs rely on short-term or output-based indicators to assess success, with insufficient evidence regarding their long-term impact on equity. Although digitalization increased accessibility on a large scale, there is a risk of reinforcing existing inequalities in the absence of inclusive design and digital support. This study provides a policy-focused synthesis that positions community-based health literacy as a viable public health intervention rather than merely an educational endeavor. This review provides practical guidance for integrating health literacy into national preventive efforts by identifying transferable implementation characteristics and governance requirements.
This study examines mass testing in three Chinese cities since 2020 as a 'stress test' for local governance. It analyses the governance performance of Shenzhen, Nanjing and Wuxi in terms of efficiency, equity and community resilience. Using Melbourne's pandemic lockdown as a reference case, it discusses the underlying mechanisms linking different governance approaches to health equity outcomes. The study adopts a nested governance framework to examine how governance capacities and policy logics operate across different local contexts. The results indicate that Chinese cities can efficiently complete mass testing within a few days, but face pressures related to health equity and community resilience. Melbourne's lockdown governance emphasised participation and institutional transparency, but advanced policies at a relatively slower pace. This study recommends building a dynamic governance mechanism that better balances efficiency and equity.
Current psychiatry reportsLaura Y Cabrera, Leonard M Fleck, Alik S Widge
PURPOSE OF REVIEW: Mental health disorders are a significant public health problem with profound impacts on individual health, communities and society. Interventional approaches are limited in both utilization and access, despite their strong evidence base in specific disorders. The objective of this review is to describe factors and challenges influencing equity in interventional psychiatry. RECENT FINDINGS: Mental health care inequities are pervasive and persistent. For interventional psychiatry tools, even with current evidence of interventions' cost-effectiveness, inequities in access persist based on geographic context, socioeconomic status, and race, as well as insurers' reluctance to cover some of them. A wide range of social factors impact access and utilization of interventional psychiatry tools. To ensure parity, we need strategies to increase awareness and to address access and utilization disparities found across these interventions, in addition to keeping up-to-date mental health coverage policies based on new safety and effectiveness evidence.
Theory in biosciences = Theorie in den BiowissenschaftenIqbal M Batiha, Shaher Momani
This study develops a fractional-order (FO) reaction-diffusion (RD) model to capture the spatiotemporal adoption dynamics of Remote Healthcare Services (RHS) in geographically constrained regions. The model integrates sociological mechanisms social contagion, external influence, relapse, and spatial diffusion within a framework enhanced by Caputo fractional derivatives to account for memory effects and historical dependencies in adoption behavior. A numerical scheme based on Grunwald-Letnikov (GL) discretization in time and finite differences method (FDM) in space is implemented and analyzed for stability using the von Neumann method adapted to FO systems. Simulation results demonstrate the emergence of spatially heterogeneous adoption patterns, damped responses to perturbations, and the influence of memory on long-term dynamics. The present work focuses on the mathematical formulation, numerical discretization, and stability analysis of the FO-RD model. Empirical calibration using field data from the Chittagong Hill Tracts (a region characterized by natural barriers and limited infrastructure) and scenario-based policy evaluations are identified as essential next steps but lie outside the scope of this paper. The model provides a robust predictive tool for evaluating policy interventions, optimizing resource allocation, and supporting equitable healthcare deployment in remote and underserved areas.
BMJ global healthBetha O Igbinosun, Gift Kawalazira, Darwin Pangani, Sara M Allinder, Yohane Kamgwira, Deborah Hoege, Samden Seunda, Chimwemwe Mablekisi, Stephanie Heung, Jacqu…
The Alma-Ata 'Health for All' Declaration of 1978 emphasised community participation in health systems and the need to 'bring health care as close as possible to where people live and work'. Since then, decentralised approaches that leverage the proximity of local governments to their populations have emerged as the preferred model for health systems over fully centralised structures. The district health system, particularly in low- and middle-income countries, has evolved as a key framework to advance the Alma-Ata vision and strengthen health system governance in decentralised settings. However, implementation has often been hindered by limited local capacity, raising a persistent question: how can district health systems be strengthened to achieve decentralisation objectives? Using Malawi's ongoing Blantyre Prevention Strategy (BPS), a systems-based project designed to build local capacity at district and city levels for HIV prevention, as a case study, this paper-reviews policies and frameworks guiding health sector decentralisation in Malawi and examines how BPS is contributing to strengthening the district health system and supporting broader decentralisation efforts in Malawi's health sector.
BMJ openYongyi Wu, Wei Bai, Fanyu Liu, Xiaohan Fan, Siyu Liu, Lili Liu, Bin Jiang, Zhao Yang
BACKGROUND: Statins are effective in lowering lipids and reducing cardiovascular risk. In recent decades, rising paediatric lipid levels, especially in low- and middle-income countries (LMICs), have led to growing demand for lipid-lowering drugs. However, access remains limited in LMICs due to financial constraints. To address this, China launched its National Volume-Based Procurement (NVBP) policy in 2019, significantly improving the price and affordability of statins. This study evaluates the policy's impact on statin use and expenditures in children. METHODS: The study used interrupted time series regression to analyse all levels of children's hospitals across the country's monthly procurement records of statins, covering the period from January 2019 to December 2020. It investigated the fluctuations in monthly drug procurement quantity (measured in defined daily doses) and expenditures (affordability) at both the national level and across different tiers of child medical facilities. RESULTS: Following the implementation of the NVBP policy, the utilisation and affordability of statins across all children's hospitals nationwide exhibited a positive upward trend. After the NVBP policy, the affordability of atorvastatin in children's hospitals nationwide improved by at least 90.54% and the affordability of rosuvastatin in children's hospitals nationwide increased by no less than 89.85%. Both before and after the NVBP policy, the majority of utilisation and expenditure in statin was contributed by atorvastatin and rosuvastatin. After the NVBP policy, the utilisation of atorvastatin and rosuvastatin bid-winning generic has increased significantly, making bid-winning generic change from the variety occupying the least market to the variety occupying the most market in children's hospitals. CONCLUSION: The implementation of China's NVBP policy has resulted in a marked increase in the dosage of atorvastatin and rosuvastatin, while effectively reducing cost expenditure for children. This achievement has been realised without compromising the quality of healthcare services. China's NVBP policy provides a reference and path for the medical reform of all countries in the world especially LMICs.
Global public healthHang Duong, Nor Kamila Kamaruzaman, Katie Attwell
Conceptually, current definitions of vaccine mandates involve two key elements: the requirement to be vaccinated and sanctions for non-compliance. However, during COVID-19, governments frequently introduced vaccine mandates in contexts where people were already denied access to work, travel, and social activities due to lockdowns and restrictions. This important context disrupts the standard operation of vaccine mandates. Accordingly, this paper explores COVID-19 vaccine mandates in New South Wales (Australia), France, Israel, Malaysia, Singapore, and Vietnam, where mandates primarily served as incentives to restore basic rights to travel, work, and access public spaces, that were restricted during the pandemic. Through document analysis and key informant interviews, the paper examines how governments employed this "removal and restoration" model and explores how mandate policy instruments create incentive structures. In discussing the implications of mandates in relation to lockdowns and restrictions, and the perception of mandates as "coercive offers", the paper proposes a revised conception and a 7S vaccine mandate framework by adding synergy and sustainment to the existing 5S model. It concludes by outlining the significance of this revised conception and framework for vaccine mandate policy research, design, and communication.
American journal of health promotion : AJHPKhansaa Abdullah, Elizabeth Ablah, Vicki Collie-Akers, Laurie P Whitsel
ContextPhysical inactivity is a major contributor to chronic disease, disability, and premature mortality in the United States and is associated with substantial healthcare expenditures. Although regular physical activity improves health outcomes, individuals with chronic conditions often require structured supervision to exercise safely and effectively. Building upon this context, the objective of this review is to synthesize evidence on the clinical, psychosocial, and economic impacts of supervised exercise interventions (SEIs) and to examine policy and implementation factors influencing their adoption. To achieve this objective, a structured literature review was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework.Eligibility CriteriaStudies published in English between 2010 and 2024 that involved adults aged 18 years or older and evaluated supervised exercise interventions with reported clinical, psychosocial, economic, or policy-related outcomes were included.Study SelectionPubMed, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using predefined keywords. Reference lists of relevant studies were also reviewed to identify additional eligible articles.Main Outcome MeasuresClinical outcomes (eg, mortality, aerobic capacity, HbA1c), psychosocial outcomes (eg, adherence, depression, quality of life), and economic and policy outcomes (eg, cost-effectiveness, reimbursement).ResultsTwenty studies met the inclusion criteria. Across cardiovascular, metabolic, oncologic, pulmonary, and geriatric populations, SEIs were associated with improved clinical outcomes, including reduced rehospitalization and mortality, enhanced aerobic capacity, improved glycemic control, and reductions in fatigue and depressive symptoms. SEIs were cost-effective across disease categories, with several studies reporting healthcare cost savings within 1 year. However, disparities in referral and participation persisted among racial and ethnic minorities, rural populations, and individuals with lower socioeconomic status.ConclusionSEIs are effective and scalable strategies for managing chronic diseases and preventing secondary complications. Evidence indicates that supervised exercise improves clinical, psychosocial, and economic outcomes across diverse populations. Expanding reimbursement and strengthening integration within health systems will be critical to improving equitable access to SEIs.
Ageing research reviewsKatarina Braune, Thorsten Schaaf, Felix Balzer, Dawn I Bershtein, Andrew Broderick, Pelin Celik, Tabea Flügge, Katherine K Kim, Nils Lahmann, David Lindemann, …
BACKGROUND: Rapid population ageing presents one of the defining global health challenges of the twenty-first century. While digital technologies are increasingly used to support older adults, their deployment often remains fragmented, inequitable, and insufficiently guided by ethical and legal frameworks. This paper proposes an integrated policy agenda for healthy longevity, based on the interdisciplinary work of the Einstein Circle Longevity - Healthy Ageing Assisted by Digital Technologies. METHODS: Drawing on literature, expert deliberation, and practical exemplars, we developed a conceptual framework encompassing seven interrelated domains-medical, technical, practical, interactive, psycho-social, ethical, and legal. The framework highlights the need to reframe health and ageing policy around functional ability and healthspan, not merely disease outcomes, and to embed equity and participation throughout the design and governance of digital health systems. INTERPRETATION: Digital technologies can extend preventive and personalised care, foster independence, and enhance participation across the life course. Yet their benefits remain unevenly distributed because of disparities in digital access, usability, and representation in data and design. Policies must ensure that technologies respect human rights, protect autonomy, and strengthen - rather than replace - social relationships and professional care. POLICY IMPLICATIONS: Realising the potential of digital health for healthy longevity requires investment in interoperable infrastructure, participatory design, and ethical and legal safeguards. Cross-sector collaboration and transparent governance are essential to ensure that technology adds not only years to life, but life to years.
BACKGROUND: The United Nations Convention on the Rights of the Child (CRC) enshrines health as a human right among other rights for children, fulfilled by each member state legally endorsing its principles through ratification of the Convention. Only the United States of America of all of the UN state parties has not ratified the CRC. OBJECTIVE: This study aimed to determine the reason(s) the CRC has not been ratified by the USA. METHOD: Method design involved a mapping literature search and in-depth interviews with key stakeholders in the fields of global health, child rights, health policy, and US law. Implementing the health policy triangle systematized themes into content, context, processes, and actors as opposition or proponents of ratification. RESULTS: While most published opinions favour ratification of the CRC, critically, the literature focuses on pros and cons of ratification, rather than reasons why the US has not ratified. Interview informants expanded themes revealing a status quo of non-ratification which has become increasingly challenging to overcome. Drawing on veto player theory to explain the status quo and introducing a new policy analysis framework of a veto fulcrum reveals that within the process of ratification, single powerful actors at a veto fulcrum have made undemocratic decisions, obstructing CRC ratification. CONCLUSION: This research has forged a new policy framework, the veto fulcrum, which examines political systems where political actors as veto players have extraordinary power to make executive decisions against public opinion, and against good health policy.
Global health actionElaine Q Borazon, Sirinya Phulkerd, Avita A Usfar, Mohd Jamil Sameeha, Nisha Arunatilake, Anne Marie Thow, Bee Koon Poh
Rapidly changing Asian food environments characterized by increased availability of cheaper, energy-dense, and low-nutrient products, are negatively impacting nutritional and health outcomes. This paper introduces SHAPE Asia, a collaborative learning network of food environment interest-holders across Indonesia, Malaysia, Thailand, the Philippines, and Sri Lanka. These countries face significant regulatory challenges. Unregulated food marketing and retail practices promote unhealthy products resulting in adverse health impacts. Policymaking is hampered by insufficient political will, industry interference, and government sensitivity to perceived economic impacts of regulation compounded by inadequate public awareness and limited prioritization of sustained behavior change. Balancing economic and public health interests requires multifaceted, multisectoral approaches to ensure commitment toward healthier food environments. SHAPE Asia generates regionally-specific knowledge through shared learning to support double-duty food policy actions. It engages policymakers, academics, government agencies, international organizations, media, and civic organizations to ensure inclusive and equitable food environment transformation. It facilitates peer learning and South-South and North-South capacity building supporting healthy food environment advocacy. It translates research into action by strengthening coordinated efforts to develop feasible, effective, and sustainable policy options while building interest-holder support and generating policy-relevant evidence. SHAPE Asia is part of a global cohort of multi-actor coalitions influencing policies and transforming food systems across Central and South America, South Asia, and Southeast Asia. These coalitions combine collaborative learning networks and communities of practice to support production, consumption, and access to healthy diets, particularly for vulnerable populations, while emphasizing sustainable, gender-equitable, and inclusive systems contributing to the health of people and ecosystems.
Multiple sclerosis and related disordersAlexandre Coelho Marques, Marina Martins Siqueira, Gabriely Rangel Pereira, Luiz Eduardo Betti Paiva, Victoria Lin, Lucas Hernandes Correa, Doralina Guimaraes …
BACKGROUND: In 2021, Brazil updated its Clinical Protocol and Therapeutic Guidelines (PCDT) for multiple sclerosis (MS), expanding first-line eligibility for natalizumab (NTZ) in patients with highly active disease and incorporating alemtuzumab (ALE). Evidence on temporal changes in disease-modifying therapy (DMT) dispensation within the Brazilian public health system (SUS) after this update is lacking. METHODS: Using big data, we analyzed 1711,342 DMT dispensation authorizations for MS from the national outpatient registry (SIA/SUS) between 2019 and 2023. DMTs were categorized as: high-efficacy (NTZ, ALE), intermediate/moderate-efficacy (FNG), and platform therapies (IFN, GA, DMF, TERI). Quasi-Poisson space-time regression models compared pre-PCDT (2019-2021) and post-PCDT (2022-2023) periods at national and regional levels, while state-level variation was assessed relative to the national mean. Treatment switches were evaluated across periods and regions. RESULTS: From 2019 to 2023, the number of MS patients treated through the SUS increased by 25.9%. Nationwide, dispensation of NTZ (+44.5%, p < 0.001), DMF (+53.1%, p < 0.001), TERI (+32.5%, p < 0.001), and FNG (+15.8%, p < 0.001) increased, while IFN (-40.3%, p < 0.001) and GA (-27.6%, p < 0.001) decreased. NTZ increased across all regions, with the largest growth in the North (+82.0%, p = 0.042), whereas IFN reduced only in the North (-41.9%, p = 0.049). State-level analyses showed heterogeneous NTZ uptake, with higher rates in parts of the Northeast (Ceará, Paraíba, Sergipe), Center-West (Federal District, Goiás), North (Pará), and Southeast (São Paulo), and lower rates across all Southern states. Most treatment switches occurred within the same efficacy class, with no differences between pre- and post-PCDT periods or across regions. ALE dispensation was limited to the late post-PCDT period. CONCLUSIONS: In this nationwide observational analysis, DMT dispensation patterns in Brazil were characterized by higher NTZ and increased dispensation of FNG, DMF, and TERI in the post-PCDT period. However, persistent regional disparities and conservative switching patterns may suggest barriers to equitable access to HE DMTs. These findings highlight the role of national guidelines in shaping real-world therapeutic practices and the value of administrative data for monitoring treatment patterns and healthcare organization in MS.
Sexually transmitted diseasesAngelica E Miranda, Jodie A Dionne, Bernardo Nuche-Berenguer, Leandro Sereno, Mónica Alonso Gonzalez, Lori Newman
BACKGROUND: Syphilis in pregnancy and congenital syphilis (CS) remain major public health challenges in Latin America despite long-standing elimination initiatives. CS incidence continues to rise, although diagnosis and treatment are available, reflecting persistent programmatic gaps. A systematic assessment of strengths, weaknesses, opportunities, and threats (SWOT) can help refine strategies and accelerate progress toward the elimination of mother-to-child transmission (EMTCT) of syphilis. METHODS: We performed a qualitative SWOT analysis of public health policies addressing syphilis in pregnancy and CS in Latin American countries. Data sources included Pan-American Health Organization databases, global monitoring databases, national data, peer-reviewed literature, and programmatic reports. Evidence was synthesized using a standardized matrix to classify internal and external factors affecting syphilis control. RESULTS: Regional strengths include political commitment, national guidelines aligned with Pan-American Health Organization/World Health Organization recommendations, high antenatal care coverage, use of rapid and HIV/syphilis tests, and established surveillance systems. Key weaknesses include late antenatal care initiation, gaps in timely testing and treatment, regulatory barriers to point-of-care testing and penicillin administration, benzathine penicillin shortages, data quality limitations, fragmented governance and care, and weak partner management. Opportunities include strengthening the EMTCT agenda via program integration, digital health expansion, regional collaboration, and innovative diagnostic strategies. Threats include rising syphilis incidence, competing public health emergencies, political and economic instability, poverty, exclusion and stigma, and loss-to-follow-up during and after pregnancy due to population mobility. CONCLUSIONS: Despite political commitment, Latin America remains far from achieving EMTCT of syphilis. Strengthening integrated services, supply chains, data systems, and partner management is needed to improve outcomes.