Australasian journal on ageingRuttiya Bhula-Or, Chadatan Osatis, Orawan Prasitsiriphon, Man Thi Hue Vo, I-Chun Chen
OBJECTIVE: To examine barriers and enablers to equitable long-term care (LTC) across ASEAN-Plus Three (APT) economies and to propose a framework for equitable active ageing, contributing to Sustainable Development Goals 3 and 10. METHODS: A qualitative participatory-observation study was conducted during the 2025 Regional Policy Dialogue on Inclusive and Equitable Care Systems. Reflexive thematic analysis, read through a life-course lens, was applied to three deliberation sessions involving 107 stakeholders from policy, academic, civil-society and provider sectors across diverse welfare regimes. RESULTS: Three themes were generated: institutional fragmentation converts earlier disadvantage into unequal access; communities absorb shortfalls in formal care without displacing public responsibility; and equity depends on redistributing voice and coordinating responsibility across levels. Costs fall heaviest on women and on rural and low-income older people. CONCLUSIONS: A critical participatory life-course framework can guide LTC redesign through inclusive governance; national coordination hubs are advanced as an author-generated proposal extending participants' calls for coordination.
Sociology of health & illnessJoseph Donia, Luca Marelli
In this article, we trace expectations associated with efforts to promote secondary use of health data in Canada and the European Union. In Canada, we focus on initiatives enabling cross-jurisdictional data access in a highly devolved federal system with parallel commitments to Indigenous data sovereignty. In the EU, we focus on the European Health Data Space, a new regulatory regime intended to facilitate access to health data for clinical care, research, policymaking and innovation across 27 member states. Drawing on a comparative analysis of policy documents and semi-structured interviews across nine EU member states and four Canadian provinces and one territory, we find that despite institutional differences, secondary use in both jurisdictions is characterised by strikingly similar promissory vocabularies. We argue that these expectations are fundamentally ones of scale: They seek to render health data interoperable, comparable and usable to different ends. At the same time, we document shared frictions: between sovereignty and integration; between access and control; and between private assets and public goods. We understand these as spaces where competing valuations of health data are negotiated. We suggest that secondary use logics are progressively reorienting health systems, with implications for public value, equity and political collectives.
Australian journal of primary healthYabo Yan, Andrew Podger
BACKGROUND: As the major regional primary health care (PHC) organisations in Australia, Primary Health Networks (PHNs) are expected to coordinate health care for patients and respond to local health needs. To evaluate their success, it is important to examine both policy practitioners' and GPs' perceptions of PHNs' role, structure and performance. METHODS: Thirty-six semi-structured interviews were conducted, including 15 interviews with policy practitioners and 21 interviews with GPs. The interviews were audio-recorded, transcribed and thematically analysed to gain a comprehensive understanding of key stakeholders' perceptions of the performance of PHNs. RESULTS: The interviews with policy practitioners gave rise to three main themes: (1) PHNs enabled federal and state collaboration in PHC; (2) PHNs played an intermediary role in system integration; and (3) further actions were needed to improve the performance of PHNs. Three further main themes were derived from interviews with GPs: (4) PHNs did not engage enough with general practice; (5) GPs preferred the former divisions of General Practice and distrusted PHNs; and (6) PHNs were viewed as a means for the federal health department to recentralise, rather than decentralise, the health system. CONCLUSION: The different sets of themes reflected different perspectives on PHNs' role, structure and performance. Although policy practitioners generally held a positive view over PHNs' role and performance, GPs complained about the lack of engagement from PHNs and demonstrated distrust of PHNs. Given GPs' critical role in the delivery of PHC, their distrust of PHNs limits the success of PHNs in terms of supporting better PHC and improving care coordination. The Australian Federal Government should find ways to mitigate GPs' distrust of Commonwealth-funded regional PHC organisations, including by encouraging improved engagement by PHNs with general practice.
European journal of nutritionChristina Breidenassel, Volker Böhm, Ibrahim Elmadfa, Maren Podszun, Karl-Heinz Wagner, Stefan Lorkowski
PURPOSE: The scientific knowledge for the essential fat-soluble vitamin E (VitE) remains inconclusive. There is still a lack of valid status parameters and deficiency symptoms for insufficient intake. Therefore, the derivation of a dietary reference value (DRV) for VitE is challenging and differs between the different organizations and countries. The aim of the current paper is to provide an overview of selected international DRVs and discuss the different derivation procedures. METHODS: DRVs from sixteen countries and international organizations were retrieved, compared and evaluated. RESULTS: The DRVs are inconsistent in the absolute value as well as the employed concept of derivation. Due to the uncertainty of the available data some organizations did not specify a DRV. Others used plasma cut off levels or the required amount for the protection of polyunsaturated fatty acids against oxidation. Many DRVs are based on population intake data and given as adequate intake. But this approach may overestimate the VitE needs. CONCLUSION: In conclusion, due to missing symptoms and markers of insufficient supply, the compensation of daily losses with the consideration of the bioavailability appears to be a good basis for deriving a DRV for VitE intake. A balanced and plant-based diet (without supplements) appears to be sufficient for an adequate VitE supply.
BACKGROUND: Despite several efforts to expand tobacco cessation services through tobacco cessation centers (TCCs) and quit lines, key operational challenges still persist. Recently, AI-based digital interventions have shown promise globally for smoking cessation; however, they remain underused in tobacco cessation strategy in the Indian context. OBJECTIVE: This study aimed to (1) codevelop the conversational interface with beneficiaries and cessation providers; (2) assess its feasibility, acceptability, usability, and user engagement; and (3) evaluate its effectiveness in promoting attempts and intention to quit tobacco. METHODS: The study consists of three phases: (1) codeveloping the comprehensive AI-powered Conversational Interface to Quit Tobacco (CARE) conversational interface through in-depth interviews with tobacco users, counselors, and health care professionals; (2) feasibility testing with tobacco users to assess engagement, usability, and acceptability; and (3) 6-month effectiveness testing using pre-post surveys. The CARE conversational interface will be developed using a retrieval-augmented generation-based large language model by the Indian Institute of Technology (Bombay, Maharashtra, India), delivering personalized, multilingual cessation support via a chatbot integrated into a mobile app. Key evaluation measures will use validated tools such as the Fagerström Test for Nicotine Dependence, Smoking Self-Efficacy Questionnaire, Decisional Balance Scale, and a Knowledge Score Questionnaire. Data will be analyzed using mixed methods, including thematic analysis for qualitative data and descriptive statistics and a multivariate logistic regression for quantitative data. RESULTS: The CARE study was funded in March 2025 and is being implemented across 3 TCCs. Preparatory activities, including tool development, site engagement, ethics approval, and trial registration (CTRI/2024/11/076916), were completed in 2025. Phase 1 (codevelopment) is scheduled from February to August 2026, followed by phase 2 (feasibility testing) from September 2026 to August 2027, and phase 3 (effectiveness assessment) from September to November 2027. Data analyses are expected to be completed by late 2027, with key findings on feasibility, acceptability, usability, user engagement, and preliminary cessation outcomes targeted for peer-reviewed publication from 2027 onward. CONCLUSIONS: The CARE study will attempt to introduce a novel, culturally tailored conversational interface targeting both smokers and smokeless tobacco users in India by integrating AI-based solutions as an adjunct to conventional counseling at the TCCs. Given the single-group pre-post design without a control arm, feasibility and effectiveness findings will be interpreted as preliminary and hypothesis-generating rather than causal evidence of intervention impact. The intervention approach of codevelopment, strengthening capacity in evidence-based content, and enabling a multilingual conversation interface is expected to enhance tobacco user engagement and improve cessation outcomes. Findings from this pilot will inform a future randomized controlled trial and provide evidence for the potential integration of the CARE interface into India's tobacco cessation platforms, offering a low-cost, high-impact solution for India and other low- and middle-income countries that face similar challenges. TRIAL REGISTRATION: Clinical Trials Registry-India CTRI/2024/11/076916; https://tinyurl.com/3vfs5d8s. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/82264.
JMIR research protocolsPhonepadith Xangsayarath, Cate Moriasi, Phayvanh Keopaseuth, Khatthanaphone Phandouangsy, Khanti Thongkham, Bouathong Simanovong, Michael S Businelle, Steven K…
BACKGROUND: Tobacco use remains the leading modifiable risk factor for causing cancer worldwide, particularly among people with HIV. In Laos, 61%-80% of male people with HIV and 3%-10% of female people with HIV smoke cigarettes. They currently have no theoretically and empirically based smoking cessation support. Our team developed a scalable and affordable mHealth (mobile health)-based automated treatment program to support Lao and Cambodian smokers to quit smoking. We also pioneered the Ask-Advise-Connect approach to identify patients who smoke and to connect them to treatment. OBJECTIVE: This hybrid type-2 pragmatic effectiveness-implementation study aims to compare 2 smoking cessation implementation strategies in 8 antiretroviral therapy (ART) clinics in the 6 most populous regions across Laos, using a parallel cluster randomized trial design. METHODS: We will compare an Ask-Advice-Connect approach paired with an mHealth-based automated treatment program (AA-MAP) with an Ask-Advice-Connect approach paired with less resource-intensive printed self-help material (AA-SH). To guide assessment of implementation determinants and outcomes, we use the Practical, Robust Implementation and Sustainability Model framework. Aim 1 is to evaluate the reach and effectiveness of AA-MAP vs AA-SH. Reach is the proportion of people with HIV who smoke and are willing to make a quit attempt that enroll in treatment. Effectiveness is the proportion of enrolled participants (n=up to 1200) who achieve biochemically confirmed point prevalence abstinence 6 months after enrollment. We hypothesize that compared with AA-SH, AA-MAP will have a lower reach but will be more effective. We will also estimate the real-world impact (impact = reach × effectiveness) of each intervention. Aim 2 is to evaluate other implementation outcomes (eg, adoption, implementation fidelity, and sustainability) and identify implementation determinants of AA-MAP and AA-SH in the ART clinic setting using mixed methods. Aim 3 is to conduct a comprehensive assessment of the resource use and costs of implementing AA-MAP and AA-SH and calculate the absolute and relative cost-effectiveness of the 2 intervention strategies. RESULTS: The study has been funded since August 2024. This study was approved by the ethical review boards of the Lao Ministry of Health-National Ethics Committee for Health Research and the University of Oklahoma Health Campus. The Multiple Principal Investigators met with the selected ART clinics. As of September 2026, we have launched the implementation of AA-SH and AA-MAP at 4 ART clinics. We plan to expand the implementation at the other ART clinics by December 2026. CONCLUSIONS: This project will contribute important actionable inputs that will inform the influential Lao National Tobacco Control Committee and Ministry of Health to implement the strategies in diverse hospital settings in future large-scale hybrid type II/III trials. Ultimately, our course of research can transform health care delivery and contribute to reducing tobacco-related morbidities and mortalities in Laos.
Global public healthYusuf Hared Abdi, Sharmake Gaiye Bashir
Antimicrobial resistance (AMR) is one of the most consequential threats to global public health. In 2021, bacterial AMR was associated with an estimated 4.71 million deaths globally, including 1.14 million directly attributable to resistance. Yet, despite its designation as a global emergency, policy responses remain heavily focused on surveillance, antimicrobial stewardship, diagnostics, and pharmaceutical innovation. These interventions are necessary but insufficient without sustained action on the social and structural conditions shaping infection exposure, access to care, and antibiotic use. This commentary argues that the One Health framework, as currently operationalised, does not sufficiently centre poverty and structural inequality as core determinants of AMR. AMR is shaped by overcrowded living conditions, inadequate water and sanitation, disrupted health systems, weak diagnostic infrastructure, gender inequities, and unreliable access to quality-assured medicines, disproportionately affecting low- and middle-income countries (LMICs). We propose four linked policy directions: aligning national AMR action plans with the Sustainable Development Goals; integrating socioeconomic disaggregation into AMR surveillance; reforming international financing to expand fiscal space for health, WASH, and diagnostics; and embedding communities as co-designers of stewardship and governance. A justice-oriented One Health approach is essential to translate global AMR commitments into equitable and durable action.
Disability assessment determines access to social and healthcare support, yet the operation of assessment pathways may be shaped by policy implementation and facility capacity. We conducted a qualitative descriptive study at the Hanoi Medical Assessment Center, Vietnam, using purposive sampling and semi-structured, in-depth interviews with 13 stakeholders, including people with disabilities, guardians, administrative and reception staff, district social-protection officials, medical examiners, and center leaders. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Four interconnected themes were identified: administrative fragmentation and procedural burden, communication gaps and reliance on informal information channels, infrastructure constraints and system-level inefficiencies, and financial ambiguity and trust-related concerns. Participants described multilevel administrative handoffs and episodic dossier submission as sources of delay; official information was often difficult to interpret, leading users to rely on healthcare professionals; limited on-site diagnostic capacity required external referrals; and uncertainty about fees, insurance coverage, and the distinction between paying for assessment and qualifying for benefits undermined trust. These findings reflected experiences at 1 urban center and were not intended to estimate prevalence or represent disability assessment nationally. They identify context-specific service priorities for Hanoi, including clearer inter-level responsibilities, accessible and standardized guidance, better coordination of diagnostic services, and transparent communication of costs. Multicenter research, including rural and under-resourced settings, is needed before broader policy implications can be drawn.
Recenti progressi in medicinaIrene Dell'Anno, Nicola Ambrosio, Letizia Dondi, Giulia Ronconi, Leonardo Dondi, Alice Addesi, Immacolata Esposito, Aldo P Maggioni, Nello Martini, Carlo Picci…
The Res Foundation PDTA Net Observatory has been updated to include all regional care pathways approved up to 2025. This up-to-date overview of which regions and which disease are covered by these pathways is useful for understanding how the implementation of the community care reform is progressing in relation to the integrated management of chronic conditions and identifying areas where action can be taken to support this process.
Health expectations : an international journal of public participation in health care and health policyPete Fleischmann, Peter Schofield
BACKGROUND: The term co-production is now very common and risks losing its original egalitarian and emancipatory meaning. Questions about what the term means relate to how the concept developed historically. We conduct a critical history of the concept to shed some light on this and inform contemporary practice. OBJECTIVES: To chart the history of co-production focusing on co-production in the design and delivery of mental health services; critically examining the extent to which the original egalitarian promise has been realised. METHODS: We draw on early foundational texts, key UK policy frameworks and legislation, mental health service user/survivor movement accounts and more recent guidelines, using illustrative cases to critically examine the concept. RESULTS: Early accounts from the US stressing reciprocity, shared power, and active citizenship directly influenced approaches to UK mental health services. Further accounts from the user/survivor movement stressed the importance of power sharing and a critique of medical models of mental distress. UK policy frameworks and legislation have since brought co-production from the margins to the mainstream, introducing a tension between a mainstream concept of co-production influencing services through collaboration and a service user/survivor concept of co-production as equal power sharing. CONCLUSION: Historically there have been a range of conceptions of co-production with different notions of what power sharing means for service users working alongside professionals. LIVED EXPERIENCE OR PUBLIC CONTRIBUTION: Both authors have past lived experience of using psychiatric services. The manuscript was also shared with a small group of user/survivors with a particular interest in co-production and their feedback incorporated in the final draft.
Journal of dental hygiene : JDHTheekshana Fernando, Sage Shirey, Simona Surdu, Jean Moore
Purpose Developments in dental hygiene (DH) practice over the past decade have influenced the professional landscape, particularly regarding scope of practice (SOP), access to care, and workforce utilization. The purpose of this study was to explore how recent regulatory changes, care delivery innovations, and technological advancements have impacted DH practice, identify persistent barriers, and recommend strategies to advance DH SOP.Methods This qualitative study employed semi-structured key informant interviews with national DH leaders. Purposive sampling was used to recruit members of the American Dental Hygienists' Association Board of Directors to ensure diverse expertise and leadership perspectives. Five of the 15 invited participants were enrolled in the study. Virtual interviews were conducted in May and June 2025. Transcripts were verified for accuracy and analyzed using thematic analysis with both deductive and inductive coding approaches.Results Four primary themes emerged: 1) regulatory constraints and representation on dental boards, 2) barriers to care delivery in underserved communities, 3) impact of technology, and 4) strategic recommendations for expanding SOP. Participants described significant variation in state laws, limited DH representation on dental boards, and a disconnect between education and legal practice authority. Regulatory barriers were reported to constrain care delivery in community-based settings. Technological innovations, including teledentistry and digital diagnostics, were viewed as enhancing care but limited by cost and reimbursement challenges. Key recommendations included establishing independent DH regulatory boards; expanding educational pathways to enhance professional recognition and care capacity; advancing licensure portability through interstate compacts; and increasing Medicaid reimbursement and direct reimbursement to dental hygienists.Conclusion Despite progress in DH practice and innovation, regulatory variability and structural barriers continue to limit professional autonomy and access to preventive oral health services. Coordinated policy reform is needed to fully leverage dental hygienists as essential contributors to a prevention-focused oral health system.
Health systems and reformAniso Mohamed Abdi, Hibo Hassan Mohamed, Ilyas Abdullahi Khalif, Ahmed Mohamed Omar, Nour Ahmed Dahir
Antimicrobial resistance (AMR) is quietly becoming Somalia's next health catastrophe. While the world focuses on immediate crises, an estimated 8,400 deaths annually are directly attributed to AMR, with another 32,700 linked to AMR complications. These numbers place Somalia among the top 10 countries globally for AMR-related mortality, surpassing deaths from maternal disease, cardiovascular conditions, and infectious disease combined. Yet Somalia has a national action plan. The problem is not policy; it is implementation. Despite developing an AMR National Action Plan aligned with global strategies, Somalia's fragile health system, weak governance, limited laboratory capacity, and unregulated antibiotic markets have created a perfect storm for untreated resistance to flourish. Community-level drivers, including self-medication, over-the-counter antibiotic access, and incomplete treatment courses, remain unaddressed. This commentary argues that AMR in Somalia is fundamentally a governance failure, not a biomedical one. We identify critical barriers: absent laboratory surveillance systems, inadequate infection prevention and control, lack of Water, Sanitation, and Hygiene (WASH) infrastructure, and missing community engagement strategies. Addressing AMR requires integrated, system-level approaches including strengthening multisectoral coordination, investing in diagnostic capacity, embedding community voices into policy design, and securing sustainable financing. Without urgent action to bridge the policy-implementation gap, AMR will become an unmanageable health security emergency in Somalia.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsM J Sharman, M Mclaughlin, P McCue, T Washington, V J Cleland
ISSUE ADDRESSED: Government policy largely determines the transport-related physical activity (TRPA) environment-an environment central to global PA promotion frameworks (e.g., Global Action Plan on Physical Activity). However, little is known about this policy environment-a knowledge gap this study aimed to fill in Tasmania. METHODS: Guided by the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework, the World Health Organisation's Health Enhancing Physical Activity Policy Audit Tool (PAT) Version 2 was contextualised to reflect the study's subnational and TRPA focus (PAT-C). In 2024, a five-person Tasmanian multi-sector project team completed the PAT-C. The audit included 20 policy documents systematically extracted from Tasmanian government websites screened for TRPA relevance. After PAT-C completion, a SWOT analysis underpinned by the CAPPA identified strengths, weaknesses, opportunities and threats of the TRPA policy environment. RESULTS: Key strengths were: 9/20 policy documents directly supported TRPA; many agencies/formal groups/mechanisms within/outside of subnational government provide TRPA leadership/advocacy. Main weaknesses were: 11/20 policy documents made no/indirect TRPA reference; certain settings and population groups for TRPA targeting were overlooked across policies; disclosure of consultation and policy cross-referencing was inconsistent; missing were mechanisms to ensure evidence-based policy, a TRPA communication strategy, dedicated funding, specific targets, robust measures and comprehensive TRPA intervention evaluation. Targeted advocacy addressing TRPA-related policy environment omissions was a key opportunity. Fluctuating political commitment and operating environments were important threats. Conclusion and So what: Many gaps in the TRPA environment were identified that, if filled, could support population-level health gain by tackling upstream influences on physical activity.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsKhalid Muse, Ayuba Issaka, Dheepa Jeyapalan, Nicola Miranda, Kevin Kapeke, Kathryn Backholer, Veronica Nunez, Sally Schultz, Hannah Jongebloed, Chioma Anidi, C…
OBJECTIVES: Marginalised and non-white voices are under-represented in food and nutrition policy in Australia. To achieve equitable food systems that support healthy diets for all, the voices and lived experiences of people from diverse cultural backgrounds must be meaningfully included in decision-making. This research aimed to understand Sub-Saharan African (SSA) young people's experiences of food and nutrition and identify opportunities for culturally sensitive policies that can improve these experiences in Victoria, Australia. DESIGN: A qualitative approach, grounded in critical theory, experience-based co-design and the Social and Emotional Wellbeing framework, was employed to attain a policy-relevant understanding of SSA young people's perspectives and engagement with food and nutrition in Australia. In-depth interview guides were co-designed with an advisory committee of multicultural young people, including two young SSA Australians. RESULTS: Twenty young people (15-25 years) with East and West African backgrounds were interviewed, mostly from metropolitan Victoria (75%). Four overarching themes were identified describing (i) young people's experiences of cultural food shaping their identity but being difficult to access due to systemic barriers, (ii) food affordability and economic opportunities influencing community wellbeing, (iii) the mixed relevance of dominant food and nutrition policy priorities and (iv) the need for stronger government prioritisation of migrants and equity. CONCLUSION: This research identifies food as a critical determinant of health and wellbeing among SSA youth, serving not only as a cultural factor but also as a pathway for economic and social advancement. Mainstream food and nutrition policies do not fully address the priorities of SSA youth and opportunities exist to develop more culturally sensitive policy options. Additional efforts are required from the public health community to address discrimination across food systems, starting with better inclusion of multicultural experiences and voices in research, policy and practice.
Health affairs (Project Hope)Dmitry Khodyakov, Erin A Taylor, Christine Buttorff, Hannah James, Melony E Sorbero, Rachel O Reid, Michael Dworsky
More than half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), yet concerns persist about overpayments to MA plans, inadequate plan oversight, and limits on beneficiaries' access to care. To identify MA reform options, we conducted a two-round e-Delphi panel with thirty-nine experts, including researchers, industry representatives, patient advocates, and former policy makers. Panelists rated fifteen policy reform ideas on their impact on beneficiaries, the federal government, and MA plans. Experts agreed that six policy ideas would benefit beneficiaries, three would benefit the government, and one would benefit plans. The most feasible near-term options are standardizing supplemental benefits, limiting the number of MA plans that insurers can offer, and reforming agent commissions. These incremental reforms could improve beneficiaries' decision making and financial protections without harming the government or plans and could be implemented through Centers for Medicare and Medicaid Services administrative action. Nonetheless, achieving the cost savings critical for Medicare's long-term financial sustainability will require policies that may cause market disruption and negatively impact MA plans.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsLaura J Kennedy, Sara F L Kirk, Alisson Dykeman, Meaghan Sim, Jeanna Parsons Leigh, Catherine L Mah
BACKGROUND: Healthy eating policies are of growing importance to the management of retail food environments in healthcare (e.g., hospital cafeterias). Several researchers have begun to analyse health promoting benchmarks within these policies. However, little is understood about the relationship between policy and continuous quality improvement (CQI) for health promotion in healthcare. Furthering our understanding of benchmarks within these policies could provide insight into how we can measure and create standards in health promotion. This policy analysis examined publicly accessible healthcare healthy eating policies in Canadian health authority jurisdictions, up until November 22, 2022. METHODS: Data was extracted using a monitoring and evaluation framework for evaluating nutrition policies in publicly funded institutions, with adaptations based on organisational CQI concepts. Policy components analysed included: policy design, nutrient profiling systems, nutrition standards, evaluation, and monitoring. A second reviewer independently extracted data and peer debriefing was completed on the extractions. RESULTS: This analysis identified five healthy eating policies meeting the inclusion criteria, from Alberta, British Columbia, Newfoundland and Labrador, Nova Scotia, and Winnipeg, Manitoba. Policies included nutrient profiling, including benchmarks for selling healthy, moderately healthy, and less healthy food and beverages. Other benchmarks were mentioned but contained fewer indicators (e.g., fundraising, catering, and advertising). Policies included benchmarks about product and placement (e.g., healthier items in visible places) but less about price. The included policies promoted collaboration amongst healthcare providers but lacked details about evaluation and monitoring. CONCLUSION: This policy analysis suggests that different healthcare settings may require different benchmarks, tailored to their contexts. Furthermore, standardisation may not be optimal if further experimentation is needed to identify benchmarks for health promotion practices, as is common in healthcare CQI. Policy implementation requires a combination of top-down and bottom-up approaches, and collaboration with multiple partners may be necessary for success. Benchmarking processes are a potential strategy for understanding improvements to other aspects of the food environment beyond nutrient standards. SO WHAT: CQI and retail food environments each focus on customer satisfaction and costs, thus sharing alignments. CQI benchmarking processes are a potential strategy for understanding improvements to other aspects of the food environment beyond nutrient standards. Further exploration is needed to implement and monitor benchmarks over time.
Artificial intelligence systems are increasingly drawn upon to inform nursing practice, education, and health policy, often on the assumption that they produce stable, broadly consistent knowledge. This paper challenges that assumption by examining how seven widely accessible large language models, developed in distinct socio-technical and geopolitical contexts, interpret a shared global nursing challenge. Through comparative qualitative analysis of responses to a standardized zero-shot prompt on the global nursing shortage, four competing policy logics were identified, namely workforce, efficiency, equity, and mobility, with patterns that appeared consistent with aspects of the institutional environments associated with those systems' development. Each response was internally coherent and presented with substantial authority, yet none acknowledged the situatedness of its own framing. The paper argues that such outputs in nursing should be understood as situated artifacts rather than as neutral knowledge, and offers a framework of questions to guide discretion for nurses, educators, and policymakers engaging with these tools. Recognizing this plurality is necessary for safe, contextually grounded decision-making and for governance that addresses both interpretive variability and accuracy.
Journal of managed care & specialty pharmacyAntal Zemplenyi, Michael J DiStefano, Hanke Zheng, Jonathan D Campbell, R Brett McQueen
BACKGROUND: Unmet medical need (UMN) is frequently referenced in health policy and health care decision-making, including the Centers for Medicare & Medicaid Services' (CMS) Drug Price Negotiation Program (DPNP). However, the concept of UMN is often defined inconsistently and has a narrow focus, primarily centered on clinical effectiveness and the availability of treatment. This approach may overlook the wider needs of patients, caregivers, and society as a whole. A broader conceptualization of UMN has been proposed, yet there remains a lack of an actionable implementation framework. OBJECTIVE: To examine how stakeholders interpret and distinguish among UMN elements, prioritize these elements based on perceived importance, and elicit perspectives on the applicability of a prioritized UMN framework in a decision-making context. METHODS: A multistakeholder workshop was conducted in June 2025 involving 17 participants representing researchers, industry, payers, policymakers, and a patient organization. Participants evaluated 38 UMN elements grouped into 7 domains derived from a prior structured literature review. Using an interactive polling platform, participants assessed the conceptual distinctness of elements within domains, ranked domains by importance, and completed a pairwise weighting exercise grounded in the Simple Multi-Attribute Rating Technique. Quantitative voting results were aggregated, and qualitative feedback from plenary discussions was recorded and thematically synthesized. RESULTS: Participants confirmed the conceptual distinctness of the proposed domains and elements. In the weighting exercise, traditional clinical effectiveness received the highest importance (24%), followed by availability of other treatments (19%) and impacts on patient, caregiver, or family quality of life (16%), although differences across domains were modest and should be interpreted with caution, given the exploratory sample. Economic burden on patients and families (13%), societal perspective elements (11%), and economic burden on society (10%) received moderate weights, whereas treatment administration attributes received the lowest weight (7%). Participants agreed that the broader element set captures dimensions of UMN not addressed by the current framework under CMS's DPNP. Key qualitative themes included perceived overlap within elements of the quality-of-life domain, the need for clearer conceptual boundaries between UMN and comparative effectiveness, and feasibility concerns around implementation. CONCLUSIONS: UMN is inherently multidimensional and extends beyond traditional clinical measures. These exploratory findings suggest that structured prioritization of UMN domains may support more transparent and policy-relevant frameworks for evaluating unmet need in the United States, including within CMS's DPNP.
Health promotion journal of Australia : official journal of Australian Association of Health Promotion ProfessionalsSiona Fernandes, Eleanor Holroyd
ISSUE ADDRESSED: Physical activity (PA) and sport are mechanisms that promote health and social belonging, yet evidence of policies promoting sports participation and inclusion for Australia's growing migrant population is limited. This study examined how Australian federal, Victorian state and local government (LG) policies address migrant inclusion and equitable sports participation, with a secondary focus on Asian Indians, Australia's largest Asian ethnic group. METHODS: Twenty public-facing policy documents drawn between 2014 and 2024 were systematically selected and thematically analysed (federal: n = 10, state: n = 2, LGs: n = 8) using content analysis with 10 predefined categories drawn from migrant-contextual PA domains and planning aspects. RESULTS: Fifteen documents referenced migrant-specific keywords. Key categories included social and cultural contexts, physical environment and target groups. Sociocultural framing in national and LG documents highlighted sport's role in migrant integration. Victorian LGs adapted the physical environment to accommodate informal and culturally specific sports (e.g., kabaddi), fee-free options and multisport facilities. Few national sport-sector documents distinctly target migrants. Immigration-sector documents identified new arrivals, highlighted cross-government partnerships that integrated sport within workplace initiatives, and adopted a migrant-focused evaluation framework. Most documents lacked actionable migrant-focused initiatives and details on budget, timeframes or legal compliance. CONCLUSION: Migrant inclusion is gaining attention in national sport policy initiatives but is insufficiently addressed in state-level documents. Intersectional approaches, targeted planning, collaboration between sport, immigration and health sectors, and increased political advocacy could advance migrant equity.
The Journal of school healthMaryam Karkhaneh, Nasrin Omidvar, Farid Zayeri, Vahid Yazdi Feyzabadi, Hamid Abbasi, Saeid Doaei, Azam Doustmohammadian
BACKGROUND: The Nutrition-Friendly School Initiative (NFSI) is a whole-school approach designed to address the triple burden of malnutrition among school-aged children. However, evidence on its implementation across diverse settings remains fragmented. METHODS: This scoping review followed Arksey and O'Malley's framework and searched PubMed, Web of Science, Embase, Scopus, and gray literature sources for studies explicitly implementing the NFSI framework. FINDINGS: Sixteen records were included. Evidence suggests that NFSI implementation improves nutrition knowledge, dietary behaviors, and selected health outcomes, including BMI, stunting, and micronutrient status. Major facilitators included institutional commitment, multisectoral collaboration, and stakeholder engagement. Common barriers were limited resources, insufficient training, weak policy enforcement, and sociocultural resistance. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Integrating NFSI principles into education and public health systems may strengthen school nutrition policies and reduce health inequities. Sustainable implementation requires cross-sector collaboration, equitable resource allocation, supportive school food environments, and stronger monitoring systems, particularly in resource-constrained settings. CONCLUSION: The NFSI is a promising framework for promoting child nutrition and health, but stronger long-term evaluations and more comprehensive implementation strategies are needed.
This paper argues that segmentation within Turkish nursing is a major factor holding back the modernisation of nurse management. Since the millennium Türkiye's healthcare system has been transformed by NPM-style reforms that changed financing mechanisms and strengthened aspects of performance management, but had only limited impact on nursing management. The entrenched power of the medical profession and persisting influence of a civil service 'officer culture' have been major obstacles to change, but a third factor is division within the nursing workforce. Our qualitative study identifies four orientations among hospital nurses. Plans for innovation proposed by bureaucratic modernisers and professional modernisers are resisted by traditionalists and pragmatists, and modernisers themselves disagree about the way forward. Western discourses concerning nurse professionalisation and leadership have had uneven impact. Interdisciplinary working is largely absent, as are the hybrid management/clinical roles and movement of nurses into executive management positions. Instead, nurse managers seek to advance a curtailed form of professional development centring of continuing professional education, evidence-based practice, guideline development and creating spaces to exercise limited autonomy. Given the huge political difficulties of reducing medical power and achieving civil service reform, the best prospect of progress is to address the tensions within nursing itself.
The Journal of school healthTiffany Beason, Zahra Ladhani, Karina M Aragón, Nancy Lever
BACKGROUND: Children's health and educational outcomes are interconnected, and unmet health needs affect youths' readiness to learn. Comprehensive school health (CSH) systems are designed to promote academic success and well-being for all youth. State and local health and education leaders benefit from guidance on how to build, fund, and sustain effective CSH systems to support the whole child. CONTRIBUTIONS TO THEORY: In this article, we offer core areas for CSH policy development with recommendations for enhancing the quality and scale of CSH systems. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Several key policy opportunities and strategies aligned with core features of a CSH are identified, including (1) adoption of a CSH framework, (2) enhancement of cross-sector coordination and collaboration, (3) use of standardized metrics to enhance CSH system quality, (4) engagement of youth and families in system building, (5) use of innovative strategies to enhance workforce capacity and development, and (6) establishment of a strategic funding plan. CONCLUSIONS: State and local health and education departments are challenged to act upon key policy opportunities to build, fund, and sustain CSH systems to promote student success, health, and well-being.
The Journal of school healthMary Curnutte, Leah Chapman, Ashely Kesack, Parisa Afsharian, Lucine Francis, Gina Genova, Erin Hager, Juliana Cohen
BACKGROUND: Healthy diets can improve cognitive function; therefore, school nutrition policies may support academic performance. Prior systematic reviews documented positive associations between school nutrition-related policies and academics, but less is known about their associations with academic inequities. This review updates the evidence while addressing the gap on academic inequities. METHODS: Building on two prior systematic reviews (2021, 2023) of naturally-occurring during-school U.S. nutrition policies and academics (i.e., attendance, test scores, behavior), we conducted an updated systematic search using their established terms and synthesized evidence on academic equity (differences in subgroup outcomes, i.e., race, ethnicity, income). RESULTS: This updated comprehensive review includes 33 studies (10 new, 23 from the prior reviews). Newly identified studies examined Universal Free School Meals (UFSM; n = 6), Breakfast After the Bell (BATB; n = 2), the School Breakfast Program (n = 1), and Recess Before Lunch (n = 1). Most reported positive or neutral academic associations. Most studies examining equity-related outcomes found larger academic improvements among subpopulations. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: School nutrition policies can improve academic achievement while addressing educational equity. CONCLUSIONS: UFSM and BATB equitably improve academic performance. More research is needed for other promising policies.
The Journal of school healthElizabeth Piekarz-Porter, Rebecca M Schermbeck, Julien Leider, Frank M Perna, Jamie F Chriqui
BACKGROUND: Children with disabilities are advised to meet the Physical Activity Guidelines for Americans and be as active as possible. A key opportunity for physical activity (PA) is physical education (PE). METHODS: State laws (50 states and DC) as of December 31, 2023, were compiled from commercial legal databases and double-coded as part of the National Cancer Institute's CLASS database. Laws were coded for any adapted physical education (APE) provision, APE teacher certification and qualification, and PE exemptions. RESULTS: While 49 states addressed the availability of APE, 16 states' laws did not indicate who is eligible. A total of 13 states' laws addressed APE curriculum standards, and 30 addressed APE teacher certification. In total, 15 states addressed who teaches APE at the elementary level and 14 at the middle/high school levels. PE exemptions for disability varied by grade. IMPLICATIONS FOR SCHOOL HEALTH POLICY AND PRACTICE: State laws represent an opportunity to better address APE, including who is qualified to teach APE and what standards could be used to guide such instruction when it falls to general PE educators. CONCLUSIONS: Greater attention to how state laws address the inclusion of students with disabilities is necessary, as PA is a key component of a healthy lifestyle for all children.
Clinical transplantationSamantha B Klitenic, Brigitte Sullivan, Gabriella Boulton, Jennifer McBride, Allan B Massie, Dorry L Segev, Macey L Levan, Babak J Orandi
INTRODUCTION: Body mass index (BMI) has long served as a screening tool for assessing procedural risk and is used as an exclusion criterion for insurance coverage. Variation in state Medicaid policies, specifically pre-transplant BMI requirements, may affect transplant eligibility and limit access to transplantation. No published literature summarizes these policies. We conducted a 50-state review of Medicaid policies to identify pre-transplant BMI requirements across solid organ transplantation (heart, lung, liver, kidney, pancreas, intestine). METHODS: Public records requests were submitted to state Medicaid offices for relevant policy documents. Policies were categorized as: (1) Restrictive: precludes transplant coverage if a specified weight/BMI cutoff is not met; (2) Somewhat restrictive: no explicit BMI requirements but deference to managed care organization (MCO)/transplant center criteria; or (3) Unrestrictive: no BMI requirements or publicly available MCO/transplant center criteria. RESULTS: Three states (HI, IA, and NC) had restrictive policies with pre-transplant weight/BMI requirements for coverage of heart, lung, and combined heart-lung transplants. None applied to kidney, liver, pancreas, or intestine transplants. Thirty-two states and DC had somewhat restrictive policies; 15 had unrestrictive policies. CONCLUSIONS: Most state Medicaid policies do not contain explicit BMI eligibility requirements for transplant coverage. Instead, BMI-based criteria typically originate from MCOs/transplant centers that establish and enforce their own criteria.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationJevaise Aballo, Porbilla Ofosu-Apea, Catherine Adu-Asare, Olivia Adzoa Mawunyo Timpo, Hikmatu Abdulai, Cristina Alvarez Sanchez, Melissa Vargas, Annette Imohe,…
BACKGROUND: Malnutrition among school-age children and adolescents in Ghana is driven by poor diet quality and weakly regulated school food environments (SFEs). School-based Food and Nutrition Education (SFNE) is a key strategy, but its effectiveness depends on coordinated capacity across sectors. This study assessed the enabling factors, and priority actions for institutionalising SFNE. METHODS: The FAO SFNE capacity needs assessment tool was used, with a multi-phase qualitative study design. Document review and stakeholder mapping were conducted, followed by a two-day consultative workshop. Capacities were assessed across system levels and prioritised through ranking. RESULTS: Ghana has supportive SNFE policies; however, implementation is fragmented, lacks unified legal framework, and constrained by inadequate data. Integration into curricula, teacher training, and SFEs is weak, with reliance on short-term funding. Priority actions included strengthening coordination, developing standards; improving data systems, aligning curricula, enhancing SFEs, and sustainable financing. IMPLICATION FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Institutionalising SFNE will ensure learners receive high-quality equitable nutrition education and access to supportive school food environment. CONCLUSION: Ghana is well-positioned to institutionalise SFNE and may serve as a model for low- and middle-income countries.
Health policy and planningThahira Shireen Mustafa, Gareth Jones, Lucy Fagan, Philip Idoko, Petar Mladenov, Arlene B Tickner, Kathleen Sherwin, Anshu Mohan, Rajat Khosla
This paper presents a timely and critical analysis of the translation of global commitments made at the landmark 2023 Global Forum for Adolescents into national action to prioritize adolescent well-being. The Partnership for Maternal, Newborn & Child Health is monitoring implementation of these commitments. Employing a mixed methods approach, the paper examines the nature of these multi-stakeholder commitments and their early implementation in four diverse country contexts, specifically Bulgaria, Colombia, Malawi, and Nigeria. Key findings highlight the critical role of multi-sectoral coordination, the imperative of fostering genuine adolescent and youth engagement, and the complexities inherent in managing policy synergies and trade-offs within varied national realities. The analysis reveals that while the Global Forum for Adolescents successfully catalyzed unprecedented attention and pledges for adolescents, effective and sustainable realization of these commitments at the national and local level is an urgent imperative contingent upon overcoming persistent structural barriers and adopting adaptive, systems-informed policy responses. The paper examines the roles of various actors including governments, civil society, and young people, and concludes with a set of recommendations aimed at supporting systemic, long-term change through enhanced cross-sectoral collaboration and integrated policies and programs; and underscores the importance of a continued focus on accountability for adolescent well-being.
Health policy and planningDavid A Ross, Bhavya Nandini, Rajat Khosla, Anshu Mohan
Adolescents aged 10-19 years represent the largest cohort in human history and a critical global resource-yet realizing their potential requires deliberate, sustained investment in their health and well-being. This editorial introduces a six-article supplement in Health Policy and Planning addressing key priorities for adolescent health and well-being policy and programming, with particular attention to young people's own perspectives and evidence from low- and middle-income countries. The supplement opens with findings from the 'What Young People Want Survey', drawing on responses from over 1.5 million young people across 89 countries. Results reveal that adolescents' priorities span multiple domains-especially learning and employability, safety and supportive environments, and health and nutrition-underscoring the necessity of multi-sectoral approaches. Three articles address financing. Together, they demonstrate that integrated health-education interventions can yield returns of at least 11 dollars per dollar invested and that scaling up treatment for adolescent depression and anxiety produces benefit-cost ratios of 15.4 and 13.9 in Colombia and South Africa, respectively-while cautioning that investments must be designed with an explicit equity focus to avoid deepening existing inequalities. Another article presents new World Health Organization and Partnership for Maternal Newborn and Child Health guidance for monitoring adolescent health and well-being holistically across the five domains of the UN conceptual framework, supported by an Excel-based data tool that maximizes use of existing data. The supplement concludes with an early assessment of commitments made at the 2023 Global Forum for Adolescents across four countries, finding that progress is hindered by fragmented systems, funding gaps, and insufficient disaggregated data. The evidence presented in this supplement makes clear that improving adolescent health and well-being is neither aspirational nor unaffordable-it is an investment with compelling returns. Realizing those returns demands that adolescents' voices shape policy and that progress is rigorously monitored.
BMJ openMosa Moshabela, Lindy Dickson, Waasila Jassat, Helen Cox, Karina Kielmann, Marian Loveday, John Black, Koleka Mlisana, Mark P Nicol, Alison D Grant
OBJECTIVE: In response to growing numbers of people with drug-resistant tuberculosis (DR-TB), South Africa was, in 2011, among the first countries to launch a national policy on the decentralisation of DR-TB management, preceding normative guidance from the World Health Organization. The objective was to understand the process of formulation of the South African policy on DR-TB service decentralisation. DESIGN: Qualitative policy analysis. We reviewed policy-related documents to create a timeline, then conducted in-depth interviews with key individuals who had influence over or insights into the policy formulation process. We used Kingdon's policy analysis framework to examine the convergence of problem, policy and politics streams in agenda-setting to create the window of opportunity for policy adoption. SETTING: South Africa. PARTICIPANTS: Policy makers, implementers and researchers in three South African provinces and at national level, and international DR-TB experts. RESULTS: International publicity concerning the extensively drug-resistant TB outbreak in Tugela Ferry positioned DR-TB as a public health crisis. The health system lacked capacity to match hospital bed supply in specialised hospitals to the high number of people with DR-TB. Reports of detention against will, victimisation and stigmatisation, and failure to uphold person-centred approaches, sparked a human rights outcry. Tensions between actors favouring 'control-based' approaches with emphasis on centralisation and control of patient treatment and resources, and those favouring 'access-based' approaches that emphasised decentralised care led to a tipping point in the policy process. Centralised, specialised DR-TB approaches were perceived to protect quality of care, but these compromised person-centred care and human rights, and restricted access to DR-TB treatment. Policy actors used lessons from pilot studies of DR-TB decentralisation and HIV programmes to overcome policy stagnation. CONCLUSIONS: Policy makers should monitor demand and supply of specialised services and support evidence-informed policy change before health system pressures make reform unavoidable.
Global health actionAugustus Osborne, Camilla Bangura, Abdirasak Sharif Ali, Umaru Sesay, Morie Vandi
BACKGROUND: The Africa Health Security and Sovereignty (AHSS) Agenda of the Africa Centres for Disease Control and Prevention (Africa CDC) provides a continental framework for strengthening health security and sovereignty. As implementation begins, no document-based readiness assessment instrument exists to monitor progress against AHSS pillars and goals, limiting efforts to identify bottlenecks and target assistance. OBJECTIVE(S): To develop and apply a document-based scorecard for assessing policy readiness for AHSS implementation across selected African countries. METHODS: We conducted a qualitative policy analysis using systematic document review, deductive framework development, structured coding, and scorecard synthesis. The corpus comprised 48 documents: the AHSS Agenda, the African Union Roadmap to 2030, WHO AFRO guidance, and national policies from 12 named African countries in 5 regional economic community zones. A 10-dimension scorecard based on AHSS pillars and WHO building blocks was applied on a 3-level scale. A second author recoded the corpus independently; materials are openly deposited. RESULTS: Readiness was most consistently reflected in governance and strategic planning and least in financing specificity, digital health architecture, and laboratory and pharmaceutical systems. AHSS-relevant provisions appeared in 3 of 12 financing strategies, 3 of 10 pharmaceutical policies, and 2 of 12 plans, indicating strategic intent but weak operational readiness across the 10 dimensions. CONCLUSIONS: The AHSS/WHO document-based scorecard is a feasible and replicable instrument for monitoring readiness. It identifies governance and implementation gaps and helps Africa CDC, WHO AFRO, governments, and partners target technical assistance. Periodic application would strengthen implementation monitoring, cross-setting comparison, and accountability.
International journal of technology assessment in health careClifford Goodman, Iga Lipska, Karen Alparce-Villanueva, Emilia Caro, Adolfo Rubinstein, Virginie Giroux, Antonio Migliore
Health technology assessment (HTA) has advanced rigorous, transparent methods for informing resource allocation; however, persistent inequities, declining trust, and rapidly evolving technologies expose a gap between technical excellence and social justice. This perspective synthesizes Plenary Three of the HTAi 2025 Annual Meeting, which examined how HTA can contribute to more transparent, equitable, and fair health systems. Drawing on multistakeholder perspectives from patient advocacy, global health equity, health policy, industry, and HTA research, this article argues that transparency, equity, and trust must be treated as foundational principles rather than optional enhancements. It highlights persistent challenges, including opaque deliberation, context-dependent definitions of equity, limited feedback to patient contributors, and evidence bases that insufficiently reflect diverse populations. Emerging practices from leading HTA bodies illustrate practical pathways forward. The article concludes that HTA's convening power can help transform it from a technical gatekeeper into a guardian of fairer health systems across diverse contexts.
BMC medicineDaniel B Ibsen, Michael Fridén, Georgia D Tomova, Natalia Ortega, Peter W G Tennant
BACKGROUND: The recent three-part Lancet series on ultra-processed foods (UPFs) argued that the displacement of traditional diets by UPFs is a major driver of poor diet quality and diet-related chronic diseases, which is becoming a major public health challenge worldwide. This Debate article aims to highlight key uncertainties surrounding that evidence base and the causal interpretation of the reported associations. MAIN BODY: We discuss uncertainties related to three core questions central for making causal claims: what are UPFs, what are the mechanisms and what is the right comparison group? We argue that the breadth of the Nova classification system as an exposure framework encompasses nutritionally and functionally diverse foods that are unlikely to share common biological effects. This heterogeneity complicates causal inferences and risks conflating well-established dietary risk factors with more speculative attributes related to processing, additives, and food structure. Many of the proposed mechanisms linking UPFs to adverse health outcomes are not unique to ultra-processing and may operate similarly across foods regardless of processing level. While much emphasis has been given to the comparison between minimally processed and UPF, the comparison between processed food and UPF may better isolate the effects of ultra-processing. By embracing these uncertainties, we outline a way forward focusing on disaggregation of UPFs into specific components and characteristics. CONCLUSIONS: Advancing the evidence base in this way will support clearer attribution of risk and more targeted interventions. Public health policy should remain grounded in well-characterised dietary exposures while transparently acknowledging uncertainty around ultra-processing as an independent causal factor.
The Lancet. OncologyClare Turnbull, Sandra Perdomo, Susan Domchek, William D Foulkes, Paul Pharoah, Patricia Ashton-Prolla, Bhawna Sirohi, Joaquin Mateo, Hilary A Robbins, Richard…
Cancer susceptibility testing is rapidly advancing beyond specialist genetics clinics into routine oncology and population-level genomics initiatives. This expansion positions germline pathogenic variants in cancer susceptibility genes and polygenic risk scores as crucial tools for precision prevention, surveillance, and early detection. However, implementation has outpaced the evidence needed to justify testing at scale, particularly in well populations. For a small number of first-wave genes-including BRCA1, BRCA2, MLH1, and MSH2-cancer risks are well established and downstream medical interventions are supported by substantial observational evidence, albeit with an absence of randomised trials. Contrastingly, for many later discovered genes now included on multigene panels, penetrance estimates remain uncertain, variant-specific risks are poorly resolved, and evidence is scarce or absent regarding mortality reduction, quality of life benefit, or cost-effectiveness for the recommended downstream interventions. Polygenic risk scores offer promise for stratified prevention, but their discriminatory capacity is constrained, performance is ancestry dependent, and clinical utility remains uncertain in most settings. Building on the Lancet Oncology Commission on cancer genomics and precision oncology, this Policy Review examines the evidentiary, clinical, and health-system challenges associated with cancer susceptibility testing across clinical care and public health prevention. We argue that the value of such testing should be assessed in terms of its clinical value and public health utility, with careful attention to the context in which testing is offered. We propose a tiered, context-specific approach to implementation, aimed at distinguishing settings in which susceptibility testing could provide a net benefit from those scenarios in which its use should remain restricted, highly selective, or confined to research.
Global health actionDalia Hyzam, Taha Al-Mahbashi, Fekri Dureab, Timo Ulrichs
BACKGROUND: Health system resilience is often described through the World Health Organization building blocks, yet in protracted crises it depends on whether governance, financing, workforce, information systems, service delivery, and accountability can convert crisis response into institutional reform. OBJECTIVE(S): This study examines how far Yemen's health system responses to prolonged conflict, economic decline, disease outbreaks, and COVID-19 progressed beyond absorptive and adaptive resilience toward transformative resilience, and how strategic health policy across the building blocks shaped this transition. METHODS: We conducted 30 in-depth interviews with national and subnational policymakers and health leaders in Yemen between May and July 2025. Data were analysed in ATLAS.ti 25 using framework-informed thematic analysis that combined a priori categories from the World Health Organization health system building blocks and resilience capacities with inductively developed empirical codes. RESULTS: Yemen demonstrated externally buffered absorptive capacity sufficient to prevent complete system collapse, together with uneven and localised adaptation through crisis committees, donor-supported financing, temporary workforce mobilisation, intensified surveillance, oxygen and isolation capacity, and referral workarounds. However, these responses were largely reactive, donor-dependent, and unevenly institutionalised. Transformative resilience remained constrained by fragmented authority, under-protected recurrent financing, workforce instability, weak data-to-decision pathways, limited referral governance, and the absence of formal learning-to-reform mechanisms. CONCLUSIONS: Yemen's experience shows that resilience in protracted crisis settings should be judged not only by the survival of repeated shocks, but by whether absorptive and adaptive gains are converted into institutional capability through strategic policy alignment across the health system.
Global public healthCarole H Browner, Gustavo Leal Fernández, Héctor Javier Sánchez-Pérez
Mexico has one of the world's highest prevalence rates of elevated body weight among adults, with more than one-third of children and adolescents also affected. These patterns create major challenges for life expectancy, healthcare system sustainability, and long-term economic productivity. This article examines current patterns of elevated body weight in Mexico and their links with chronic disease. It explores the sociohistorical, political-economic, and cultural factors that have shaped these trends and critically evaluates President Claudia Sheinbaum's Healthy Republic Plan as a policy framework for addressing the structural drivers of elevated body weight.
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.
Journal of the American Heart AssociationJeff Lane, Signe Burchim, Amanda Li, Janessa M Graves, Chris Longenecker, Sarah Masyuko, Jennifer Bacci, Sarah Gimbel, Allison Webel, Margaret Hammersla, Cassa…
BACKGROUND: Heart disease is the leading cause of death in the United States with a disproportionate impact in rural America, and health worker shortages contribute to these disparities. Team-based heart disease care models can help mitigate health worker shortages, but lack of role clarity and restrictive scope of practice laws can be a barrier to their implementation. METHODS: To better understand the intersection of licensed scope of practice laws with rural heart disease care, we performed a legal epidemiology analysis to identify and describe licensed scope of practice laws for 9 health worker cadres in 13 state and federal jurisdictions for 8 heart disease services. RESULTS: We found substantial ambiguity, variation, and some important gaps, which may undermine the predictability of regulatory and reimbursement environments and hinder implementation of innovative team-based care models. CONCLUSIONS: Three policy opportunities to address the identified gaps include: (1) linking licensed scope of practice definitions to the scope of accredited training curricula, (2) shifting away from collaborative practice agreements to define licensed scope of practice, and (3) prohibiting insurance plans from conditioning reimbursement based solely on provider cadre.
Expert review of vaccinesJiyeon Suh, Marc Brisson, Emily A Burger, Jane J Kim, Jean-François Laprise, Mark Jit
BACKGROUND: Although safe and effective human papillomavirus (HPV) vaccines have been available since 2006, national introduction in low- and middle-income countries (LMICs) has progressed slowly. HPV vaccine adoption may have been shaped by evolving World Health Organization (WHO) recommendations, funding policies of Gavi, the Vaccine Alliance, and the disruption from the Coronavirus Disease 2019 pandemic. However, their relative contributions have not been quantified. RESEARCH DESIGN AND METHODS: This study analyzed policy determinants of national HPV vaccine introduction rate in LMICs from 2006 to 2025, using: (i) generalized linear model (GLM) to assess predetermined policy events, and (ii) changepoint analysis to identify shifts in adoption trends. RESULTS: Across a range of GLMs exploring different events and outcome variables, WHO's one-dose recommendation in 2022 was most strongly associated with an increase in country introductions, with the expansion of Gavi's funding policy for HPV vaccines (2017-2025) also important in some models. Comparing model projections with and without the one-dose schedule yielded an estimated 22.46 additional national HPV vaccine introductions in LMICs. Changepoint analysis identified a significant increase in introductions in 2022. CONCLUSIONS: These results quantify the primary global drivers of HPV vaccine uptake, offering actionable insights for expanding equitable vaccine access.
BMJ openMohammad S Alyahya, Samer Abu Rumman, Mohammed Ibrahim, Moawiah Khatatbeh
OBJECTIVES: To explore how senior stakeholders assess Jordan's institutional readiness for universal health coverage (UHC), identify institutional pathways connecting fragmentation, purchasing strategies, accountability and public trust, and develop a bounded, phased policy roadmap. DESIGN: Exploratory qualitative study using semi-structured key-informant interviews and reflexive thematic analysis. SETTING: Jordan's national health-policy, financing, insurance, regulatory, digital-health and service-delivery institutions. PARTICIPANTS: 18 purposively selected senior stakeholders, supplemented by selective snowball referrals, representing legislative, executive, public-finance, civil-insurance, digital-health, public and private provider and technical functions. RESULTS: Nine themes were organised into four higher-order groups: (1) institutional fragmentation, governance and equitable access; (2) financing, information and digital readiness; (3) strategic purchasing and coordinated service delivery; and (4) social legitimacy, resilience and adaptive implementation. Participants described political commitment and substantial provider capacity as important foundations, but identified fragmented authority and insurance arrangements, weak purchasing, limited actuarial and integrated claims data, inconsistent public-private regulation, geographic inequities and conditional public trust as major constraints. The analysis suggests an institutional translation gap through which existing assets are not consistently converted into equitable, financially sustainable coverage. CONCLUSIONS: Jordan's readiness is multidimensional and uneven rather than binary. A phased pathway should first establish governance, legal, actuarial, data and social-protection foundations; then pilot benefit, claims, purchasing and primary-care reforms; and subsequently scale coverage subject to predefined readiness criteria. Findings concerning social acceptability reflect elite stakeholder perceptions and require direct validation with uninsured people, refugees, rural communities and frontline providers.
The objective of this study was to analyze the ideas about quality of AE, established through the legal documents of the National School Feeding Program (PNAE) in the period from 1955 to 2020, based on the constitutive dimensions of the FNS concept formalized in national legislation. Based on the method of document analysis and the theoretical references of discursive institutionalism, ideas about quality were problematized in light of the concept of food and nutritional security (SAN, acronym in Portuguese). 16 PNAE legislations were analyzed considering the historical, political and social context and conceptions about quality. The analysis was compared with scientific production, food and nutrition policy documents, SAN, AE and historical research. Ideas about AE quality have undergone transformations in several parameters and values, being influenced by SAN policies. The PNAE was initially institutionalized as a "food supplementation" program and was consolidated as a SAN program, where the quality of the AE considers everything from the origin of the food to its suitability for the local food culture. It currently incorporates the dietary guidelines of the food guides, indicating that the institutionalization of the PNAE enhances the combination of different dimensions of quality.