Search Results (369)

The global Black Lives Matter movement and COVID-19 pandemic drew attention to the urgency of addressing entrenched structural dynamics such as racialization, gender, and colonization shaping health inequities for diverse racialized people. Canadian community-based research with racialized immigrant women recognized the need to enhance service provider capacity using a strengths-based activism approach to support client health and wellbeing. In this study, we aimed to understand the impacts of this mental health promotion practice on service providers and strategies to support them. Through purposeful convenience sampling, three focus groups were completed with 19 service providers working in settlement and mental health services in Toronto, Canada. Participants represented varied ethnicities and work experiences; most self-identified as female and racialized, with experiences living as immigrant women in Canada. Postcolonial feminist and critical mental health promotion analysis illuminated organizational and structural dynamics contributing to burnout and vicarious trauma that necessitate a focus on trauma- and violence-informed care. Transformative narratives reflected service provider resilience and activism, which aligned with and challenged mainstream biomedical approaches to mental health promotion. Implications include employing a postcolonial feminist lens to identify meaningful and comprehensive anti-oppression strategies that take colonialism, racialization, gender, and ableism and their intersections into account to decolonize nursing practices. Promoting health equity for diverse racialized women necessitates focused attention and multilevel anti-oppression strategies aligned with critical mental health promotion practices. Full article

Despite growing global momentum to reduce the number of children who never received a dose of any vaccine, i.e., zero-dose (ZD) children, persistent geographic and social inequities continue to undermine progress toward universal immunization coverage. In Madagascar, where routine vaccination coverage remains below 50% in most regions, the non-governmental organization Doctors for Madagascar and public sector partners are implementing the SOAMEVA program: a targeted community-based initiative to identify and reach ZD children in sixteen underserved districts in the country’s south. This paper outlines the equity-sensitive evaluation design developed to assess the implementation and impact of SOAMEVA. It presents a forward-looking evaluation framework that integrates both quantitative program monitoring and qualitative community insights. By focusing at the fokontany level—the smallest administrative unit in Madagascar—the evaluation captures small-scale variation in ZD prevalence and program reach, allowing for a detailed analysis of disparities often masked in aggregated data. Importantly, the evaluation includes structured feedback loops with community health workers and caregivers, surfacing local knowledge on barriers to immunization access and program adoption. It also tracks real-time adaptations to implementation strategy across diverse contexts, offering insight into how routine immunization programs can be made more responsive, sustainable, and equitable. We propose eight design principles for conducting equity-sensitive evaluation of immunization programs in similar fragile settings. Full article

Background: Cognitive decline is a growing public health concern in Latin America, driven by rapid aging, widespread micronutrient inadequacies, and socioeconomic disparities. Despite the recognized importance of nutrition, many older adults struggle to meet daily dietary micronutrients requirements, increasing the risk of mild cognitive impairment (MCI). This study aimed to establish expert consensus on the role of Multivitamin and Mineral supplements (MVMs) in promoting cognitive healthy aging among older adults in Latin America. Methods: A panel of nine experts in geriatrics, neurology, and nutrition applied a modified Delphi methodology to generate consensus statements. The panel reviewed the literature, engaged in expert discussions, and used structured voting to develop consensus statements. Results: Consensus was reached on 14 statements. Experts agreed that cognitive aging in Latin America is influenced by neurobiological, lifestyle, and socioeconomic factors, including widespread micronutrient inadequacies (vitamins B-complex, C, D, E, and minerals such as zinc, magnesium, chromium, copper, iron and selenium), which were identified as critical for global cognitive function and brain structures, yet commonly inadequate in the elderly. While a balanced diet remains essential, MVMs can be recommended as a complementary strategy to bridge nutritional gaps. Supporting evidence, including the COSMOS-Mind trials, demonstrate that MVM use improves memory and global cognition, and reduces cognitive aging by up to 2 years in older adults. Conclusions: MVMs offer a promising, accessible adjunct for cognitive healthy aging in Latin America’s elderly population, particularly where dietary challenges persist. Region-specific guidelines, public health initiatives, and targeted research are warranted to optimize outcomes and reduce health inequities. Full article

Cancer disparities in low- and middle-income countries (LMICs) arise from multifaceted interactions between environmental exposures, infectious agents, and systemic inequities, such as limited access to care. The exposome, a framework encompassing the totality of non-genetic exposures throughout life, offers a powerful lens for understanding these disparities. In LMICs, populations are disproportionately affected by air and water pollution, occupational hazards, and oncogenic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), Helicobacter pylori (H. pylori), human immunodeficiency virus (HIV), and neglected tropical diseases, such as schistosomiasis. These infectious agents contribute to increased cancer susceptibility and poor outcomes, particularly in immunocompromised individuals. Moreover, climate change, food insecurity, and barriers to healthcare access exacerbate these risks. This review adopts a population-level exposome approach to explore how environmental and infectious exposures intersect with genetic, epigenetic, and immune mechanisms to influence cancer incidence and progression in LMICs. We highlight the critical pathways linking chronic exposure and inflammation to tumor development and evaluate strategies such as HPV and HBV vaccination, antiretroviral therapy, and environmental regulation. Special attention is given to tools such as exposome-wide association studies (ExWASs), which offer promise for exposure surveillance, early detection, and public health policy. By integrating exposomic insights into national health systems, especially in regions such as sub-Saharan Africa (SSA) and South Asia, LMICs can advance equitable cancer prevention and control strategies. A holistic, exposome-informed strategy is essential for reducing global cancer disparities and improving outcomes in vulnerable populations. Full article

More than 50 years ago, children were viewed as naturally resilient and often labeled invulnerable or invincible. Resilience is now understood to be the result of dynamic interactions between individual, familial, social, and environmental systems, decentralizing the focus from the individual to the global society. Experiences with adversity may emanate from the youth’s family environment, their community, the school system, and larger structural challenges related to poverty, discrimination, health disparities, and educational inequities. Youth experiences with adversity, trauma, and tragedy have the potential to negatively impact youth well-being, with consequences manifesting across the lifespan. Children and adolescents generally hold limited power to change their circumstances and are often ill-equipped to resolve the adverse or traumatic experiences occurring within their ecosystem. The value of social supports in the young person’s ability to be resilient has been affirmed. This understanding is particularly important for children growing up in poverty or in Low- and Middle-Income Countries (LMICs) where significant challenges occur as a result of economic and social disadvantage. Resilience at the individual level is unlikely to eliminate macrolevel issues. Developing and deploying strategies to enhance the ability of youth to rebound from adversity represents a positive step at the micro level, but the larger issues of economic and social disadvantage are unlikely to change without macro-level interventions. Glancing toward the future, traumatized youth may grow into traumatized adults without appropriate interventions and changes in social policies, programs, and protections. Full article

Background/Objectives: Syphilis, a re-emerging global public health issue, has shown increasing incidence over the past decade, particularly among key populations such as men who have sex with men (MSM), people living with HIV, and pregnant women. This narrative review aimed to synthesize global epidemiological trends of syphilis from 2015 to 2025, with a focus on surveillance gaps, regional disparities, and structural determinants. Methods: A broad narrative approach was used to collect and analyze epidemiological data from 2015 to 2025. The literature was retrieved from databases (PubMed, Scopus) and official reports from the WHO, CDC, and ECDC. Included materials span observational studies, surveillance reports, and modeling data relevant to global trends and public health responses. Results: Globally, syphilis incidence has increased, with notable surges in North America, Europe, and Asia. MSM remain disproportionately affected, while congenital syphilis is resurging even in high-income countries. Low- and middle-income countries report persistent burdens, especially among women of reproductive age, often exacerbated by limited screening and surveillance infrastructure. The COVID-19 pandemic disrupted syphilis-related services and further exacerbated underreporting, hindering timely detection and response efforts. Surveillance systems vary widely in their completeness and quality, which significantly hinders global data comparability and coordinated public health responses. Conclusions: Despite its curability, syphilis continues to spread due to fragmented prevention strategies, inequities in access to care, and insufficient surveillance. Strengthening diagnostic access, integrating prevention efforts into broader health systems, and addressing social determinants are essential. Improved surveillance, equitable access, and innovation—including diagnostics and potential vaccine research—are critical to controlling the global syphilis epidemic. Full article

Teacher mental health is a growing concern in educational and public health systems worldwide. This meta-analysis systematically examines the relationship between teacher self-efficacy—a core construct in social cognitive theory—and job satisfaction, both considered crucial indicators of occupational well-being. A total of 39 studies involving teachers across 18 countries were analyzed, yielding a significant positive correlation between self-efficacy and job satisfaction (r = 0.41, p < 0.001), with notable heterogeneity (I² = 97%). Subgroup analyses revealed that the relationship was significantly stronger among teachers in high school and post-secondary contexts, and in studies conducted in Southern Hemisphere countries, highlighting the role of contextual and systemic moderators such as educational level and geographic inequality. The findings underscore the need for school- and policy-level interventions that bolster teachers’ self-efficacy through professional development, emotional support, and improved working conditions. Such interventions are essential not only for enhancing job satisfaction and reducing attrition but also for promoting the psychological resilience and well-being of the global teaching workforce. The study provides evidence-based insights into education and health policymakers aiming to support teacher retention and mental health through scalable, targeted initiatives. Full article

Scientific knowledge and international collaboration are critical to achieving the Sustainable Development Goals (SDGs). This study conducts a large-scale bibliometric analysis of 49.4 million publications indexed in the Web of Science (1945–2023) related to the SDGs, with a specific focus on SDG 3 (Good Health and Well-Being). Since 1992, SDG 3 has accounted for 58% of SDG-related scientific output. Using K-means clustering and network analysis, we classified countries/regions by research productivity and mapped core–periphery collaboration structures. Results reveal a sharp concentration: the United States, China, England, and Germany account for 51.65% of publications. In contrast, the group composed of the 195 least productive countries and territories accounts for approximately 5% of the total scientific output on the SDGs, based on the same clustering method. Collaboration patterns mirror this inequality, with 84.97% of partnerships confined to the core group and only 2.81% involving core–periphery cooperation. These asymmetries limit the capacity of developing regions to generate health research aligned with local needs, constraining equitable progress toward SDG 3. Expanding scientific cooperation, fostering North–South and South–South collaborations, and ensuring equitable research funding are essential to promote inclusive knowledge production and support sustainable global health. Full article

Background and aim: The death of a woman while pregnant or within 42 days of delivery, regardless of the cause of death, or even up to one year after the end of the pregnancy, due to causes related to or aggravated by pregnancy remains a critical public health problem globally and in Colombia. While the country shows a general decreasing trend (preliminary Maternal Mortality Ratio 38.6/100,000 live births in 2023), significant regional disparities persist. Understanding precise underlying causes, especially in high-complexity referral centers, is vital. This study describes the sociodemographic and anatomopathological characteristics associated with autopsy-verified maternal mortality cases at a Level-4 hospital in southwestern Colombia (2000–2023). Methodology: A descriptive observational retrospective study analyzed 42 maternal mortality cases verified by clinical autopsy (2000–2023) at the Pathology Department of Universidad del Valle, a Level-4 referral center in Cali, Colombia. Cases met the WHO definition. Data on sociodemographic, clinical, and pathological characteristics were retrospectively extracted from clinical records and autopsy reports. Results: The analysis of 42 autopsies (2000–2023) showed that 85.7% were early maternal deaths. Indirect causes predominated (57.1%, n = 24) over direct (42.9%, n = 18). Septic shock was the main indirect cause (65.2% of indirect), often from endemic infections. Hypovolemic shock due to PPH was the main direct cause (50% of direct). A high proportion were from subsidized/uninsured schemes (65.7%) and had a migratory history (20%). Discussion and conclusions: This study highlights the value of autopsy in revealing maternal mortality etiologies, showing a predominance of indirect/infectious causes and endemic diseases often missed clinically, despite PPH remaining the main direct cause. Findings reaffirm the strong link between maternal death and social/economic inequity, access barriers, and regional/migratory vulnerabilities. Effectively reducing maternal mortality necessitates rigorous clinical management, regionalized public health strategies addressing inequities, and integrating pathological data for targeted surveillance. Full article

Global refugee flows’ increasing scale and complexity pose significant challenges to national education systems. Turkey, hosting one of the largest populations of refugees and individuals under temporary protection, faces unique pressures in ensuring equitable educational access for refugee students. Addressing these challenges requires a shift from linear, fragmented interventions toward holistic, systemic approaches. This study applies a Community-Based System Dynamics (CBSD) methodology to explore the systemic barriers affecting refugee students’ participation in education. Through structured Group Model Building workshops involving teachers, administrators, and Non-Governmental Organization (NGO) representatives, a causal loop diagram (CLD) was collaboratively developed to capture the feedback mechanisms and interdependencies sustaining educational inequalities. Five thematic subsystems emerged: language and academic integration, economic and family dynamics, psychosocial health and trauma, institutional access and legal barriers, and social cohesion and discrimination. The analysis reveals how structural constraints, social dynamics, and individual behaviors interact to perpetuate exclusion or facilitate integration. This study identifies critical feedback loops and leverage points and provides actionable insights for policymakers and practitioners seeking to design sustainable, systems-informed interventions. Our findings emphasize the importance of participatory modeling in addressing complex societal challenges and contribute to advancing systems thinking in refugee education. Full article

In the intersecting field of energy consumption and human well-being, many macro-level studies link national energy use with well-being. These studies often rely on aggregate data, however, limiting insights into intra-national inequities and diverse well-being outcomes. To bridge this gap, this study used a single Nordic survey that allowed for the calculation of consumption-based energy footprints alongside well-being measures, focusing on Icelandic participants. A factor analysis of well-being responses identifies four factors: Eudaimonic, Financial, Housing/Local, and Health-related well-being. We found that well-being in Iceland largely remains decoupled from energy footprints across income and consumption groups, except for financial well-being. However, these groups differ significantly in consumption lifestyles and associated footprints, with only a small fraction of consumers maintaining energy use within global sufficiency thresholds. Most exceed these levels, suggesting that Iceland could reduce energy consumption without significantly harming well-being. Future research should explore strategies to lower consumption without triggering negative social reactions or declines in well-being. Full article

Promoting clean energy transition in rural areas is a key path to achieving global sustainable development, protecting public health, and promoting ecological livability. Based on data from the China Family Panel Studies (CFPS), this paper employs a multi-dimensional fixed effects model to evaluate the impact of income inequality on rural households’ clean energy transition (CET) and examines its underlying mechanisms. Research findings indicate that income inequality significantly suppresses rural households’ CET, primarily by reducing basic energy consumption and hindering the upgrading of basic energy consumption structures. Government governance quality exerts a significant negative moderating effect on the relationship between income inequality and rural households’ CET. Further analysis shows that the inhibitory effect of income inequality on CET is more significant in the regions with a low economic development level and low coal resource endowment, and in the western and northeastern regions of China. Therefore, while continuously promoting rural income growth, the government should prioritize equitable distribution, strengthen institutional capacity-building, improve the social service and security system, and facilitate rural households’ CET. Full article

Background: Subjective socioeconomic status (SES) is a powerful determinant of health and well-being, capturing individuals’ perceptions of their material conditions and security. While higher perceived financial and basic needs security are generally linked to better health outcomes, little is known about how these associations differ across global contexts. Drawing on data from 23 countries, this study tests whether these relationships are systematically weaker in Global South countries. Methods: Cross-sectional data from Wave 1 of the Global Flourishing Study (n = 207,000) were used to examine associations between subjective SES indicators—financial security and security in basic needs (food, housing, safety)—and two outcomes: self-rated physical health and mental health. All variables were measured on 0–10 scales. Linear regression models were estimated separately by Global South and Global North country status, adjusting for age and sex. Global South classification was based on standard development and geopolitical frameworks. Results: In both global regions, individuals with higher perceived financial and basic needs security reported significantly better mental and physical health. However, the strength of these associations was consistently weaker in Global South countries. Interaction terms confirmed that Global South status moderated the association between subjective SES and health outcomes. Conclusions: These findings suggest global-scale “diminished returns” of subjective SES on health, echoing patterns previously observed within countries. Structural inequalities, weaker public systems, and contextual adversity may dilute the health benefits of perceived security in Global South settings. Global health equity efforts must therefore move beyond individual-level interventions to address the broader systems that constrain the translation of socioeconomic resources into health. Full article

Global data reveal ongoing inequalities faced by minorities, often reinforced by media portrayals that depict them as threats, victims, or passive individuals without agency. While media framing has been extensively studied, especially in terms of media content and representation, few studies have examined how journalists perceive and navigate the coverage of minorities. This study addresses that gap by examining how Greek journalists perceive mainstream media coverage of refugees and migrants, LGBTQ+ individuals, and people with mental health challenges, with particular attention to their sourcing practices and sense of ethical responsibility. Fourteen journalists participated in semi-structured interviews, and thematic analysis was applied to identify key patterns. Journalists described dominant media narratives as fragmented, stereotypical, and dehumanizing, noting the frequent use of linguistic inaccuracies, misinformation, and the absence of personal stories. At the same time, they reported opportunities within their own sourcing practices to promote more inclusive and accurate coverage. Ethical concerns were expressed on three levels—union; corporate; and personal—with calls for clearer editorial guidelines and dedicated training. Many participants emphasized the role of personal ethics as a guiding compass in navigating complex newsroom pressures. Full article

Gender inequality remains a persistent issue in healthcare, especially in ophthalmology, where women face systemic barriers such as pay gaps, limited surgical opportunities, harassment, and unequal family expectations. Despite increasing entry into the field, women remain underrepresented in leadership, affecting career advancement and patient care. This study examines how virtual platforms, and co-led initiatives can address gender disparities in eye health. In 2021, Women in Ophthalmology, Seva Foundation, and Orbis International launched the Women’s Leaders in Eye Health (WLEH) initiative—a global community promoting mentorship, networking, and leadership development. Starting with virtual webinars and informal networking, the initiative expanded to in-person events in 2023 due to strong global engagement and demand. Early virtual programming, including webinars and “Coffee Hour” sessions, proved effective and laid the groundwork for broader offerings such as mentorship and professional development grants. WLEH’s success underscores the power of collaboration in promoting gender equity. By fostering connections and leadership pathways, WLEH offers a scalable model to break down gender challenges and uplift the next generation of women leaders to deliver more accessible eyecare globally. Full article