The COVID-19 pandemic highlighted the importance of integrating the concepts of Public Health Emergency Preparedness and health system resilience, emphasizing the role of coordination across sectors, which is essential for ensuring that systems can respond effectively to public health threats and manage resources efficiently. This paper aims to summarize the lessons learned from the COVID-19 pandemic among European Union Member States, focusing on gaps and improvement areas within coordination of healthcare services. The study analyzes the experience of Croatia, Finland, Germany, Italy, and Spain during the initial phase of the pandemic. These countries were selected for their diverse organizational structures and varying responses to COVID-19. The research involved literature reviews, analyses of pandemic preparedness plans, and interviews with national focal points and experts. Key areas of public health emergency capabilities were examined using the Public Health Emergency Preparedness Logic Model developed in 2017, with a particular focus on coordination of health services. The analysis focused on four capabilities in the health services domain. Among them, coordination of population-based medicine emerged as a key element in integrating public health and primary care during pandemics and to ensure consistent and coherent response within the whole health system. Common challenges included organizational fragmentation and communication barriers, which hindered effective coordination across healthcare services. The COVID-19 pandemic revealed, at national, regional and local levels, several gaps in coordination between hospitals, primary care, and public health services. At the same time, it provided lessons on measures that countries can implement to enhance Public Health Emergency Preparedness and thus resilience of health systems, for future health emergencies. By fostering collaboration between services and addressing systemic barriers, healthcare systems can enhance coordination and deliver high-quality, patient-centered care​. More than anything, the pandemic underscored the importance of effective leadership and system adaptability strongly aligned with comprehensive emergency plans that clearly outline in advance tasks, responsibilities and procedures. Furthermore, creating effective communication channels and tools can significantly improve information exchange between healthcare providers and emergency responders, ensuring timely and efficient responses to emerging health threats.
BACKGROUND: The COVID-19 pandemic exposed weaknesses in health systems globally, highlighting chronic underinvestment, fragmentation, and a lack of preparedness with catastrophic impact on public health, economies and societies. Lessons learned reconfirmed the necessity to build health systems resilience, integrating efforts to achieve Universal Health Coverage (UHC) and health security in tandem. RESULTS: This study identified 63 global and regional policies, collaborations, and investments (collectively termed “initiatives”) that came out post-COVID-19 and reviewed them in reference to their focus on integration of UHC and health security through the lens of WHO’s seven policy recommendations for building resilient health systems. The findings indicate that while efforts to align UHC and health security are evident at global and regional levels, they vary in depth and coherence. 81% of initiatives align with at least four of the seven WHO policy recommendations. While there is emphasis for health security preparedness, focus on primary care and health promotion is less pronounced. Policy initiatives show stronger alignment with WHO policy recommendations compared to Collaborations or Investments, indicating synergies between policies, while apparently a gap between policy and practice. Multilateral groups, including UN agencies, and government-affiliated organizations show greater alignment with the WHO policy recommendations too, while there is less alignment with those from non-governmental and other entities. CONCLUSIONS: This review shows that while post COVID-19 policies increasingly articulate visions for integrated health systems strengthening, existing collaborations and investments have not demonstrated comparable commitment to the implementation of these visions. This underscores a prevailing disconnect among global health actors and the mostly reactive and short-term nature of external investments and partnerships. In low-income and fragile health system contexts, this misalignment risks the inefficient use of global support and may perpetuate foundational weaknesses in health systems. Moreover, this is particularly problematic given worsening fiscal constraints from reductions in overseas development assistance and country-level economic contractions. By (re)orienting global health policies, collaborations, and investments toward more unified approaches to achieving UHC and health security, the international community can more effectively support countries in building health systems capable of withstanding future crises, maintaining essential health services and safeguarding gains in health equity.
BACKGROUNDS: Rising interest in solidarity in global health reflects a growing need to understand why and how it can shape global health policy, practice, and research. This study seeks to review existing studies on solidarity in relation to global health and to identify gaps in current knowledge. METHODS: We conducted a scoping review of papers published between 2007 and 2024 to explore how solidarity is conceptualised and practised in the context of global health. Our search, guided by the key concepts of solidarity and global health, identified 752 studies across four databases: SCOPUS, PubMed, Global Health, and Google Scholar. Following a rigorous screening and full-text review process, 83 peer-reviewed journal articles meeting the inclusion criteria were selected for thematic review. This analysis focused on examining the relationships between solidarity and global health problems, norms, and practices. RESULTS: The majority of the 83 reviewed articles were theoretical or conceptual in nature (63.9%) and predominantly authored by individuals affiliated with institutions in high-income countries (65.1%). The articles spanned multiple disciplines, with philosophy and applied ethics, including bioethics, being the most prominent (34.9%). Our findings indicate a growing interest in incorporating non-Western perspectives on solidarity and health into recent scholarship. The literature at the intersection of solidarity and global health showed that solidarity is often broadly defined–frequently without explicit reference to global health–and conceptualised in diverse ways, although some agreement exists on its core components. Solidarity’s focus on relationality and interdependence was found to align well with decolonial, feminist or ecological approaches. However, this review also identified a significant gap between the conceptualisation of solidarity and its practical implementation, largely due to structural barriers that impede its translation into action, often leading to undesirable outcomes. CONCLUSION: This review underscores the conceptual and practical potential of solidarity to reshape some of the foundational assumptions, objectives, and processes of global health. However, substantial work is still needed to clarify more nuanced understandings of solidarity within the global health context, to establish a comprehensive and prescriptive framework that guides an understanding of genuine solidarity and its applications while avoiding merely rhetorical uses and adverse outcomes, and to address the structural barriers that hinder their practical application. CLINICAL TRIAL NUMBER: Not applicable.
BACKGROUND: While a global player in the mining and metals sector, there is little regulatory oversight by Canada of Canadian mining companies in relation to their transnational activities. Much mineral exploration and mining take place in remote and rural areas inhabited by Indigenous and other minoritized and/or marginalized communities, and has been linked to worsening health, social, and environmental conditions. Few effective legal mechanisms exist to monitor, investigate, and provide effective remedies for their harmful impacts. METHODS: Three focal mining communities representing different mining life stages were studied: exploratory phase (Philippines), midlife (Brazil), and a transitioning to end-stage that has now been reinvigorated post-nationalization (Kyrgyz Republic). A qualitative approach based on locale-specific community consultations was employed with analysis informed by a theoretical framework based on the commercial, political, and social determinants of health, environmental justice, and their interactive and embodied impacts. RESULTS AND DISCUSSION: The community consultations yielded the following notable findings: a failure to acknowledge Indigenous rights (all sites); intimidation and harassment of local residents raising objections (Brazil and Philippines); the centrality of mines entrench social and economic inequities —including pre-existing ones (all sites); prior experience and knowledge of harms linked to extractive resource industries affect perception and resistance to mines (Brazil and Philippines) and the presence of widespread illness and disease among miners (Brazil and Kyrgyz Republic). Participants expressed support for community-driven mining and health studies documenting long-term occupational and environmental health impacts, particularly respiratory and water-borne illnesses. CONCLUSIONS: Despite the lethargy, obfuscation, and refusal of the Canadian government to take action on the global interests and actions of its corporations operating abroad, local efforts to resist the experienced and potential harms of transnational Canadian mining operations are noteworthy. Canada must comply with its binding international human rights obligations and move beyond its failed policy approach to addressing the harmful impacts of these endeavours. Future research must be conducted with and be accountable to local communities. CLINICAL TRIAL NUMBER: Not applicable.
The arms industry and the global trade in weapons pose significant direct and indirect risks to population health and equity. While health-harming industries such as tobacco, alcohol, and ultra-processed foods have been extensively examined with a commercial determinants of health lens, the commercial strategies of the arms industry remain critically underexplored in public health research. To address this gap, we conducted a scoping review of peer-reviewed literature published between 2004 and 2024. Searches were undertaken across four academic databases (Web of Science, Scopus, ABI/INFORM, and Business Source Complete) and Google Scholar. Data were extracted and analysed using deductive and inductive coding, guided by a previously published typology of commercial practices: financial, political, scientific, marketing, supply chain and waste, labour and employment, and reputational management practices. Forty-one studies met the inclusion criteria. Marketing and political practices were the most frequently reported, while supply chain and waste, financial, labour and employment, reputational management, and scientific practices were less common. Our review found that the arms industry not only engages in commercial practices identified within established commercial determinants of health frameworks but also employs additional strategies, such as bribery and corruption, worker surveillance, contesting worker illness claims, and a number of supply chain practices that extend beyond existing typologies. The majority of studies focused on firearms-related practices, particularly within the United States, while few addressed other arms industry sub-sectors such as major conventional weapons and nuclear weapons, and little attention was given to low- and middle-income countries. Despite the scale and influence of the arms industry, its commercial sector practices remain largely overlooked in public health research. Greater scrutiny and recognition of the arms industry as a commercial determinant of health is essential to mitigate the health harms and inequities associated with the global production, proliferation, and use of weapons.
The Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) has generated intense debate in Thailand, concerning its implications for public health, particularly intellectual property, and access to medicines. During 2018-2022, Thailand undertook an extended in-country process to provide evidence on its economic opportunity and public health challenges for the Cabinet decision. However, there is no evidence indicating whether Thailand has decided to join the CPTPP. This study examines Thailand's CPTPP negotiation process using a political economy framework, focusing on the institutional and actor landscape that shaped the negotiations. This study employed a qualitative research design grounded in political economy theory, integrating state-centred and power-centred analytical frameworks. Data collection comprised a document review and in-depth interviews with 31 stakeholders from the health and trade sectors, covering state officials, academics, the private sector, and civil society representatives. The findings demonstrate critical public health concerns centred on pharmaceutical access, plant variety protection, and medical device regulatory standards. The findings also reveal a complex landscape of stakeholder dynamics and power asymmetries in Thailand's CPTPP negotiation process. Although both state and non-state actors played influential roles in shaping public discourse and decision-making, the decision-making was dominated by state trade actors, as the lead negotiating authority, marginalising health sector perspectives despite their active engagement. While civil society leveraged collaborative power to exert political pressure, structural imbalances and a lack of transparency persisted. In addition, intra-sectoral differences also existed and were influenced by institutional positioning. The study highlights the need for stronger institutional mechanisms to promote inclusive stakeholder participation and greater policy coherence between trade and public health objectives in future trade negotiations. Not applicable.
Fossil-fuel dependant energy systems are bad for human health, unequally distributed and environmentally destructive including as a major source of greenhouse gas emissions. Low- and middle-income countries are expected to account for the bulk of emissions growth in the coming decades. How the energy transition is supported in those countries will affect planetary health equity - the equitable enjoyment of good health in a stable earth system. Much of the health and climate-related finance research has focused on health-care systems adaptation and emissions reduction. Little attention has been paid by the health community to the role of public finance in the energy transition more broadly and what that means for planetary health equity. In this paper we examine the role of export credit agencies (ECAs) in creating an equitable global energy transition towards renewables and the implications for planetary health equity. ECAs rank among the leading public financial institutions in global energy investment. To characterize the topology of global energy finance networks, we examined lender-recipient investment ties and calculated structural metrics that enabled comparison of the integration, fragmentation, and relational patterns of fossil fuel and clean-energy finance networks. Using these network analysis methods, we found that fossil fuel investments dominate ECAs' energy finance globally, with cumulative support 12 times larger than renewable energy by 2021. Five countries (Canada, China, Japan, South Korea and US) account for 84% of fossil fuel support. The flow of clean-energy finance from high-income to low- and middle-income countries remains limited, with most investments in renewable energy occurring between high-income countries. The continuation of current ECA practices risk widening global inequities in the energy transition, drive greenhouse gas emissions, and ultimately contribute to climate-related death and disease. To enable planetary health equity, ECAs must cease all new fossil fuel project financing; expand policies to increase clean energy exports to developing nations; simplify processes for clean-energy enterprises; and expand ECAs' role in blended finance for development. Health actors must engage in this area of public finance to ensure funding decisions do not exacerbate global health and planetary health inequities.
Contemporary crises increasingly draw health systems, humanitarian access, medical supply chains, and civilian protection into security-oriented governance. While the health consequences of war and economic coercion, and geopolitical rivalry are widely documented, less attention has been paid to the discursive processes through which such consequences are rendered legitimate, unavoidable, or politically peripheral. This paper addresses this gap by applying a critical geopolitics framework and critical discourse analysis to examine how geopolitical narratives may structure health-relevant governance during crises. Drawing on a purposive, illustrative corpus - (i) a primary corpus of institutional and policy discourse (state communications, United Nations and World Health Organization documents, sanctions guidance, and international non-governmental organizations' reports) and (ii) a secondary corpus of scholarly literature, the study identifies three recurring discursive mechanisms: securitization, exception-making, and displacement of responsibility. Across five illustrative case contexts-US-China geopolitical rivalry, the Russia-Ukraine war, the Israel-Palestine/Gaza crisis, Iran-related sanctions and protest governance, and US-Venezuela sanctions governance-the analysis suggests how security narratives can condition humanitarian access, reshape the practical meaning of civilian protection, and diffuse accountability for health harms. Rather than arguing that discourse alone causes health outcomes, the paper treats discourse as one governance condition among others: it influences what becomes politically thinkable and institutionally actionable while interacting with military, economic, legal, and health-system factors. The findings advance critical health geopolitics and peace and security scholarship by showing how health inequities can function as a diagnostic lens through which norm erosion and the normalization of exceptional governance become empirically visible.Clinical trial numberNot applicable.
Background/Objectives: The increasing burden of non-communicable diseases, together with accelerating environmental degradation, highlights the urgent need for sustainable dietary patterns that promote both human and planetary health. The Mediterranean diet (MedDiet), traditionally followed in countries bordering the Mediterranean basin, has gained recognition as a model of sustainable nutrition due to its well-documented health benefits and relatively low environmental impact. However, its broader role within sustainable food systems requires comprehensive and interdisciplinary evaluation. The aim of this review is to provide a state-of-the-art synthesis of the evidence on the MedDiet as a sustainable dietary pattern, integrating its health, environmental, economic, and socio-cultural dimensions. Methods: This state-of-the-art narrative review synthesizes evidence from peer-reviewed literature on the MedDiet and sustainability. Relevant studies were identified through major scientific databases, focusing on publications addressing nutritional, environmental, economic, and socio-cultural dimensions. Both observational and interventional studies, as well as modeling and life cycle assessment analyses, were included. Additional sources from international organizations and policy reports were incorporated to contextualize global trends and challenges. Results: High adherence to the MedDiet is consistently associated with a reduced risk of cardiovascular disease, type 2 diabetes, cancer, and all-cause mortality. From an environmental perspective, the MedDiet is associated with lower greenhouse gas emissions, reduced land and water use, and enhanced biodiversity conservation compared with Western dietary patterns. Economically, it may represent a cost-effective dietary model and support local food systems when grounded in traditional practices, although affordability varies across contexts. Socio-culturally, the MedDiet promotes food heritage, culinary skills, and social cohesion. Nevertheless, globalization, urbanization, and the increasing consumption of ultra-processed foods have contributed to declining adherence, posing significant challenges to its sustainability and scalability. Moreover, the sustainability benefits of the MedDiet seem to be context-dependent rather than intrinsic, raising several challenges and limitations for its adoption. Conclusions: The MedDiet should be viewed not as a definitive solution to global food-system challenges but as a valuable reference model that illustrates how dietary practices can contribute simultaneously to human health, environmental sustainability, and cultural continuity. Modern sustainable dietary strategies should build upon the strengths of the MedDiet while recognizing its limitations, embracing contextual adaptation, and addressing the structural determinants that shape food choices.
The 2025 Lancet Series on ultra-processed foods (UPFs) marks a turning point in global health by reframing UPFs not simply as unhealthy products, but as outcomes of food systems shaped by corporate power, trade liberalisation, and extractive economic models. The Series demonstrates that UPFs are a distinct category of harm and a major structural driver of the global obesity crisis, with profound implications for equity, sustainability, and food sovereignty. This commentary builds on the Series to identify pathways for effective policy and civil society action, focusing on the political economy of UPF proliferation and the role of local and community-based food systems in countering corporate power. It also considers structural constraints on government action, including limited fiscal capacity linked to sovereign debt and restricted policy space. In line with the Series, we encourage civic action to advance food policies in all countries, including taxation, legislation on the right to food, statutory restrictions on the marketing of unhealthy foods, and mandatory front-of-package warning labels. Strengthening food sovereignty through community financing and support for small-scale producers is a critical but underdeveloped lever for obesity prevention and health equity. We contend that, in the face of globally organised UPF industries, local action requires sustained support. This involves protecting civic space and securing sustainable financing for civil society, potentially through health-related fiscal revenues, so it can organise, participate meaningfully, and hold both states and corporations accountable. Regulating the food industry is essential to creating healthier food environments. Scaling local food systems, in turn, requires supportive national policies and strengthened global governance, including stronger safeguards against corporate interference and, potentially, treaty-level mechanisms. We outline how the World Obesity Federation can support this agenda by amplifying evidence from the Lancet Series, facilitating policy learning, strengthening alliances, building coalitions, and promoting accountability. Together, these actions can help shift food systems away from UPFs towards healthier, more equitable, and sustainable futures.
BACKGROUND: International air border crossings are crucial for controlling the spread of respiratory pandemics like COVID-19. Effective screening at these points is vital for national health security and meeting global health obligations under the revised International Health Regulations (IHR) 2005. This qualitative study aimed to identify and analyze the challenges, barriers, and proposed solutions in COVID-19 screening and management at Iran’s air border crossings and situates these findings within the context of global health governance and pandemic response frameworks. METHODS: Using purposive sampling, twelve key stakeholders involved in border health management were interviewed between Mar and Nov 2024. Data were collected through semi-structured interviews and supplemented by a field visit to Imam Khomeini International Airport’s border health base and a review of relevant international regulations and recent scholarly literature. Content analysis combined with Fishbone root cause analysis was employed to explore underlying factors. RESULTS: Findings revealed multifaceted challenges including inconsistent implementation of screening protocols, shortage of trained personnel, inadequate technological infrastructure, poor interagency coordination, and legal ambiguities related to data privacy and quarantine enforcement. Behavioral factors such as passenger resistance and limited airline cooperation further undermined screening effectiveness. Additionally, the assessment identified significant gaps in meeting global standards and IHR core capacities (points of entry, public health emergency preparedness and surveillance) at air border points. Proposed solutions emphasized integrated digital platforms for real-time data sharing, enhanced staff training, improved quarantine facilities, legal reforms, and targeted multilingual communication campaigns. CONCLUSION: This study indicates that strengthening air border screening during pandemics requires a multisectoral approach aligned with IHR. Identified human, technical, organizational, legal, and environmental challenges may hinder full compliance with these regulations. Addressing these barriers through practical solutions could improve preparedness and response to health emergencies at both national and international levels.
Patient organizations have become increasingly influential in the healthcare sector, offering unique insights into unmet health needs, disease impact, and patients' quality of life. These groups have evolved from advocates for access to treatment, as seen during the HIV/AIDS crisis, to active participants in the research and policy-making processes. Despite growing recognition of their critical role, a comprehensive understanding of their interactions with various healthcare actors remains limited. This rapid review aims to map the landscape of patient organization involvement in healthcare, particularly in high-income settings. We conducted a systematic search of MEDLINE, focusing on literature published between 2000 and 2024, and identified 61 relevant articles. The analysis revealed that patient organizations interact with a range of actors, including pharmaceutical companies, healthcare professionals, payers, health technology assessment bodies, and regulatory agencies. Key themes were identified around conflicts of interest, especially with regards to the pharmaceutical industry, where concerns about transparency and independence were prevalent. The review also highlighted the vital role patient organizations play in research and development, regulatory approval processes, and reimbursement decisions. The conceptual framework developed from this review outlines these interactions across the pharmaceutical lifecycle, emphasizing the varied and significant contributions of patient organizations. This review underscores the need for more transparency and meaningful engagement of patient organizations in healthcare decision-making. While their involvement has been primarily studied in the context of pharmaceutical industry relations, further research is needed to explore their interactions with other relevant actors. Addressing funding challenges and expanding research beyond well-studied regions are crucial for fully understanding and optimizing the role of patient organizations in healthcare. Not applicable.
Cross-border postgraduate education is reshaping the public health workforce, yet little is known about what "return" looks like in aid-reliant health systems where authority, resources, and evidence are co-produced across government, research institutes, and international organizations. In Nepal, internationally trained public health scholars re-enter a mixed institutional landscape shaped by global higher-education markets, donor accountability regimes, and transnational procurement and supply chains. This study examines how Nepali returnees translate overseas training into system-facing work upon returning home, and how the timing of key milestones shapes what becomes actionable. Semi-structured interviews were conducted with 12 Nepali public health scholars who returned after postgraduate study abroad (five doctoral graduates; seven master's graduates) and were working in Nepal at two research institutes and two international non-governmental organizations. Positive deviance purposive sampling targeted returnees with identifiable system impact. Data were analyzed using applied thematic analysis, guided by Bronfenbrenner's bioecological model (micro-, meso-, exo-, and macrosystems), with the chronosystem examined as a cross-cutting influence. Four interconnected themes described patterned engagement across ecological levels. (1) Microsystem-reconstituting role and voice at home: return decisions were anchored in close relationships and early workplace recognition, with a time-sensitive shift from "credentialed outsider" to trusted colleague. (2) Mesosystem-boundary navigation: participants described convening and translating across institutions, with coordination accelerating after early probation and crystallizing around budget cycles, grant windows, and emergencies. (3) Exosystem-rules, resources, and distant decision-makers: procurement timelines, ethics review procedures, donor reporting templates, and customs/banking processes frequently determined the feasibility and tempo of reforms. (4) Macrosystem-national imaginaries, credential politics, and moral horizons of work: participants described credentials as opening initial doors, but sustained legitimacy depended on visible delivery amid shifting political and administrative cycles; some trained in regional Asian hubs emphasized the practical transferability of methods and policy argumentation. Across themes, timing mattered: family events, contract endings, fiscal quarters, monsoon disruptions, and crisis periods re-shaped constraints and opportunities. In this cohort, returnee contribution was bioecological and time-sensitive: agency was not simply "brought home," but assembled through relationships, cross-organizational brokerage, arm's-length governance, and national legitimacy contests, all modulated by temporal milestones. Treating return as a time-sequenced ecology of action-rather than skill transfer-can better inform how governments, funders, and academic institutions design re-entry supports, procurement and reporting architectures, and evidence-use processes so that international learning more reliably translates into public value. Not applicable.
Uganda faces a rising burden of noncommunicable diseases (NCDs) at a time when pressure to mobilize domestic health financing is increasing. These challenges have become more acute since January 2025, when geopolitical shifts and donor fiscal tightening led to substantial reductions in external health funding. Consequently, policymakers have renewed interest in health taxes as a mechanism both to reduce consumption of harmful products and generate domestic revenue for health. While tobacco taxation has received sustained policy attention, largely due to the influence of the WHO Framework Convention on Tobacco Control, considerably less is known about the political dynamics shaping alcohol and sugar-sweetened beverage (SSB) taxation. This study therefore examines the factors contributing to the relatively low prioritization of alcohol and SSB taxes within Uganda's policy agenda. Guided by the framework on political priority, we conducted 25 semi-structured interviews with stakeholders from government, parliament, civil society, academia, industry, and the media. We also reviewed 22 documents from 2015 to 2025, including policy papers, fiscal records, parliamentary debates, and industry materials. We analyzed the data thematically following an inductive thematic analysis approach. Coding was informed by the framework and strengthened through triangulation across interviews and documentary sources to enhance credibility. We identified three levels of barriers. First, transnational norms promoted health taxes, but regional tax harmonization commitments within the East African community constrained national policy space. Second, domestic advocacy was weakened by fragmented ministerial mandates, limited local evidence, retreating policy entrepreneurs, and industry lobbying. Third, within the national political environment, the multiparty legislative dynamics, the high cost of sponsoring private members' bills, and revenue-centric fiscal framing limited traction. The 2025 donor financing contraction acted as a focusing event that revived debate on health taxes primarily as domestic health financing stabilization instruments rather than NCD prevention tools. While policymakers support health taxes to curb NCDs and increase domestic revenues, taxes on alcohol and SSBs remain underprioritized in Uganda due to institutional fragmentation, political-economic incentives, and legislative resource constraints. As external financing declines, it will be essential to strengthen locally grounded evidence, cross-sector coalitions, and integration of health objectives into fiscal reforms. In this way, health taxes represent a durable policy option for quickly mobilizing financial resources for health and preventing NCDs.
The contemporary landscape of medical education faces profound transformations driven by globalization of healthcare systems, intensified competition among medical universities, and evolving societal expectations regarding institutional accountability. These developments necessitate comprehensive examination of operational models adopted by medical universities and their implications for socio-ethical marketing standards-encompassing transparency in institutional communications, ethical conduct in student recruitment, responsible representation of training outcomes, and accountability for healthcare workforce preparation quality. To systematically identify and analyze contemporary operational models of medical universities, establish explicit selection criteria for model prioritization, define socio-ethical marketing standards applicable to medical education contexts, and examine how different institutional frameworks shape implementation of these standards with specific reference to Georgian medical education. Systematic literature review methodology with clearly defined parameters. Literature search conducted across PubMed, Scopus, and Web of Science databases covering 2015-2024. Search strategy utilized combinations of keywords: 'medical university models', 'academic medicine', 'healthcare innovation', 'medical education transformation', 'clinical entrepreneurship', 'socio-ethical standards', 'healthcare marketing ethics'. peer-reviewed English-language articles, institutional reports from accredited universities, policy documents from regulatory bodies. non-peer-reviewed sources, pre-2015 publications except foundational works, studies without institutional-level analysis. Initial search: 247 articles; after screening: 52 articles plus 22 institutional/regulatory documents analyzed. Model selection employed four explicit criteria: prevalence in literature (minimum 10 institutions), documented regional healthcare impact, alignment with contemporary challenges, and applicability to diverse contexts including Georgia. Analysis identified four priority models: (1) Clinical-entrepreneurial model (34 institutions, 12 countries) integrating education with innovation commercialization; (2) Community-engaged model (28 institutions) prioritizing health equity and regional workforce development; (3) Network-based model (19 institutions) leveraging collaborative partnerships; (4) Traditional research-intensive model (15 institutions) maintaining biomedical research focus. Socio-ethical marketing standards were defined across five domains: transparency and disclosure, truthfulness in outcomes representation, conflict of interest management, stakeholder accountability, and mission integrity protection. Comparative analysis revealed clinical-entrepreneurial universities demonstrate superior performance in transparent stakeholder communication and innovation disclosure but require enhanced governance for managing commercial-educational tensions. Community-engaged models excel in mission-marketing alignment but face sustainability challenges. Each model presents distinct ethical considerations requiring tailored socio-ethical standards. Socio-ethical marketing standards in medical education must be contextualized within institutional operational models, as different frameworks create distinct ethical tensions and governance requirements. Clinical-entrepreneurial model demonstrates effectiveness in healthcare innovation when implemented with robust ethical oversight. For Georgian universities, model selection requires alignment with national healthcare priorities, institutional capacity, regulatory environment, and commitment to defined socio-ethical standards. The study establishes theoretical foundation and empirical evidence for benchmarking frameworks connecting operational models with socio-ethical marketing implementation capabilities.
The rising consumption of unhealthy foods, characterized by high levels of sugar, salt, and unhealthy fats, poses significant health risks to women. Urbanization and globalization have shifted dietary patterns, leading many people to opt for processed and fast foods over traditional, nutrient-rich meals. This trend contributes to increased rates of non-communicable diseases, such as diabetes, and cardiovascular conditions, particularly among women of reproductive age. To determine the socio-demographic and economic factors associated with unhealthy food consumption among women of reproductive age in Tanzania. The study analyzed secondary data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey. The study included a weighted sample of 15,254 women of reproductive age. The "svy" command in Stata was used to assign the sample weight. Multivariable logistic regression was employed to identify significant factors associated with unhealthy food consumption, with significance set at a 5% level. The overall unhealthy food consumption among women of reproductive was 14% (95% CI: 12.9, 15.2). The study found that women residing in urban areas (AOR = 1.37, 95% CI = 1.17, 1.61), women with secondary education (AOR = 1.72, 95% CI = 1.36, 2.17), higher education (AOR = 2.39, 95% CI = 1.73, 3.31), women from middle quintile (AOR = 1.35, 95% CI = 1.06, 1.73), and rich quintile (AOR = 2.42, 95% CI = 1.92, 3.05), married women (AOR = 0.87, 95% CI = 0.75, 1.00), women who listened to radio (AOR = 1.18, 95% CI = 1.04, 1.34), watching television (AOR = 1.23, 95% CI = 1.08, 1.40), having 0-2 children (AOR = 1.30, 95% CI = 1.06, 1.58) were significantly associated with unhealthy food consumption. The study found that overall unhealthy food consumption among women of reproductive age was 14%. This was associated with place of residence, education level, wealth status, listening to radio, watching television and number of children. The study recommends implementation of community-based nutritional education programs focusing on healthy eating habits, particularly targeting urban areas where unhealthy food consumption is higher as well as utilize mass media platforms to disseminate information about healthy dietary habits.
BACKGROUND: Healthcare systems across Africa continue to face a wide range of shocks. Using Ebola and COVID-19 as case studies, this study examines the various resilience strategies implemented in different countries and synthesises them in a way that can serve as a practical guide to make health systems in Africa more resilient for future emergencies. METHODOLOGY: The study is a scoping review that synthesises evidence from peer-reviewed journal articles and grey literature, structured around a conceptual framework developed by the authors. We focused on various aspects of health system resilience during the Ebola outbreaks and the COVID-19 pandemic in Africa. KEY FINDINGS: This review identifies six key elements vital to health system resilience in Africa: strong leadership and governance, equitable social protection, digital health innovation, trusted community engagement, a sustainable and flexible workforce, and adaptable infrastructure. However, several gaps must be addressed to strengthen resilience against future health emergencies. While political commitment and coordination mechanisms improved integration and awareness, poor decentralisation, weak accountability, and fragmented governance undermined effectiveness. Social protection initiatives and digital tools enabled rapid responses but persistent inequities in access and data gaps hindered their reach. Telemedicine and workforce expansion showed adaptability but lacked sustainability. Community trust and local innovations supported resilience, yet their potential was curtailed by top-down strategies and insufficient institutional support. CONCLUSION: This review emphasises the need for equitable, inclusive, and coherent strategies to strengthen resilient health systems in Africa. It calls for a shift from reactive, fragmented approaches to a long-term system-wide transformation grounded in inclusive governance, equitable social protection, robust digital health systems, a sustainable workforce, integrated and trusted community engagement, and adaptive physical infrastructure. Importantly, the review affirms that addressing deep-seated political, structural, and social inequities is crucial to ensuring resilience does not become an empty concept. The framework developed from this review provides a roadmap for policymakers to embed resilience as a core, institutional principle of long-term health system transformation, rather than a temporary emergency measure.
BACKGROUND: In Latin America and the Caribbean (LAC), diets are increasingly dominated by ultra-processed products (UPPs). Although public health policies aimed at reducing UPPs consumption show promise, these are often undermined by corporate influence. Understanding how countries respond to this influence is essential for strengthening food policy development in LAC. OBJECTIVE: Examine how different sectors (government, academia, and civil society organizations) respond to corporate influence throughout the public policy cycle and analyze the key determinants that enable or constrain industry power across six analytical environments in five LAC countries, with the aim of informing actionable policy directions. METHODS: The study follows two sequential and complementary components: (1) policy mapping conducted to assess the progress of six health, food, and nutrition policies within the policy cycle in LAC countries, and (2) a qualitative component consisting of in-depth interviews with key informants from Guatemala, Paraguay, Argentina, Jamaica and Barbados; conducted between May 2024 and May 2025. Data analysis followed a constant comparative approach to identify cross-cutting patterns and context-specific insights. RESULTS: Policy progress varies substantially across food policies and countries. For example, taxation on sugar-sweetened beverages is generally advanced, while marketing restrictions on unhealthy products remain at earlier stages. Regarding the qualitative component, fifteen informants were interviewed; Argentina and academia were the most represented. Based on informants´ responses, corporate strategies and counterstrategies were identified and classified into six environments, each comprising determinants that either constrain corporate power or hinder efforts to address it. These encompassed: (1) political and governance processes; (2) legal and regulatory frameworks, as evidenced in Argentina and Jamaica; (3) narrative and communication strategies leveraging media; (4) knowledge production and dissemination characterized by misleading or suppressed information; (5) advocacy efforts, notably observed in Argentina and the Caribbean; and (6) a cross-cutting, cross-sectoral collaboration to present a unified response to corporate influence. CONCLUSION: Findings indicate that the UPPs industry operates across multiple environments and is shaped by country-specific contexts. Nevertheless, promising responses include transparency and conflict-of-interest mechanisms, strengthened civil society advocacy, and cross-sectoral collaboration to counter corporate influence. These strategies require adaptation to national and local conditions. CLINICAL TRIAL NUMBER: Not applicable.
Mosquitoes and sandfly species are well-known vectors of viral pathogens of public health concern. However, the diversity and ecology of viruses within mosquitoes, including those responsible for clinical and sub-clinical infections in humans, remain poorly understood. In this study, we investigated the presence of phleboviruses and flaviviruses in Aedes albopictus and Culex pipiens mosquitoes, as well as Phlebotominae species, collected from the Siena and Grosseto districts (Tuscany, Italy) during the 2022-2024 summer season. Furthermore, A. albopictus and C. pipiens larvae were reared under laboratory conditions, and adults were collected for further virological analysis. Molecular investigations (reverse-transcription polymerase chain reaction [RT-PCR]) detected phleboviruses and/or flaviviruses in several batches of both field-collected and laboratory-reared flies. Notably, the highest incidence and co-circulation of both viral genera were observed in samples from the 2024 season. Furthermore, metagenomic analysis was performed on only 42 out of 67 RT-PCR-positive pools of mosquitoes and sandflies. This approach aimed to identify wild-type or recombinant viruses and assess the virome of autochthonous arthropods, contributing to knowledge on viral ecology in southern Tuscany and potential threats to humans. The resulting data revealed a wide viral community shared among mosquitoes, spanning over 30 taxonomic virus families, albeit no potential human pathogen virus was identified. Furthermore, our findings confirmed the mosquito specificity of certain endogenous arthropod viruses and provided evidence of their potential transovarial transmission in some cases. The present study provides a comprehensive analysis of the mosquitoes and sandflies virome, contributing to viral surveillance efforts and underscoring the need for enhanced monitoring of arthropod-borne pathogens.IMPORTANCEIn this study, we analyzed the co-circulating phleboviruses and flaviviruses, providing foundational data on the diversity, composition, and transmission of insect-specific and vector-borne viruses in Central-Southern Tuscany, an area increasingly exposed to arbovirus threats due to climate change and globalization. This is the first comprehensive metagenomic study to characterize the virome of Aedes albopictus, Culex pipiens, and Phlebotomine spp. in this region. Furthermore, we identified for the first time Punique virus (PUNV) in Italy, a phlebovirus with potential (though not yet confirmed) human pathogenicity.
The World Health Organization’s 2026 global appeal seeks nearly US$1 billion to sustain life-saving health interventions amid escalating humanitarian crises. This Letter highlights persistent funding shortfalls affecting fragile and conflict-affected states, including Somalia, Sudan, and Yemen, where service suspensions and outbreaks have compounded morbidity and mortality. Despite WHO and partners reaching millions in 2025, financing remains insufficient, jeopardizing maternal and child health, outbreak response, and health system resilience. We argue that predictable, front-loaded financing is critical to support local actors, strengthen health systems, and safeguard global health security. Integrating climate-resilient infrastructure, One Health surveillance, and equity-focused strategies can mitigate preventable deaths and stabilize vulnerable populations. The 2026 appeal represents a strategic investment in global health and security, and by mobilizing front-loaded, flexible support alongside sustained assessed contributions requires urgent international solidarity and collective action.