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Violence against healthcare workers has prompted policy responses across health systems that often emphasise security measures, legal sanctions, and behavioural interventions. While these approaches are essential to protect healthcare workers, their effectiveness remains limited. This Policy Comment argues that such framing may underemphasise determinants of violence arising at multiple levels of health systems, including broader policy choices (e.g., workforce planning, financing, and service configuration), governance arrangements (e.g., performance monitoring, administrative control, and regulatory standards), and organisational conditions (e.g., staffing shortages, workload, and care pathway bottlenecks), within a context influenced by international policy frameworks and societal factors. Drawing on a multi-level conceptual framework and examples from different countries, we suggest that violence can also be understood as an indicator of systemic strain arising from the persistent gap between healthcare needs and available capacity, reflecting how healthcare systems are organised, governed, and resourced. Rebalancing prevention efforts to address these policy and governance drivers may offer more sustainable solutions.
Reimbursement decisions for new health interventions focus on maximizing health gains, with limited attention to who benefits from these gains or the impact on income related health inequalities. This study aimed to examine the preferences of Dutch citizens regarding the distribution of health gains of new interventions across income groups. A discrete choice experiment (DCE) was completed by 614 Dutch adults. Respondents were presented with 12 choice tasks. In each choice task, they were asked to choose between two health interventions that differed on the following attributes: total healthy life years gained, distribution of healthy life years gained across income groups, additional costs in terms of health insurance premium increases and whether the intervention was curative or preventive. Preferences were estimated using multinomial logit (MNL) models, relative attribute importance, willingness-to-pay, and willingness-to-trade total health gains. Preference heterogeneity was examined using latent class (LC) analyses. Respondents found the distribution of health gains by income the most important attribute in their decision between health interventions (relative importance [RI] = 40.5%, 95% CI: 38.3%-42.7%). Overall, respondents preferred an equal distribution of healthy life years gained across income groups (βhigher income groups = -1.427, 95% CI: -1.547--1.307; βlower-income groups = -0.315, 95% CI: -0.395--0.235). A health intervention should yield 14 283 (95% CI: 10 463-18, 102) additional healthy life years or reduce the yearly health insurance premium by €39.96 (95% CI: €29.03-€50.89) if it mainly favors lower-income groups. Preventive interventions were generally preferred over equally effective or more effective curative interventions (βprevention = 0.270, 95% CI: 0.204-0.336). While preferences displayed a similar direction across LCs, the classes differed in the RI assigned to the attributes. Our findings suggest societal support for interventions that prioritize preventive programs over equally effective or more effective curative interventions and prioritize interventions that provide equal benefits across different income groups.
Countries around the world worry about the financial sustainability of their health systems as populations age; however, few have considered the consequences of future gaps in health financing on the risk of financial hardship due to out-of-pocket payments. If countries are unable to raise sufficient revenues to meet health needs, people will pay more out-of-pocket to use health services and risk experiencing catastrophic or impoverishing health spending. We aim to simulate the effect of health financing gaps due to changes in the population age-mix on the risk of financial hardship from out-of-pocket payments and to identify relevant policy mechanisms. Using the Population Ageing financial Sustainability gap for Health systems (PASH) simulator and the WHO Europe approach to measure catastrophic and impoverishing out-of-pocket expenditure, we simulate the effects of ageing-related health financing gaps on financial hardship in Bulgaria, Italy, Slovakia, Slovenia, and Spain through 2060. Our results indicate that all five countries will face significant health financing gaps due to population ageing. These gaps are expected to lead to increased out-of-pocket spending, resulting in higher incidences of catastrophic and impoverishing health expenditures to varying extents depending largely on each country's current approach to revenue raising and co-payment policies. We argue that countries should adopt diverse and sustainable health financing mechanisms and implement strong coverage policies to protect households from financial hardship as their populations age. This study underscores the importance of addressing health system financial sustainability to ensure progress towards universal health coverage.
This work analyses policies related to the Problematic Usage of the Internet (PUI) and its relationships to adolescent mental health across the United Kingdom, France, Germany, Italy, Australia, Canada, the United States, and New Zealand. Using a policy path dependency framework, national legislation was examined to assess relationships with PUI. The study maps policy by reviewing governmental legislation and databases, analysing them on macro (societal), meso (market/intermediary organisations), and micro (citizen rights, duties, and protection) levels. It explores legal instruments related to PUI, including data protection, cybersecurity, content regulation, and harassment, offering both historical and comparative analyses across the eight countries. Findings indicate that while several countries have policies indirectly regulating PUI, significant legislative gaps persist relating to adolescent mental health. Most policies address broader internet concerns without specifically targeting PUI or its effects on mental health. Overall, the analysis highlights the need for more targeted public health policies to address the root causes of PUI, advocating for tailored interventions focused on adolescent well-being.
The United Arab Emirates has undergone rapid healthcare transformation since implementing comprehensive reforms, particularly following the Abu Dhabi Healthcare Strategic Plan launch in 2014. To provide the first comprehensive assessment of UAE healthcare reform progress from 2017 to 2024, building upon previous evaluations to examine recent developments in this rapidly evolving health system. A systematic review searched PubMed, EMBASE, and PsycINFO databases plus grey literature for studies published January 2017 to December 2024. Studies focusing on UAE healthcare reforms and addressing strategic priorities were included. Two reviewers independently screened 472 titles and abstracts, with 49 studies meeting inclusion criteria and synthesised across seven thematic areas. The review identified a three-fold increase in research output (49 vs. 17 studies in previous review), reflecting growing scholarly attention to UAE healthcare reforms. Key achievements include 16.8% annualised growth in Joint Commission International-accredited facilities (229 by 1 February 2026-one of the highest outside the US), widespread electronic medical record adoption (75% penetration in Dubai's private clinics), and successful implementation of innovative care models. Significant progress occurred in antimicrobial stewardship (81.7% cost reduction), quality improvement (40% reduction in hospital stays), and preventive care. Persistent challenges include workforce gaps, limited digital health interoperability, and equity disparities between Emirates. The UAE achieved substantial system-level progress between 2017-2024, suggesting substantial progress following reform implementation. While significant achievements in quality, access, and technology integration are evident, addressing workforce development, digital interoperability, and inter-Emirate equity remains critical. These findings offer valuable insights for other rapidly developing health systems pursuing comprehensive transformation.
Synthetic data generation (SDG) structured health data is increasingly promoted as a solution to longstanding barriers in health data access. It is offering the promise of privacy-preserving data reuse for research, innovation, and policy. Despite rapid technical advances, the adoption of synthetic health data in real-world settings remains limited. Shaped by challenges around data quality, representativeness, infrastructure readiness, trust, and legal uncertainty, this viewpoint draws on experiences from 7 European research initiatives within the HealthData4EU cluster to reflect on how SDG is being operationalized in practice. It synthesizes cross-project insights to highlight recurring methodological and governance tensions and to examine their implications for trust and responsible use. The analysis argues that trustworthy SDG cannot be achieved through technical optimization alone but requires alignment between evaluation practices, upstream data stewardship, regulatory clarity, and sustained stakeholder engagement. Addressing these conditions is essential for moving synthetic data from experimental pilots toward a credible and sustainable component of European health research ecosystems.
Ageing is usually associated with physiological decline, increased mental health issues, and cognitive. deterioration, alongside specific changes in the gut microbiome. However, the relationship between the neuroactive potential of the gut microbiome and mental health and cognition among the elderly remains less explored. This study examines a cohort of 153 older Chilean adults with cognitive complaints, assessing anthropometric data, mental health via five distinct tests, and gut microbiome composition through 16SV4 sequencing. Our findings reveal associations between anthropometric factors and depression scores in mental tests of participants with their gut microbiome composition. Notably, depression was associated with changes in the abundance of Lachnospiraceae Eubacterium xylanophilum group and Fusobacteriaceae Fusobacterium. Additionally, bacterial pathways involved in metabolising neuroactive compounds such as tryptophan, short-chain fatty acids, p-cresol, glutamate, and nitric oxide were associated with participant age, sex, and cognitive performance. Moreover, participants' sex was associated with the neuroactive potential of specific bacteria, suggesting a role of the gut microbiome in sex-related mental health differences in the elderly. Altogether, this study provides the first evidence from a South American cohort linking the inferred neuroactive potential of the gut microbiome to cognitive and psychological function in older adults with cognitive complaints, offering novel insights into microbiota-based mechanisms that may contribute to mental health and ageing.
Health Canada is proposing to use decisions by foreign regulators in approving new drugs to speed up their marketing. To investigate the length of gaps in submissions to and approvals by Health Canada compared to the Food and Drug Administration (FDA) for the same drugs for the same indications. To determine if the gaps are hindering the availability of drugs with significant additional therapeutic value. A list of new drugs approved by Health Canada from January 1, 2011 onwards and the FDA for the same indications was constructed. The median length of gaps in submissions and approvals was calculated. The distribution of therapeutic value - major, moderate, minor - was compared for all drugs and antineoplastic agents depending on the length of the gap (0-1, 1-2, 2-3, 3+ years). The number of FDA approved drugs not available in Canada was counted along with their therapeutic value. Health Canada and the FDA approved 502 drugs for the same indication. The length of the gap in submissions and approvals did not increase over the period (p = 0.5972 and p = 0.0875, respectively). The distribution of therapeutic value for all drugs and antineoplastic agents was the same regardless of the length of the gap (p = 0.7091 and p = 0.3395, respectively). Out of 542 FDA approved drugs 134 were not marketed in Canada. It is unclear whether gaps in submissions and approvals are preventing therapeutically important new drugs from reaching Canadian patients in a timely manner.
When outbreaks of emerging and reemerging zoonotic diseases are discussed, little attention is paid to differential gender impacts, or to gender involvement and roles in different settings during the outbreak. Gender roles shape how individuals' interactions with animals, wildlife, other people and the environment, which influences exposure to zoonotic pathogens. For example, in some rural communities, men may face risks of exposure to emerging pathogens during hunting whilst women who primarily take care of domestic animals may face prolonged exposure to other zoonotic diseases. In some settings, women (and men) lack access to health protection, education or communication with health officials (medical doctors or veterinarians). In some cultures, women are not allowed to speak directly with male service providers, further limiting their access to critical information and services. One Health is a holistic, inclusive approach which should be incorporating a gender lens when considering zoonoses. This includes thinking about the need to create appropriate gender sensitive policies that address disparities in surveillance, response, prevention, detection, and control of the disease (or health issue) being addressed. In this paper, we highlight these issues through several case studies that demonstrate the importance of including gender in zoonotic disease response and, ideally, when implementing prevention measures.
Evidence-based parenting programmes are widely used to prevent violence against children and improve parenting and mental health. Despite hundreds of randomised trials, little is known about their outcomes when delivered at scale within routine delivery. This study assesses the WHO-endorsed and UNICEF-endorsed Parenting for Lifelong Health programme for caregivers and adolescents, delivered through non-governmental organisation and government in Botswana, the Democratic Republic of the Congo, Eswatini, South Africa, South Sudan, Tanzania, Zambia and Zimbabwe, with support from the President's Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID) and the European Union. Pre-post surveys for caregivers and adolescents were integrated into service data collection between 2016 and 2022. Abbreviated standardised measures of physical abuse, emotional abuse, approval of corporal punishment, positive involved parenting, monitoring/supervision, caregiver depressive symptoms, parenting stress and adolescent depressive symptoms and externalising behaviour were used. Individual country scores were analysed separately for caregivers and adolescents using generalised linear mixed-effects models, and cross-country data were combined using a random-effects meta-analytic model. 123 050 participants were included (93% retention, 57 908 adolescents (96% female), 56 423 caregivers at follow-up). In all-country meta-analyses, estimates showed reduced physical abuse (-65%; 95% CI 51% to 74%), emotional abuse (-59%; 95% CI 48% to 68%) and approval of corporal punishment (-55%; 95% CI 48% to 60%). Positive involved parenting increased (+52%; 95% CI 24% to 87%) and poor supervision/monitoring decreased (-48%; 95% CI 34% to 58%). Caregiver depressive symptoms (-25%; 95% CI 8% to 48%), parenting stress (-46%; 95% CI 41% to 52%), adolescent depressive symptoms (-22%; 95% CI 1% to 38%) and adolescent externalising behaviour problems (-43%; 95% CI 29% to 54%) all declined. There was heterogeneity in pre-intervention scores and extent of change between humanitarian and development settings, and between different target groups, but strong consistency across caregiver and adolescent reports. In eight African countries, including humanitarian and pandemic-affected contexts, an evidence-based parenting programme showed consistent associations with reduced violence against adolescent girls and improved parenting and mental health.
Finding new therapeutic indications for established medicines continues to have important impact. Although drug repurposing (DR) offers the potential for a faster and more affordable complement to de novo development, barriers to successful DR remain pervasive. To prioritize barriers identified earlier in a systematic literature review by the REMEDi4ALL Horizon Europe project, involving multiple stakeholder groups, to create a shortlist of the most important barriers and to examine differences in stakeholders' perceptions. A policy survey was conducted among stakeholder groups involved in DR. Participants rated the barriers based on their impact and actionability, using 5-point categorical scales. A weighted scoring method was used to create the shortlist by combining scores across domains, while ensuring that each stakeholder group's preferences were retained in the final shortlist. 60 individual responses were collected. The final shortlist contained 22 barriers, including 4 barriers related to exclusivity rights for repurposed medicines (RMs), 2 to pricing of RMs, 5 to market authorization of RMs, 2 to perception off-patent RMs, 2 to business case for off-patent RMs, 2 to non-industry funded DR, 2 to health technology assessment of RMs, 2 to ecosystem for non-profit or small-medium sized enterprises-driven DR, and 1 to business case for repurposing on-patent compounds. Prioritizing barriers helps identify solutions by addressing the critical challenges first. Acknowledging that different stakeholder groups may perceive the impact and actionability of these barriers differently is crucial for building a shared, multi-stakeholder perspective when formulating policy recommendations to address the barriers.
Europe faces rapidly accelerating population ageing, driving multimorbidity and unsustainable healthcare costs. This paper calls for the establishment of an EU Coordination and Support Programme on Healthy Ageing and Longevity to integrate research, innovation, regulation, and capacity‑building across Member States.
This work presents a policy analysis regarding Problematic Usage of the Internet (PUI) across seven countries (Netherlands, Spain, Hungary, Lithuania, Portugal, Estonia, and Switzerland) belonging to or associated with the European Union (EU). I It examines legislative instruments addressing PUI and its multifaceted impacts on society, including social, economic, and political dimensions. Despite the growing prevalence of PUI, particularly among adolescents, and its association with various mental health concerns, the study reveals a notable gap in direct policy interventions targeting PUI within these countries. Existing regulations largely focus on broader digital governance issues like data protection, cybersecurity, and market regulation, offering only indirect approaches to mitigating PUI's adverse effects. Our findings highlight a pressing need for innovative policy frameworks that incorporate mental health considerations into digital governance, promoting a balanced approach that fosters market innovation while ensuring robust public health protections. Building on the policy discourse examined in this study, future research should focus on developing targeted, multidimensional strategies to mitigate the risks associated with problematic internet use (PUI), with particular emphasis on safeguarding the well-being of vulnerable populations.
Vision impairment is increasingly recognised as a complex condition shaped not only by ocular pathology but also by cognitive, psychological, social and environmental factors that influence participation and quality of life. In line with the United Nations Convention on the Rights of Persons with Disabilities and the International Classification of Functioning, Disability and Health, contemporary vision rehabilitation frameworks adopt a biopsychosocial perspective that extends beyond treatment of the eye condition alone toward holistic support to improve the lives of individuals with vision loss. An overview of the effectiveness and future directions of multidisciplinary vision rehabilitation in clinical practice is presented, and a summary of the findings concerning the international standards of vision rehabilitation, focusing on adults. Furthermore, some examples of achievements in emerging fields are presented, such as neuroplasticity and visual system recovery, technological interventions and psychosocial support, including their future directions. Multidisciplinary models are widely supported but remain difficult to implement because of limited resources, workforce constraints and differences in culture and health policy. Overcoming these barriers is critical to expanding and strengthening multidisciplinary vision rehabilitation. The evidence highlights the need for implementation-focused research, closer collaboration across disciplines and core outcome measures that capture participation, mental health and quality of life, not just impairment. The overview also points to the importance of structured models that integrate neurorehabilitation (artificial intelligence-based) technology and mental healthcare while adapting to regional and cultural contexts. Embedding multidisciplinary vision rehabilitation within health systems is both a clinical necessity and a prerequisite for advancing global commitments to inclusion and equity for people with vision impairment. As population ageing and global demographic change are expected to increase the absolute numbers of adults with vision loss, strengthening collaboration between research, clinical practice and service delivery will be essential to further improve the quality of life of individuals with vision loss.
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Economic evaluations such as Benefit-Cost Analysis (BCA) are often used to guide priority setting. However, in adverse contexts, low benefit-cost ratios (BCR) are often not evidence of weak interventions, but reflections of structural barriers. We should therefore invest more in these cases, to tackle these barriers, rather than less.
Dementia is a leading health policy challenge, with cases expected to triple by 2050, particularly in low- and middle-income countries. Epidemiological evidence demonstrates falling age-specific incidence rates in high-income countries, suggesting risk can be lowered at the population level.The Population-Level Approaches to Dementia Risk Reduction (PLADRR) Research Group is a diverse, international network of researchers committed to investigating how structural, social, and environmental conditions can promote life course brain health and reduce dementia risk across the population.This Policy Forum article sets out the guiding principles of our approach, the building blocks required, our research priorities, and how PLADRR research can inform and translate into policy changes.