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Although socioeconomic inequalities in oral health persist despite universal dental care, the role of social determinants remains unclear. Social capital may influence oral frailty, but evidence is limited, particularly regarding individual- and community-level social capital and differences by socioeconomic status (SES). This study examined these associations among community-dwelling older adults. We analyzed longitudinal data from the Japan Gerontological Evaluation Study (JAGES) collected at baseline (2019) and follow-up (2022), including 31,378 older adults. Social capital was assessed across three domains: civic participation, social cohesion, and reciprocity at individual and community levels. Oral frailty was estimated using a validated predictive model incorporating age, remaining teeth, chewing ability, and swallowing function. Multivariable logistic regression analyses examined associations between individual- and community-level social capital and oral frailty risk, as well as the interaction effects of social capital, stratified by SES, on oral frailty risk across SES groups. All models were adjusted for potential confounders, including sex, age, education, household composition, and chronic conditions. Over three years, 21.6% of participants developed oral frailty risk, with a higher incidence among low-SES participants (24.6%) than among high-SES participants (19.9%). At the higher individual level, higher health-related social capital and social cohesion were significantly associated with lower odds of oral frailty risk across SES groups. Higher civic participation was also associated with lower oral frailty risk across SES groups, with a stronger association observed among low-SES participants. At the community level, higher civic participation was associated with lower oral frailty risk in the overall sample and among low-SES participants. A significant interaction between SES and individual-level civic participation was observed, while no significant interactions were found for other social capital measures. Individual-level health-related social capital was associated with a lower risk of oral frailty among older adults. Furthermore, the inverse association between civic participation and oral frailty was stronger among individuals with low socioeconomic status, suggesting that promoting social participation may be a promising strategy for reducing socioeconomic inequalities in oral frailty.

Despite rising investment in health and social services, loneliness, mental distress, and social disconnection continue to worsen across high-income countries. This pattern suggests the challenge may not lie solely in insufficient provision, but in how systems conceptualize people and value. Within increasingly individualized and consumption-oriented contexts, people are often positioned as recipients of services rather than contributors to social and civic life, with value reduced to economic or service-based metrics rather than relational and civic contributions. These assumptions shape system design, giving rise to two recurring patterns of failure. In ethical abandonment, systems retreat into markets and transactions, positioning people as consumers without preserving conditions for meaningful agency or contribution. In ethical overreach, systems use prescriptive, behavioral, or medicalised approaches that substitute institutional control for personal authorship, positioning people as objects to be optimized. Although these approaches appear opposed, both deny that people can matter to others beyond their consumption of support, undermining reciprocity, eroding shared life, and driving system expansion. Contributory reciprocity is proposed as an alternative ethical orientation, recognizing people as potential contributors to shared life, not merely recipients of support. It partitions responsibility: systems secure real opportunity and preserve civic space; individuals retain authorship over engagement. The framework maintains expectation, rather than obligation, that people can create value for others, rejecting the drift toward lives organized around consumption alone. Social prescribing is examined as a practice through which contributory reciprocity can be enacted. When practiced as invitation rather than prescription, it renders opportunities visible, lowers barriers to entry, and returns authorship to individuals. When reduced to behavioral direction or commodified experience, it risks reproducing the consumption-oriented logic it seeks to address. Actionable recommendations are provided across system design, commissioning, evaluation, and policy development, emphasizing opportunity over activity delivery, relational work, and distinguishing invitation from uptake.

Obesity and related chronic diseases in the U.S., particularly within rural communities and/or medically underserved areas, are a major societal and cost burden. Built environments with health-promoting attributes, which can be influenced through civic engagement, are a potential pathway to help address this substantial problem. We conducted a community-randomized delayed intervention trial in medically underserved rural communities (n = 12) in Texas and New York to evaluate the impacts of a civic engagement curriculum designed to create healthier physical activity and nutrition environments, called the Change Club, on individual measures of chronic disease risk and related behaviors and on collective and environmental outcomes 2 years after baseline. Residents within each community were recruited and enrolled to help lead community change activities; they are referred to as Change Club Members. Using an intent-to-treat framework, no net effects were observed when comparing year-2 individual and collective outcomes for the intervention arm relative to the control arm, adjusting for baseline outcome values. Exploratory analyses compared attendees (61%) to non-attendees (39%) in the intervention group and found attendees had higher year-2 values than non-attendees (with baseline adjustment) on the primary outcome and two other individual measures: Life's Simple 7 composite cardiovascular risk score (+0.93, p = 0.006), World Cancer Research Fund/American Institute for Cancer Research composite cancer risk score (+0.54, p = 0.008), and healthy eating motivation (+0.27, p = 0.028). This is among the first studies to evaluate how a civic engagement curriculum targeting built environment change may impact the health of residents who actively attend the Change Club meetings. While net impacts on the whole sample were not observed, exploratory analysis indicated that the approach holds promise when participants attend. http://www.clinicaltrials.gov, identifier (NCT05002660).

This study investigated psychosocial profiles of potential renewable energy community (REC) participants in Italy, examining how individual-level, community-level, and societal-level factors combine to shape participation intentions. Latent Profile Analysis identified distinct profiles among Italian citizens (N = 580) using 11 indicators: Pro-environmental Values, Civic Engagement, Intrinsic/Extrinsic Motivation, RECs acceptability (individual level); Sense of Community, Institutional Trust, Common Good Orientation, Sense of Responsible Togetherness (community level); and communication clarity (societal level). Three distinct profiles emerged: Civic-minded Interested (35.5%), Uncommitted (56.4%), and Private-minded Uninterested (8.1%). Counterintuitively, the Private-minded profile showed the highest stated participation intention (72.3%), followed by Civic-minded (67.0%) and Uncommitted (60.2%), though this overall pattern was non-significant (p = 0.110). No significant differences emerged across profiles in preferred level of engagement. Findings reveal the multilevel, ecological nature of REC participation while highlighting the distinction between stated intentions and the psychosocial resources that typically sustain actual engagement. Results underscore the need for differentiated engagement strategies and community capacity building tailored to distinct psychosocial configurations.

Israel's ultra-Orthodox (Haredi) community combines strong religious and cultural separation from secular society with increasing dependence on state institutions, labor markets, higher education pathways, and public resources. This tension is especially salient in debates over employment, secular curricula, and military service, where practical pressures for integration may conflict with communal authority, symbolic boundaries, and fears of secularization. The Haredi case provides a theoretically informative setting for examining the Homobiasos framework, which proposes that moral reasoning can function as a coherence-preserving system under identity threat. A cross-sectional national survey of 429 Haredi adults in Israel examined attitudes toward employment, education, military and civic service, communal belonging, national identity, and political representation across four Haredi subgroups: Lithuanian, Hasidic, Sephardic, and Modern-Others. Quantitative analyses were complemented by thematic analysis of substantive open-ended responses. The findings revealed a patterned form of bounded adaptation. Openness was greater in domains that could be framed as pragmatic, economically necessary, or compatible with communal continuity, particularly in employment and women's education. Resistance was stronger in domains perceived as threatening core symbolic boundaries: 53.3% opposed secular curricula in Haredi schools, and roughly two-thirds opposed an adapted military-service track. Qualitative narratives showed how adaptation was morally reframed as continuity, while nonparticipation was often justified as Torah study, communal protection, or alternative civic contribution. These findings suggest that collective moral reasoning may preserve group coherence by absorbing some forms of change while resisting others experienced as assimilation or moral defeat. Thus, integration in polarized societies may depend not only on incentives or factual correction, but on whether new obligations can become morally inhabitable within the group's existing self-understanding.

The ability to anticipate public behavior shapes first responders' actions during emergencies. Discrepancies between empirically grounded knowledge of public behavior and persistent disaster-related myths held by first responders may lead to misaligned decisions, placing human lives at risk. A systematic scoping review mapped the existing evidence on how belief in myths influences the decision-making of first responders (e.g., police/fire services) during the emergency response phase. The review followed the Population-Concept-Context framework and is reported according to PRISMA-ScR guidelines. The search strategy included three stages: a systematic search of electronic databases (Scopus, PubMed, JSTOR, ScienceDirect, and Google Scholar), manual screening of reference lists, and forward citation tracking from 2020 onward. Of the 859 sources identified, 21 met all inclusion criteria and were included in the review. Findings demonstrate that myths, such as assumptions of public panic, looting, and social breakdown, exert direct and indirect influence across multiple levels of the emergency system. These beliefs are embedded in organizational culture, training, procedures, policies, and communication practices, often leading to centralized, security-oriented, and command-and-control responses. Such approaches divert resources from life-saving actions, suppress civic initiatives, restrict information flow, and undermine trust, ultimately reducing response effectiveness and exacerbating harm. These patterns recur across disaster types and contexts, indicating that decision-making failures stem less from disaster characteristics than from myth-based assumptions. The study concludes that improving emergency response requires a paradigm shift toward evidence-based models that recognize the public as a resource, promote decentralized coordination, support civic participation, and prioritize transparent, empowering communication.

In the Philippines, community health workers (CHWs) face psychosocial difficulties as they deliver health services to communities with limited access to healthcare, yet they receive no support for their well-being. To maintain their psychological strengths, we adapted the Locus-of-Hope Enhancement Program (LEAP), a positive intervention that strengthens hope of CHWs from urban-poor communities in Metro Manila. Using a double-blind, parallel randomized alternative-treatments experiment, LEAP's effects on locus-of-hope and other psychological resources across three time-points were tested in Manila. Group contrast estimates indicate improvements in external-peer and family locus-of-hope, and psychological well-being. LEAP boosted external-peer and family locus-of-hope after 1 month via peer and family hope at posttreatment. LEAP also increased psychological well-being, civic engagement attitudes, and behaviors posttreatment, and civic engagement attitudes at follow-up through peer locus-of-hope at posttreatment. Findings suggest how LEAP empowers CHWs from urban-poor communities by fortifying hope, thus sustaining their role in community health. Trial Registration: Open Science Framework (OSF) Registries (https://osf.io/egtju).

Health disparities arise from unequal power relations shaping resource allocation, governance, and community agency. Community power is a key mechanism for addressing disparities. This study examines how visible, hidden, and invisible power operate within a U.S. county to inform inclusive governance. We conducted seven focus groups with Black and Hispanic residents (n = 68) and sixteen semi-structured interviews with elected officials, government staff, and advocacy leaders in Greenville County, South Carolina. Data were collected between March and December 2024. Transcripts were collaboratively coded in NVivo and analyzed using thematic analysis guided by Heller et al.'s Three Faces of Power framework. Visible power appeared through inequitable resource distribution, limited transparency, and barriers to civic participation. Hidden power functioned through faith based organizations, schools, nonprofits, and social media, connecting residents with decision makers. Invisible power reflected how socioeconomic status, race and ethnicity, immigration, and language shaped perceptions of agency and trust. Participants called for participatory structures that move beyond consultation toward shared authority and sustained engagement. Strengthening community power through structural reforms, inclusive governance practices, and targeted civic engagement may improve health outcomes and reduce disparities. Future research should examine scalable co-governance models.

Informed consent is both a foundational principle of research ethics and a human right grounded in self-determination and bodily integrity. During the COVID-19 pandemic, legislative attempts were made in South Korea to bypass informed consent and ethics review requirements for research involving patients with infectious diseases. Framed as emergency measures to accelerate biomedical innovation, the proposals sparked resistance from a broad coalition of civil society actors, including human rights advocates, patient organizations, labor unions, medical professionals, and bioethics scholars. This coalition, drawing on international bioethics norms and lessons from past research ethics controversies, mounted a coordinated public response, warning that such deregulation could erode fundamental ethical safeguards and set a concerning precedent. Their efforts helped prevent the proposed legislation from advancing in the parliamentary process. This defense of informed consent must be understood within the context of South Korea's post-authoritarian democratic evolution. Decades of civic struggle-from resistance to military dictatorship to the response to a constitutional crisis triggered by a martial law declaration in 2024-have shaped a politically conscious and ethically engaged public. This case study illustrates how informed consent can function not simply as a technical or procedural requirement but as a hard-won civil right anchored in democratic participation. South Korea's experience offers globally relevant insights into the role of civic vigilance in safeguarding human rights, especially during public health crises and emergency rule.

This article examines solidarity as both a promise and a problem in public health discourse. Against accounts that treat solidarity as a moral feeling, civic mood or exhortation to comply, it argues that solidarity becomes ethically meaningful only when it is tethered to action, institutional obligation and distributive consequence. The article develops this claim through a medical humanities reading of two epidemic archives: HIV/AIDS activism and COVID-19 governmental address. Reading AIDS Coalition to Unleash Power (ACT UP) repertoires in the USA, France and England, it shows how grief, anger and care were converted into targeted institutional pressure directed at governments, regulatory bodies, medical authorities and markets. Solidarity here appears not as sentiment but as a political technology for making abandonment visible and costly. The article then turns to COVID-19 speeches in France, the UK, the USA and Italy, where solidarity is repeatedly mobilised through war metaphors, unity claims and appeals to sacrifice. These addresses often recast public health failure as individual moral responsibility, making compliance the most visible sign of civic virtue while leaving institutional accountability comparatively underspecified. The article concludes that solidarity can be reclaimed only if it is constrained into obligation-talk: a language of enforceable duties, material supports, rights to care and institutional accountability. Where that constraint cannot hold, solidarity risks becoming an alibi for unequal vulnerability rather than a response to it.

Volunteering plays a growing role in supporting community resilience in times of crisis. This paper takes a closer look at the role of political trust for volunteering, distinguishing between trust in local and national government. We conduct secondary analysis of a large-scale longitudinal social survey in the United Kingdom (three timepoints, N = 5,039), to estimate a random-intercept cross-lagged panel model to assess the relationships between political trust and volunteering over time. Results reveal a positive link at the between-person level between volunteering and local but not national trust (random intercepts). At the within-person level (cross-lagged paths), an increase in local trust is related to a greater likelihood of volunteering 3 months later. Moreover, an increase in national trust is related to a lower likelihood of volunteering. We highlight implications for initiatives to promote civic engagement.

Zoning codes influence the built environments of communities in the United States (U.S.), which in turn have potential to promote social connections. This study assessed associations between code reform zoning (CRZ) and activity-oriented zoning (AOZ) exposure and perceived neighborhood social connectedness and whether these associations were mediated by walkability and park coverage. Data from the Current Population Survey September 2019 Volunteering and Civic Life Supplement were linked to U.S. county-level data on (1) population-level exposure to CRZ and an index of 10 AOZ measures as of 2010, (2) EPA's 2021 National Walkability Index, and (3) proportion of area devoted to parks from the 2018 National Neighborhood Data Archive (n = 21,616). Multivariable logistic regression models with robust standard errors examined associations between CRZ and AOZ exposure and three perceived neighborhood social connectedness measures and mediation analyses examined mediation by walkability and park coverage. CRZ (OR: 1.22, 95% CI: 1.08-1.36) and each additional AOZ measure (OR: 1.03, 95% CI: 1.01-1.05) were associated with having conversations or spending time with neighbors. CRZ (OR: 1.22, 95% CI: 1.10-1.35) was also associated with neighbors doing favors for each other, as was AOZ (OR: 1.03, 95% CI: 1.01-1.04). None of these associations were mediated by walkability or park coverage. CRZ (OR: 1.29, 95% CI: 1.14-1.46) and AOZ (OR: 1.04, 95% CI: 1.02-1.06) were associated with neighbors getting together to do something positive; both associations were mediated by walkability but not park coverage. Zoning is a policy lever that can promote neighborhood social connectedness.

A lacuna of information exists on how to build a One Health system that integrates human, animal and environmental health for the early detection and prevention of emerging infectious diseases. This study aimed to identify and articulate perceptions of practitioners and government stakeholders regarding the COVID-19 pandemic in Indonesia within a One Health framework. Key findings highlight the ability of local governments to rally stakeholders and form a progressive evidence-based response. While civil society's role is often overlooked, with appropriate government facilitation, it can serve as an effective agent of change on the ground. By adopting a bottom-up approach, this study provides a unique contribution to policy development discourse in line with One Health. The findings also emphasize challenges in the capacity of national and subnational governments to organize multi-actor responses, as well as the role of civil society and civic institutions in policy implementation. Persistent vulnerabilities at the human-wildlife interface were also evident, especially in relation to trade in wildlife, wild meat consumption, and the domestic keeping of wildlife, which have been exacerbated by fragmented coordination and implementation. New policy instruments, such as digital zoonotic disease surveillance, integrated early warning systems, and social forestry present opportunities for mitigating risk. To better address Indonesia's health security concerns in the post-COVID context, there is a need to strengthen One Health integration, enhance participatory risk communication, and align environmental management with health preparedness to mitigate future spill-over risks.

Real world data are increasingly used to evaluate revascularisation outcomes in chronic limb threatening ischaemia (CLTI). However, variation in data availability, accuracy, completeness, and granularity may influence the validity of outcome measurement. This review mapped outcomes reported in real world studies of CLTI revascularisation, examined how data infrastructure limitations affected outcome measurement and developed a framework for appraising the validity of reported outcomes. This was a scoping review of observational studies evaluating CLTI revascularisation using standalone or linked national registry, administrative, and insurance based datasets. MEDLINE and Embase were systematically searched (2015 - 2025) for eligible studies. Extracted information included data source(s), country, outcome definitions, reporting frequency, time period(s) covered, and linkage status. Outcome measurement issues were assessed in relation to data infrastructure characteristics. Fifty five studies from 10 countries reported 293 outcomes (31 unique). Reporting was dominated by mortality, major amputation, and reintervention, collectively accounting for 47% of all reported outcomes. Composite outcomes including amputation free survival, major adverse limb events, and major adverse cardiovascular events contributed a further 19%. Outcome definitions were heterogeneous, with 22 definitions of reintervention identified. Linkage with civic death registers improved mortality ascertainment. Amputation and reintervention event capture was most robust in data infrastructures supporting granular limb specific procedural analysis. Patient reported outcome measures, patency, and wound healing were infrequently reported. Linkage between registries, administrative datasets and death registers strengthened reliability of long term outcome measurement. A framework for appraising real world studies of CLTI revascularisation reflects these observations. Outcome validity in real world studies of CLTI revascularisation is influenced by the characteristics of the underlying data infrastructures, particularly coding granularity and linkage capability. Greater standardisation of outcome definitions and improved integration of data infrastructures are required to support more reliable and interpretable real world evidence in CLTI.