Although progress towards implementation of international agreements since publication of the UCL-Lancet Commission on Migration and Health in December, 2018, has been slow, global trends in migration and forced displacement have continued to rise. However, the COVID-19 pandemic showed that reaching refugees and migrants with health interventions is feasible with political will. The benefits of refugee-inclusive and migrant-inclusive health-care systems during emergencies (eg, COVID-19 and the war in Ukraine) are apparent, with numerous examples of inclusive policy making being rapidly introduced and innovative models developed to support health-care access, including preventive measures such as vaccination. Lessons from these successes should be learned and incorporated into future policy and practice. However, global political and financial uncertainty and disruption-combined with multiple conflicts and natural disasters-have increased individuals' need to move, which will continue to be exacerbated by the climate crisis. Although new conflicts and exacerbations of existing ones have led to a rise in forced displacement within and across national borders, labour migration has also risen dramatically, with the pandemic highlighting the health and social needs of these groups globally. The need for strong leadership and accountability, engagement of policy makers in the highest-level fora, and improved access to quality health services for refugees and migrants has never been greater. In this Review, nearly 8 years after the UCL-Lancet Commission on Migration and Health was published, we renew our call for action to: (1) improve health-care access and optimise outcomes for refugees and migrants by emphasising health in all migration and forced displacement policies; (2) establish data systems to monitor progress, together with appropriate use of new technologies to improve access, prevent harm, and safeguard privacy; (3) support research on adaptation to and mitigation of the health consequences of climate change on refugees and migrants; and (4) renew focus on the political determinants of health outcomes for people on the move. At this pivotal moment, with geopolitical, sociodemographic, and environmental turmoil, political leaders and societies can shape a better future by leveraging the human capital of migrants and upholding the human rights and dignity of all.
Expectations of integrating health and social care providers have driven the development of digital solutions aimed at overcoming interoperability challenges and ensuring access to information needed for integrated care across fragmented services. However, challenges persist in aligning diverse coding practices, heterogeneous data-sharing mechanisms, and stakeholder needs. We examine how expectations of interoperability and integrated care have shaped the growth of regional information infrastructures in Scotland, using the Key Information Summary (KIS), a summary record that shares key patient information from general practitioner records with out-of-hour services, ambulance services, hospitals, social workers, and caregivers across multiple care settings, as a case study. This qualitative study examined the development, implementation, and adoption of KIS in Lothian, Scotland, across health and care settings, where it has been in use for 13 years. Multisited ethnography was used to understand how technology design, implementation, and adoption were shaped by social, organizational, cultural, and political factors. Data were collected through interviews with users, vendors, and implementers; observations of technology use and multidisciplinary team meetings; and documentary analysis of policies, user guides, and internal reports. A hybrid analytical approach was applied: the Technology, People, Organization, and Macroenvironment framework guided initial coding, while the sociology of expectations and information infrastructure theory were used inductively to trace evolving visions of integration, and the long-term development of regional information infrastructure. Data included 54 qualitative interviews, 20 hours of observation, and 59 documents collected between April 2024 and March 2025. Findings illustrate how information infrastructures for integrating health and care providers evolved through successive concerted efforts, conceptualized as waves. Three waves were identified, each characterized by attempts to interlink disparate information systems used by various health and care providers. The first wave focused on linking health care providers by developing networks and architectures required for sharing clinical information, which later supported the development and sharing of KIS. Subsequent waves sought to interlink information systems used by health care providers with those used by local authorities and social care providers. In the absence of shared data standards across these sectors, interoperability was achieved by extending the existing health care-centric infrastructure to different social care settings through workarounds such as providing proxy access to hospital systems and secure emailing networks. This work illustrates how regional information infrastructures for integrated care evolve through orchestrated waves of change. Some expectations for change required coordinated, system-level action, such as setting up standards, networks, and architecture, while others were realized through local adaptations. Integrating health and care providers through digitalization is a long-term process requiring sustained coordination, with progress often occurring through incremental, local extensions. Policies must support adaptive, long-term coordination, balancing system-level initiatives with local adaptations to achieve meaningful integration.
This review examined 28 studies to understand how political economy analysis (PEA) is conceptualized and applied in health. Definitions of political economy varied, with only 11 studies offering explicit definitions. Most commonly, political economy was framed as the study of power, interests, institutions, and ideas shaping health policy processes and outcomes. Applications ranged from analysing structural determinants of health to understanding stakeholder influence in health reforms. Across studies, 31 distinct frameworks and theories were used. Frequently employed models included Campos and Reich's Political Economy of Health Financing Reform Framework, Harris's Applied PEA, and the DFID and World Bank 'How-to' notes. Theoretical underpinnings were drawn from economics, political science, and sociology-such as historical institutionalism, stakeholder theory, and discursive institutionalism-highlighting the interdisciplinary nature of PEA. Health issues analysed through a political economy lens primarily included health financing, governance, human resources for health, and service delivery. PEA was used to explore challenges such as policy reform feasibility, institutional capacity, health workforce equity, and donor dependency. The rationale for applying PEA included uncovering the influence of actors, navigating complex political contexts, and enhancing policy implementation. Overall, PEA in health is marked by conceptual diversity and methodological pluralism. Its growing application reflects the need to understand the interplay of politics, institutions, and economics in addressing systemic health challenges.
Antimicrobial resistance (AMR) poses a serious threat across human, animal and environmental health. The One Health approach emphasises multisectoral collaboration and is critical in addressing AMR. While One Health governance has gained recognition from international organisations, there remains limited understanding of how it can be effectively implemented across institutional, social, economic and political contexts. This scoping review aims to explore the design and implementation of One Health governance across contexts. Scoping review DATA SOURCES: We searched PubMed, Scopus, Web of Science and grey literature sources in December 2024, updating our search in March 2026. Eligible sources included empirical and conceptual work on One Health governance. We searched for and screened documents and extracted data following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We then applied qualitative analysis to examine governance mechanisms; implementation contexts; conceptualisations of effectiveness; evidence of effectiveness and key barriers and facilitators. We included 171 documents from over 50 countries. We explored six dimensions of One Health governance: participation, leadership, coordination, decision-making, resourcing and accountability. Existing governance structures and wider aspects of country context shaped One Health governance. While there was broad agreement on the goals of One Health governance-namely, to support disease prevention, detection and response-empirical evidence on effective approaches was relatively limited. Facilitators included strong political will and crisis-driven momentum, while barriers included siloed systems, sectoral dominance, limited accountability, inadequate funding and lack of institutionalisation. This review highlights the range of approaches to One Health governance that exist and outlines how context may shape the design and implementation of One Health governance. Evaluative research should further explore which approaches to One Health governance are most effective in specific contexts. These insights are particularly relevant for AMR, where sustained cross-sectoral governance beyond outbreak-driven responses is essential to counter the 'silent pandemic'.
Emerging biomedical advancements necessitate an understanding of public attitudes toward future vaccine technologies. While existing literature largely focuses on current vaccine hesitancy, this study shifts the focus to future-oriented vaccine-related techno-optimism. Using microdata from Special Eurobarometer 557 (N = 26,500 across 27 EU member states), this study estimates cumulative link mixed models to examine how political ideology and objective science literacy interact to shape public expectations about the societal impact of vaccines over the next 20 years. Importantly, the outcome variable measures prospective techno-optimism and does not measure direct vaccine hesitancy, vaccine refusal, or personal vaccination intention. The findings reveal an asymmetric political polarization: right-wing and far-right respondents exhibit significantly lower future-oriented vaccine optimism compared to centrists, whereas a symmetric 'horseshoe' pattern involving the far-left is not observed. Furthermore, contrary to the knowledge deficit model, higher objective science literacy paradoxically exacerbates this right-wing gradient rather than mitigating it. While adjustment for distrust in scientists modestly attenuates the political gradient, a substantial ideological gap persists. The observed interaction between political ideology and scientific knowledge challenges traditional science communication frameworks. The findings suggest that education-only communication tactics may be insufficient to address skepticism toward future biomedical innovations and should be complemented by trust-sensitive and value-aware approaches. However, recognizing the limitations of cross-sectional data, the actual effectiveness of specific communication interventions requires separate, data-driven assessment.
Three-dimensional (3D)and four-dimensional (4D) ultrasound technologies have evolved from their clinical applications to become integral components of in digital platforms, private commercial settings, and online communities. This article explores how online discourses pertaining to 3D and 4D foetal ultrasound images contribute to the reconfiguration of parental wellbeing during the transition to parenthood. The study draws upon feminist science and technology studies and digital sociology in order to demonstrate how pregnancy, foetal visibility, and parental subjectivities are increasingly mediated by digital infrastructures, and to conceptualises the practices of transition to parenthood as part of a broader process of "platform pregnancy" and "digital birth". The article employs a Multimodal Critical Discourse Analysis to empirically study the content of posts and images shared on two UK-based parenting forums. The analysis focuses on how parents - predominantly expectant mothers - describe, interpret, and emotionally negotiate their encounters with 3D/4D ultrasound scans, and how these experiences are collectively discussed and reframed within online environments. The findings demonstrate that 3D/4D ultrasound images exhibit an ambivalent role in parental wellbeing. Whilst often anticipated as sources of reassurance, fostering bonds, and facilitating emotional connections with the foetus, these experiences can also generate feelings of anxiety, discomfort, and frustration, particularly when the actual experience of viewing diverges from culturally idealised representations of the foetus and the concept of ideal parenthood. Online forums have been shown to function as affective infrastructures in which these tensions are negotiated through storytelling, peer support, humour, and the circulation of images. This enables the collective management of uncertainty and emotional distress. The article presents a conceptual argument that the circulation of ultrasound images on digital platforms contributes to the emergence of the "digital foetus", defined as a hybrid entity produced through the entanglement of medical imaging, parental affect, and platform-mediated visibility. This process anticipates social recognition prior to biological birth, thereby giving rise to what is termed "digital birth". The article employs the concept of "digital timescapes", the article to demonstrate how digital technologies compress, accelerate, and reorganise the temporalities of pregnancy, thereby reshaping the rhythms of anticipation, waiting, and becoming a parent. The article contributes to sociological debates on reproduction, embodiment and parenthood in the digital age by foregrounding the interplay between digital technologies, visual culture and wellbeing.
Yemen's health system has faced prolonged shocks, including war, epidemics, and COVID-19, challenging both governance and resilience. This study examines how formal governance structures and institutional capacities shaped the system's ability to anticipate, absorb, adapt, learn, and transform across a decade of crisis (2014-2025). We conducted a longitudinal qualitative analysis based on interviews with health system leaders and technical actors. Using a resilience-capacity framework, we analyzed governance functions across four phases: pre-conflict period (pre-2014), conflict escalation (2015-2019), COVID-19, and the post-pandemic period. Data were thematically coded and interpreted through the sequential resilience lens of preparedness, absorption, adaptation, learning, and transformation. Participants consistently described a health system with intact formal governance structures but fragile functional capacity. Pre-2014 governance was administratively stable yet centralized and poorly prepared for shocks. During the conflict, preparedness collapsed amid fragmented authorities, and absorptive capacity relied heavily on donor-driven service delivery. COVID-19 triggered temporary improvements in coordination and emergency response, but these were largely ad hoc and poorly institutionalized. Post-pandemic, preparedness remained procedural, absorptive capacity weakened as external funding declined, adaptive measures persisted in localized and reversible forms, and transformative governance remained constrained by political instability and weak enforcement. Digital "workaround governance," including WhatsApp-based coordination, facilitated rapid decision-making but highlighted gaps in formal systems and accountability. Across phases, learning was fragmented, donor-driven, and rarely institutionalized, limiting system-wide reform. Yemen's experience demonstrates that maintaining formal governance structures does not guarantee health system resilience. Sustainable resilience requires institutionalized preparedness, domestic contingency financing, integration of adaptive innovations, and embedding learning into routine governance. Efforts to strengthen health systems in fragile and conflict-affected settings must address governance, capacity, and political economy simultaneously to move beyond reactive crisis management toward transformative change.
Scaling up is a complex process. As a multi-dimensional concept, it requires efforts to (1) increase population coverage (coverage), (2) expand or diversify what is included in the health service package (expansion), and/or (3) institutionalise a health innovation or new practice into health system services (institutionalisation). In this paper, we provide the theoretical basis for the model joining linear as well as complex pathways - stemming from implementation and complexity science - towards three-dimensional scaling. Our scale-up model positions expansion as the backbone for scale-up, and proposes multiple back-and-forth waves between institutionalisation and coverage. This allows an incrementalist approach, going step-by-step from one to the other scale-up dimension, as well as a multi-player complexity approach, emphasising the interactions between scale-up dimensions and actors involved, to achieving population health. By offering a dual incrementalist-complexity focus, we acknowledge that there is a starting point to scale-up, and thus path dependency, in addition to highly contextual cultural, historical, socio-political, and economic forces that underpin population health and any attempt at scaling up access and integration of health services, thereby pointing at their fragmented and incomplete nature. The visualisation and underlying hypotheses offer speculation on potential pathways for scale-up, which are key processes to understand and untangle in future research.
Youth experiencing homelessness and housing instability (YEH) face disproportionate health risks and structural barriers to health equity, which were intensified during the COVID-19 pandemic. We conducted a community-based participatory research study with 21 adolescents (ages 13-17) and transitional-aged youth (ages 18-26) experiencing homelessness or housing instability in San Diego, California, USA. Between February and July 2023, we conducted six "arts-based engagement sessions" (5 in English, 1 in Spanish) that blended expressive arts and focus group approaches to examine how YEH accessed, evaluated, and applied health information, and how trust and material and structural resource constraints shaped engagement with COVID-19 information and prevention guidance. We analyzed data via applied thematic analysis. Participants described how COVID-19 restrictions and economic disruption amplified pre-existing housing precarity, worsening material conditions and mental health. Participants selectively trusted COVID-19 information based on who provided it, how credible it felt, and whether it aligned with their lived experiences. Community-based providers and, for some, churches and cultural or ancestral knowledge were key information sources. Trust in government and public health messaging was conditional and shaped by perceptions of credibility, coherence, and political motivation. Participants described information overload and rapidly changing guidance as overwhelming and often incompatible with their material realities, leading to disengagement, reliance on intuition, or deprioritization of prevention behaviors. Effective communication during future health emergencies must center trusted relational messengers, align guidance with lived realities, and address the structural conditions that shape whether health information can be meaningfully acted upon.
Embedded implementation research (EIR) integrates research within health programmes to address delivery bottlenecks and improve uptake of evidence. While widely promoted, its influence on policy, programme delivery, and service outcomes in low- and middle-income countries (LMICs) remains under-documented. We examined how EIR has influenced policy adaptation, programme design, and service delivery outcomes across LMICs where UNICEF has supported EIR initiatives. We conducted a mixed-methods cross-sectional synthesis drawing on survey data, document review, and case analyses of UNICEF-supported EIR projects conducted between 2015 and 2022. The analysis was guided by Proctor's implementation outcomes framework (adaptation, fidelity, sustainability) and the Consolidated Framework for Implementation Research to explore how contextual mechanisms shaped observed outcomes. We included 33 researchers and implementers representing 24 completed EIR projects from 11 countries who participated in an online structured survey (69% response rate). Their responses were triangulated with project reports and UNICEF monitoring documentation. Two-thirds (67%) of projects reported that their findings informed policy or programme adjustments, most commonly through revised immunisation strategies, integration of digital tools, and strengthened community engagement. Half (50%) documented measurable service-delivery improvements, such as increased vaccination coverage and improved routine child health indicators, reflecting greater fidelity to evidence-informed practices. Examples from Pakistan, Malawi, and Ethiopia demonstrated policy adaptation and scaling of interventions derived from EIR evidence. Across projects, early engagement of decision-makers, alignment with programme cycles, and participatory dissemination were key enablers of uptake. Persistent barriers included limited political commitment, competing priorities, and inadequate post-research financing. When co-led by decision-makers, integrated into programme cycles and national coordination structures, embedded implementation research can accelerate the use of evidence and strengthen programme performance. To maximise its potential, future EIR efforts should prioritise sustained political commitment, dedicated financing, and mechanisms for ongoing follow-up and learning to ensure that research findings translate into policy and service-delivery improvements.
To identify and explain the health system factors influencing private general dental practitioners (GDPs) engagement in state-funded, contracted primary oral healthcare for low-income adults in Ireland, in which circumstances, for which groups, how and why. Nineteen realist interviews were conducted with frontline GDPs, health system actors and academic subject experts from Ireland and elsewhere. Collected data were then transcribed, coded, and analysed to generate context-mechanism-outcome configurations (CMOCs) and develop an overarching realist programme theory to explain causation. Thirteen individual and abstracted CMOCs were crafted and subsequently consolidated into five high level CMOCs. GDPs' engagement with state funded care is influenced by a myriad of complex health system contextual factors. These include low political and resource commitment to oral health; cost containment measures characterised by limited and outdated baskets of care and low remuneration; overtly bureaucratic oversight or contract administrative processes; adversarial communications and the absence of consultative mechanisms between the health system and GDPs. Other factors such as oral healthcare 'market' dynamics, GDPs' professional networks and community ties can also influence engagement in state care. As Ireland looks to reform its primary oral healthcare system to widen population access to care and meet national oral health policy and WHO commitments on oral health, the findings of this study provide health system leaders with evidence to leverage system change and increase or sustain GDPs' engagement in state care. Leveraging such change has the potential to improve access to care for vulnerable populations and reduce oral health inequalities.
A strong and growing evidence base across multiple dimensions of health and wellness supports the value of physical activity with cultural or regional relevance, such as ethnic dance and traditional games. Greater inclusion of culturally and regionally relevant physical activity (CURE-PA) into health promotion is concordant with international public health goals, yet CURE-PAs have traditionally been underused in health and physical activity promotion especially at the population level. The specificity of deep community and cultural context of these activities, an important strength for public health promotion, can obscure communalities in approaches, synergies and outcomes across locations, programmes and populations. Following a narrative review method by a multinational expert team as preparation for the development of formal search protocols in this vast, multidisciplinary literature, this paper: (1) provides a preliminary assessment of the potential size and nature of relevant research, (2) develops a definition of CURE-PA and (3) delineates relevant characteristics supporting inclusion of CURE-PA in population level health promotion. Numerous articles and scientific disciplines with vital evidence on CURE-PA were identified, including nature and health, sport(s), dance, Indigenous health, physical literacy, sociology, political science, youth leadership development, resilience models, community design, ecology, leisure studies, cultural revitalisation and decolonialisation in sports. In formal searches, 100 000s of relevant articles would be found, highlighting the importance of clarifying CURE-PA boundaries, definitions and conceptual models in advance of formal search protocols. A synthesising literature about CURE-PA from a global health promotion perspective can guide future work and support engagement, planning, study, uptake, funding and implementation of CURE-PA in population-level public health. Greater inclusion of CURE-PA in health promotion can help to address physical inactivity as well as chronic disease, mental health concerns, loneliness and other global public health challenges, building from community strengths, preferences and knowledge systems.
Trust is foundational to the functioning of health systems and public health initiatives, yet it is increasingly strained by misinformation, politicization, and persistent structural inequities. Although multiple disciplines have examined how trust is built, maintained, and repaired, evidence remains fragmented and often lacks sufficient specification to support comparison or practical application. We conducted a scoping review to map empirically examined trust-related strategies across disciplines and to clarify how these strategies are articulated in actionable terms. We searched seven databases from inception to March 15, 2024, and included experimental, quasi-experimental, and observational studies assessing trust-related strategies. Screening and data extraction were completed in duplicate. Strategies were coded using the Action, Actor, Context, Target, Time (AACTT) framework and categorized by trust phase (building, maintaining, repairing). A reproducible, human-verified Python workflow supported data standardization and thematic clustering. Across 327 studies, we identified 1017 strategy instances (919 unique) spanning disciplines including psychology, sociology, political science, economics, technology, and healthcare. Strategies clustered into 14 themes, most commonly values-based approaches, structural assurances, transparency and disclosure, humanizing framings, and interpersonal communication. Strategies were predominantly enacted by individual actors within institutional contexts and primarily targeted individual trustors, with limited emphasis on structural or post-violation repair interventions. Overall, findings highlight the dominance of relational and informational strategies alongside structural safeguards, while underscoring gaps in institutional-level approaches. This review advances an interdisciplinary, action-oriented understanding of trust, offering a foundation for developing more explicit, evaluable, and contextually responsive trust-building strategies in health and social systems.
While the presence of organizations in neighborhoods has been widely studied, studies have generally not considered whether sentiment toward neighborhood organizations might be associated with public health. Neglecting this affective dimension of organizations limits our grasp on the influence of organizations on processes that mitigate or exacerbate health disparities. We used the 2023 Baltimore Area Survey (weighted n = 1,135,389 adults) to assess whether respondents viewed nearby businesses, nearby nonprofits, and local government positively and whether "positive organization sentiment" was associated with better self-reported physical and mental health. Respondents rated their physical and mental health, depressive symptoms (Patient Health Questionnaire-2), and anxiety symptoms (Generalized Anxiety Disorder-2). We also assessed civic engagement as a complementary but distinct measure from positive organizational sentiment. Population-weighted multivariable linear regression models estimated the relationship between civic and health variables. Positive business sentiment, nonprofit sentiment, local government sentiment, and civic engagement were positively associated with self-rated physical and mental health and negatively associated with depressive and anxiety symptoms. The largest associations were seen for government sentiment and anxiety (β = -0.31; 95% CI = -0.48, -0.13), government sentiment and depression (β = -0.28; 95% CI = -0.42, -0.13), and business sentiment and anxiety (β = -0.28; 95% CI = -0.45, -0.11). Civic engagement and anxiety were not significantly related. Our results support the hypothesis that civic engagement and organizational sentiment are related to better physical and mental health. The results of this study suggest that fostering citizens' trust in neighborhood civic organizations and ensuring these organizations are perceived as trustworthy may enhance public health and well-being and vice versa.
Vaccinations have been established as one of the most effective strategies to prevent the spread of infectious diseases. However, vaccine hesitancy has been a growing issue that needs to be monitored and understood to ensure successful promotion. Historic structural, social, and health disparities have been demonstrated to have significant impact on many health outcomes including vaccination uptake. This study applied the National Institute on Minority Health and Health Disparities Research Framework to examine factors influencing COVID-19 vaccination intention during the COVID-19 pandemic among adults in Pima County, Arizona. Between 22 Aug and 05 Dec 2020, 10 focus group discussions stratified by race/ethnicity, gender and language spoken (FGDs) were conducted virtually among 56 adult residents of Pima County, Arizona. After transcription and translation of FGDs conducted in Spanish, transcripts were organized by demographic characteristics and coded in Dedoose software by four independent coders. The NIMHD Framework's Domains of Influence were used as a priori codes in the thematic analysis. All participants completed an informed consent process prior to participation. Of the 56 participants who took part in the ten focus groups, 27% self-reported being Hispanic or Latinx, 25% were White/non-Hispanic, 9% were Black, and 4% were Asian. The preferred language was most often reported as English. Unique challenges for each demographic group emerged from this analysis, such as language barriers among Hispanic participants, historical mistreatment concerns among Black participants, and conflicting political messages for White participants. Cultural norms, family influences, and attitudes toward autonomy versus community responsibility further shaped vaccine decisions. Effective communication about vaccine safety, clinical trials, and public health messaging were identified as critical to addressing mistrust and vaccine confidence across diverse groups. Major themes in this study that predict vaccine intention include health literacy challenges, misinformation, mistrust in healthcare systems, and the desire to protect others. Understanding the behaviors and decisions behind vaccination acceptance and receipt is important for developing effective vaccine communication strategies. Identifying health disparities driving vaccination hesitancy may help guide future strategies and policies to improve vaccination rates, especially among minority groups.
Digital labour platforms are reshaping the world of work across a wide range of sectors, offering greater flexibility and accessibility than traditional labour markets. However, existing research suggests that platform work is often associated with low-quality working conditions and may exacerbate inequalities. This study examines the economic and social dimensions of digital platform labour in Italy-a country characterised by labour market fragmentation and the widespread use of non-standard employment-using official survey data collected in 2018 and 2021. Applying advanced machine learning (ML) and explainable artificial intelligence (XAI) techniques, the analysis explores the demographic, occupational, and economic factors that predict participation in platform work and drive segmentation within the platform workforce. The findings reveal that platform work in Italy is a heterogeneous and stratified phenomenon, deeply embedded in longstanding labour market fragmentation and regional disparities. Economic vulnerability is concentrated not among the youngest workers, as often suggested in the literature, but among older or more established individuals facing job instability, underemployment, or declining income from traditional occupations. Moreover, the analysis reveals that platform work is associated with structural vulnerabilities typical of non-standard employment, including unstable contracts, gender inequalities, and economic insecurity, and it primarily functions as a compensatory mechanism to supplement insufficient earnings from precarious jobs. Among jobseekers, engagement with platforms is more likely among younger individuals experiencing moderate-rather than severe-financial strain, suggesting that platform work is not generally perceived as a last-resort strategy but rather as a temporary or adaptive response to limited labour market opportunities. The COVID-19 pandemic further intensified these dynamics, acting as a catalyst for workers experiencing economic and social stress. During this period, platform work expanded as a fallback option for the unemployed, providing an informal buffer amid declining employment opportunities and persistent income insecurity.
Population aging in rural China is increasing, making the promotion of health among rural older adults an urgent issue. Physical activity is a crucial way to maintain health in later life and has attracted significant attention from researchers both domestically and internationally. Grandparental childcare, as an important form of intergenerational family support, may play a key role in influencing older adults' participation in physical activity. However, there is limited empirical evidence on the mechanisms that explain these effects. This study explores the association between grandparental childcare and physical activity among rural older adults and further examines potential mechanisms underlying this relationship. The study used data from 6,188 respondents in the 2023 China Longitudinal Aging Social Survey. After controlling for sociodemographic factors such as gender, age, education, self-rated health, and income, a binary logistic regression model was applied to examine the association between grandparental childcare and physical activity. Descriptive statistics show that 60% of rural older adults provide grandparental childcare, and 44.2% participate in physical activity. The regression results indicate that providing grandparental childcare is associated with a 6.66-percentage-point higher probability of engaging in physical activity. Heterogeneity analysis reveals that this association is stronger among women and older adults aged 60-69. Grandparental childcare is significantly associated with participation in physical activity among rural older adults, with stronger associations observed among women and younger older adults. It is recommended that rural communities integrate physical activity opportunities into daily caregiving contexts, make better use of existing public spaces, and provide health education and caregiver support for older adults who provide grandparental childcare. These initiatives can help support caregiving responsibilities and contribute to healthy aging among rural older adults.
Migrant and left-behind children experience health vulnerability that are shaped by climate change, including by climate change, including illness, displacement, and family separation, but also by the organisation of healthcare systems. This scoping review maps the evidence on healthcare services for migrant and left-behind children, with attention to health needs, service provision, barriers and facilitators to access, and gaps in care. Following PRISMA-ScR reporting guidance, searches were conducted in Web of Science/MEDLINE and Scopus for peer-reviewed English-language publications from the database inception to May 2026. After duplicate removal and two-stage screening, 35 publications were included. The evidence shows that migrant and left-behind children require a continuum of preventive, primary, specialist, developmental, nutritional, dental, mental health, and emergency care. However, access is frequently constrained by legal exclusion, documentation requirements, cost, language barriers, limited health system navigation, discrimination, mobility, disrupted continuity of care, and under-resourced services. Left-behind children remain especially under-represented, with limited evidence on preventive, mental health, and chronic care access. Facilitators include inclusive entitlements, community outreach, school provision, interpreters, bilingual professionals, culturally responsive care, health literacy support, and cross-sector coordination. The review argues that healthcare inequity for children affected by migration is produced not only by service absence, but by systems that fail to adapt to children's legal, linguistic, relational, and transnational realities. Rights-based child health policy should therefore move from episodic and discretionary provision towards universal entitlements, continuous care pathways, and integrated support that is culturally responsive, developmentally appropriate, and accountable to the lived experiences of migrant and left-behind children.
To examine socioeconomic and demographic differences in who complains about healthcare and whether these factors are associated with the outcomes of complaint cases. Nationwide cross-sectional study in Denmark using linked national health, complaint and administrative registers. The Danish healthcare system provides universal coverage and has a centralised system for handling complaints with linked patient-level data to sociodemographic variables. All healthcare contacts in 2022 in general practice (GP), non-psychiatric hospitals and psychiatric hospitals were included. We examined two outcomes: (1) submission of a complaint and (2) whether the authorities upheld the complaint. We then assessed how these outcomes varied by socioeconomic position (SEP), focusing on the contrast between patients with the lowest and highest SEP profiles. Relative risks (RRs) were estimated using modified Poisson regression with cluster-robust variance estimation at the patient level. There were 31.9 million GP contacts, 4.8 million non-psychiatric hospital contacts and 345 000 psychiatric contacts, with 1381, 3545 and 439 complaints, respectively (0.43-12.7 per 10 000 contacts). Clear socioeconomic disparities emerged. Low-income patients were more likely to complain about GP and non-psychiatric hospitals, while higher education was associated with fewer complaints in these settings but more complaints about psychiatry. Patients outside the workforce were more likely to complain, whereas elderly patients were consistently underrepresented in the complaints.Low-SEP profiles had notably higher complaint probabilities than high-SEP profiles in GP (RR 2.60, 95% CI 2.22 to 3.70) and non-psychiatric hospitals (RR 1.69, 95% CI 1.40 to 1.98), but not in psychiatric hospitals (RR 0.93, 95% CI 0.47 to 1.38). Although individual SEP indicators showed no consistent differences in complaint outcomes, the combined SEP profiles revealed lower probabilities for complaints being upheld in lower SEP patients in GP (RR 0.58, 95% CI 0.22 to 0.94) and non-psychiatric hospitals (RR 0.70, 95% CI 0.43 to 0.96), while the estimate for psychiatric hospitals was inconclusive (RR 0.71, 95% CI 0.24 to 1.66). In this nationwide study, socioeconomic and demographic factors were linked to clear differences in both complaint submission and complaint outcomes. Except for psychiatric hospital services, patients with fewer socioeconomic resources were more likely to file a complaint yet had a lower probability of having it upheld. These findings point to disparities in who complains and in how complaints are assessed, and they underline the need to consider all complaints, regardless of outcome, when using complaint data to inform quality improvement efforts.
Currently children's needs, perspectives, and rights are not adequately included in public policies, with negative consequences for the health and wellbeing of children and future generations. The 2020 WHO-UNICEF-Lancet Commission reviewed threats to children's health and concluded that children's needs and voices should be centred in all policies for a sustainable future. Since 2021, Children in All Policies 2030, a global collaboration of policy makers, scientists, and advocates, has implemented the Commission's recommendations by fostering new approaches to participatory, intersectoral policy making across diverse countries. Efforts to implement the Commission's recommendations encountered challenges including flawed assumptions in prevailing policy-making models, failure to fulfil children's right to participate, and an ongoing scarcity of intersectoral policy integration. Eight lessons on what works for improving policy making and implementation emerged: use creative means to involve children, patiently assemble coalitions, prepare to seize political opportunities, harmonise global data to bridge UN partnerships, create national political and technical platforms, use media to change cultural perceptions, use strategic framing to overcome sectoral barriers, and embrace joint learning. Harnessing people's consideration and concern for children and future generations and engaging children's voices represents a powerful political opportunity to reach current development goals and ensure a healthier, more sustainable future.