Search Results (420)

Depression, anxiety, and stress-related disorders continue to rise globally, with South Africa’s burden intensified by structural inequalities and a 91% mental health treatment gap, making accessible complementary interventions urgently needed. This exploratory mixed-methods pilot study examined the feasibility and acceptability of astronomy-based mental health support grounded in Attention Restoration Theory and awe research and sought a preliminary signal of change in psychological well-being. Two sequential retreat iterations combined guided naked-eye and telescope-based stargazing with nature immersion: a proof-of-concept peer camp (n = 19, Glencairn) and a family-focused retreat (n = 22 across nine family groups, Sutherland). The Depression Anxiety Stress Scale (DASS-21) was administered before (T1) and after (T2) the Glencairn retreat; qualitative data comprised the Most Significant Change focus groups (Glencairn) and asynchronous text-based interviews (Sutherland). Mean depression, anxiety and stress scores were lower at T2 than at T1. Because questionnaires were completed anonymously, individual T1 and T2 responses could not be linked. A valid paired analysis was therefore not possible, and inferential significance testing was not undertaken. These results represent descriptive cohort level patterns and should not be interpreted as evidence of within person change. Qualitative findings across both settings indicated calm, perspective shifts, and relational connection, while environmental novelty and family dynamics introduced competing cognitive demands at Sutherland. These preliminary findings suggest that astronomy-based interventions may support short-term psychological well-being and highlight three design considerations for implementation in African contexts, offered as provisional insights rather than established implementation principles with the design considerations being: cognitive spaciousness, contextual onboarding and relational anchoring. Full article

Environmental injustices in the United States are rooted in structural racism, particularly policies of racial segregation and disinvestment such as redlining that have produced enduring inequalities in the built environment and population health. This concept paper examines extreme heat as a racialized environmental exposure in Buffalo, New York—a post-industrial Great Lakes city increasingly framed as a “climate haven”. While such designations suggest relative protection from climate risk, they obscure the socio-spatial inequalities that shape uneven vulnerability on the ground. Drawing on a structural racism framework and insights from urban political economy, this study argues that extreme heat vulnerability in Buffalo is not incidental but produced through historically embedded patterns of disinvestment in housing, infrastructure, and environmental resources. Neighborhoods such as the East Side, Black Rock, and the West Side exhibit heightened exposure due to concentrations of thermally inefficient housing, limited tree canopy and green space, and unequal access to cooling resources. These conditions reflect the material legacy of segregation and uneven urban development, which continue to structure differential capacity to adapt to rising temperatures. Although extreme heat is widely recognized as a major public health threat, it remains underexamined in mid-sized northern and Rust Belt cities, where risk is often perceived as episodic rather than structurally produced. This paper addresses this gap by advancing a conceptual critique of the “climate haven” narrative, demonstrating that relative geographic advantage does not equate to equitable resilience. By theorizing extreme heat as a mechanism through which structural racism is reproduced, this study highlights the need for place-based, justice-oriented climate adaptation strategies that confront the historical and institutional drivers of vulnerability in Great Lakes cities. Full article

Young women living in urban informal settlements experience intersecting structural and environmental conditions that shape health and well-being. Alcohol environments (the physical, social, and commercial contexts in which alcohol is sold, marketed and consumed) represent an important but understudied social and commercial determinant of health. Young women in these settings face intersecting vulnerabilities, including poverty, unemployment, and gender inequality, that increase their exposure to alcohol-related harm. Although alcohol use and alcohol-related harms are increasingly understood as shaped by social and commercial determinants of health, little is known about how young women experience alcohol environments in low-resource settings. This exploratory, site-specific secondary, qualitative analysis draws on data from a 2022 Photovoice project conducted over several weeks with 15 young women (ages 18–24) living in urban poverty in Kampala. Participants used photography and group discussions to explore how alcohol shapes their lives. Our inductive thematic analysis included all five participants from the Makindye site, where alcohol-related photographs and narratives emerged prominently during the Photovoice discussions. Six key themes were identified from 42 narrative excerpts and two photographs, highlighting alcohol’s dual role as both a source of livelihood and a source of harm. Participants described pervasive exposure to aggressive marketing, unregulated drinking venues, and the normalization of alcohol use, often linked to interpersonal violence, emotional distress, and disruption of household dynamics. Alcohol environments also constrained women’s mobility and safety, limiting their participation in public life. These findings suggest that alcohol environments may shape young women’s exposure to violence, economic precarity, and psychological distress in this setting. They also point to the potential value of gender-responsive policies, stronger regulation, and community-based prevention strategies to address alcohol-related harm and health inequities in low-resource urban settings. Full article

Global environmental change, biodiversity loss, emerging infectious diseases, antimicrobial resistance, and widening social inequalities increasingly interact to create complex risks for human, animal, and ecosystem health. Although international One Health frameworks and funding mechanisms are essential, implementation at national and especially community levels often remains uneven, fragmented, and weakly evaluated. This Perspective presents a structured, reproducible networking model designed to strengthen community-level One Health implementation through voluntary global collaboration among civil society organisations. The model connects bottom-up community mobilisation with interdisciplinary scientific support, shared evaluation templates, and iterative learning cycles. It outlines a transparent process for identifying and engaging One Health-oriented organisations and for organising their collaboration through thematic Project Working Groups that support situation analysis, strategic planning, implementation, evaluation, and dissemination. The framework translates community action into seven intervention fields: surveillance and early warning, animal health and welfare, water/sanitation/hygiene, food safety and food systems, community awareness and education, environmental risks and ecosystem health, and multisectoral governance. By linking local practice to comparative synthesis, joint publication, and policy dialogue, the network aims to transform isolated initiatives into a coordinated learning system while preserving community and organisational autonomy. As a conceptual framework, the model is ready for empirical testing in diverse settings to assess feasibility, participation, and evaluation quality. Full article

Rapid urbanization and climate change have intensified environmental pressures and social inequalities, making the integration of urban resilience and sustainable development a critical global challenge, with Nature-based Solutions (NbS) emerging as a promising pathway; however, the knowledge structure, collaboration patterns, and evolutionary trends of NbS research remain fragmented and insufficiently understood. This study conducts a comprehensive bibliometric analysis of 1261 publications from the Web of Science Core Collection (2005–2025), employing tools including VOSviewer 1.6.20, CiteSpace 6.4.R1, and Bibliometrix 4.1.3 to map publication trends, collaboration networks, knowledge bases, and thematic evolution. The results reveal a rapid expansion of NbS research since 2013, characterized by strong interdisciplinarity and a multicentric yet uneven geographical distribution dominated by China, the United States, and Europe. Four major research clusters are identified, encompassing policy governance, environmental benefits, ecosystem services, and social equity, reflecting a shift from ecological performance to integrated socio-ecological frameworks. Additionally, thematic evolution indicates growing emphasis on governance mechanisms, public health, and environmental justice. Overall, NbS research is transitioning toward a multi-scale, multi-objective, and governance-oriented paradigm. These findings highlight the need for strengthened international collaboration, standardized evaluation frameworks, and inclusive policy design to enhance the effectiveness and global applicability of NbS in advancing urban sustainable development. Full article

Background/Objectives: Environmental air pollution and structural barriers to preventive dental care are increasingly recognized as determinants of population health inequalities. However, their combined association with oral disease burden across European Union (EU) Member States remains insufficiently examined. This study evaluated whether ambient particulate matter (PM2.5) exposure is associated with oral health outcomes and whether preventive system capacity modifies this association. Methods: An ecological panel analysis was conducted using country-level data from the 27 EU Member States for the period 2020–2023. Age-standardized prevalence of untreated dental caries (primary outcome), edentulism (secondary outcome), and periodontal diseases (exploratory outcome) were obtained from the Global Burden of Disease database. PM2.5 exposure was operationalized using national mean annual baseline values. Preventive care access was proxied by the percentage of the population reporting unmet dental care needs (Eurostat EU-SILC). Pooled panel regression models with year fixed effects and country-clustered robust standard errors were estimated. An interaction term between PM2.5 exposure and unmet dental care needs was included to assess effect modification. Results: PM2.5 exposure was not independently associated with caries prevalence after adjustment for preventive access and GDP per capita. However, a statistically significant interaction was observed: higher PM2.5 levels were associated with increased caries prevalence in countries reporting greater unmet dental care needs. PM2.5 exposure was positively associated with edentulism prevalence, independent of preventive access. No significant associations were detected for periodontal diseases. Conclusions: Based on this ecological analysis of European Union Member States, higher PM2.5 exposure in combination with greater unmet dental care needs was associated with higher population-level caries prevalence, whereas PM2.5 exposure alone showed a positive association with edentulism prevalence. These findings are exploratory and should be interpreted with caution, given the use of aggregated country-level data, the potential for ecological fallacy, and the absence of causal inference. Further individual-level and longitudinal studies are needed to clarify these relationships and their underlying mechanisms. Full article

Urban public parks are vital for recreation, public health, environmental quality, and sustainable urban growth. Yet access to these parks remains uneven across many cities, disproportionately affecting low-income, marginalised, and spatially segregated communities. This study systematically examines socio-spatial disparities in park access and their implications for spatial justice. Using the PRISMA 2020 framework, 108 peer-reviewed articles published between 2000 and 2025 were analysed through thematic narrative synthesis. The results identify key factors shaping accessibility disparities, including socio-economic status, residential location, race and ethnicity, transport infrastructure, urban form, governance, and demographic vulnerability. The most common determinants were socio-economic status (24%), residential location and spatial distribution (20%), race and ethnicity (18%), and urban form and transport systems (17%). Limited park access exacerbates socio-economic inequality, worsens environmental injustice, contributes to health gaps, reinforces spatial segregation, hampers urban sustainability, and marginalises vulnerable populations. The review integrates Spatial Justice Theory, Environmental Justice Theory, and Urban Political Ecology into a comprehensive analytical framework and introduces a conceptual model linking accessibility factors to spatial justice outcomes. These findings underscore the importance of equitable green infrastructure planning, inclusive governance, and improved access in underserved urban areas. Full article

Background/Objectives: School feeding is a fundamental component of public policies aimed at promoting health, improving educational outcomes, reducing inequalities, and guaranteeing the human right to adequate food. This study aimed to evaluate the nutritional quality of school meals offered to public school students in a federal unit of Brazil, quantify the environmental impacts using carbon and water footprints, and simulate potential reductions through a strict vegetarian menu. Methods: This cross-sectional, descriptive study analyzed 130 daily menus (390 meals) from full-time public schools in the Federal District of Brazil in 2024. Nutritional quality was assessed based on energy, nutrients, food groups, degree of processing, and food origin. Carbon and water footprints were estimated using literature-based indicators. A nutritionally adequate strict vegetarian menu was then developed and compared with the observed menus. Results: The current menus presented good overall nutritional quality, with high food diversity and predominance of fresh or minimally processed foods. Most nutritional parameters met the recommended levels; however, protein and saturated fat exceeded the recommended limits. Animal-based foods accounted for most of the carbon and water footprints. The simulated strict vegetarian menu demonstrated significantly lower environmental impacts while maintaining nutritional adequacy. Conclusions: These findings highlight the importance of integrating nutritional and environmental strategies, such as a weekly “Meatless Monday” initiative alongside food and nutrition education, to improve student health outcomes and reduce the environmental burden of public school meals. Incorporating environmental sustainability criteria into school meal planning and public food procurement may advance nutritional quality, resource efficiency, and climate goals, positioning school feeding programs as strategic instruments for sustainable development. Full article

Background and Objectives: Dengue is emerging as a multifaceted public health challenge that extends beyond traditional vector-borne disease frameworks. Climate change, rapid urbanisation, environmental transformation, global mobility, and digital ecosystems are progressively reshaping transmission dynamics, outbreak patterns, and preparedness needs worldwide. This narrative review aimed to examine dengue from an integrated public health perspective, focusing on climate-sensitive transmission, urban health, surveillance and preparedness, digital epidemiology, artificial intelligence (AI), and health communication. Materials and Methods: A structured narrative review was conducted through targeted literature searches in PubMed, Scopus, and Web of Science between April and May 2026. To this end, a series of separate thematic search strategies were developed to explore the principal conceptual domains addressed in the review. The synthesis was organised around five interconnected preparedness domains: climate change and environmental transformation; urbanisation and urban health; surveillance, vaccination, and integrated preparedness; digital health, artificial intelligence, and mathematical modelling; and health communication and community engagement. The retrieved literature was analysed using a thematic narrative synthesis approach. Results: The retrieved evidence indicated the progressive expansion and redefinition of dengue risk across both endemic and historically non-endemic regions. Climate variability, environmental transformation, rapid urbanisation, and increasing human mobility have emerged as interconnected drivers capable of influencing vector ecology, transmission dynamics, outbreak frequency, and healthcare system vulnerability. Urbanisation has been frequently associated with infrastructural inequalities, environmental degradation, inadequate water and waste management, and territorial conditions favourable to vector proliferation. The extant literature has also placed significant emphasis on the growing importance of integrated surveillance systems and early warning approaches combining epidemiological, environmental, climatic, entomological, and mobility-related data. Digital epidemiology, AI-based predictive models, and digital surveillance tools may contribute to strengthening outbreak forecasting and preparedness capacity, although important limitations related to data quality, interoperability, interpretability, and implementation remain. In parallel, misinformation, risk communication challenges, and digital communication ecosystems emerged as relevant factors influencing public perception, preventive behaviours, institutional trust, and adherence to public health interventions. Conclusions: Dengue is a systems-level public health challenge shaped by climate change, urbanisation, environmental disruption, human mobility, health-system preparedness, and digital ecosystems. Conventional vector-control strategies alone are unlikely to adequately address this growing complexity. Strengthening dengue preparedness should therefore be considered a broader indicator of public health resilience and long-term health-system adaptation. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a major global public health threat, compromising prevention and treatment of infectious diseases. This narrative review examines AMR as a multifactorial and transnational crisis through epidemiological, One Health, social and bioethical perspectives, and discusses emerging non-antibiotic preventive and therapeutic strategies. Methods: PubMed and Scopus were searched using terms related to AMR, epidemiology, public health, surveillance, One Health, bioethics, equity and alternative therapies. Peer-reviewed medical and public health articles were considered, together with selected reports from international organizations and public health agencies. Results: AMR is driven by inappropriate antibiotic use in human medicine, livestock, aquaculture and agriculture, combined with weaknesses in infection prevention, stewardship, environmental control and surveillance. Epidemiological evidence shows a substantial global burden, marked regional inequalities in resistance patterns, surveillance capacity and policy response, and major consequences, including increased mortality, prolonged hospitalization, rising healthcare costs and disproportionate effects on vulnerable populations. Key bioethical concerns include collective responsibility, equitable access to effective treatment, stewardship, global justice and intergenerational accountability. Emerging non-antibiotic strategies vary in translational maturity: vaccines and selected microbiome-based interventions have preventive or supportive roles in defined settings, bacteriophage therapy is used mainly in compassionate or specialized contexts, and many antimicrobial peptides and nanotechnology-based platforms remain experimental or early translational. Conclusions: AMR requires coordinated global action grounded in One Health, strong public health systems, integrated surveillance, responsible antimicrobial use and sustained innovation. Effective containment must also address social inequalities, ethical stewardship, equitable access to diagnostics and treatment, and responsibility toward future generations. Full article

Sustainable urban transportation is fundamentally linked to public health outcomes, specifically the mitigation of fatal traffic risks under environmental stress. While stressors like adverse weather affect entire cities, traditional road safety models often assume uniform risk, thereby masking the spatial inequalities inherent in the urban fabric. This study addresses this gap by investigating the geographically heterogeneous impact of environmental stressors—including rainfall, surface moisture, and lighting conditions—on the conditional probability of fatal crash outcomes in Melbourne, Australia. Analyzing 43,075 severe crashes through a multi-stage geospatial framework (Getis-Ord Gi* and Geographically Weighted Logistic Regression), this research diagnoses how varying urban development patterns mediate the lethality of these stressors. The findings unmask a critical “threshold-crossing” pattern for wet surfaces, where risk transitions from protective to hazardous based on local infrastructure form and street geometry. Significant spatial inequalities are identified: high-density inner-urban cores and adjacent coastal corridors exhibit a heightened sensitivity to visibility failures and moisture, whereas newer industrial peripheries show stronger protective “risk compensation” effects. These results reveal a systemic mismatch between historical urban form and contemporary climate-driven public health risks. By identifying localized “lethality thresholds”, this study provides a robust evidence base for integrated planning and equitable resource allocation. It enables urban planners to move beyond generalized safety warnings toward targeted structural interventions, ensuring that sustainable transportation networks prioritize safety equity for all citizens regardless of their location within the urban environment. Full article

Ensuring equitable access to urban green spaces is a major challenge in contemporary urban planning, with important implications for public health, well-being and environmental justice. However, comparative cross-city analyses based on harmonised methodologies remain limited, particularly across contrasting European climatic and morphological contexts. This study aims to: (i) assess the spatial distribution of public green spaces; (ii) evaluate neighbourhood-level accessibility and identify environmental justice inequalities; and (iii) examine how urban form and climatic context influence accessibility outcomes across the following three medium-sized European cities: Faro (Portugal), Tartu (Estonia) and Nitra (Slovakia). A GIS-based approach was applied using consistent criteria, including publicly accessible green spaces ≥ 1 ha, Euclidean buffers of 300 m and 500 m, and harmonised population data from the Global Human Settlement Layer (GHSL). Accessibility was quantified as the proportion of residents living within the defined walking-distance thresholds. The results reveal substantial inter- and intra-urban disparities. Tartu exhibits the highest green space provision (23.34 m²/inhabitant), while Faro presents the lowest (5.67 m²/inhabitant). However, accessibility patterns do not directly reflect provision levels: Faro achieves accessibility values at 500 m comparable to those of Tartu, whereas Nitra shows lower accessibility despite moderate provision. These findings demonstrate that accessibility is shaped primarily by the spatial configuration of green spaces rather than by overall provision alone. The study highlights the importance of integrating urban morphology and climatic context into environmental justice assessments and urban green infrastructure planning in order to reduce spatial inequalities in access to urban nature. Full article

Background: Health accessibility is a key determinant of equitable cancer care. In many countries, specialized oncology services are concentrated in urban and socioeconomically advantaged regions, forcing many patients to travel long distances for treatment. Consequently, geographic and social characteristics may be impactful in determining cancer healthcare outcomes. Objective: The aim of this study was to evaluate the association between the municipal-level Social Progress Index (SPI) and geographic travel burden, stage at diagnosis, treatment, and survival in patients with pancreatic cancer in São Paulo state, Brazil. Methods: We conducted a population-based study using data from “Fundação Oncocentro” on adults with pancreatic adenocarcinoma (2005–2025). The SPI (0–100 scale), a composite measure of municipal social and environmental development, was the primary exposure. It is structured into 3 dimensions and 12 components: Basic Human Needs (nutrition, medical care, water and sanitation, housing, safety); Foundations of Well-being (education, information access, health, environmental quality); and Opportunity (rights, freedom of choice, social inclusion, higher education). Municipal residence and cancer center locations were geocoded, and travel distance (km) was estimated. Multivariable Cox, logistic, and linear regression models assessed associations between SPI and overall survival, stage IV at diagnosis, surgery, and travel distance. Results: A total of 13,478 patients were included (mean follow-up 15.1 ± 27.2 months; mean age 62.3 years; 50.4% male). Stage IV disease was frequent (46.3%), and surgery was performed in 33% of cases. Over half of patients (53.2%) traveled more than 10 km for treatment. Increasing SPI was strongly associated with shorter travel distance (β −62.6 km per SPI unit; p < 0.001) and higher odds of surgery (OR 1.04; p < 0.001) and remained independently associated with a higher likelihood of undergoing surgical treatment (adjusted OR 1.04; p < 0.001). The proportion of stage IV disease did not decrease with increasing SPI and was slightly higher in the highest quartile (49.3%). In survival analysis, SPI demonstrated a protective effect in univariate modeling (HR 0.987; p < 0.001), but lost significance in multivariable analysis (p = 0.125). Travel burden was not retained as an independent predictor of survival after adjustment. Conclusions: Municipal-level SPI was a strong determinant of healthcare access and the likelihood of receiving surgical treatment for pancreatic cancer. Social and geographic vulnerability directly influence care pathways, revealing structural inequities in access to treatment. SPI-based stratification may serve as a practical tool to identify priority regions for transport support and equitable allocation of oncology services. Full article

Background: Dementia and Type 2 diabetes (T2D) represent two of the most pressing global public health challenges of our time, both exacerbated by physical inactivity. These conditions disproportionately affect Global Majority populations, who experience earlier onset, higher prevalence, and poorer access to culturally appropriate preventive care. However, conventional research and interventions often overlook the sociocultural and structural factors that underpin this disparity. This study synthesises current evidence to understand how these three conditions intersect and to identify equitable pathways for prevention and support. Methods: A meta-narrative review approach was employed to integrate evidence from diverse biomedical, public health, sociocultural and intervention science traditions. Searches were undertaken across MEDLINE/PubMed-adapted searches, CINAHL, PsycINFO, Web of Science Core Collection, AMED and ASSIA, supplemented by grey literature searching and citation chasing. Five meta-narratives were identified: biomedical and epidemiological, public health, health disparities, sociocultural and behavioural, and intervention science. Cross-narrative synthesis produced a conceptual framework linking upstream determinants, lifestyle factors, and disease outcomes. Results: The review revealed that structural inequities such as deprivation, environmental barriers and sociocultural factors including stigma, gendered norms, limited access to culturally appropriate facilities that restrict physical activity (PA) opportunities within Global Majority communities. These constraints elevate T2D and dementia risk through biological pathways involving insulin resistance, vascular injury, and neuroinflammation. Community-based participatory research (CBPR) interventions particularly those delivered in trusted cultural or faith settings emerged as effective strategies to improve PA, glycaemic control, and cognitive well-being. Conclusions: This synthesis reframes dementia and diabetes as interlinked within a wider syndemic driven by structural and sociocultural inequities. The proposed framework underscores the importance of culturally grounded, community-led approaches to promote brain health, reduce risk, and achieve equitable healthy ageing among Global Majority populations. Full article

Climate change represents one of the defining global health challenges of the 21st century, with far-reaching implications for population health, health systems, and health equity. The acceleration of environmental change, evidenced by record-breaking global temperatures, extreme weather events, and ecological degradation, poses a direct threat to achieving Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all. This manuscript presents a narrative review and policy analysis of the intersection of climate change and global public health in light of the outcomes of the 2025 United Nations Climate Change Conference (COP30) in Belém, Brazil. Drawing on peer-reviewed literature, major institutional reports, and relevant policy documents, we explore how climate change exacerbates communicable and non-communicable diseases, undermines health system resilience, and disproportionately affects vulnerable populations worldwide. Particular attention is given to heat-related morbidity, infectious disease expansion, air pollution, food and water insecurity, displacement, gender inequities, antimicrobial resistance, and mental health impacts. The paper highlights the significance of the Belém Health Action Plan (BHAP), which is treated here as a COP30-associated action framework that places health more centrally within climate policy discussions. However, major challenges remain, including its voluntary orientation, the absence of dedicated financing mechanisms within the framework itself, and limited clarity on accountability arrangements, as identified through our synthesis of the available policy and evidence base. We argue that achieving SDG 3 is no longer feasible without integrating climate adaptation and mitigation into health systems and policies, and that progress will depend on translating global commitments into context-specific country strategies, governance arrangements, and implementation pathways. Full article