The COVID-19 pandemic prompted widespread public health measures, including non-pharmaceutical (NPIs) and pharmaceutical interventions (PIs). This study explores the prevention strategies adopted by transgender individuals and examines how structural and attitudinal factors shaped their uptake within trans-specific healthcare and social contexts. As part of the LITE Connect mixed-methods study (N = 2,092), 30 participants engaged in qualitative, semi-structured interviews between October 2021 and June 2022. Content analysis identified the use of NPIs such as masking, sanitizing, social distancing, and testing, as well as the PI of vaccination. Structural and attitudinal barriers influenced these strategies, including healthcare discrimination, limited testing accessibility, and vaccine hesitancy driven by mistrust and concerns about side effects. Vaccine uptake was facilitated by access to trusted health information and alternative vaccine delivery methods. Findings emphasize the importance of culturally competent healthcare, inclusive public health policies, and community-driven approaches to improving prevention efforts. Addressing both structural and attitudinal barriers is essential to reducing inequities and ensuring equitable access to effective health interventions in future pandemics, particularly for marginalized communities.
BackgroundThe global burden of mental health disorders is increasing, placing strain on healthcare systems. Physical activity is an evidence-based strategy for improving mental health; however, access remains inequitable. This study examined how embedding trauma- and violence-informed principles within physical activity programming can support mental health among self-identified women who experience interpersonal and/or structural violence.MethodsWe conducted semi-structured interviews within a feminist participatory action research project that delivered group-based trauma- and violence-informed physical activity (TVIPA) programs across three low-income Canadian communities. Women were interviewed after completing at least 6 weeks of programming. Data were analyzed thematically using an intersectional lens (considering overlapping social identities and structural inequities) to explore perceived benefits, mechanisms of change, and contextual factors.ResultsData were drawn from n = 74 participants who self-identified mental health concerns, from the total study cohort of n = 168. Three themes were constructed: (1) Enhancing mental health and building self-efficacy through TVIPA, (2) Safety as a foundational pillar for engagement, and (3) Physical activity as a catalyst for connection and community. Participants discussed experiencing improved mental health symptoms, enhanced body awareness, and support for recovery from substance use and addiction. These outcomes were fostered by foundational principles of trust and safety, as well as program features like women-only classes and group-based formats.ConclusionIntegrating trauma- and violence-informed principles into physical activity programming offers a novel approach to enhancing mental health benefits, particularly for individuals with complex needs. Emphasizing safety, enjoyment, and social support helped reduce barriers and highlights the potential of TVIPA to promote mental health equity.
Background: The engagement of individuals with lived or living experience (PWLE) of accessing various health services or experiencing certain health conditions is increasingly promoted within health services co-design processes as crucial to enhancing service delivery and quality.Purpose: This qualitative case study presents findings and entry points for critical reflection from an evaluation of a health service co-design process in Ontario, Canada involving PWLE. From a researcher-practitioner team, and grounded in the case study context, potential tensions and complexities to critically consider when engaging PWLE in co-design are highlighted, alongside practice implications.Results: First, equitable and diverse recruitment and representation is discussed, along with the need for a flexible, accommodating, and intentional approach to engaging diverse groups. Second, tensions in navigating power imbalances and pre-existing dynamics within a hybrid governance model involving PWLE and service providers are presented, along with potential approaches for consideration. Third, a need for sustained and intentional support for PWLE inclusion as initiatives evolve is described, along with a broader need for flexibility and nimbleness in the practical management of these types of dynamic co-design processes. Finally, the challenges involved in evaluating complex, dynamic processes, such as in the case study, are acknowledged.Conclusion: Overall, this case study illustrates the complexity of factors that shape the engagement of community 'lived experience' within health service co-design. By complicating the discourse around lived experience engagement, this study aims to contribute to the strengthening of co-design processes for enhanced health service co-design and delivery.
BackgroundSchool-based iron supplementation is a key national intervention to reduce anaemia among adolescent girls, however evaluation regarding processes is lacking. This study evaluated adherence to iron supplementation and its determinant factors among schoolgirls in Indonesian settings.MethodsA cross-sectional study was conducted at selected schools in priority areas of East Java (n = 3) and Bali (n = 4) from April-September 2023. A questionnaire administered to approximately 100 girls at each school collected data on the individual factors and adherence. School databases and interviews with 7 health unit staff was used to understand the environmental factors, and content analysis elicited the themes. Binary logistic regression summarised associations of individual and environmental factors contributing to adherence.ResultsA total of 694 girl respondents reported a mean adherence of 40%. Environmental themes included location (East Java/Bali), type and level of schools (private/public and Junior/Senior High School), iron tablet distribution and administration mechanisms (1-week supply/1-month supply/varied and weekly program at school/self-administered at home/no fixed program). Binary logistic regression confirmed that individual associations (i.e., attitude, Odds Ratio (OR) 2.69; peer support, OR 2.03), and environmental factors (i.e., type of school, OR 7.41; location, OR 2.38; administration mechanisms, OR 8.80) were independently associated with adherence.ConclusionLow adherence levels among schoolgirls reported in this study warrants attention. Identified contributing factors provide a basis for the development of strategies to improve adherence to school-based iron supplementation programs in Indonesian settings, particularly at priority areas.
The Healthy Living Practices (HLPs) outline nine essential guidelines for maintaining health in remote Aboriginal communities, yet high costs and poor availability make them financially out of reach for many families. We assessed the cost and availability of essential goods required to support the HLPs in eight remote Kimberley community stores, recording prices during three visits in 2022 as part of the SToP (See, Treat, Prevent) Skin Sores and Scabies Trial, and retrospectively comparing these (inflation-adjusted) with Perth and Broome prices in 2024. Owing to limited stock, data were analysed at a Cluster level (geographically proximal communities) using paired-sample t-tests in SPSS. Across 23 store visits, a standardised 'shopping basket' was significantly cheaper in Perth ($20.29) and Broome ($21.76) than in remote communities ($39.19-$47.87; p < 0.001); whitegoods (refrigerators, washing machines) were also significantly more expensive remotely (p < 0.01). Availability was inconsistent-the full basket was available in remote stores in only 56.5% of visits, with essential healthcare items frequently unavailable. These findings indicate that affordability and access to goods required to support the HLPs are substantially compromised in remote Kimberley communities, emphasising the need for targeted policy interventions to ensure equitable health outcomes.
BackgroundSexually transmitted infections (STIs) remain a major public health concern among college students, particularly at Historically Black Colleges and Universities (HBCUs), where structural barriers may limit access to routine screening. Community-based partnerships represent a promising strategy to expand sexual health services and address persistent inequities.PurposeThis study evaluated the impact of an on-site STI screening program delivered through a partnership with a local community-based organization (CBO) on screening utilization, provider efficiency, and student satisfaction within an HBCU consortium.MethodsA retrospective chart review was conducted among students aged 17 years and older who received STI screening between August 2022 and April 2025. The intervention provided free testing for chlamydia, gonorrhea, HIV, and syphilis through a CBO operating 3 days per week within the student health center. Appointments were scheduled online, by phone, or via walk-in. Data included screening volumes, demographic characteristics, provider visit patterns, and satisfaction survey responses. Descriptive statistics compared outcomes before and after implementation.ResultsSTI screening volumes increased from 1692 during the pre-implementation period (August 2022-September 2023) to 1817 and 1950 during the first (October 2023-April 2024) and second (August 2024-April 2025) post-implementation periods, respectively. Shifting asymptomatic screening to the CBO increased provider capacity for non-STI primary care visits.ConclusionIntegrating a CBO into campus health services expanded access to STI screening, optimized provider workflow, and maintained high-quality, student-centered care. This partnership model offers a scalable, equity-focused approach for strengthening sexual health services at HBCUs and other minority-serving institutions.
This study investigates married Palestinian women's experiences of sexual rights, autonomy, and pleasure, emphasizing the interplay of religion, culture, and marital communication. Using a qualitative phenomenological design, 20 women from urban, rural, and refugee camp settings were interviewed. Findings reveal that women perceive sexual rights and pleasure in Islam as mutually reciprocal, yet cultural norms and social expectations often constrain the enactment of sexual autonomy and enjoyment. Religious guidance serves as both empowerment and a site of negotiation, helping women interpret their rights and navigate tension with local customs. Emotional wellbeing, trust, privacy, and knowledge of sexual rights emerged as critical enablers of sexual decision-making and pleasurable experiences. The study underscores the importance of culturally and religiously sensitive education, counseling, and marital support to foster sexual autonomy and pleasure, contributing to relational equity and wellbeing in Palestinian marital contexts.
Although many migrant and refugee women in Australia experience healthy pregnancies, inequities in perinatal outcomes persist. Perinatal education supports health literacy and informed decision making about pregnancy, birth and early parenting, yet little is known about how migrant and refugee women become aware of and experience these services. This study explores the experiences of migrant and refugee women in Western Sydney in navigating the Australian health system and accessing perinatal education. We adoted a mixed-methods phenomenological research approach, comprising semi-structured interviews in Arabic, Mandarin, Dari and Hindi alongside a quantitative survey. Purposive sampling was used to recruit women from culturally and linguistically diverse backgrounds through antenatal clinics and community health centres, with participants representing varying levels of engagement in perinatal education. Qualitative data was analysed using thematic analysis and quantitative data were analysed descriptively. A total of 22 participants completed interviews, and 246 participants completed the survey. Nearly all survey participants (92.3%) spoke a language other than English, representing more than 18 languages and 34 countries of birth. Quantitative findings demonstrated low uptake of perinatal education, with 86.2% (n = 212) reporting no engagement with formal programs. Qualitative analysis identified four key themes: (1) Pregnancy as a pivotal introduction to health care; (2) Mirrored barriers to engagement with care and education; (3) Care through connection - social and cultural bridges, and (4) Scrolling for solutions: the digital classroom. Across both qualitative and quantitative data, women described intersecting barriers including language, cost, cultural expectations, and limited awareness of available services alongside facilitators such as bilingual providers, community networks and digital platforms. These findings highlight the need for equity-oriented approaches to perinatal education, including community based and culturally responsive awareness and delivery methods.
Childhood anemia remains a major public health challenge in low-resource settings, particularly in rural Amazonian regions of Peru. This study evaluated the impact of a community-based educational program known as "Compromiso 1," implemented through home visits by trained social agents. A quasi-experimental design was used to follow a cohort of 145 six-month-old infants diagnosed with anemia in our city. Over a 6-month period, caregivers received three structured home visits that included nutritional education, iron supplementation guidance, and the use of age-appropriate visual and written materials. Hemoglobin levels were measured at 6, 7, 9, and 12 months of age to assess the effectiveness of the intervention. Statistical analyses included descriptive measures, paired t-tests, chi-square tests, and Spearman correlations. The results showed a progressive and significant increase in hemoglobin levels over time, with higher values among infants who adhered consistently to iron supplementation. Sociodemographic variables such as maternal age, education, occupation, and income level were not significantly associated with hemoglobin outcomes, although residence in rural areas was linked to slightly higher values. These findings suggest that targeted, home-based education delivered through structured visits can effectively promote adherence and improve child health outcomes. The program offers a replicable model for anemia prevention in underserved regions with limited access to formal healthcare.
BackgroundSuicide is a critical public health issue, particularly among vulnerable populations of all ages living in slums. People residing in these environments often face unique psychosocial challenges that contribute to elevated rates of suicidal ideation and behavior. This study aims to consider the strategies and implementation considerations for suicide prevention programs in slums.MethodsA systematic scoping review was conducted according to Arksey and O'Malley's framework in 2024. Multiple electronic databases were searched systematically to identify studies focusing on suicide prevention strategies in slum populations. Studies were selected based on their relevance to suicide prevention, risk factors, and considerations for implementation. A narrative synthesis approach was applied to summarize the findings from the included studies.ResultsA total of 15 studies were included from an initial search of 3914 records screened. Synthesis of findings led to the identification of suicide control strategies for some target groups, including the general population, individuals at risk, and individuals with warning signs or previous suicide attempts. The strategies can be considered in the form of primary, secondary, and tertiary prevention. Strategies focus on enhancing mental health services access, promoting community awareness, reducing access to lethal means, and providing responsive crisis services.ConclusionAddressing suicide prevention in slum areas requires a multifaceted approach that considers the unique socio-economic contexts of these communities. Community-based interventions, enhanced healthcare access, and targeted mental health programs, adapted to the unique resource and structural constraints of slum environments, are crucial for reducing the incidence of suicidal ideation and behaviors.
BackgroundMenstruation in Nepal is shaped by intersecting factors of caste, ethnicity, religion, geography, and generational norms, with practices ranging from subtle restrictions to overt seclusion. Despite being a natural biological process, menstruation is deeply stigmatized, affecting women's dignity, safety, and daily activities. PurposeThis study explored menstrual practices and intergenerational knowledge transmission among mothers and grandmothers in a rural far-west Nepali village.Research DesignUsing Collaborative Filmmaking - a participatory visual method - women participated in the study as filmmakers, co-researchers, and storytellers. Thirteen women, aged 23-68, from diverse caste and ethnic backgrounds co-created two films, 8-Day Journey and Stay Away, which documents daily routines, restrictions, and rituals in Kanchanpur.ResultsFindings revealed persistent limitations around sacred spaces, kitchens, water sources, and interpersonal contact, and highlighted evolving practices such as greater autonomy in sleeping arrangements, nutrition practices, and menstrual product use. Religious traditions were especially enduring even as other taboos declined. Participants reported enhanced comfort, hygiene, and agency due to increased access to menstrual products and knowledge, yet intergenerational tensions persist, with younger women challenging norms while elders maintain tradition.ConclusionsThe films provide visual insight into the subtle negotiation, reinterpretation, and resistance of restrictive practices, which illustrate both tradition and adaptation. These findings underscore the importance of multi-generational engagement, culturally and religiously sensitive interventions, and creative participatory approaches to amplify local voices. Integrating these strategies can inform policy, advocacy, and programmatic efforts to reduce menstrual stigma, enhance autonomy, and promote holistic health and well-being for women and girls in Nepal.
Translational products can help bridge the gap between research and practice by sharing scientific evidence in ways that non-academic audiences find accessible and useful. Here we present five translational design principles for dissemination of research evidence to public health practitioners and partners. The result of more than two decades of work in the development, production, revision, and continuous improvement of the Best Practices User Guides and supplemental reports, we illustrate the principles here using Tobacco Where You Live: Native Communities, a guide for tobacco prevention and control for American Indian and Alaska Native groups and their public health partners. The team developed the translational design principles through a multi-phase process: (1) conducting a multi-state evaluation and national advisory workgroup to identify translational features for communicating evidence, (2) applying findings to develop a set of translational products, CDC's Best Practices User Guides and Tobacco Where You Live Supplements, and (3) evaluating product quality through a national survey. Users find the evidence-based guides helpful, easy to understand, and actionable. The five principles contend that translational products should: (1) stem from evidence-informed sources, (2) include actionable information, (3) have a modular structure, (4) use language for an understandable delivery, and (5) come in accessible formats. Though the User Guides and the example here address tobacco use, researchers and practitioners can use the translational design principles to communicate evidence for various public health challenges and opportunities. Broad applications of the principles can help to increase intervention fidelity and the impact of public health evidence.
BackgroundMedicines constitute the fulcrum of therapy across diseases, with patients needing to follow prescribed regimens (practice medication adherence (MA)) to derive optimal clinical benefits from medications. Poor MA is linked with increased mortality, morbidity and health costs, worse disease outcomes and reduced quality of life. Aotearoa New Zealand (NZ) operates a publicly funded health/medicines system, but available MA supports are unclear.MethodsUsing document analysis, this narrative review collated MA interventions and strategies recommended in several broad NZ health and medicine -specific policies to outline the NZ MA policy landscape for the first time. Eight policy documents underwent document analysis to identify proposed MA-related interventions and the responsible bodies.ResultsThe identified interventions targeted health system, socioeconomic, disease, therapy and patient-specific factors. Incorporating MA promotion across the health system (in IT platforms, MA services and others) by all healthcare professionals, pharmacists especially, was central to the interventions, as was including patients in medicines therapy decisions via robust communication. The interventions aligned with the MA needs of NZ chronic disease patients, indicating that implementing them could improve patients' MA. The lack of a national MA policy or responsible entity and other policy gaps, however, appeared to hinder implementation, ownership and accountability.ConclusionThe wide-ranging MA promotion interventions recommended across NZ health and medicines policies need implementation which would require multipronged efforts of stakeholders across government and the pharmacy/health sectors.
Responses to crisis in the community have gained significant attention, recognizing potential life and death consequences of such responses, with particularly significant impacts for systematically marginalized communities and individuals. Dominant conceptualizations of crisis have been critiqued as medicalized and focused primarily on what medical care an individual in crisis receives, overlooking contextual and structural issues. This paper explores descriptions of crisis and considers how understandings of crisis align or misalign with the responses to crisis that exist within communities in Ontario, Canada. Utilizing a critical qualitative ethnographic case study approach and informed by a critical mental health lens, semi-structured interviews (n = 53), open-ended surveys (n = 60), and document analysis were conducted to gather perspectives from community members with lived experience, community-based organizations, and acute-care institutions such as paramedicine, police services, and emergency departments. Crisis was described as: broad, inclusive and self-defined; impacted by structural living conditions; resulting from barriers to access and the misfit of services to needs; and as resulting of the conditions of care. These findings contribute to a conceptualization of crisis that considers contextual, structural, and systemic issues impacting crisis. We discuss the importance of moving beyond a biomedical reductionist understanding of crisis and the ways in which we can challenge and shift medicalized and carceral systems of crisis care. As attention increasingly shifts towards the development and expansion of crisis-related responses, it is crucial to ensure that these responses adequately meet people's needs and, where possible, prevent further crises.
BackgroundWalkability is an important contributor to physical activity, aiding the prevention of chronic diseases. Decision makers rely on accurate, nuanced data to inform the planning of walkable communities. While objective walkability tools have variable capacity to predict walking behaviour, combining community perceptions with these tools can provide more nuanced insights, especially in areas of socioeconomic disadvantage. This study explored the potential to apply a citizen science approach to monitor and improve walkability of socially diverse neighbourhoods by understanding the perspectives of key decision makers and practitioners.MethodsInterviews with stakeholders from local councils, government health services, and a community volunteer group explored walkability in Western Sydney, including use and experiences of walkability assessment tools, and views on using citizen science for walkability monitoring and improvement. Data were analysed inductively using thematic analysis.ResultsParticipants saw a need to improve walkability in certain areas of Western Sydney, but identified insufficiencies with existing auditing tools. A citizen science approach was considered a promising means of capturing and addressing the multitude of factors influencing walkability, through its ability to provide nuanced and compelling local information. However, council staff had concerns about managing public expectations and attaining representation of the community's diversity. Participants provided insights for possible avenues of effective and meaningful engagement.ConclusionIf stakeholders' concerns are addressed and supported by policy commitment, the adoption of a citizen science approach has potential to bring considerable value to the monitoring and improvement of walkability in socially diverse localities.
BackgroundDespite a robust research literature on the importance of promoting health equity and stated commitments by public health authorities to this goal, progress in doing so has been disappointing in Canada. One reason is the failure to mobilize the public in support of this goal. Almost a decade ago, Sir Michael Marmot called for a "social movement" to promote health equity but there are reasons for why such a movement has not taken hold in Canada.PurposeWe carry out a critical narrative review and case study of Canadian health equity activities that examines the intersection of these activities with definitions of what constitutes a social movement.AnalysisEmploying Harvey's concept of critical social research as not taking for granted apparent social structure and processes, we look beneath the surface of appearances to ask why health equity activities have generally failed in Canada such that a social movement - as defined in the social movements literature - is required to move forward.FindingsSocial movements engage the public to resist problematic social conditions outside of established governance structures and processes yet for the most part, health equity advocacy in Canada has been limited to those who do so as part of their paid employment or research funding by Canadian governing authorities whose policies create these conditions. As a result of these arrangements, health equity advocacy cannot readily meet the conditions necessary for a social movement: communicating the need for such a movement; identifying those responsible for health inequities; establishing networks supporting such a goal; and cultivating a distinct health equity identity.ConclusionWe suggest reviewing the structures, processes, and successes and failures of a variety of social movements, e.g., Social Medicine, Environmental, Labour, and Anti-Globalization, among others, to identify lessons and insights that may assist in the development of a health equity social movement in Canada.
Background. Despite widespread COVID-19 vaccine availability, vaccine hesitancy remains a barrier to achieving public health goals, especially in underserved communities. Trust in healthcare providers, scientists, and government institutions plays a critical role in shaping vaccine perceptions and uptake. Purpose. To inform targeted interventions, we tested a mediational path model examining predictors of perceived vaccine safety, effectiveness, and vaccination status among public housing residents. Methods. We surveyed 120 public housing residents in Central and Southeast Virginia. Participants completed questionnaires assessing trust in various people and institutions, a sense of community responsibility, beliefs about vaccination as a personal choice, and vaccination-related perceptions and status. A mediational path model was tested to examine direct and indirect associations. Results. Among 10 trust domains examined, only trust in the federal government and trust in local clinics and pharmacies significantly predicted vaccination-related perceptions and behavior. Trust in local clinics was directly associated with perceived vaccine safety (β = .42, 95% CI [.18, .66]) and effectiveness (β = .36, 95% CI [.11, .62]) and indirectly predicted vaccination status through perceived safety (β = .11, 95% CI [.01, .22]). Trust in the federal government directly predicted perceived effectiveness (β = .35, 95% CI [.04, .66]) but not safety. The final model explained 62% of the variance in vaccination status. Discussion. An indirect effect emerged where trust in local clinics predicted vaccination status via perceived safety, underscoring the critical role of local health centers in fostering vaccine confidence and uptake. Strengthening relationships between local providers and their communities may be a key strategy for addressing vaccine hesitancy. These findings highlight the importance of building trust to support vaccine uptake efforts.
BackgroundMaternal health in at-risk communities is a significant public health issue, especially in areas characterized by socio-economic and healthcare inequalities. This study aims to uncover the multiple factors that influence maternal well-being in Morocco, providing insights for targeted interventions and policy development.MethodsAn interpretive grounded theory approach was employed, combining in-depth interviews, observations and constant comparative data analysis. Participants (n = 69, aged 17-49) were recruited from six provinces across five main regions, representing diverse socio-economic backgrounds, cultural contexts, and healthcare systems.ResultsThe analysis identified four main categories explaining the interactions and interrelations of factors shaping maternal and reproductive health. First, childbirth and postpartum maternal healthcare experiences reveal contrasting realities between home and hospital births, marked by fear, neglect, obstetric violence, and the critical role of family support. Second, cultural practices and beliefs strongly shape perceptions of pregnancy, delivery, and postpartum care, sometimes providing protection and other times reinforcing harmful traditions. Third, maternal health dynamics in the societal context highlight systemic barriers to healthcare access, the weight of sociocultural expectations, and the compounded burden of rural living. Finally, women's reproductive autonomy and family size underscore limited decision-making power, ambivalence toward contraceptive use, son preference, and contraceptive misinformation. Together, these categories illustrate the complexity of relationships between socioeconomic status, access to healthcare services, education, cultural beliefs, and social support networks, which emerge as important determinants of maternal and reproductive health outcomes in Morocco.ConclusionsBy amplifying their voices and perspectives, this research advocates for holistic, equitable, and empowering approaches to maternal healthcare. The findings underscore the need for interventions tailored to local contexts, based on a thorough understanding of the determinants of maternal health.
BackgroundTurkish-, Moroccan-, and potentially Syrian-Dutch women in the Netherlands are disproportionately affected by cervical cancer (CC), yet participate less in CC screening and Human papilloma virus (HPV) vaccination program compared to other ethnic minorities and native Dutch women. Existing informational materials insufficiently address their practical, emotional, cultural, and religious concerns. Our aim was to investigate the information seeking behavior and the information needs regarding CC screening and HPV vaccination among Turkish-, Moroccan-, and Syrian-Dutch women.MethodsSemi-structured interviews were held with 51 Turkish-, Moroccan-, and Syrian-Dutch women (n = 20, n = 19, and n = 12, respectively). The interview guide was based on the Health Belief Model, the Reasoned Action Approach, and Betancourt's Model of Culture and Behavior. Interviews were transcribed verbatim and thematically analyzed.FindingsThis study identified language barriers and cultural factors related to virginity, fertility, and sexual activity as key influences on decision-making. Most participants reported not actively seeking information and expressed a need for tailored content delivered through trusted and recognizable key community figures and accessible channels, both online and offline. Comparison with CC prevention measures in their countries of origin may facilitate information processing and understanding.DiscussionThese findings underscore the importance of culturally sensitive materials and outreach to support informed decision-making and improve participation in cervical cancer prevention. These results provided concrete guidance for the development of targeted policies and communication strategies that better address the specific needs and barriers regarding CC prevention faced by Turkish-, Moroccan-, and Syrian-Dutch women.
Legal violence is a structural determinant of health in U.S. immigration governance. This essay examines how the shift from civil to criminal enforcement-marked by surveillance, detention, and deportation-inflicts systemic harm on undocumented immigrants, deferred action for childhood arrivals (DACA) and temporary protected status (TPS) holders, lawful permanent residents (LPRs), and U.S. citizens in mixed-status families. Framing these practices as legal violence reveals how structural forces embedded in law and policy create and sustain public health disparities. While the Social Determinants of Health framework identifies conditions affecting health outcomes, this essay emphasizes how structural determinants-immigration policy, legal exclusion, and enforcement-shape and perpetuate these conditions. Drawing on illustrative examples of empirical research on preterm births, mental health impacts, and reduced safety-net participation, this essay demonstrates that legal violence inflicts measurable harms. Addressing these harms requires structural reform; public health leaders and policymakers must confront legal violence to advance health equity.
