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.

BACKGROUND:The fossil fuel industry's practices and products create wide‑ranging harms to human health, with disproportionate impacts on communities already affected by structural disadvantage. Young people, particularly adolescents, are among those most affected by these harms, yet they are often excluded from health and climate decision-making. At the same time, youth-led initiatives to counter the fossil fuel industry's practices and products are increasing globally. Despite this momentum, little is known about what interventions involving adolescents exist, how they work, and under what circumstances they may reduce health inequities driven by the fossil fuel industry. This study protocol aims to address this gap by conducting a realist review to explore how interventions involving adolescents can counter industry practices and products. It takes a structural racism lens to examine how inequities shape both exposure to harm and opportunities for participation. The review seeks to identify relevant interventions, understand the mechanisms through which they produce change, and examine the contexts that enable or hinder their effectiveness. METHODS:The study follows established realist review standards and draws on diverse sources of evidence, including published research and grey literature. Adolescents and a multidisciplinary expert steering group have contributed to shaping the review questions and will continue to be involved throughout the process. The review will generate explanations about how interventions work by developing context-mechanism-outcome configurations. These explanations will be refined through iterative synthesis and engagement with advisory groups. DISCUSSION:The review is expected to produce a set of theories illustrating how adolescents' participation can influence action against the fossil fuel industry to help reduce health inequities. The findings will inform public health practitioners, policymakers, organisations working with adolescents, and researchers seeking to design, adapt, or scale interventions that amplify adolescents' role in addressing the fossil fuel industry's health harms.

Racial-ethnic and gender inequalities are well documented in Special Educational Needs and Disability (SEND) provision for Social, Emotional and Mental Health (SEMH) and mental health-related referrals, hospital admissions and service use. Understanding whether coordination between these systems differs systematically across groups is essential for identifying opportunities for equitable provision and access. Developed in partnership with peer researchers and community stakeholders, we examined cross-system pathways, between SEND-for-SEMH and mental health-related hospital contacts, based on gender and racial-ethnic group. Population-level analysis of ECHILD linked National Pupil Database and Hospital Episode Statistics for 1.7m children (ages 5-16) attending state schools in England (2005-2018). We examined rates, timing and risk ratios of pathways between systems. Substantial variation exists by gender, racial-ethnic group, and at their intersection. Nearly all girls were significantly less likely to receive SEND-for-SEMH following mental health-related hospital contact. Among girls with hospital contacts who never received SEND-for-SEMH, 49.8% had an inpatient admission. All pupils from Asian, Black African, Mixed Other, white Other and Other racial-ethnic backgrounds were significantly less likely to receive SEND-for-SEMH following hospital contacts. Conversely, Black Caribbean, Mixed white-Black Caribbean, Romani and Irish Traveller boys were recorded with SEND-for-SEMH at substantially higher rates and faster on enrolment. Linked administrative data reveals intersectional discrimination and systematic coordination failures not captured in single-system analyses. Findings demonstrate need for standardised mental health guidance and equity-oriented frameworks to address the persistent biases in system pathways as well as statutory integrated care pathway to address unmet need following in-patient hospital admissions.

Despite decades of documented ethnic inequalities in Special Educational Needs and Disability (SEND), the well-established role of social determinants of health and growing awareness of cultural safety and trauma-informed practices in supporting children's mental health, their integration into England's SEND policy remains unclear. This study, co-produced with peer researchers and community stakeholders, examined national and local SEND policy and guidelines in England across three domains: justice and equity; content related to mental health, cultural safety and trauma-informed practice; and effective implementation. Systematic searches of national documents (n = 129) and Local Authority websites (n = 152) identified eligible content analysed using a co-developed coding framework. We calculated the frequency of content meeting baseline criteria and examined patterns and implications. Findings revealed current policy does not align with aspects of equitable and effective policy. Inequalities are superficially acknowledged with little recognition of social determinants of health. Although SEND provision, particularly for mental health, sits at the crossroads of education and health/healthcare rights, this connection is rarely addressed and requirements for children's participation are inconsistently exemplified. The SEND system lacks clarity in supporting mental health, cultural safety approaches are absent, and clear direction on trauma-informed practices is missing. Accountability mechanisms are insufficient with poorly defined roles, lack of transparency in complaints processes, inadequate monitoring of inequalities and missing enforcement mechanisms. There is an urgent need to establish a unified rights-based vision with tangible accountability measures and explicit equity-orientation to achieve an inclusive and equitable system.

Summary Objectives To assess how UK postgraduate medical organisations have responded to calls for action on structural racism, and to examine the extent to which anti-racism is embedded in postgraduate medical curricula and learning outcomes. Design We conducted a review of publicly available statements and commitments from organisations responsible for postgraduate medical education, and a content analysis of all General Medical Council (GMC)-approved postgraduate curricula. Search terms related to racism, ethnicity, religion and discrimination were used, with double-coding of extracted data and inductive thematic analysis of relevant learning outcomes. Settings United Kingdom. Participants Twenty-one organisations responsible for postgraduate medical training and all 102 GMC-approved postgraduate medical curricula. Main outcome measures Presence of explicit anti-racism commitments, inclusion of education-related actions and accountability mechanisms, and representation of racism and its impacts on health within assessed curricular competencies. Results Sixteen organisations (76%) had public commitments addressing racism or related issues, with ten (48%) including education-related measures and five (24%) specifying accountability mechanisms. Across 102 curricula, only 11 (11%) mentioned racism, and just 10 included it in learning outcomes, largely confined to three specialities. Mentions of race, ethnicity and religion were more common but often lacked reference to structural drivers of health inequalities. No curricula addressed xenophobia, Islamophobia, antisemitism or decolonisation. Conclusions Despite widespread institutional commitments, anti-racism is minimally represented in UK postgraduate medical curricula. There is an urgent need to integrate explicit anti-racism competencies into training to equip doctors with the knowledge and skills required to address structural determinants of health and reduce inequalities.

ABSTRACT Introduction Although the mechanisms of racism may be globally consistent, both these mechanisms and their context-specific expressions require further investigation. Comparing perceptions and experiences of minoritised adolescents across countries helps reveal how racism manifests in different contexts. This multi-country study investigates how adolescents understand, experience, and demand action against the racisms that shape their health and lives. Methods We conducted semi-structured interviews with 93 adolescents from minoritised groups across Brazil, Peru, South Korea, Sri Lanka, Uganda, and the UK, using culturally adapted vignettes. Using inductive thematic analysis, country-based and external coders applied a co-developed cross-country codebook, achieving high inter-rater reliability, and identified seven key themes. Results Participants’ narratives showed how appearance, language, and socioeconomic status functioned as social markers through which racism reproduced inequities in education, healthcare, and economic opportunity. Across contexts, racism imposed psychological strain, through social exclusion combined with pressure to succeed. This affected adolescent health, contributing to emotional distress, low self-esteem, and uncertainty, while shaping help-seeking, institutional trust, and exposure to material conditions that worsened physical health. Experiences varied: ethnic diversity in the UK offered perceived protection from interpersonal discrimination; economic security in South Korea helped render a minoritised identity an asset; while spatial segregation in Brazil, Peru, Sri Lanka, and Uganda reduced external threat but intensified structural disadvantage. Adolescents called for stronger support networks, anti-racist education, accountability, improved opportunities, and broader justice in workplaces and online spaces. Conclusion Our findings underscore that addressing racism’s impacts on adolescent health requires a health justice approach. This must recognise racism as a public health crisis, confront racialised structural inequities, promote resource access, and engage adolescents in policy development.

INTRODUCTION:We aimed to determine the association between paternal labour migration and the growth of the left-behind children in Dhanusha district, Nepal, where child stunting and international labour migration are highly prevalent. METHODS:We used growth data at birth, 6 months, 1 year and 2 years from a birth cohort study conducted 2012-2014, and growth data at age 6 years collected in 2018. We collected household migration history data to determine the children's exposure to paternal migration. The primary outcome was child length/height-for-age z-score (HAZ). Children's body circumferences, skinfold thicknesses, body composition, tibia length and grip strength were secondary outcomes measured at 6 years. We tested (i) the overall association between paternal international migration and the growth of the left-behind child; the roles of (ii) the duration of migration (≤12 mvs >12 m) and (iii) child age (≤6 mvs 12-72 m) as moderating factors; (iv) the association between receipt of remittances from the migrant father and child growth outcomes; and (v) stratified the main analyses by child gender. We fitted mixed-effects linear regression models for longitudinal data and linear regression models for cross-sectional data, adjusted for potential confounders. RESULTS:Analysing across all time points, daughters of labour migrants had lower HAZ than daughters of non-migrants (-0.13, 95% CI -0.24 to -0.03), but no overall association was found in boys. The negative associations were largest at <6 m (girls: -0.23, 95% CI -0.41 to -0.05), but in boys only if the father had recently (≤12 m) migrated (-0.26, 95% CI -0.51 to 0.00). Children of migrants showed a tendency towards smaller body sizes compared with children of non-migrants. We found no association between remittances and any measure of child growth. CONCLUSIONS:Interventions should target support for pregnant women and mothers with young infants to provide gender-equitable childcare, especially if their husband just left for work overseas.

To draw attention to the research gap on the impact of racism, xenophobia and discrimination in European health systems on child migrant health inequities, and inspire cross-sector action to prevent and mitigate against potentially harmful policies and practices. A literature review was undertaken. There are an estimated 9 million children in Europe who have been forcibly displaced because of conflict, persecution, violence, natural or environmental disasters, climate change, and trafficking. They often have increased health needs due to their experiences pre, during, and post displacement. Despite host countries’ duty to address these needs, many European states are implementing restrictive and hostile immigration policies that further marginalise this population. Racism, xenophobia, and systemic discrimination within healthcare systems contribute to inequalities in access, entitlements, and quality of care. Healthcare barriers include: discriminatory user-fees; inadequate interpretation services; cultural biases; and discrimination by healthcare professionals. These obstacles limit access to essential medical care and health promotion services, and negatively impact the mental health of child migrants by reinforcing social exclusion and systemic inequities. Studies suggest that providing inclusive healthcare services to displaced populations could be a cost-effective public health approach, yet many countries fail to implement such policies. To combat racism, xenophobia, and discrimination in healthcare and address the inequities experienced by forcibly displaced children an integrated approach is necessary. Prioritising research on health system discrimination and sharing successful interventions can improve health equity and public health outcomes. Robust data collection and reporting on the health of child migrants are crucial for developing evidence-based inclusive healthcare policies. The content of this presentation will draw on the authors’ paper: Stevens, AJ. et al. (2024). Discriminatory, racist and xenophobic policies and practice against child refugees, asylum seekers and undocumented migrants in European health systems. The Lancet Regional Health – Europe, Volume 41,100834.

Racism is a public health threat and is firmly ingrained in the healthcare system. The reasons for this are complex as racism is rooted in historical, political, economic and social structures of society. To improve the health of their patients and the public, doctors must be able to recognise, name and act on the impact of racism. This study aims to understand action taken by postgraduate medical organisations in the UK in the aftermath of the global public reckoning of structural racism and its longstanding impacts on societal health in 2020. We analysed the public statements made by postgraduate medical organisations and then how this relates to the learning outcomes that doctors in training need to complete. We found that while many institutions (n=14) issued public commitments to anti-racism, reviewing the content of all GMC-approved postgraduate curricula (n=102) shows that the majority of UK doctors are receiving minimal or no education or training in anti-racism. As such, we call institutions involved in postgraduate medical education to include anti-racism competencies in medical curricula to support doctors to develop the skills, behaviours and knowledge to name and address the role of racism in health inequalities. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Large inequities in child health exist across the world, with minoritised children being more likely to experience adverse health outcomes. By the end of the session, participants will have enhanced their understanding of racism as a public and global health threat and strengthened their capacity to advocate for systemic changes that prioritise the health and rights of minoritised children. We propose an interactive seminar format where the audience explores the complex intersections between racism and child health globally. We propose a panel of speakers followed by a scenario-based activity. We will use a broad conceptualisation of racism based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour, as described in the Lancet series on racism (The Lancet, 2022) and apply this to child health globally. Building on the work of the new and current Lancet commission on racism and child health, we will explore the associations between racism and mental and physical health outcomes, a complex systems approach for understanding systemic racism, designing anti-racism interventions, and finally the policy implications of this work. Scenarios will include applying a conceptual model to participants’ contexts and designing an intervention to achieve racial equity in child health. Speakers would come from The Lancet commission on racism and child health (https://www.raceandhealth.org/lcrch-people). Steering group members will be present and facilitate the session.

We conducted a scoping review to examine how racism affects the health of minoritized populations in Brazil. A comprehensive search was carried out, and identified articles underwent independent double screening. The 145 included studies consistently highlighted structural health inequities, with White advantage functioning as a protective factor. Institutional racism restricts healthcare access and availability, exacerbating minoritized populations’ vulnerability to violence and disease through discrimination and substandard care. Spatial segregation further exposes minoritized populations to harmful environmental conditions and limited infrastructure, while traditional and migrant communities experience marginalization, social isolation, increased disease exposure, and poorer livelihoods. Interpersonal racism negatively impacts mental and physical health across the lifespan, with gender and socioeconomic conditions intersecting and shaping these experiences. The study provides critical insights for practice, policy, and research by demonstrating how racism at multiple levels shapes health inequities in Brazil and by emphasizing the need for human rights-centred, redistributive interventions that promote justice, equity, and inclusive care for minoritized populations.Funding: This publication was funded by Edital 02/2025—PRPPG/UFBA (Scientific Publications Support Program) and by the CNPq Productivity in Research Scholarship (process number 306359/2024-3).

According to the United Nations Convention on the Rights of the Child, all children have the right to the highest attainable standard of health "without discrimination of any kind".1 The UK has committed to upholding this right. However, not all children in the UK are equally protected. Racism is a known risk factor for health in children, ranging from preterm birth and low birthweight, to major depression and asthma, and childhood is a vital period that can shape health throughout the life course.

Objectives This study aimed to qualitatively explore (1) the experiences of female survivors of domestic abuse and mental health problems in Afghanistan; (2) how female survivors of violence and abuse, male members of the community and service providers perceive and respond to mental health and domestic violence in Afghanistan and (3) the provision of mental health services for female survivors of violence and abuse in Afghanistan, including the barriers and challenges faced around accessing mental health services.Design Qualitative interviews and framework thematic analysis.Setting Kabul, Bamyan and Nangarhar in Afghanistan.Participants 60 female survivors of domestic abuse, 60 male community members and 30 service providers who work with female survivors of domestic abuse.Results Experiences of multiple and compounding traumatic experiences of violence, armed conflict, and complex and competing psychosocial concerns were common among the female survivor participants. All female survivor participants reported experiencing negative mental health outcomes in relation to their experiences of violence and abuse, which were further precipitated by widespread social stigma and gender norms. Support and service provision for female survivors was deemed by participants to be insufficient in comparison to the amount of people who need to access them.Conclusions There are many risks and barriers women face to disclosing their experiences of violence and mental health problems which restrict women’s access to psychological support. Culturally relevant services and trauma-informed interventions are necessary to respond to these issues. Service providers should be trained to effectively recognise and respond to survivors’ mental health needs.