Despite the life-saving potential of mental health interventions, their scalability and integration within healthcare systems present significant challenges, particularly in low-resource global settings. This study investigated scaling IDEAS for Hope, a telehealth counseling intervention designed to reduce suicide risk and improve HIV care engagement among people living with HIV in Kilimanjaro, Tanzania, and identified actionable implementation strategies for successful scale-up. We conducted 20 semi-structured interviews, between May and July of 2024, with purposively sampled stakeholders from the Ministry of Health, healthcare administrations, telecommunications, insurance providers, and community organizations. We analyzed the data thematically in NVivo 14 and used CFIR-ERIC mapping to align identified barriers and participant-recommended strategies with evidence-based implementation strategies. Findings showed institutional support and emerging policy directives promoting mental health integration within HIV care, but also persistent barriers, including shortages of trained mental health professionals, inadequate rural digital infrastructure, criminalization of suicide and stigma. Stakeholders recommended policy reform, workforce capacity strengthening, digital infrastructure expansion, integration of telehealth into insurance schemes, and task-shifting strategies. Implementation of IDEAS for Hope appears feasible but requires addressing systemic, legal, and infrastructural barriers. These findings inform future scale-up and provide a framework for integrating telehealth mental health services within national healthcare systems.

Reducing the under-5 mortality rate (U5MR) is a key public health priority and remains a persistent challenge in low- and middle-income countries. Many interventions have been developed in attempts to lower U5MR through partnerships between governments, funding partners, researchers, product developers and non-governmental organisations. The well-intentioned desire to use data to set priorities has led to many large-scale evaluations that specify U5MR as a primary outcome. The results of these evaluations are then used to inform investments, policies and advocacy efforts. While important insights can be gained from tracking U5MR at the population level, these evaluations often present serious scientific, pragmatic and ethical challenges. In this article, we outline six problems associated with evaluations targeting a U5MR outcome. We describe why U5MR is primarily informative as an outcome measure for trials of new clinical procedures or treatments designed to cure a life-threatening condition. For interventions that aim to lower U5MR by preventing disease or other potentially fatal events at the population level, or by improving implementation of existing evidence-based interventions, we recommend evaluations that specify intermediate outcomes that offer timelier information and more reliable causal inference. We present limitations to using results of a single study as the basis for policy or funding decisions about an intervention or implementing partner. Finally, we reinforce the need for rigorous methodology, national periodic U5MR measurement, verbal and social autopsies, strong mixed-methods implementation research and reliance on local implementer knowledge.

Recent research has examined factors contributing to the successful transition of middle-income countries away from international health aid. Three factors are especially important: effective leadership, using domestic resources to close the financing gap created by loss of aid, and realigning country systems to new sources of domestic funding.

Abstract Despite three decades of expanding scholarship on social determinants of health (SDH), progress in reducing health inequities has remained limited. While the SDH framework has reshaped global health discourse and informed policy rhetoric, the translation of knowledge into transformative action has been insufficient. The gap between evidence and impact is not explained by political constraints alone but is also contributed to by the orientation, methods, and practices of SDH research itself. We identify key limitations in what is studied, how research is conducted, and who leads knowledge production. Thematic gaps include the dominance of descriptive research, limited evidence on effective policy interventions, insufficient engagement with structural determinants and political economy, and underdeveloped attention to emerging drivers such as climate change, digitalization, and commercial determinants. Methodological limitations include underuse of policy, implementation, modelling, and participatory approaches, alongside persistent data gaps. Deficiencies in research practice constrain the transformative potential of SDH scholarship, including a lack of multi-disciplinary work, limited community and policymaker engagement and leadership, and inequitable power dynamics in global health research itself. We propose a reorientation of SDH research toward agency and action with greater focus on solutions and implementation pathways, methodological pluralism, multisectoral and participatory knowledge production, improved communication and policy engagement, and reforms to research incentives, funding and governance. By repositioning SDH research as an active contributor to political and institutional change, researchers can more effectively support equitable and sustainable health outcomes in a global context increasingly inhospitable for attention to health equity.

En el informe Salud Global 2050, la Comisión de la revista The Lancet sobre la Inversión en Salud concluye que, para mediados de siglo, es posible lograr mejoras significativas en el bienestar humano con inversiones en salud focalizadas. El informe establece el objetivo de reducir en 50% la probabilidad de muerte prematura, es decir, morir antes de los 70 años, para el año 2050, respecto a 2019. Para lograr este objetivo conocido como “50 para el 50”, se propone tratamiento de 15 afecciones prioritarias: ocho enfermedades infecciosas y afecciones maternas, y siete enfermedades no transmisibles y lesiones, las cuales, se anota, deberían ser subsidiadas por los gobiernos de los países que decidan invertir en dichas mejoras en materia de salud. Estas intervenciones también deberían reducir la morbilidad y la discapacidad. Además, se propone el fortalecimiento de los sistemas de salud mediante intervenciones costoefectivas y políticas como impuestos elevados al tabaco. Finalmente, el informe enfatiza en la preparación ante pandemias (debido al riesgo excepcionalmente alto de mortalidad) y un apoyo financiero integral y global para garantizar el desarrollo y la accesibilidad universal a servicios y tecnologías de salud.

BACKGROUND:The COVID-19 pandemic exposed significant weaknesses in global health multilateralism, particularly in its failure to achieve fair and equitable global distribution of COVID-19 vaccines. Soon after vaccines were available, huge inequities in vaccination rates between populations in the global north and the global south became apparent. This study explores why multilateralism fell so short during the pandemic and identifies the steps that must be taken now to ensure global vaccine equity in the next pandemic. METHODS:We conducted in-depth interviews with 20 expert key informants (KIs) worldwide from May 2023 to January 2024, comprising 16 individual interviews and two group interviews (each group interview had two KIs). The experts included representatives of academia, multilateral health and development agencies, civil society organizations, non-governmental organizations, think tanks, and the pharmaceutical industry. We used a qualitative study design to explore the perspectives, experiences, and insights of global health experts. We used purposive sampling to select participants based on their experience and knowledge of pandemic vaccines and pandemic preparedness. We continued conducting interviews until we had reached theoretical saturation. FINDINGS:Five key themes emerged on why multilateralism fell short when it came to global COVID-19 vaccine distribution. Prioritization of national interests-so-called "vaccine nationalism"-was a barrier to sharing doses. COVAX, the global vaccine sharing mechanism, lacked incentives for high-income and upper-middle-income nations to participate or compulsory mechanisms to make them do so, undercutting its ability to serve as an equitable distribution platform. COVAX also left out important constituents from the decision-making process. Rich countries benefitted from having stronger market power in the global economy due to their established, long-term relationships with the pharmaceutical companies. Inadequate vaccine supply fed into inequitable distribution. Five key themes emerged on ways to avert global vaccine inequity in the next pandemic. Promoting regional self-sufficiency in research and development and vaccine manufacturing is crucial. Building manufacturing capacity cannot be deferred until the next pandemic-it must begin now. International collective action will still be important, especially technology transfer agreements between large companies in the global north and partners in the global south as well as south-south partnerships. Public funding for pandemic vaccine development should include conditionalities that support global access. Finally, new kinds of intellectual property agreements are essential in preparing for the next pandemic. INTERPRETATION:Vaccine nationalism-combined with vaccine supply constraints, the dominance of manufacturing by countries in the global north, and the greater purchasing power of wealthy nations-created a "perfect storm" for rich nations to buy up the supply and to leave COVAX and many low- and middle-income countries at the back of the queue. To prevent such inequity in the next pandemic, regions should build capacity not just in manufacturing vaccines but also in regulatory approval and the financing and procurement of vaccines at scale. Such capacity needs to be built now-it cannot be deferred until the next crisis. FUNDING:This study was funded by a research grant to Duke University from the Carnegie Corporation of New York (https://www.carnegie.org/grants/grants-database/?q=duke&per_page=25#!/grants/grants-database/grant/937399121.0/).

[This corrects the article DOI: 10.1371/journal.pone.0316329.].

Introduction In Texas, the adolescent birth rate is higher than the national average and STIs have steadily increased over the last decade. Sex education is not mandated in Texas and the majority of public schools provide an abstinence-based sex education. Comprehensive sexuality education (CSE) programs are widely endorsed by national and global health organizations and research has shown that they are more effective in reducing poor sexual health outcomes than abstinence-based programs. The purpose of this study is to identify barriers and facilitators to implementing CSE at local and state levels in Texas. Methods Qualitative study design consisting of ten semi-structured interviews with eleven key informants (n = 11) conducted in 2021. Results Three barriers- ideological opposition to CSE, discrimination against LGBTQ+ people, myths and misconceptions about CSE- and two facilitators- champions, collaboration with community stakeholders- to implementing CSE policy were identified. Conclusion Study findings provide insight into the opposition faced by sex education advocates, which often stems from myths and misperceptions of CSE content and the stigmatization of sexual and gender minoritized groups. Parents, youth, medical professionals, and academic researchers are instrumental in dispelling sex education myths and misperceptions and engaging with community stakeholders.

Importance Persistent disparities in mortality across countries suggest uneven improvements in living standards and access to life-extending health technologies, as well as context-specific obstacles. Studies have analyzed cross-country inequality in mortality but have not widely contextualized those disparities in terms of developmental progress relative to a frontier representing a level of mortality achievable with broad access to the best health-enhancing technology and living standards available. Objective To examine probability of premature death (PPD)-defined as probability of dying before 70 years of age-across countries and regions, benchmarking progress as years behind the lowest country-level PPD (the frontier). Design and Setting This cross-sectional study used aggregate-level data from the 2024 United Nations World Population Prospects and Human Mortality Database to calculate PPD across 7 global regions and the 30 most populous countries. Data were analyzed from May to September 2025. Main Outcome and Measures The primary outcomes were PPD and the number of years behind the lowest country-level PPD. Results The frontier PPD fell from 57% to 12% from 1900 to 2019. Sub-Saharan Africa's PPD in 2019 was 52%, corresponding to the 1916 frontier PPD. However, sub-Saharan Africa had converged toward the frontier by over 40 years since 2000, when it had a 65% PPD. China has been converging toward the frontier since 1970, having been 93 years behind the frontier PPD in 1970 (with a 60% PPD) and 35 years behind in 2019 (21% PPD). The US has diverged away from the frontier, having been 29 years behind in 1970 (38% PPD) and 38 years in 2019 (22% PPD). Of the regions included, the North Atlantic (Western Europe and Canada) was the closest to the frontier, being 13 years behind in 2019 (15% PPD). The US, Central and Eastern Europe, and sub-Saharan Africa were the furthest above the 2019 PPD Preston curve (ie, they had a greater PPD than predicted by their per capita gross domestic product). Conclusions and Relevance In this cross-sectional study, disparities in PPD were likely to reflect major inequality in access to health-enhancing technologies and living standards, as well as context-specific obstacles. Technological and medical advancements leading to universal health benefits need to be rapidly and fairly disseminated.

Misuse and overconsumption of certain consumer products have become major global risk factors for premature deaths, with their total costs in trillions of dollars. Progress in reducing such deaths has been slow and difficult. To address this challenge, this review introduces the definition of market-driven epidemics (MDEs), which arise when companies aggressively market products with proven harms, deny these harms, and resist mitigation efforts. MDEs are a specific within the broader landscape of commercial determinants of health. We selected three illustrative MDE products reflecting different consumer experiences: cigarettes (nicotine delivery product), sugar (food product), and prescription opioids (medical product). Each met the MDE case definition with proven adverse health impacts, well-documented histories, longitudinal product consumption and health impact data, and sustained reduction in product consumption. Based on these epidemics, we describe five MDE phases: market expansion, evidence of harm, corporate resistance, mitigation, and market adaptation. From the peak of consumption to the most recent data, U.S. cigarette sales fell by 82%, sugar consumption by 15%, and prescription opioid prescriptions by 62%. For each, the consumption tipping point occurred when compelling evidence of harm, professional alarm, and an authoritative public health voice and/or public mobilization overcame corporate marketing and resistance efforts. The gap between suspicion of harm and the consumption tipping point ranged from one to five decades-much of which was attributable to the time required to generate sufficient evidence of harm. Market adaptation to the reduced consumption of target products had both negative and positive impacts. To our knowledge, this is the first comparative analysis of three successful efforts to change the product consumption patterns and the associated adverse health impacts of these products. The MDE epidemiological approach of shortening the latent time to effective mitigation provides a new method to reduce the impacts of harmful products.