This article examines how people with disabilities in the state of Kerala, India experience and respond to the impacts of climate change, drawing on 72 semi-structured interviews with disabled individuals, caregivers, and key stakeholders. Although Kerala has comparatively strong social development indicators and has taken steps toward disability-inclusive climate and disaster planning, our findings reveal persistent social, economic, and institutional barriers that heighten climate vulnerability for people with disabilities. Participants described how inaccessible early-warning systems, evacuation procedures, emergency shelters, and relocation programs intensify exposure to climate hazards and limit their ability to respond effectively. Longer-term structural factors, including poverty, inadequate housing, limited access to assistive devices and medical care, and discriminatory attitudes, further constrain their adaptive capacity. Using a social-relational model of disability, the article shows how ableism intersects with other inequalities to shape exposure, sensitivity, and adaptive capacity in the face of climate risks. At the same time, the study highlights the agency and expertise of disabled individuals, who engage in creative adaptation strategies, mutual aid, and other forms of community support, strengthening resilience within and beyond the disability community. The article argues for disability-inclusive and universally designed solutions across multiple sectors relevant to climate resilience and underscores the importance of centering disabled people’s knowledge in adaptation planning.

Many government sectors view tobacco growing to hold significant economic value for smallholder farmers, a narrative driving policy and practice. Corresponding to this narrative, there has been a marked increase in land allocated to leaf production and cigarette manufacturing. We tested this narrative in Mozambique by quantifying the economic net income of smallholder tobacco growers (n = 1 315 households) in four major tobacco growing districts and compared income across four groups of tobacco farmers; persistent growers; persistent non-growers; new growers; and no-longer growers using panel survey data collected in 2019/2020 and 2020/2021. Overall, the economic net income was higher amongst those who were no-longer growers and non-growers. Relative to those who cultivated tobacco in 2020 but decided not to grow in 2021, a partnership contract with a leaf-buying company was strongly associated with continued growing of tobacco. The second factor associated with tobacco cultivation in both years was farmers’ use of hired labor, which is likely a function of the high labor intensity of the crop. These facts are important to inform further discussions on policy and programming pertaining to more robust rural livelihoods in Mozambique. These findings are consistent with a burgeoning literature from countries in Africa. Not applicable. Tobacco growing has been viewed as a lucrative crop for smallholder farmers by governments as reflected by their prioritization of tobacco in development plans. The evidence supporting this view is often limited or non-existent. This study finds that persistent growers and new growers showed a reliance on tobacco revenue, but this appeared to come at the expense of other diversified income streams. It also finds that the highest economic net incomes were found among households that had either exited the tobacco sector (Group B: 57,082 MZN) or never entered it (Group D: 52,369 MZN). Relative to those who exited tobacco growing, partnership contracts remained the strongest predictor of persistence in tobacco growing (RRR = 13.47, p < 0.001). This suggests that structural credit-for-input schemes may structure a path dependency that makes exiting the sector economically difficult. A central finding of this study confirms the findings from other studies in the region that tobacco revenue is largely an illusion created by the exclusion of labor costs.

Malnutrition in all its forms presents an urgent global health challenge and food systems transformation is a critical component of the necessary policy response. However, cross-sectoral policy engagement between nutrition policy makers and the policy sectors responsible for food systems change has proved challenging. This policy analysis focused on how policy makers act as agents within institutions to advance cross-sectoral policy making on food systems and nutrition, informed by theories of policy making and power. Forty-three interviews were conducted with policy actors working at global, regional and national level, in relevant sectors. The interview data were analysed iteratively, informed by theory, with a focus on actor roles, characteristics, skills and capacities and the dynamics between these dimensions. We found that successful cross-sectoral policy engagement for nutrition resulted from a dynamic interaction between agents and institutional structures, within which policy agents were able to exert 'power to' influence outcomes, and exert 'power with' multidisciplinary teams and cross-sectoral colleagues to effect change. These policy actors were able to shape ideas and create cultures and norms that supported cross-sectoral engagement, which led to effective engagement between policy sectors, characterised by constructive dialogue, shared decisions, trust, goodwill and balancing objectives across sectors. The result of this engagement was consideration of nutrition in policy making in sectors other than health, in ways that resulted in tangible policy outcomes. Success in cross-sectoral policy engagement was seen as strengthening both institutional support for cross-sectoral action on nutrition, and the ability of policy actors to overcome barriers.

Tobacco continues to be viewed as a path to economic development by some governments, including Zimbabwe, despite widespread knowledge of tobacco's negative consequences for users, farmers and the environment. Zimbabwe is one of the top five tobacco producers in the world and the largest tobacco producer in the African region. Zimbabwe's focus on tobacco production creates difficulties for the implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) which it signed in 2014. Our objective was to understand the political economy of tobacco in Zimbabwe, which can inform the implementation of WHO FCTC. We conducted 23 interviews with government, non-governmental, para-statal and other stakeholders in Zimbabwe's tobacco sector. The findings illustrate intersecting issues that make tobacco a complex policy issue in the country. Interviewees indicated that WHO FCTC implementation faces barriers due to tobacco being an important economic commodity. Specifically, interviewees highlighted the prioritization of tobacco in government strategic plans and as a priority agricultural crop. Additionally, lack of alternatives and debt obligations makes it challenging for smallholder farmers to shift away from tobacco. However, findings indicate that tobacco production is facing rising challenges including tobacco use among youth, deforestation and farmer health, poverty and debt making the supply and demand measures of the WHO FCTC even more crucial. These challenges may be starting points to engage with the government in order to encourage strategies to move away from tobacco as a key economic commodity.

INTRODUCTION:Tobacco use is a major public health crisis in Kenya, leading to over 6000 deaths annually. With a significant number of young people and adults using tobacco, the nation faces a rising health burden. The Kenyan government has implemented educational programs to curb consumption. This study analyzes data from the 2022 Kenya Demographic and Health Survey (KDHS) to assess changes in tobacco use from 2014 to 2022 and identify key demographic and socioeconomic determinants. METHODS:This study is a secondary data analysis of the 2022 Kenya Demographic and Health Survey (KDHS), a nationally representative survey of 46609 adults (aged 15-54 years). Data access was through the MEASURE DHS platform, ensuring ethical handling. A logistic regression model was used to estimate odds ratios of tobacco use, adjusting for socioeconomic and demographic factors. The analysis accounted for the survey's complex design using survey weights and clustering and was conducted in Stata 17 software. RESULTS:Between 2014 and 2022, overall tobacco use declined. Among men, prevalence dropped from 17.3% to 12.81% (25.95% decrease), and among women from 3.10% to 2.64% (14.84% decrease). While women's smoking slightly increased (0.18-0.35%), their smokeless use decreased (0.93-0.77%). Tobacco use was linked to age, marital status, residence, region, education level, and gender. Men's tobacco use odds increased with age, with those aged 20-24 years nearly five times more likely to use tobacco than those aged 15-19 years (AOR=4.44; 95% CI: 4.44-4.44). Married men were less likely to use tobacco than divorced, separated, or widowed men. CONCLUSIONS:The observed declines in tobacco use, especially among males, suggest that current tobacco control efforts are positively impacting public health. Given the financial strain of health costs, preventive interventions are crucial. Research on socioeconomic and demographic factors can guide targeted behavioral change strategies. Continued policy measures like increased tobacco taxation, raising the legal sale age, and enforcing advertising bans and smoke-free policies remain essential to further reduce tobacco's health burden in Kenya.

INTRODUCTION:Tobacco cultivation is associated with financial instability, health risks, and environmental degradation. While Thailand has made progress in tobacco control, challenges remain in supporting farmers with sustainable alternatives. This study examined the perceived economic, health, and environmental impacts of tobacco cultivation among Thai tobacco farmers. METHODS:A cross-sectional survey was conducted from October 2021 to January 2022 in Chiang Mai, Phrae, and Sukhothai, the major tobacco-growing provinces in Thailand. A total of 1505 tobacco farmers completed self-administered questionnaires. The instrument measured perceived impacts on a 3-point Likert scale (low to high). Frequencies and proportions for descriptive statistics are reported along with adjusted odds ratios and 95% confidence intervals for logistic regression models. RESULTS:Economic impacts were most frequently reported (43.7%), particularly increased debt (47.6%) and income loss (43.5%). Health impacts (31.6%) included symptoms of Green Tobacco Sickness (47.2%) and reduced work capacity (29.9%). Environmental concerns (14.4%) included pesticide contamination (10.8%) and degradation of soil and water resources (10.6%). Higher economic impact was associated with cultivating Virginia tobacco (AOR=6.51; 95% CI: 4.90-8.63), higher level of education (AOR=1.39; 95% CI: 1.01-1.92), contract farming (AOR=1.27; 95% CI: 0.99-1.63), and farming experience (AOR=1.00; 95% CI: 0.99-1.01). Health impact was associated with age (AOR=1.04; 95% CI: 1.03-1.05), land rental (AOR=0.75; 95% CI: 0.58-0.98), female gender (AOR=0.74; 95% CI: 0.58-0.94), and Virginia cultivation (AOR=0.32; 95% CI: 0.23-0.44). Environmental impact was linked to labor hiring (AOR=2.68; 95% CI: 1.41-5.07) and land rental (AOR=0.56; 95% CI: 0.39-0.79). CONCLUSIONS:Thai tobacco farmers face significant economic, health, and environmental burdens. Policy interventions should promote sustainable alternatives to mitigate these impacts.

BACKGROUND:Tobacco taxes are an effective method of reducing consumption, but Bangladesh's tax policy is weak and needs improvement in many areas. OBJECTIVE:This study aimed to analyse the political economy of tobacco tax design and implementation in Bangladesh. METHODS:We reviewed 45 tobacco tax documents, conducted stakeholder mapping, 12 key informant interviews and stakeholder analysis. We used thematic and content analysis approaches. RESULTS:In Bangladesh, the tobacco tax structure is complex and difficult to implement and not designed to curb tobacco consumption. The dual role of the Bangladesh government as regulator of and shareholder in the largest tobacco company weakens the formulation and implementation of tobacco taxes as health policy instruments. Tobacco is one of Bangladesh's highest revenue sectors. As such, tobacco companies yield significant indirect influence on the government and media to shape the conversation around tobacco taxes and to weaken those taxes' design and implementation. Despite significant challenges, a strong antitobacco network (including academia, civil society organisations, non-government organisations, the WHO and media actors) continues to advocate for the use of tobacco taxes to reduce tobacco consumption. CONCLUSION:Our findings illustrate a complex interplay of political economy factors that challenge the design and implementation of tobacco taxes in Bangladesh. Creating opportunities for consultation and collaboration between the Ministries of Finance and Health regarding the formulation of tobacco taxes will be very important. National action plans with multi-stakeholder involvement are essential to achieving tobacco control goals through actionable steps.

PurposeThis paper examines the intrahousehold dynamics between women and men present in tobacco farming households in Mozambique. Attention to the experiences and realities of the smallholder farmers is crucial for understanding approaches to alternative livelihoods. Intrahousehold dynamics can provide important insights into how these households and their members view tobacco production and engage with the political economy of tobacco farming, how they make decisions, and the rationale and values behind these decisions. MethodsData were collected through single-gender focus group discussions (n=8) with 108 participants (men=57, women=51). Analysis was informed by a qualitative description methodology. This research presents a gender-based analysis examining the perspectives, roles, decision-making processes and desires of female and male tobacco farmers in four key tobacco-growing districts in Mozambique. FindingsThroughout this paper, women are found to hold leverage and influence in tobacco farming households, and this leverage is in part gained via the necessity of women's unpaid labour in achieving profitability in tobacco farming. Both women and men are also found to strongly desire and pursue the well-being of the household. ConclusionWomen hold agency within tobacco-growing households and participate in decision-making processes regarding tobacco agriculture. Women should be included in future tobacco control policies and programmes pertaining to Article 17.

INTRODUCTION:Studies examining profit suggest that former tobacco farmers do as well or better than current tobacco farmers. Research has yet to examine the relationship among current and former tobacco farmers, poverty, and receipt of government social assistance. This type of research is critical to understanding the direct and indirect subsidization of tobacco growing. This study analyzed tobacco farmers' poverty levels and receipt of government social assistance programs. AIMS AND METHODS:We designed and conducted an original four-wave economic survey of current and former tobacco farming households in Indonesia between 2016 and 2022. We then used descriptive analysis and probit regression for panel data to estimate the relationship between tobacco farming and poverty status. RESULTS:Tobacco farmers' per capita income and poverty rates vary across years. The poverty rate was significantly higher in the year with a higher-than-normal rainfall as it negatively affected farming outcomes. During this year, the poverty rate among current tobacco farmers was also higher than that of former tobacco farmers. Regression estimates from the panel data confirm the association between tobacco farming and the likelihood of being poor. We also found a high share of current tobacco farmers who receive government social assistance programs, such as cash transfer programs and a universal healthcare program. CONCLUSIONS:Our findings show high poverty rates-particularly during bad farming years-and high rates of government social assistance among tobacco farmers. The high rates of government assistance among tobacco farmers living in poverty show that the government is indirectly subsidizing the tobacco industry.

According to the World Health Organization (WHO), tobacco use causes over 8 million deaths annually including 1.3 million due to second-hand exposure. Furthermore, data from the Tobacco Atlas show that the tobacco industry continues to target new markets in the WHO African region, one of two regions where absolute numbers of smokers continue to increase. Understanding context contributes to policy formulation and implementation ensuring relevance to a country's political economy. Focusing on the WHO African region, this scoping review (i) maps the extent of academic research examining contextual factors on the WHO Framework Convention on Tobacco Control (WHO FCTC) national-level implementation, and (ii) reports on contextual factors impacting the WHO FCTC implementation. Using a stepwise structured approach, we conducted a search across four academic databases, yielding 10 342 articles and 42 were selected for full data extraction. Leichter's four categories of context (situational, structural, cultural and exogenous) and the stages of heuristic policy model guided data extraction. Study findings indicated that situational contextual factors such as the burden of disease or its impact on health can push governments toward policy formulation. Structural contextual factors included political considerations, economic interests, funding, institutional congruence, strength of policy and institutional capacity as important. Cultural contextual factors included the influence of policy entrepreneurs, current social trends and public opinion. Exogenous contextual factors included the WHO FCTC, tobacco industry influence at the national-level and bi-lateral partnerships. Further understanding contextual factors affecting the WHO FCTC national implementation can strengthen policy formulation and align required support with the WHO FCTC Secretariat and other relevant bodies.

Eliminating gender inequality and promoting population health are stand-alone goals in the Sustainable Development Goals (SDGs). It is crucial to understand goal setting and policy making processes aimed at promoting gender and health equality given the entrenched and structural natures of these inequalities. Our research examines the process of problem and solution representation, priority setting, and factors that shape the policymaking process concerning women and girls within the UN system in relation to the SDGs. Data for this study were collected from semi-structured one-on-one interviews with participants who have work experience within the United Nations (UN) (n = 9). The analysis was informed by a qualitative descriptive methodology. Our findings identify the role of political forces in influencing policy, the challenges of limited and tied financial resources, the role of scientific evidence and data, and the purpose of different mandates across agencies. Political forces were found to shape the work of UN agencies, often hindering advancement of the SDG agenda. At the same time participants noted how they navigated opposition or what they considered regressive approaches to women and girls’ health in order to pursue a more progressive agenda. Finite financial resources were also noted to play an important role in shaping SDG implementation pertaining to women and girls’ health. Identification of the types of knowledge, evidence, and data that drive and are given preference in policy creation and development can highlight shortcomings and strengths of current modes of policy development and implementation. Key stakeholders and future research in health and development policy spheres can draw from our findings to gain insight into problem representation and prioritization. This will help identify underlying assumptions that inform work on women’s and girls’ health and how they shape policy agendas.

Mozambique ranks fifth on the list of tobacco producing countries in Africa, while also being a Party to the WHO Framework Convention on Tobacco Control (FCTC). Tobacco farming is regarded by some governments as a strategic economic commodity for export and remains deeply entrenched within Mozambique's political and economic landscape. This study uses a qualitative description methodology to identify tensions, conflicts and alignment or misalignment in policy on tobacco across government sectors and levels in Mozambique. We conducted semi-structured qualitative interviews with 33 key informants from sectors across national and subnational levels including health, agriculture, economic and commercial sectors, as well as non-state actors from civil society organizations, the tobacco industry, farmers unions and associations and individual farmers. Incoherence was present across sectoral mandates, perspectives on industry's presence in the country and regions and between FCTC provisions and informant perceptions of tobacco production as a development strategy. Despite tobacco being viewed as an important economic commodity by many informants, there was also widespread dissatisfaction with tobacco from both farmers and some government officials. There were indications of an openness to shifting to a policy that emphasizes alternatives to tobacco growing. The findings also illustrate where points of convergence exist across sectors and where opportunities for aligning tobacco policy with the provisions of the FCTC can occur.

The field of global health is at a pivotal moment of transformation. Decoloniality has emerged as a critical framework to assess and transform the pathologies that mark the field. These pathologies include the inequitable sharing of resources, the power hierarchies that entrench decision-making in institutions largely based in North America and Europe and the general predisposition towards paternalistic and exploitative interactions and exchange between North and South. The energy being generated around this transformative moment is widening circles of participation in the discourse on what transformation should look like in the field. The importance of decoloniality cannot be overstated in driving the transformative agenda. At the same time, the popularity of decoloniality as a critical framework may risk omissions in our understanding of the origins of injustice and the pathways to a new global health. To complement the work being done to decolonise global health, I illustrate how the ‘human condition’ intersects with the transformative agenda. By human condition, I mean the universal features of humanity that lead to oppression and those that lead to cooperation, unity and a shared humanity.

Introduction: The COVID-19 pandemic brought unprecedented challenges for youth with neurodevelopmental disabilities (NDD) and their families. Although health measures were implemented to contain the COVID-19 virus, they disrupted public service, pro-foundly impacting youth and their families' access to services. This study sought to better understand the perspectives and experiences of parents and caregivers of youth with NDD across Canada in accessing services and their mental health needs during the pandemic. Method: The study used a qualitative research design in which we interviewed 40 parents and caregivers across Canada. Results: The results enabled us to understand the impact of ser-vice disruptions in significant areas of life, including health, educa-tion, employment, and risk mitigation.Discussion: Policymakers must consider a disability-inclusive lens during public health emergency planning and response to reduce the disproportionate impacts faced by youth with NDD and their families. J Pediatr Health Care. (2023) 37, 122-132

The tobacco epidemic remains the most preventable health threat of our time, with nearly eight million people dying annually from tobacco use (World Health Organization [WHO], 2019a). While governments continue to pursue tobacco control measures around the world, such efforts face strong opposition from tobacco interests (Bump & Reich, 2013). This ubiquitous opposition manifests in familiar and novel forms in tobacco-growing countries, particularly in countries such as Zambia where the establishment of tobacco control policy is fairly recent (Labonté et al., 2018), and where the colonial roots of tobacco production date back to 1912 (Harkema, 1972). With 182 parties having signed on to the Framework Convention on Tobacco Control (FCTC), governments around the world continue to pursue important measures such as smoke-free laws, increases in excise taxes on tobacco products, graphic health warnings on tobacco packaging, education and/or mass media campaigns, youth access laws, and information exchange. One key measure from the FCTC – promoting alternative livelihoods for tobacco farmers – continues to confront challenges, as political and economic conditions and forces emphasize tobacco production as a key economic development strategy (Chung-Hall et al., 2019). Governments continue to support investment and stimulate processing and manufacturing in contravention of the provisions of the FCTC, with implications for domestic tobacco consumption (Labonté et al., 2019). In Zambia, the country of focus of this case study, this context of policy conflict is rooted in the continued presence of tobacco farming and more recent developments to further enhance leaf processing and build manufacturing capacity. The limited progress in addressing tobacco supply partly stems from the unique features of the problem and the unfamiliarity of many tobacco control advocates and scholars with the complex political economy of agricultural production (Chingosho et al., 2020; Mazwi et al., 2020). Amplifying this challenge is a persistent and wide-spread perception that tobacco farmers tend to earn more than other farmers even though the growing literature demonstrates otherwise (Magati et al., 2019; Donald Makoka et al., 2017). But the problem of alternatives to tobacco production is also deeply rooted in the conception of state-market-society relationships held by governments in tobacco-producing countries, largely informed by the (neoliberal) notion that government should not interfere with production, but rather let demand for tobacco drive production levels (Lencucha & Thow, 2020). Such an approach tends to focus on demand-side issues in isolation from the political and economic conditions that shape the tenuous relationship between sectors of government, driven by mandates that are often

Protecting policy-making from tobacco industry influence is central to effective tobacco control governance.The inclusion of industry actors as stakeholders in policy processes remains a crucial avenue to corporate influence.This influence is reinforced by the idea that the tobacco industry is a legitimate partner to government in regulatory governance.Addressing the influence of the tobacco industry demands a focus on the government institutions that formalize relationships between industry and policy-makers.Industry involvement in government institutions is particularly relevant in tobacco-growing countries, where sectors of government actively support tobacco as an economic commodity.In this paper, we discuss how controlling tobacco industry influence requires unique consideration in tobaccogrowing countries.In these countries, there is a diverse array of companies that support tobacco production, including suppliers of seeds, equipment and chemicals, as well as transportation, leaf buying and processing, and manufacturing companies.The range of companies that operate in these contexts is particular and so is their engagement within political institutions.For governments wanting to support alternatives to tobacco growing (Article 17 of the Framework Convention for Tobacco Control), we illustrate how implementing Article 5.3, aimed at protecting tobacco control policies from tobacco industry interference, is fundamental in these countries.Integrating Article 5.3 with Article 17 will (i) strengthen policy coherence, ensuring that alternative livelihood policies are not undermined by tobacco industry interference; (ii) foster cross-sector collaboration addressing both tobacco industry interference and livelihood development; and (iii) enhance accountability and transparency in tobacco control efforts.