Lancet Public Health最新文献

{"title":"The burden of bacterial antimicrobial resistance in the WHO Eastern Mediterranean Region 1990–2021: a cross-country systematic analysis with forecasts to 2050","authors":"","doi":"10.1016/s2468-2667(25)00201-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00201-4","url":null,"abstract":"<h3>Background</h3>Antimicrobial resistance (AMR) is an urgent global crisis and one of the world's most complex challenges. Although there is increasing evidence of its impact on human mortality and morbidity, precise burden estimation has many challenges, and thus far has been elusive for the Eastern Mediterranean Region. Here, we present a comprehensive time-trend analysis of regional and country-level AMR burden estimates in the WHO Eastern Mediterranean Region (EMR), between 1990 and 2021, with forecasts up to 2050.<h3>Methods</h3>We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 11 infectious syndromes, 22 bacterial pathogens, and 84 pathogen–drug combinations for the WHO EMR and each of its countries from 1990 to 2021. Data were obtained from mortality registries, surveillance systems, hospital records, systematic literature reviews, and other sources. We based our modelling approach on five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths and DALYs attributable to AMR (considering an alternative scenario where drug-resistant infections are replaced with susceptible infections), and deaths and DALYs associated with AMR (considering an alternative scenario where infections would not occur at all). Predictive statistical modelling was applied to generate estimates of AMR burden for each country. We also generated AMR burden forecasts up to 2050. We generated 95% uncertainty intervals (UIs) for the final estimates by taking the 2·5th and 97·5th percentiles across 500 draws through the multistage computational pipeline, and models were cross-validated for out-of-sample predictive validity.<h3>Findings</h3>We estimated 380 000 deaths (95% UI 332 000–426 000) associated with bacterial AMR and 92 800 deaths (78 300–111 000) attributable to bacterial AMR in the EMR in 2021. In the past 31 years, there was considerable variation in AMR mortality trends across countries of the region and different age groups. Between 1990 and 2021, associated deaths among children younger than 5 years decreased by 50·0% (38·2–62·0), while those among adults aged 70 and older rose by over 85·7% (95% UI 57·0–115·7). Six pathogens were identified as the primary generators of burden: <em>Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii</em>, and <em>Pseudomonas aeruginosa</em>. A substantial increase in the AMR burden due to <em>S aureus</em> was observed between 1990 (28 200 deaths [21 600","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"38 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National roll-out of social prescribing in England's primary care system: a longitudinal observational study using Clinical Practice Research Datalink data","authors":"Feifei Bu, Alexandra Burton, Naomi Launders, Amy E Taylor, Alvin Richards-Belle, Stephanie Tierney, David Osborn, Daisy Fancourt","doi":"10.1016/s2468-2667(25)00217-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00217-8","url":null,"abstract":"<h3>Background</h3>Social prescribing is growing rapidly in England and across the world. However, it remains unclear who it is reaching and how effectively it is being implemented. This study aimed to assess longitudinal trends in social prescribing in England's primary care system, including growth trajectories and target alignment, sociodemographic profiles of referred patients, and predictors of service refusal over time.<h3>Methods</h3>This nationwide, longitudinal observational study analysed primary care records from 1·2 million patients from 1736 general practitioner (GP) practices in the Clinical Practice Research Datalink in England. We estimated social prescribing trends between 2019 and 2023 using growth curve modelling on social prescribing numbers at the practice level. Descriptive analyses were used to show changes in sociodemographic profiles of social prescribing patients over time. To assess sociodemographic disparities in service refusal (defined as having a medical code of social prescribing declined), we used multilevel logistic regression models stratified by year, accounting for nested data structure where patients were nested within practices.<h3>Findings</h3>As of the end of 2023, an estimated 9·4 million GP consultations in England have involved social prescribing codes, and 5·5 million consultations have specifically led to social prescribing referrals. In 2023 alone, an estimated 1·3 million patients were referred to social prescribing. 60% of patients offered social prescribing were female and 23% were from ethnic minority groups. Representation from patients living in more deprived areas increased from 23% to 42% between 2017 and 2023. Service refusal declined from 22% to 12% between 2019 and 2023. Age, sex, and ethnicity were associated with service refusal across multiple years. Notably, in 2023, all age groups had higher odds of refusal compared with the youngest age group. Female patients had 21% (95% CI 0·77–0·82) lower odds of refusal than males, and patients from White ethnic backgrounds had 32% (1·26–1·39) higher odds of refusal than ethnic minority patients.<h3>Interpretation</h3>Social prescribing has expanded rapidly in England, far exceeding initial targets of 900 000 patients by 2023–24, suggesting broad service acceptability. Progress is being made in reaching specific target groups, such as more deprived communities. However, there are still disparities in accessibility and uptake, calling for targeted strategies to address underlying inequalities.<h3>Funding</h3>MQ Transforming Mental Health, Rosetrees-Stoneygate Trust Fellowship, National Academy for Social Prescribing.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"21 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is a Wellbeing Economy, and what might its impact be on population health?","authors":"Gerry McCartney, Milena Büchs, Martin Hensher, Micaela Mazzei","doi":"10.1016/s2468-2667(25)00192-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00192-6","url":null,"abstract":"The current polycrisis (intersecting and mutually-reinforcing crises that are impacting our ecological, social, and economic systems) has foregrounded the need to transform economies to put them in service of people and planet, rather than design them in pursuit of ever more economic growth. This approach, termed a Wellbeing Economy, is the subject of considerable policy interest and could have substantial impacts on population health if widely implemented. We discuss different interpretations of similar terms for economic systems and how these interpretations imply incremental reforms to the dominant capitalist model, or a radical break in economic design. We detail routes to a Wellbeing Economy and suggest that more radical approaches hold greater potential to address the polycrisis and protect population health. We summarise how the implementation of a Wellbeing Economy could be a commensurate response to the polycrisis that might also yield substantial benefits for population health.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"9 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in use and utilisation patterns of drugs with reported shortages between 2010 and 2024 in Europe and North America: a network cohort study","authors":"Marta Pineda-Moncusí, Alexandros Rekkas, Álvaro Martínez Pérez, Angela Leis, Carlos Lopez Gomez, Eric Fey, Erwin Bruninx, Filip Maljković, Francisco Sánchez-Sáez, Jordi Rodeiro-Boliart, Loretta Zsuzsa Kiss, Michael Franz, Miguel-Angel Mayer, Neva Eleangovan, Pau Pericàs Pulido, Pantelis Natsiavas, Selçuk Şen, Steven Cooper, Sulev Reisberg, Katrin Manlik, Theresa Burkard","doi":"10.1016/s2468-2667(25)00194-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00194-x","url":null,"abstract":"<h3>Background</h3>Drug shortages can negatively impact patient care. We aimed to estimate the incidence and prevalence of use of medicines with shortages announced by the European Medicines Agency between January, 2013, and September, 2023, and to characterise the users of these drugs.<h3>Methods</h3>In this multinational network cohort study, we used routinely collected data from 52 databases across 18 European countries and the USA covering primary care, secondary care, health insurance claims, and disease registries. We included all participants with a minimum of 365 days of medical history between 2010 and 2024. We estimated annual incidence rates and period prevalence of use of medicines with a reported shortage (n=16), and their key alternatives (n=41). A reduction of 33% or more in incidence or prevalence after the shortage announcement was considered confirmation of a shortage. Additionally, we analysed changes in utilisation in terms of age, sex, indication, duration, and dosage.<h3>Findings</h3>Eight drugs had a 33% or higher reduction in incidence and nine drugs had a 33% or higher reduction in prevalence. Varenicline and amoxicillin (alone or combined with clavulanate) were the medicines affected in the highest number of countries and databases. Additionally, we observed changes in the indication of alteplase (pulmonary embolism indication increased in hospitals in Finland and Germany during the shortage period) and sarilumab (rheumatoid arthritis indication decreased in databases in the UK, Spain, Finland, and Sweden); and among incident users of sarilumab, a decrease in the cumulative dose was observed in databases in the Netherlands (from 84 mg in 2020 to 28 mg in 2023) and a reduction in treatment duration was observed in databases in Finland (from 104 days in 2020 to 1 day in 2022) and Belgium (from 71 days in 2020 to 30 days in 2022).<h3>Interpretation</h3>This study highlighted changes in incidence and prevalence of use of medicines after shortage announcements, and changes observed in patient care in terms of the indication, duration, or prescribed dose of medicines. Our findings showed that some reductions in use were observed across Europe and the USA, and others differed across countries. More research is needed to reduce the effects of drug shortages globally.<h3>Funding</h3>Innovative Medicines Initiative 2 Joint Undertaking.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"59 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taxing unhealthy foods: a Philippine case for food policy reform","authors":"Michael R M Abrigo","doi":"10.1016/s2468-2667(25)00218-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00218-x","url":null,"abstract":"With ultra-processed food consumption increasing, the question confronting policy makers is no longer whether unhealthy diet is a major health risk, but what to do about it. In <em>The Lancet Public Health</em>, Akshar Saxena and colleagues<span><span>¹</span></span> offer a compelling answer: tax unhealthy foods.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"83 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Housing: a determinant of health and equity","authors":"","doi":"10.1016/s2468-2667(25)00229-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00229-4","url":null,"abstract":"Housing is a fundamental human right. Yet, <span><span>UN Habitat</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> estimates that 2·8 billion people around the world face some form of housing inadequacy, 1 billion people live in informal settlements and slums, and 300 million people are homeless. Adequate, safe, and affordable housing is not a luxury. The Sustainable Development Goal target 11.1—ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums by 2030—is clear, and the next 5 years will be crucial for countries to meet their targets. Housing is increasingly recognised as a determinant of health and wellbeing, yet governments are slow to act and poor housing remains a substantial challenge and a threat to public health in many countries.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"27 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Housing as a social determinant of health: a contemporary framework","authors":"Rebecca Bentley, Kate Mason, David Jacobs, Tony Blakely, Philippa Howden-Chapman, Ang Li, Gary Adamkiewicz, Aaron Reeves","doi":"10.1016/s2468-2667(25)00142-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00142-2","url":null,"abstract":"Housing is a key social determinant of health. Healthy housing is affordable, suitable, and secure. It is characterised by warmth, dryness, and proper ventilation; free from hazards such as mould and toxins; accessible to occupants with functional limitations; and provides foundational security. Conversely, exposure to unhealthy home environments can negatively affect respiratory and cardiovascular health, mental wellbeing, infectious disease transmission, and injury risk. Housing-focused health interventions and programmes offer a unique opportunity to bridge the gap between housing and health, potentially leading to improved population health outcomes across various domains. This Series paper integrates contemporary understanding of housing and housing systems into a social and economic determinants framework. We illustrate how housing systems contribute to poor health outcomes and health inequalities, providing a foundation for exploring housing's potential to support health across jurisdictions globally. Although our framework can be used to examine the relationship between specific housing hazards (eg, mould, cold, or heat) and health, its primary focus is on understanding how these hazards are generated and distributed through characteristics of the housing system (eg, building codes or housing finance). By addressing these housing system determinants, we propose an alternative approach to achieving healthier housing. This framework aims to support the strategic use of housing to promote good health for all populations.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"38 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Housing at the intersection of health and climate change","authors":"Ang Li, Mathew Toll, Ralph Chapman, Philippa Howden-Chapman, Diana Hernández, Holly Samuelson, Alistair Woodward, Rebecca Bentley","doi":"10.1016/s2468-2667(25)00141-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00141-0","url":null,"abstract":"Anthropogenic climate change is causing rapid shifts in temperature and weather patterns, both in location and intensity, making living conditions increasingly hazardous. This complicates housing's frontline role in protecting human health. When housing systems fail to provide universal access to secure, affordable, and suitable housing, social and health inequalities related to climate change are amplified. The location, construction, and operation of homes influence greenhouse gas emissions and must be improved to reduce their environmental impacts. This paper, the second in a Series on housing as a social determinant of health, builds a framework for conceptualising the interactions between housing, climate, and health. It identifies the pathways through which climate change affects housing and exacerbates health risks, and reflects on policy responses for climate resilience in housing and health.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"26 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Displacement, health outcomes, and the human rights of people experiencing homelessness in the USA","authors":"Jesse Lloyd Goldshear, Tina Kempin Reuter, Ricky N Bluthenthal, Annick Borquez","doi":"10.1016/s2468-2667(25)00197-5","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00197-5","url":null,"abstract":"The USA is currently experiencing multiple overlapping economic and public health crises: rising costs of housing, increased homelessness, and record drug overdose mortality. In many urban areas, people who are homeless have become increasingly visible, often congregating in so-called encampments. The public reaction and policy response to this increased visibility has been largely punitive and carceral. Jurisdictions across the USA have adopted policies of forced displacement, often carried out by law enforcement officers and sanitation workers, and enforced via threat of fines, arrest, or both. The widespread adoption of these policies—especially given the 2024 US Supreme Court decision (<em>City of Grants Pass v Johnson</em>)—represents a violation of international human rights law. Public health professionals should use the framework of international human rights to fight against these harmful policies.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"77 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing men's health policy: the 5R Framework","authors":"Paul M Galdas, Zac E Seidler, John L Oliffe","doi":"10.1016/s2468-2667(25)00202-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00202-6","url":null,"abstract":"Despite growing awareness of gendered health inequalities, men remain under-represented in public health policy and practice. They have shorter life expectancy, higher preventable mortality, and lower engagement with health services compared with women, especially among groups living in marginalising conditions. To support system-level responses, we propose the 5R Framework (Research, Reach, Respond, Retain, and Relational) to guide the development of gender-responsive health systems. Each component offers direction for addressing men's needs through inclusive data, targeted engagement, tailored care, sustained participation, and equity-driven policy. The 5R Framework builds on earlier work for programme design by applying gender-transformative principles at a system level. The 5R Framework offers a strategic model for translating evidence into scalable, equitable policy and service reform.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"26 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}