I write in tribute to my friend Larry Gostin, who has long emphasized that accountability and governance are central to global health policy.

Global health law in theory and practice can either work to ameliorate the devastating consequences of colonialism, class hierarchies, and structural racism in health, or it can ratify and exacerbate them. It can protect, under protect, overprotect, or fail to protect – it is not and cannot be neutral. Global health law reflects the choices and practices of States and other actors, which includes both action and inaction. Inaction or silence on the part of global health law is a choice that ratifies the status quo of coloniality, class exploitation, and structural racism in health.

During outbreaks of diseases like cholera, HIV/AIDS, H1N1, and Ebola, governments often impose international border restrictions (for example, quarantines, entry restrictions, and import restrictions) that disrupt the economy without stopping the spread of disease. During COVID-19, international travel restrictions were ubiquitous despite initial World Health Organization recommendations against such measures because of their limited public health benefit and the potential for imposing a range of harms. Why did governments adopt these measures? This article argues and finds evidence that governments use international border restrictions as security theatre: ‘measures that provide not security, but a sense of it’. Quantitative analysis of original data on states’ first border restrictions during the pandemic suggests that behaviour was not just driven by the risk of COVID-19 spread. Instead, nationalist governments, which are likely to be attracted to policies associating disease with foreigners, were more likely to impose border restrictions, did so more quickly, and adopted domestic measures more slowly. A case study of the US further illustrates the security theatre logic. The findings imply that overcoming or redirecting governments’ attraction to security theatre could promote international cooperation during global health emergencies.

In longer-form writing with Larry Gostin, especially on global health, I have been particularly struck by how careful he is not to lose the narrative voice, especially of the vulnerable. He truly believes that these stories are “on loan” to us, and that there is an almost holy reverence and devotion we owe to the lives of those whose stories we tell.

With the objective of informing theoretical accounts of social learning and gendered conflict, we explore the role of prestige in the formation of men’s beliefs about gender in a semi-rural but fast urbanizing community in north-western Tanzania. Using focus groups and participant observation, we contrast the extent to which young men view elders and men from the neighbouring city as prestigious, and the beliefs they ascribe to each category. Elders were viewed as prestigious because of their age and position as preservers and teachers of societal norms. Their prestige was culturally mandated, as evidenced by customs bestowing respect. In contrast, only subcategories of city men were deemed prestigious dependent on individual achievement. Prestige was difficult to distinguish from dominance, as both elders and city men can exert penalties on those with differing views. Elders were viewed as mostly, but not always, unsupportive of women’s empowerment, whereas city men were viewed as mostly, but not always, supportive of women’s empowerment. We conclude that urbanization shifts the distribution of prestige, exposing individuals to novel sources of social influence. However, future studies should be wary not to oversimplify elders as upholders of patriarchal beliefs and city men as universally supportive of women’s empowerment.

Disaster Medicine is a critical and often neglected component of health care. The World Association for Disaster and Emergency Medicine (WADEM) Board of Directors, as well as the WADEM Student and Young Professional Special Interest Group, recognize the importance of introducing Disaster Medicine concepts early in health care education and have put forth a position statement emphasizing this importance. As leaders in Disaster Medicine, we aim to highlight the need for the integration of Disaster Medicine education into health care profession training. By acknowledging this educational need and by providing recommendations to appropriate stakeholders, we anticipate that this investment in Disaster Medicine education will assist in developing well-prepared health care professionals who will improve prehospital and emergency medicine, public health, and day-to-day health care throughout local and global communities.

In low- and middle-income countries, fewer than 1 in 10 people with mental health conditions are estimated to be accurately diagnosed in primary care. This is despite more than 90 countries providing mental health training for primary healthcare workers in the past two decades. The lack of accurate diagnoses is a major bottleneck to reducing the global mental health treatment gap. In this commentary, we argue that current research practices are insufficient to generate the evidence needed to improve diagnostic accuracy. Research studies commonly determine accurate diagnosis by relying on self-report tools such as the Patient Health Questionnaire-9. This is problematic because self-report tools often overestimate prevalence, primarily due to their high rates of false positives. Moreover, nearly all studies on detection focus solely on depression, not taking into account the spectrum of conditions on which primary healthcare workers are being trained. Single condition self-report tools fail to discriminate among different types of mental health conditions, leading to a heterogeneous group of conditions masked under a single scale. As an alternative path forward, we propose improving research on diagnostic accuracy to better evaluate the reach of mental health service delivery in primary care. We recommend evaluating multiple conditions, statistically adjusting prevalence estimates generated from self-report tools, and consistently using structured clinical interviews as a gold standard. We propose clinically meaningful detection as ‘good-enough’ diagnoses incorporating multiple conditions accounting for context, health system and types of interventions available. Clinically meaningful identification can be operationalized differently across settings based on what level of diagnostic specificity is needed to select from available treatments. Rethinking research strategies to evaluate accuracy of diagnosis is vital to improve training, supervision and delivery of mental health services around the world.

The framework presented in the World Bank report Open and Inclusive: Fair processes for Financing Universal Health Coverage effectively connects proposed decision-making principles with practical examples that country governments can use to pursue greater fairness. In this commentary, we consider the suggestion that international development partners might use the report's criteria to examine their own processes. We consider what the report's primary Fair Process principles – equality, impartiality and consistency – imply for development partners. Specifically, we address two questions in turn: (i) how relevant the Fair Processes report is to development assistance for health; (ii) if it is deemed relevant, what practical implications does the report have for how aid works? We address the second question by briefly applying the framework to a particular global health initiative, namely the United States President's Emergency Plan for AIDS Relief (PEPFAR). Our analysis suggests that development partners' additional sets of accountabilities, particularly linked to funding sources, may pose more fundamental challenges to impartiality than to equality and consistency in decision-making processes. A question inviting further examination, then, is how development partners can redesign their processes to optimise impartiality given institutional constraints that bind them independently of the populations they purport to serve.

Mental health is deteriorating quickly and significantly globally post-COVID. Though there were already over 1 billion people living with mental disorders pre-pandemic, in the first year of COVID-19 alone, the prevalence of anxiety and depression soared by 25% worldwide. In light of the chronic shortages of mental health provider and resources, along with disruptions of available health services caused by the pandemic and COVID-related restrictions, technology is widely believed to hold the key to addressing rising mental health crises. However, hurdles such as fragmented and often suboptimal patient protection measures substantially undermine technology’s potential to address the global mental health crises effectively, reliably, and at scale. To shed light on these issues, this paper aims to discuss the post-pandemic challenges and opportunities the global community could leverage to improve society’s mental health en masse.

Incorporating contextual factors into engineering design processes is recommended to develop solutions that function appropriately in their intended use contexts. In global health settings, failing to tailor solutions to their broader context has led to many product failures. Since prior work has thus far not investigated the use of contextual factors in global health design practice, we conducted semi-structured interviews with 15 experienced global health design practitioners. Our analysis identified 351 instances of participants incorporating contextual factors in their previous design experiences, which we categorized into a taxonomy of contextual factors, including 9 primary and 32 secondary classifications. We summarized and synthesized key patterns within all the identified contextual factor categories. Next, this study presents a descriptive model for incorporating contextual factors developed from our findings, which identifies that participants actively sought contextual information and made conscious decisions to adjust their solutions, target markets and implementation plans to accommodate contextual factors iteratively throughout their design processes. Our findings highlight how participants sometimes conducted formal evaluations while other times they relied on their own experience, the experience of a team member or other stakeholder engagement strategies. The research findings can ultimately inform design practice and engineering pedagogy for global health applications.

Experiential learning opportunities are recognized to help students put classroom discussions into practice, build new peer networks, and challenge their own preconceptions about the roles of global structures and systems to advance health and wellbeing. After a pandemic-related hiatus, the University of Southern California Institute on Inequalities in Global Health returned to Geneva, Switzerland with students for two weeks at the time of the 2024 World Health Assembly to learn and engage with how global health governance plays out on an international stage. We brought eleven passionate and engaged USC Master’s in Public Health (MPH) students whose interests covered a range of issues, including child and maternal nutrition, sexual and reproductive health and rights in conflict settings, mental health, and noncommunicable diseases, among many other topics. We spent two weeks meeting with inter-governmental organizations, international advocacy organizations, United Nations agencies, and joint funded programs, and our students built their own event schedule during the World Health Assembly to cover the health topics they were most interested in pursuing. Our aim was to have students engage with the complex interplay of health, law, and rights, and to see in real time how research and education inform policy, on local, national and global levels. As instructors and coordinators, we are convinced that the role of experiential learning has never been more important or influential. Multilateralism is under attack, and rights regressions are rampant. We found that fostering honest, content driven conversations with our organizational partners, and then having intense follow-up with our students, resulted in new perspectives– personally and professionally – which is likely to serve the work of the students in global health for the years to come. When the distance between classroom readings and the actual people steering global health can be bridged, university courses that center experiential learning offer the opportunity for emerging health leaders to truly understand the structures and systems in place, and better imagine their own roles in the fight for the right to health.

In this article, we examine the relationship between the World Health Organization International Health Regulations (IHR) and human rights and its implications for IHR reform, considering the evolution of human rights in the 2005 IHR, the role of human rights in IHR reforms and the implications of these reforms in key domains including equity and solidarity, medical countermeasures, core capacities, travel restrictions, vaccine certificates, social measures, accountability, and financing.

Perinatal depression is associated with adverse maternal, newborn and child health outcomes. Treatment gaps and sociocultural factors contribute to its disproportionate burden in low- and middle-income countries (LMICs). Task-sharing approaches, such as peer counseling, have been developed to improve access to mental health services. We conducted a scoping review to map the current literature on peer counseling for perinatal women experiencing depression in LMICs. We searched CINAHL, MEDLINE, APA PsycINFO, Global Health and EMBASE for literature with no date limits. We included 73 records in our analysis, with most being systematic reviews and meta-analyses, randomized controlled trials and qualitative studies. Most studies were conducted in India and Pakistan and published from 2020 onward. The Thinking Healthy Program (THP) and its Peer-Delivered (THPP) adaptation were the most common interventions. Studies suggested effectiveness, feasibility, acceptability and transferability of peer counseling, particularly within the THPP, for perinatal depression. Studies indicated that local women, as peers and lay counselors, are preferred and effective implementation agents. Gaps in the evidence include those relating to understanding perinatal depression (e.g., contextual understandings of the etiology, comorbidity and heterogeneity and social conditions of psychosocial distress including long-term impacts on relationships and children’s development) and understanding and improving implementation. Further research on the adaptation, scaling up and integration of peer-delivered approaches with other approaches to improve impact are needed. There are also gaps in understanding the perspectives and experiences of peer counselors. Evidence gaps may stem from an emphasis on conventional public health approaches and measures derived from Western psychiatry, such as randomized controlled trials. There is relatively little research or implementation that prioritizes peer counselors in terms of understanding their perspectives and experiences (e.g., of professionalization), despite them being central to peer-delivered models. Task sharing has the potential to both empower peer counselors through mental health benefits and professional opportunities but also render peer counselors susceptible to vicarious exposure to traumatic stories and difficult situations amid limitations in available support. Better understanding counselors’ and perinatal women’s experiences can help decolonize the evidence base and improve implementation.

Recent advances in clinical prediction for diarrhoeal aetiology in low- and middle-income countries have revealed that the addition of weather data to clinical data improves predictive performance. However, the optimal source of weather data remains unclear. We aim to compare the use of model estimated satellite- and ground-based observational data with weather station directly observed data for the prediction of aetiology of diarrhoea. We used clinical and etiological data from a large multi-centre study of children with moderate to severe diarrhoea cases to compare their predictive performances. We show that the two sources of weather conditions perform similarly in most locations. We conclude that while model estimated data is a viable, scalable tool for public health interventions and disease prediction, given its ease of access, directly observed weather station data is likely adequate for the prediction of diarrhoeal aetiology in children in low- and middle-income countries.

Disordered eating (DE) is associated with elevated cardiometabolic risk (CMR) factors, yet little is known about this association in non-Western countries. We examined the association between DE characteristics and CMR and tested the potential mediating role of BMI. This cross-sectional study included 2005 Chinese women (aged 18–50 years) from the 2015 China Health and Nutrition Survey. Loss of control, restraint, shape concern and weight concern were assessed using selected questions from the SCOFF questionnaire and the Eating Disorder Examination-Questionnaire. Eight CMR were measured by trained staff. Generalised linear models examined associations between DE characteristics with CMR accounting for dependencies between individuals in the same household. We tested whether BMI potentially mediated significant associations using structural equation modelling. Shape concern was associated with systolic blood pressure (β (95 % CI) 0·06 (0·01, 0·10)), diastolic blood pressure (DBP) (0·07 (95 % CI 0·03, 0·11)) and high-density lipoprotein (HDL)-cholesterol (–0·08 (95 % CI –0·12, −0·04)). Weight concern was associated with DBP (0·06 (95 % CI 0·02, 0·10)), triglyceride (0·06 (95 % CI 0·02, 0·10)) and HDL-cholesterol (–0·10 (95 % CI –0·14, −0·07)). Higher scores on DE characteristics were associated with higher BMI, and higher BMI was further associated with lower HDL-cholesterol and higher other CMR. In summary, we observed significant associations between shape and weight concerns with some CMR in Chinese women, and these associations were potentially partially mediated by BMI. Our findings suggest that prevention and intervention strategies focusing on addressing DE could potentially help reduce the burden of CMR in China, possibly through controlling BMI.

The Covid-19 pandemic saw a surge in cyber attacks targeting pharmaceutical companies and research organisations working on vaccines and treatments for the virus. Such attacks raised concerns around the (in)security of bioinformation (e.g. genomic data, epidemiological data, biomedical data, and health data) and the potential cyberbio risks resulting from stealing, compromising, or exploiting it in hostile cyber operations. This article critically investigates threat discourses around bioinformation as presented in the newly emerging field of ‘cyberbiosecurity’. As introduced by scholarly literature in life sciences, cyberbiosecurity aims to understand and address cyber risks engendered by the digitisation of biology. Such risks include, for example, embedding malware in DNA, corrupting gene-sequencing, manipulating biomedical materials, stealing epidemiological data, or even developing biological weapons and spreading diseases. This article brings the discussion on cyberbiosecurity into the realms of International Relations and Security Studies by problematising the futuristic threat discourses co-producing this burgeoning field and the pre-emptive security measures it advocates, specifically in relation to bioinformation. It analyses how cyberbiosecurity as a concept and field of policy analysis influences the existing securitised governance of bioinformation, the global competition to control it, and the inequalities associated with its ownership and dissemination. As such, the article presents a critical intervention in current debates around the intersection between biological dangers and cyber threats and in the calls for ‘peculiar’ policy measures to defend against cyberbio risks in the ‘new normal’.