The promotion of menstrual health and hygiene globally, especially in lower-middle-income countries (LMICs), is a major public health imperative. The primary study objective was to ascertain the change in the patterns of menstrual hygiene practices and their sociodemographic determinants amongst adolescent girls and young women in India. The present study analyses data from the Indian National Family and Health Survey (NFHS), round 4 (2015–2016) and round 5 (2019–21). Women in the age group 15–24 years (n = 241,180) were interviewed regarding their menstrual hygiene practices. The proportion of women using sanitary napkins as absorbent during menstruation increased from 41.8% (NFHS-4) to 64.1% (NFHS-5), with more than six in ten adolescent girls and young women in India using sanitary pads during menses, although the socioeconomically vulnerable more likely to lack access. The higher age group (20–24 years), rural residence, lower wealth quintile, absence of schooling, absence of flush toilets, and lack of exposure to media were factors that were independently associated with the use of cloth as menstrual absorbent. Vaginal discharge was reportedly higher among women using unhygienic products, however, on adjusted analyses, no statistically significant association was observed with the type of absorbent used. The transition from cloth to sanitary pads has nearly doubled on average in the states implementing free and subsidised government pad distribution schemes during the same period.

Endogenous public health responses include the individual behaviours, community-based organizational responses, and informal rules that resolve economic problems during public health crises. We explore the relevance of endogenous responses in Orthodox Jewish communities during the COVID-19 pandemic. We analyse Orthodox newspapers in New York City and find that (a) rabbis advised their communities on how to stay healthy and observant to their religious beliefs; (b) rabbinical councils and advisory boards provided private, public health guidance; (c) private, Jewish ambulatory services provided religiously sensitive healthcare; (d) Orthodox Jewish schools privately provided public health services; and (e) community members altered religious rules, rituals, and traditions to mitigate the spread of the virus. While these responses did not occur seamlessly or without conflict, the Orthodox community worked diligently to provide public health services to remain healthy while also observing religious traditions. Our paper provides shows how communities develop endogenous public health responses during crises.

The discipline of public health has begun to recognize the structural inequities of the carceral system as drivers of poor individual and population health. The number of people incarcerated and the length of their incarceration determine the scope and gravity of their exposure to these individual and public health effects. Plea bargains all but guarantee a period of incarceration, often for many years, because prosecutors have significant bargaining power against defendants who often do not fully understand their rights or the likelihood of receiving the sentences that prosecutors would be seeking in trial. I propose and analyze several pathways through which to eliminate or severely restrict the practice of plea bargaining to minimize the health effects associated with incarceration. I conclude that state legislation would be most feasible and effective at eliminating plea bargains but, without concurrent interventions addressing mandatory minima and/or bail, would not fundamentally address the primary concerns of sentence length and overcrowding.

In the decade since the first edition of Global Health Law was published, the world has moved incrementally towards global health with justice, at least by one basic metric: life expectancy has edged up globally, with more rapid gains in low- than high-income countries. But to look around the world, global health with justice still seems a distant dream. Health gaps between people in rich and poor countries remain shocking and unconscionable—as do health inequities within countries. The pandemic also gave salience to profound health injustices—from injustices in access to lifesaving vaccines to gaping disparities in morbidity and mortality based on income, race, and national origin. So did the Trump administration’s decision to pause, and then slash, foreign assistance, bringing an end to lifesaving programs around the world. Guided by the overarching theme of justice, these reflections canvass the history of global health law as a field and discuss developments and challenges in the field across four core themes: multilateralism; equitable distribution of the benefits of scientific advancement; global health law for the poly-crises; and human rights and equity.

Dietary habits, particularly vegetable consumption, play a crucial role in preventing noncommunicable diseases. However, despite international guidelines advocating daily vegetable intake, adherence remains low across many populations. As a result, more focused efforts to boost vegetable consumption at the population level are essential. This study aimed to assess the impact of a health communication campaign (HCC) in City A, which combined information dissemination and incentives to promote vegetable consumption. In 2021, a new app-based vegetable quiz was introduced as part of the ongoing campaign, which had been implemented since 2017. Participants earned 10 points per correct quiz answer, which could be redeemed for product certificates, with a maximum of 30 points. To evaluate the effectiveness of the quiz, we analysed vegetable intake data from 786 quiz users. A multiple regression analysis was conducted to consider factors such as sex, age, body mass index, pre-campaign points, prior vegetable intake, and frequency of food recording during the campaign. We ensured robustness of the results by analysing data from 605 individuals whose vegetable intake had been tracked one year earlier, during a non-incentivized version of the campaign. The results demonstrated that participants who completed all three quizzes consumed 10.7% more vegetables than non-participants. Year-over-year comparisons further showed a significant increase in vegetable intake among frequent quiz participants compared to the previous year, highlighting the positive impact of gamified quizzes on vegetable consumption. These findings suggest that incentivized HCC, especially those incorporating gamification elements, can be highly effective in encouraging healthier eating habits.

Over the last decade, the USA experienced an unprecedented opioid crisis. While there are myriad causes for this crisis, here we examine how social capital shapes the public’s demand for opioids and the government’s responses to the crisis. First, we posit that communities with higher levels of social capital are associated with lower rates of opioid use/abuse. Second, we posit that higher levels of social capital will be associated with a more robust public response in providing necessary resources to address substance abuse resulting in lower rates of drug-related deaths. Using county-level data from the USA, we find support for an indirect relationship where social capital is associated with higher levels of community support for drug treatment, which, in turn, is associated with lower drug-related deaths and deaths of despair.

Disinfection is a standard water treatment process. Plastics are found in various components of water infrastructure and the presence of microplastics in the water cycle raises environmental and human health concerns. Thus, this research investigated the physicochemical impacts of chlorination and chloramination on seven types of virgin and biofouled polymers (125–250 μm) under three disinfectant doses, three pH conditions in potable and recycled water. Our results indicated that both chlorination and chloramination impacted the seven polymers, with polypropylene (PP), expanded polystyrene (EPS) and polyamide (PA) being most impacted, signalling these as polymers of concern. Surface morphological changes were observed. FTIR spectra revealed cleavage of bonds and formation of carbonyl groups indicating degradation. While disinfection is helpful for treating pathogenic microorganisms, the risks of generating microplastics below detection limits are highlighted. Microplastics in disinfected water can lead to biofilm formation, increased adsorption of contaminants and disinfection by-products, compromising water quality and posing challenges for treatment. This research provides valuable insights into the physicochemical impacts of chlorination and chloramination on polymers, enhancing our understanding of their behaviour and fate in water and wastewater environments. While additional ecotoxicological research is needed to fully understand health implications, our study emphasizes the need for targeted intervention strategies of high-use polymers of concern.

The presence of pesticide residues in food products, particularly milk, poses significant public health risks, especially in developing regions where agricultural practices often involve extensive pesticide use. This study aimed to assess the levels of pesticide contamination in milk collected from agro-pastoral cattle settlements in Niger State, Nigeria, and evaluate the associated health risks for both children and adults. Milk samples were systematically collected and analyzed using Gas Chromatography-Mass Spectrometry (GC-MS) to detect and quantify the concentrations of various pesticides, including organophosphates, organochlorines, and herbicides. The detected pesticides included Dichlorvos, β-Hexachlorocyclohexane, Malathion, DDT, and Dieldrin, among others, with Dichlorvos and β-Hexachlorocyclohexane showing the highest concentrations. Using the Estimated Daily Intake (EDI) model, we calculated the potential health risks associated with the consumption of contaminated milk for different age groups. The results indicated that children were particularly at risk, with EDI values exceeding the Acceptable Daily Intake (ADI) for certain pesticides, such as Dieldrin, leading to a risk ratio of 1.288. In contrast, adults showed a lower risk, with EDI values generally within safe limits. The findings underscore the urgent need for stricter pesticide regulation, enhanced monitoring of pesticide residues in livestock products, and the adoption of sustainable agricultural practices such as Integrated Pest Management (IPM) to mitigate the public health risks. This study highlights the vulnerability of children to pesticide exposure through dairy consumption and calls for immediate intervention to safeguard food safety and protect public health.

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.

Despite its relative invisibility to most people living in the urban Asia-Pacific, endemic malaria occurs across the region. The unique character of Asian-Pacific malaria includes a serious problem of drug resistance, dominance of a particularly difficult species to control and treat, and another that normally dwells in monkeys but often infects humans. Most nations in the region with endemic malaria have called for its elimination by the year 2030. Meeting that ambitious goal will require mobilizing technical and financial resources, and social and political will. Malaria is a formidable foe fully capable of defeating halfhearted efforts to eliminate it.

We present a large scale study where a nationally representative sample of 1000 participants were asked to make real purchases within an online supermarket platform. The study captured the effect of price changes, and of the signposting of such changes, for breakfast cereals and soft drinks. We find that such taxes are an effective means of altering food purchasing, with a 20% rate being sufficient to make a significant impact if (and only if) the tax is signposted. Signposting represents a complementary “nudge” policy that could enhance the impact of the tax, though its effectiveness depends on the product category.