Annals of Global Health最新文献

We recently completed a comprehensive systematic review of the literature on fluoride exposure and neurodevelopment and cognition, resulting in two publications. The 2024 National Toxicology Program Monograph concluded-with moderate confidence-that higher fluoride exposure is associated with lower IQ in children. The 2025 meta‑analysis, published in JAMA Pediatrics, quantitatively synthesized over 70 epidemiological studies and likewise reported an inverse association between fluoride exposure and children's IQ. This inverse association persisted when analyses were restricted to the best evidence, the high‑quality studies, and was consistent across subgroups defined by sex, age, country, outcome assessment method, timing of exposure, and exposure matrix (e.g., urine or drinking water). Notably, among the high‑quality evidence, inverse associations were still observed at fluoride exposure levels below 1.5 mg/L, based on both urinary and drinking‑water measurements. These publications have received considerable public and media attention, prompted healthy scientific discourse, and have been cited by public health decision‑makers. Many scientific comments were carefully considered and resolved during development and peer review, which contributed to the rigor of the final documents. However, some recurrent critiques continue to be raised. This viewpoint provides a high‑level summary of these key critiques and corresponding responses to help the public, media, and the scientific community better understand the strength and implications of the scientific evidence on fluoride exposures and neurodevelopment and cognition.

Background: Pradhan Mantri Jan Arogya Yojana (PMJAY) is the world's largest publicly funded health insurance scheme with over 500 million beneficiaries. It was formulated to provide financial risk protection against health expenditures among the socio‑economically bottom 40% of the Indian population. Objective: To understand equity in surgical care provision under PMJAY by examining patterns across five dimensions: health sector, gender, age, surgical specialty, and geographical distribution. Methodology: We reviewed multiple policy briefs and working papers by the National Health Authority. Results: For both supply and utilization sides, PMJAY is predominantly about surgical care services. About 65% of procedures listed in the scheme cover surgeries and ~82% empaneled hospitals provide surgical care. Regardless of the health sector, over two‑thirds of claims by volume and value were raised for surgical patients. However, key differences and disparities exist in utilization across dimensions. Men have 23.6% greater surgical claims than women beneficiaries, after excluding obstetric and gynecological surgeries. Regional disparities exist with states like Bihar, Madhya Pradesh, and Uttar Pradesh having lower service utilization compared with Gujarat and Kerala. Only 7% of hospitals in "Aspirational Districts" offer specialized surgeries such as cardiothoracic and vascular, compared to 17% in other districts. Conclusion: PMJAY mirrors the broader inequities in Indian healthcare and society. Its role in financing surgical care is significant, yet uneven. To ensure equity and progress toward universal health coverage, proactive steps such as better monitoring and evaluation of disaggregated data, targeted enrollment of individuals in the bottom quintiles of the "bottom 40%," and increased allocation to surgical services are needed. PMJAY must evolve not just as a financial safety net but as a systemic driver of equitable surgical care.

Background: Climate change poses a significant threat to food security in the Federated States of Micronesia (FSM) by disrupting fisheries and global rice supply chains. Rice, an entirely imported staple, dominates local diets and is associated with a high prevalence of non‑communicable diseases (NCDs), particularly obesity and diabetes. Reviving traditional foods such as swamp taro has been proposed as a strategy to improve nutrition, reduce NCDs, and enhance climate resilience. Objectives: This study examines whether traditional agriculture-specifically the promotion of swamp taro flour-can serve as a viable intervention to address obesity and food insecurity in FSM. It aims to identify the social, cultural, institutional, and environmental barriers and enablers influence the sustained uptake of traditional starches. Methods: Using a case study approach focused on Pohnpei, the study applies the Consolidated Framework for Implementation Research. It combines analysis of secondary quantitative data on NCDs, key‑informant interviews, and a review of relevant national and state‑level policy documents to assess the implementation and outcomes of an intervention led by the Island Food Community of Pohnpei. Findings: The uptake of swamp taro flour is shaped by complex interactions among historical preferences for rice, taste and convenience, supply‑chain constraints, gendered labor roles, limited institutional support, and weak community ownership of intervention infrastructure. Despite widespread availability and strong nutritional benefits, swamp taro remains underconsumed, while rice and processed foods continue to dominate diets. Conclusions: Traditional agriculture can contribute to addressing obesity, food insecurity, and climate adaptation in FSM, but only if interventions account for the intertwined social, cultural, economic, and institutional factors shaping food choices. Institutional analysis, community participation, supportive public policy, and culturally sensitive communication are critical to scaling and sustaining such efforts in Pacific Island contexts.

Background: Oral cancer represents a critical global health equity challenge, with over 80% of cases occurring in low- and middle-income countries (LMICs) and markedly lower survival rates in these regions compared to high-income countries (HICs). Objective: To examine oral cancer disparities in LMICs through a global health equity lens by analyzing prevention strategies, early detection programs, and treatment access barriers, with the aim of identifying evidence-based interventions to reduce these inequities. Methods: This comprehensive narrative review synthesized evidence from peer-reviewed literature (2020-2025), including systematic reviews and reports from international health organizations. We searched PubMed, Web of Science, and Scopus using terms related to oral cancer, global health disparities, LMICs, prevention, screening, and treatment access. Results: Oral cancer demonstrates profound global disparities. LMICs bear ~82% of the global disease burden yet achieve five-year survival rates of only 25-45%, compared to 65-85% in HICs. Key contributing disparities include the following: tobacco use remains high (LMICs account for 1.3 billion tobacco users) due to weak control programs. Limited human papillomavirus vaccination coverage is under 50% in most LMICs (vs. ~70-85% in HICs), and 70% of LMICs have no systematic oral cancer screening. In addition, 60-80% of oral cancer cases in LMICs present at advanced stages (vs. ~40-60% in HICs). They have severely limited access to surgery, radiotherapy, and chemotherapy (roughly 1 available service for every 5-10 needed). Conclusions: Addressing oral cancer disparities in LMICs requires comprehensive strategies, including strengthened tobacco control, cost-effective screening programs using innovative technologies, task shifting to expand the health-care workforce, and international partnerships to improve treatment infrastructure in resource-poor settings. These combined efforts are essential to close the outcome gap and achieve global health equity in oral cancer care.

Background: Globally there is a grown concern about the ethics and effectiveness of short-term global health activities, also known as short-term medical missions (STMMs). Guidelines for better practices have been developed exclusively by organizations in the Global North, with no mechanisms to enforce and monitor any of these. Objective: The goal of this study is to analyze regulations in three host countries where such STMMs take place. Methods: Researchers from Ghana, Uganda, and Guatemala were recruited to investigate regulations affecting STMMs. Interviews were performed with 129 participants, including policymakers, health services staff and administrators, patients, and community leaders. Data was analyzed using NVIVO and R Package for Qualitative Analysis, having as the foundation grounded theory and sentiment analysis for identification of patterns in responses. Findings: In all three countries, there are regulations regarding the practice of health care generally, as well as governing the importation of medications, but these are rarely enforced when it comes to STMMs, and many participants were unaware of them. In Ghana and Uganda, there is no specific regulation for STMMs. In Guatemala, specific and detailed regulations do exist governing the practice of STMMs, but participants did not report awareness of these regulations. Conclusions: The lack of explicit regulation of STMMs in some countries and the lack of enforcement of existing professional regulations and rules on importation of medications can easily be exploited by those volunteers who prefer not to follow them. All three countries studied do have procedures to be followed by any person who intends to perform STMMs.

Background: Occupational heat stress mediated acute kidney injury (AKI) has been linked to the development of chronic kidney disease of non-traditional causes (CKDnt) in agriculture workers. Rest-shade-hydration-sanitation (RSH-S) programs are promising interventions for preventing CKDnt. An obstacle to the implementation of RSH-S programs is the concern that the reduced work time associated with these programs may reduce productivity and earnings. Objective: This study analyzes the economic impact of an RSH-S program implemented at a sugar mill in Nicaragua. Approach: Data were obtained from the sugar mill over a six-year, five-harvest period (Harvest 1: 2017-2018 through Harvest 5: 2021-2022). Data included health and productivity metrics and RSH-S program costs. During Harvest 1, existing heat mitigation strategies were in place but were not optimal. Thus, 2017 was considered the pre-RSH-S (baseline) period. Over subsequent harvests, progressively improved RSH-S programs were implemented. A cost-benefit analysis was conducted to estimate the return on investment of the RSH-S program. The analysis considered both fixed and variable costs associated with the program. Benefits were calculated based on productivity improvements and reductions in AKI cases. Findings: As soon as 2020, the costs of implementing the RSH-S program were offset by savings resulting from increased productivity and reduced cases of AKI. The RSH-S program yielded a positive return on investment from 2020 and onward. The average return on investment over the five-year period was 0.02 (or a return of $1.02 for every $1.00 invested), which takes into consideration the first two years of the intervention in which there was a negative return on investment. In 2022, every $1.00 invested in the RSH-S program saw a return of $1.60. Conclusions: Implementing an RSH-S program can provide both economic and health benefits, particularly in locations where climate change is increasing the already present risk and burden of occupational heat stress.

Introduction: Despite increased advocacy, women and professionals from low- and middle-income countries (LMICs) remain underrepresented in global surgery. To address this, the Gender Equity Initiative in Global Surgery (GEIGS) launched an annual General Assembly (GA). This study evaluates trends in academic representation and leadership at the GA, emphasizing pathways to equitable mentorship, academic voice, and faculty development. Methods: A retrospective cross-sectional analysis of GEIGS GA speakers from 2020 to 2025 was performed. Data from conference records and public sources included gender, country of practice, degree(s), leadership role, citation count, prior speaking experience, and topic area. Linear regression assessed trends in gender representation. Results: A total of 104 speakers were identified. Women comprised 83.7% (n = 87; p < 0.001). Leadership positions were held by 64.4% (n = 67). The most common degrees were MD (62.5%) and PhD (16.4%); 15.4% (n = 16) were medical students. Of the speakers, 60.6% (n = 63) practiced in high-income countries (HICs) and 39.4% (n = 41) in LMICs. Representation by women was consistent across regions: 84.1% in HICs and 82.9% in LMICs. Among LMIC speakers, 65.9% held leadership roles, 34.2% multiple degrees, and 68.3% prior speaking experience. No significant differences in academic qualifications were observed between HIC and LMIC speakers (p > 0.05). Conclusion: The GEIGS GA demonstrates that intentional, equity-focused planning can achieve high female participation and meaningful inclusion of LMIC professionals. These findings provide a practical framework for promoting equitable representation in global surgery conferences. Continued attention to supporting LMIC voices in leadership and academia may help sustain progress.

Background: On December 14, 2024, the tropical cyclone Chido hit the French department of Mayotte, an archipelago in the western Indian Ocean. It was the most violent storm in at least 90 years, causing widespread devastation. Objectives: We address different aspects of the Chido disaster, including deaths, Mayotte's vulnerabilities, and risk management, and review the hurricane's health consequences, notably post-traumatic stress disorder (PTSD). Methods: Information was collected through informal interviews with inhabitants, physicians, and stakeholders. Public data were provided by the public health authorities and through online searches. Findings: Addressing pre-Chido vulnerabilities, risk perception, fatality assessment, community management, and post-Chido psychological consequence constitutes a major challenge for the Mayotte society. Conclusion: We recommend launching an exploratory health study and planning to provide medico-psychological support to victims and to favor scientific investigations.

Background: Oral health and dental care access are disproportionately limited among newly resettled refugees in the United States (US). Objectives: This study aimed to describe self-reported oral health practices and dental care access among refugees in Syracuse, New York. Methods: A cross-sectional survey was conducted from April to September 2023 with 60 heads of household representing 313 family members from Afghanistan, Somalia, Congo, Syria, Burma, and Nepal. Descriptive and bivariate analyses were performed. Findings: Half of the participants were women (51.8%), and 29.4% were aged 10-<20 years. Over half had lived in the US for less than 5 years (51.7%). Language, difficulty finding a dentist, and lack of insurance were key barriers to dental care. Only 24.0% had access to dental care in their home country, compared to 48.5% in the US. Significant associations were found between having a dentist in the US and the last visit to the dentist (p < 0.05), and between years in the US and dental care access (p < 0.001). Conclusions: Our study found that dental care access among refugees in Syracuse was limited, with disparities by country of origin and length of US residence. These findings highlight the need for targeted interventions to improve dental care access and health literacy among refugee populations in the US.