Pub Date : 2025-08-27DOI: 10.1016/s2468-2667(25)00188-4
Ilias Kyriopoulos, Kostas Athanasakis, Stergiani Tsoli, Elias Mossialos, Irene Papanicolas
Health systems are under growing pressure from ageing populations, chronic diseases, and financial constraints, compounded by challenges, such as COVID-19 and climate change. In Greece, these pressures have converged in the past 15 years, exposing structural weaknesses and testing the health system's resilience. Despite successive reforms targeting funding, care delivery, and public health, persistent structural weaknesses, poor planning, and limited monitoring have undermined progress. Most policy responses have remained fragmented and are unable to fulfil their potential to address current public health challenges or prepare for future crises. Building health system sustainability and resilience requires more than enacting reforms. The reform process demands evidence-informed policy making, sustained political commitment, strong institutional capacity, and effective multisectoral coordination. Greece offers valuable lessons for countries facing similar pressures: resilience depends not only on policy adoption, but also on the institutions, resources, and accountability mechanisms that support implementation and translate policies into sustained action.
{"title":"Addressing public health and health system challenges in Greece: reform priorities in a changing landscape","authors":"Ilias Kyriopoulos, Kostas Athanasakis, Stergiani Tsoli, Elias Mossialos, Irene Papanicolas","doi":"10.1016/s2468-2667(25)00188-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00188-4","url":null,"abstract":"Health systems are under growing pressure from ageing populations, chronic diseases, and financial constraints, compounded by challenges, such as COVID-19 and climate change. In Greece, these pressures have converged in the past 15 years, exposing structural weaknesses and testing the health system's resilience. Despite successive reforms targeting funding, care delivery, and public health, persistent structural weaknesses, poor planning, and limited monitoring have undermined progress. Most policy responses have remained fragmented and are unable to fulfil their potential to address current public health challenges or prepare for future crises. Building health system sustainability and resilience requires more than enacting reforms. The reform process demands evidence-informed policy making, sustained political commitment, strong institutional capacity, and effective multisectoral coordination. Greece offers valuable lessons for countries facing similar pressures: resilience depends not only on policy adoption, but also on the institutions, resources, and accountability mechanisms that support implementation and translate policies into sustained action.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"34 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910738","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}
Pub Date : 2025-08-27DOI: 10.1016/s2468-2667(25)00189-6
Mark Robinson, Lennert Veerman
Alcohol has become increasingly affordable in the USA in recent decades, coinciding with rising alcohol related harms.1, 2 Yet, in contrast to many other high-income countries, and despite increased alcohol pricing being identified as a WHO best buy policy, there has been scarce research on the potential effects of price changes on alcohol-related outcomes in the USA. In this context, the study by Carolin Kilian and colleagues provides timely and policy-relevant evidence.3
{"title":"Modelling the case for alcohol pricing policy in the USA","authors":"Mark Robinson, Lennert Veerman","doi":"10.1016/s2468-2667(25)00189-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00189-6","url":null,"abstract":"Alcohol has become increasingly affordable in the USA in recent decades, coinciding with rising alcohol related harms.<span><span>1</span></span>, <span><span>2</span></span> Yet, in contrast to many other high-income countries, and despite increased alcohol pricing being identified as a WHO best buy policy, there has been scarce research on the potential effects of price changes on alcohol-related outcomes in the USA. In this context, the study by Carolin Kilian and colleagues provides timely and policy-relevant evidence.<span><span><sup>3</sup></span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"27 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910991","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}
Pub Date : 2025-08-27DOI: 10.1016/s2468-2667(25)00167-7
Isobel L Ward, Sarah L Barrett, Cameron Razieh, Charlotte Standeven, Ania Zylbersztejn, Emyr John, Francesco Zaccardi, Neena Modi, Kamlesh Khunti, Daniel Ayoubkhani, Vahé Nafilyan
Background
The UK currently has one of the highest rates of child mortality in Europe. Robust population-level estimates of differences in neonatal and child mortality by ethnic and socioeconomic group are currently scarce for England and Wales. We aimed to examine variation in neonatal and child mortality by maternal ethnic group and indicators of socioeconomic status to help understand which groups are most at risk of neonatal and child mortality.
Methods
In this nationwide cohort study, we used linked population-level data for England and Wales, comprising birth registrations and notifications (2011–16), Census 2011, and death registrations (2011–21). Our population was restricted to livebirths, post-24 weeks’ gestation, and to mothers aged 12 years or older at time of birth. Our primary exposures were self-reported maternal ethnic group, household socioeconomic position, and maternal education from Census 2011. We estimated mortality rates and hazard ratios from Cox proportional hazards models for different ethnic and socioeconomic groups separately for neonatal (<28 days) and child (from ≥28 days to 10 years) mortality. We adjusted for sex of baby; birth term; suspected congenital anomaly; maternal age; disability; country of birth; main language; and household tenure, region, and rural or urban location. Babies were followed from birth for up to 10 years and until Dec 31, 2021, or death, whichever occurred earlier.
Findings
A total of 3 018 020 babies were included in our cohort, with the average age of the mother at delivery being 29·8 years (IQR 26–34). There were 4750 neonatal deaths and 5205 child deaths in the follow-up period. Compared with White British mothers, babies born to Pakistani mothers (hazard ratio [HR] 2·39 [95% CI 2·15–2·66]) or Black African mothers (HR 1·65 [1·43–1·91]) had the highest risk of neonatal mortality. These differences remained after fully adjusting the models for maternal, household, and gestational characteristics (adjusted HR 1·95 [95% CI 1·72–2·22] and HR 1·38 [1·15–1·66], for babies born to Pakistani and Black African mothers, respectively). The differences in child mortality by maternal ethnic group were similar and remained after accounting for maternal, household, and gestational characteristics. For socioeconomic factors, babies born to mothers with no formal education (HR 1·55 [95% CI 1·42–1·69]) or living in households with long-term unemployment (HR 1·93 [95% CI 1·69–2·19]) were most at risk from neonatal death compared with babies born to mothers who had school- level qualifications or in households where the main earner was employed in a higher managerial, administrative and professional occupation, respectively. Differences in neonatal and child mortality by education persisted for the models, accounting for maternal, household, and gestational characteristics.
Interpretation
Health inequalities exist from birth; the present findings identify the most at-risk gr
英国目前是欧洲儿童死亡率最高的国家之一。在英格兰和威尔士，目前还缺乏按种族和社会经济群体对新生儿和儿童死亡率差异的人口水平的可靠估计。我们的目的是检查产妇种族和社会经济地位指标在新生儿和儿童死亡率方面的差异，以帮助了解哪些群体的新生儿和儿童死亡率最高。方法在这项全国性队列研究中，我们使用了英格兰和威尔士的相关人口水平数据，包括出生登记和通知（2011 - 16年）、2011年人口普查和死亡登记（2011 - 21年）。我们的人群仅限于活产，妊娠24周后，以及出生时年龄在12岁或以上的母亲。我们的主要暴露是2011年人口普查中自我报告的母亲种族、家庭社会经济地位和母亲教育程度。我们根据不同种族和社会经济群体的Cox比例风险模型分别估计了新生儿（28天）和儿童（≥28天至10岁）死亡率和风险比。我们根据婴儿的性别进行了调整；出生术语;疑似先天性异常；母亲的年龄;残疾;出生国家；主要语言;以及家庭所有制、地区、农村或城市位置。婴儿从出生到2021年12月31日（或死亡，以较早者为准）被跟踪长达10年。结果本队列共纳入3 018 020例婴儿，产妇平均分娩年龄为29.8岁（IQR 26-34）。在随访期间，有4750名新生儿死亡，5205名儿童死亡。与英国白人母亲相比，巴基斯坦母亲（危险比[HR] 2.39 [95% CI 2.15 - 2.66]）或非洲黑人母亲（危险比[HR] 1.65[1.43 - 1·91]）所生婴儿的新生儿死亡风险最高。在完全调整了母亲、家庭和妊娠特征的模型后，这些差异仍然存在（调整后的HR分别为1.95 [95% CI 1.72 - 2·22]和1.38[1.15 - 1.66]，分别针对巴基斯坦和非洲黑人母亲所生的婴儿）。在考虑了母亲、家庭和妊娠特征后，不同种族的儿童死亡率的差异是相似的。在社会经济因素方面，母亲未受过正规教育（HR 1.55 [95% CI 1.42 - 1·69]）或生活在长期失业家庭（HR 1.93 [95% CI 1.69 - 2·19]）的婴儿与母亲受过学校教育或主要收入来源从事较高管理、行政和专业职业的家庭所生的婴儿相比，新生儿死亡风险最高。考虑到母亲、家庭和妊娠期的特征，在模型中，新生儿和儿童死亡率因教育而存在差异。健康不平等从出生就存在；目前的发现确定了最危险的群体，未来的研究应该针对这些群体，以揭示新生儿和儿童死亡的因果关系。
{"title":"Maternal ethnic group, socioeconomic status, and neonatal and child mortality: a nationwide cohort study in England and Wales","authors":"Isobel L Ward, Sarah L Barrett, Cameron Razieh, Charlotte Standeven, Ania Zylbersztejn, Emyr John, Francesco Zaccardi, Neena Modi, Kamlesh Khunti, Daniel Ayoubkhani, Vahé Nafilyan","doi":"10.1016/s2468-2667(25)00167-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00167-7","url":null,"abstract":"<h3>Background</h3>The UK currently has one of the highest rates of child mortality in Europe. Robust population-level estimates of differences in neonatal and child mortality by ethnic and socioeconomic group are currently scarce for England and Wales. We aimed to examine variation in neonatal and child mortality by maternal ethnic group and indicators of socioeconomic status to help understand which groups are most at risk of neonatal and child mortality.<h3>Methods</h3>In this nationwide cohort study, we used linked population-level data for England and Wales, comprising birth registrations and notifications (2011–16), Census 2011, and death registrations (2011–21). Our population was restricted to livebirths, post-24 weeks’ gestation, and to mothers aged 12 years or older at time of birth. Our primary exposures were self-reported maternal ethnic group, household socioeconomic position, and maternal education from Census 2011. We estimated mortality rates and hazard ratios from Cox proportional hazards models for different ethnic and socioeconomic groups separately for neonatal (<28 days) and child (from ≥28 days to 10 years) mortality. We adjusted for sex of baby; birth term; suspected congenital anomaly; maternal age; disability; country of birth; main language; and household tenure, region, and rural or urban location. Babies were followed from birth for up to 10 years and until Dec 31, 2021, or death, whichever occurred earlier.<h3>Findings</h3>A total of 3 018 020 babies were included in our cohort, with the average age of the mother at delivery being 29·8 years (IQR 26–34). There were 4750 neonatal deaths and 5205 child deaths in the follow-up period. Compared with White British mothers, babies born to Pakistani mothers (hazard ratio [HR] 2·39 [95% CI 2·15–2·66]) or Black African mothers (HR 1·65 [1·43–1·91]) had the highest risk of neonatal mortality. These differences remained after fully adjusting the models for maternal, household, and gestational characteristics (adjusted HR 1·95 [95% CI 1·72–2·22] and HR 1·38 [1·15–1·66], for babies born to Pakistani and Black African mothers, respectively). The differences in child mortality by maternal ethnic group were similar and remained after accounting for maternal, household, and gestational characteristics. For socioeconomic factors, babies born to mothers with no formal education (HR 1·55 [95% CI 1·42–1·69]) or living in households with long-term unemployment (HR 1·93 [95% CI 1·69–2·19]) were most at risk from neonatal death compared with babies born to mothers who had school- level qualifications or in households where the main earner was employed in a higher managerial, administrative and professional occupation, respectively. Differences in neonatal and child mortality by education persisted for the models, accounting for maternal, household, and gestational characteristics.<h3>Interpretation</h3>Health inequalities exist from birth; the present findings identify the most at-risk gr","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"22 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910997","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}
People experiencing homelessness have a high mortality risk. Estimates of absolute risk, such as life-years lost, provide a more accurate measure of mortality differences in transient populations than conventional life expectancy estimates and enable direct comparisons with the general population and other high-risk populations. We aimed to examine mortality risks and life-years lost in people experiencing homelessness and other high-risk groups by sex, age group, and cause of death.
Methods
We conducted a nationwide, register-based cohort study of people aged 17–100 years living in Denmark between Jan 1, 2002, and Dec 31, 2020. Data from the Danish Civil Registration System was linked to the Homeless Register and the Cause of Death Register. The outcome was overall and cause-specific mortality during follow-up. We estimated mortality rates per 10 000 person-years at risk and estimated adjusted mortality rate ratios using Poisson regression analysis. We calculated both average and age-specific life expectancy and life-years lost for people experiencing homelessness and compared these figures with those of the general population, as well as with individuals with schizophrenia, alcohol use disorder, and drug use disorder.
Findings
Among 6 286 512 Danish residents, 58 376 (0·9%) people had at least one homeless shelter contact during the study period. Among people with a history of homelessness, the mortality rate was 240·3 (95% CI 236·3–244·4) per 10 000 person-years. In the general population with no history of homelessness, the mortality rate per 10 000 person-years was 117·8 (95% CI 117·6–118·1) in the general population with no history of homelessness, which resulted in an absolute difference of 122·5 (118·5–126·5). The mean excess life-years lost was 15·9 (95% CI 15·8–16·2) for males and 15·3 (14·8–15·7) for females compared with the general population, which was higher than in other high-risk groups, such as people with schizophrenia, alcohol use disorder, and drug use disorder (with and without homelessness history). Most of this excess mortality in people experiencing homelessness was attributed to external causes of death, psychiatric disorders, and diseases of the liver and digestive system. Life-years lost from external causes of death, including suicide and unintentional injuries, was 5·2 (95% CI 5·0–5·5) for males and 3·9 (3·5–4·2) for females, compared with the general population.
Interpretation
The substantial number of life-years lost among people experiencing homelessness is a key public health concern, highlighting pronounced inequalities in health among some of the most vulnerable individuals. Such metrics should be useful to inform policies and preventive efforts to reduce excess mortality in this population.
{"title":"Life-years lost in people experiencing homelessness and other high-risk groups in Denmark: a population-based, register-based, cohort study","authors":"Sandra Feodor Nilsson, Annette Erlangsen, Camilla Munch Nielsen, Merete Nordentoft, Seena Fazel, Thomas Munk Laursen","doi":"10.1016/s2468-2667(25)00171-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00171-9","url":null,"abstract":"<h3>Background</h3>People experiencing homelessness have a high mortality risk. Estimates of absolute risk, such as life-years lost, provide a more accurate measure of mortality differences in transient populations than conventional life expectancy estimates and enable direct comparisons with the general population and other high-risk populations. We aimed to examine mortality risks and life-years lost in people experiencing homelessness and other high-risk groups by sex, age group, and cause of death.<h3>Methods</h3>We conducted a nationwide, register-based cohort study of people aged 17–100 years living in Denmark between Jan 1, 2002, and Dec 31, 2020. Data from the Danish Civil Registration System was linked to the Homeless Register and the Cause of Death Register. The outcome was overall and cause-specific mortality during follow-up. We estimated mortality rates per 10 000 person-years at risk and estimated adjusted mortality rate ratios using Poisson regression analysis. We calculated both average and age-specific life expectancy and life-years lost for people experiencing homelessness and compared these figures with those of the general population, as well as with individuals with schizophrenia, alcohol use disorder, and drug use disorder.<h3>Findings</h3>Among 6 286 512 Danish residents, 58 376 (0·9%) people had at least one homeless shelter contact during the study period. Among people with a history of homelessness, the mortality rate was 240·3 (95% CI 236·3–244·4) per 10 000 person-years. In the general population with no history of homelessness, the mortality rate per 10 000 person-years was 117·8 (95% CI 117·6–118·1) in the general population with no history of homelessness, which resulted in an absolute difference of 122·5 (118·5–126·5). The mean excess life-years lost was 15·9 (95% CI 15·8–16·2) for males and 15·3 (14·8–15·7) for females compared with the general population, which was higher than in other high-risk groups, such as people with schizophrenia, alcohol use disorder, and drug use disorder (with and without homelessness history). Most of this excess mortality in people experiencing homelessness was attributed to external causes of death, psychiatric disorders, and diseases of the liver and digestive system. Life-years lost from external causes of death, including suicide and unintentional injuries, was 5·2 (95% CI 5·0–5·5) for males and 3·9 (3·5–4·2) for females, compared with the general population.<h3>Interpretation</h3>The substantial number of life-years lost among people experiencing homelessness is a key public health concern, highlighting pronounced inequalities in health among some of the most vulnerable individuals. Such metrics should be useful to inform policies and preventive efforts to reduce excess mortality in this population.<h3>Funding</h3>Independent Research Fund Denmark.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"18 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910591","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}
Pub Date : 2025-08-27DOI: 10.1016/s2468-2667(25)00193-8
Lucie Richard
Excess and premature mortality among people experiencing homelessness has been documented for over half a century.1, 2 Studies in high-income countries consistently show mortality rates that are several times higher among people experiencing homelessness compared with those among housed individuals,1, 2, 3, 4, 5 even after accounting for income and other markers of social disadvantage.3, 4, 5 These disparities persist across the life course but are most pronounced among youth and young adults,4, 5 leading to drastically reduced overall life expectancies. Despite this troubling consensus, most evidence to date comes from studies using prevalent cohorts.1, 2, 3, 4, 5 These studies recruit individuals who have been homeless for some unknown and potentially lengthy period. This approach introduces potential selection and survival bias and limits our understanding of when excess risk begins and how it changes over time.
{"title":"Mortality risk from first shelter contact: rethinking exposure","authors":"Lucie Richard","doi":"10.1016/s2468-2667(25)00193-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00193-8","url":null,"abstract":"Excess and premature mortality among people experiencing homelessness has been documented for over half a century.<span><span>1</span></span>, <span><span>2</span></span> Studies in high-income countries consistently show mortality rates that are several times higher among people experiencing homelessness compared with those among housed individuals,<span><span>1</span></span>, <span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span>, <span><span>5</span></span> even after accounting for income and other markers of social disadvantage.<span><span>3</span></span>, <span><span>4</span></span>, <span><span>5</span></span> These disparities persist across the life course but are most pronounced among youth and young adults,<span><span>4</span></span>, <span><span>5</span></span> leading to drastically reduced overall life expectancies. Despite this troubling consensus, most evidence to date comes from studies using prevalent cohorts.<span><span>1</span></span>, <span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span>, <span><span>5</span></span> These studies recruit individuals who have been homeless for some unknown and potentially lengthy period. This approach introduces potential selection and survival bias and limits our understanding of when excess risk begins and how it changes over time.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"160 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910993","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}
Pub Date : 2025-08-27DOI: 10.1016/s2468-2667(25)00199-9
No Abstract
没有抽象的
{"title":"Correction to Lancet Public Health 2025; 10: e668–81","authors":"","doi":"10.1016/s2468-2667(25)00199-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00199-9","url":null,"abstract":"No Abstract","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"70 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910995","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}
Pub Date : 2025-08-27DOI: 10.1016/s2468-2667(25)00190-2
David Taylor-Robinson, Oluwaseun B Esan
In The Lancet Public Health, Isobel Ward and colleagues1 used linked longitudinal data for 3 million children born in England and Wales to assess ethnic and socioeconomic inequalities in neonatal and child deaths. By linking census data and birth and death registrations over a 10-year period, they constructed birth cohorts and used rich census data to evaluate inequalities in mortality in the neonatal period and for children (>28 days to 10 years) based on ethnicity, maternal education, and occupational social class. They explored how these relationships are attenuated after adjusting for potential mediators of these inequalities such as household, maternal, and birth characteristics.
{"title":"Addressing ethnic and socio-economic inequalities in child mortality in the UK","authors":"David Taylor-Robinson, Oluwaseun B Esan","doi":"10.1016/s2468-2667(25)00190-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00190-2","url":null,"abstract":"In <em>The Lancet Public Health</em>, Isobel Ward and colleagues<span><span><sup>1</sup></span></span> used linked longitudinal data for 3 million children born in England and Wales to assess ethnic and socioeconomic inequalities in neonatal and child deaths. By linking census data and birth and death registrations over a 10-year period, they constructed birth cohorts and used rich census data to evaluate inequalities in mortality in the neonatal period and for children (>28 days to 10 years) based on ethnicity, maternal education, and occupational social class. They explored how these relationships are attenuated after adjusting for potential mediators of these inequalities such as household, maternal, and birth characteristics.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"23 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910592","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}
Pub Date : 2025-08-27DOI: 10.1016/s2468-2667(25)00170-7
Elisa Pineda, Thomas E Beaney
No Abstract
没有抽象的
{"title":"Salt substitutes and misrepresentation of WHO recommendations – Authors' reply","authors":"Elisa Pineda, Thomas E Beaney","doi":"10.1016/s2468-2667(25)00170-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00170-7","url":null,"abstract":"No Abstract","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"15 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910994","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}
Pub Date : 2025-08-25DOI: 10.1016/s2468-2667(25)00191-4
Akshar Saxena, Adam D Koon, Christine Johnson Curtis, Eva A Goyena, Josie P Desnacido, Apple Joy D Ducay, Eldridge B Ferrer, Lindsay Steele, Laura K Cobb, Megan E Henry, Lawrence J Appel, Imelda Angeles-Agdeppa, Matti Marklund
Background
In 2018, the Philippines implemented a tax on sugar-sweetened beverages. A broader tax on unhealthy foods is being considered. We aimed to estimate the effect of a tax on unhealthy packaged foods.
Methods
In this modelling study, we used a multiple-cohort, proportional multistate life table model to estimate the effect of a 20% tax on packaged foods exceeding WHO thresholds for sodium or sugar, excluding beverages already taxed. Using nationally representative nutrition, sales, and Global Burden of Diseases, Injuries, and Risk Factors Study data, we projected changes in sodium and sugar intake and related health outcomes (cardiovascular disease and type 2 diabetes) and economic outcomes (health-care costs, tax revenue, and implementation costs) over 20 years, comparing Filipino adults aged 25 years and older in 2020 (reference population) with the same population under the intervention with reduced intakes from the tax, assuming 100% pass-through to prices. Cost-effectiveness was estimated from extended health-care and government perspectives and stratified by wealth quintile.
Findings
Compared with the base-case scenario (ie, the status quo), the tax was estimated to avert 2775 deaths (95% uncertainty interval 2685–2853), 13 632 incident ischaemic heart disease events (13 153–14 029), 5287 ischaemic strokes (5090–5445), and 21 763 type 2 diabetes cases (21 532–22 006) over 20 years, generating 326 253 health-adjusted life-years (321 577–330 434). The tax could be cost saving from the government perspective and cost-effective from the health-care perspective, with an estimated 2·37 billion Philippine pesos (PHP; 2·32–2·42) in health-care savings, PHP 647·99 billion (646·42–649·45) in tax revenue, and PHP 12·96 billion (12·93–12·99) in implementation costs over 20 years. Estimated health gains were concentrated among people in middle-income groups, whereas tax revenue increased with income.
Interpretation
A nutrient-based tax on unhealthy packaged foods could reduce diet-related disease burden and generate sustained tax revenue in the Philippines. These findings support nutrient-based food taxes as a cost-effective strategy to reduce disease burden, and raise revenue in low-income and middle-income countries.
Funding
Resolve to Save Lives funded by Bloomberg Philanthropies.
{"title":"Estimated health impact, cost, and cost-effectiveness of taxation on unhealthy packaged foods in the Philippines: a modelling study","authors":"Akshar Saxena, Adam D Koon, Christine Johnson Curtis, Eva A Goyena, Josie P Desnacido, Apple Joy D Ducay, Eldridge B Ferrer, Lindsay Steele, Laura K Cobb, Megan E Henry, Lawrence J Appel, Imelda Angeles-Agdeppa, Matti Marklund","doi":"10.1016/s2468-2667(25)00191-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00191-4","url":null,"abstract":"<h3>Background</h3>In 2018, the Philippines implemented a tax on sugar-sweetened beverages. A broader tax on unhealthy foods is being considered. We aimed to estimate the effect of a tax on unhealthy packaged foods.<h3>Methods</h3>In this modelling study, we used a multiple-cohort, proportional multistate life table model to estimate the effect of a 20% tax on packaged foods exceeding WHO thresholds for sodium or sugar, excluding beverages already taxed. Using nationally representative nutrition, sales, and Global Burden of Diseases, Injuries, and Risk Factors Study data, we projected changes in sodium and sugar intake and related health outcomes (cardiovascular disease and type 2 diabetes) and economic outcomes (health-care costs, tax revenue, and implementation costs) over 20 years, comparing Filipino adults aged 25 years and older in 2020 (reference population) with the same population under the intervention with reduced intakes from the tax, assuming 100% pass-through to prices. Cost-effectiveness was estimated from extended health-care and government perspectives and stratified by wealth quintile.<h3>Findings</h3>Compared with the base-case scenario (ie, the status quo), the tax was estimated to avert 2775 deaths (95% uncertainty interval 2685–2853), 13 632 incident ischaemic heart disease events (13 153–14 029), 5287 ischaemic strokes (5090–5445), and 21 763 type 2 diabetes cases (21 532–22 006) over 20 years, generating 326 253 health-adjusted life-years (321 577–330 434). The tax could be cost saving from the government perspective and cost-effective from the health-care perspective, with an estimated 2·37 billion Philippine pesos (PHP; 2·32–2·42) in health-care savings, PHP 647·99 billion (646·42–649·45) in tax revenue, and PHP 12·96 billion (12·93–12·99) in implementation costs over 20 years. Estimated health gains were concentrated among people in middle-income groups, whereas tax revenue increased with income.<h3>Interpretation</h3>A nutrient-based tax on unhealthy packaged foods could reduce diet-related disease burden and generate sustained tax revenue in the Philippines. These findings support nutrient-based food taxes as a cost-effective strategy to reduce disease burden, and raise revenue in low-income and middle-income countries.<h3>Funding</h3>Resolve to Save Lives funded by Bloomberg Philanthropies.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"22 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144897962","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}
Pub Date : 2025-08-14DOI: 10.1016/s2468-2667(25)00200-2
Aug 9th marked the International Day of the World's Indigenous Peoples—a moment to reflect on the profound inequalities affecting Indigenous Peoples worldwide. Representing 476 million people across more than 90 countries, Indigenous Peoples today are arguably among the most disadvantaged and vulnerable groups of people. With worse health outcomes than non-Indigenous populations and a substantially lower life expectancy, Indigenous Peoples suffer considerable health inequalities—shaped by historical injustices, persistent structural, economic, and cultural barriers, and inequitable health systems. A series of papers published this month in The Lancet Public Health and The Lancet Regional Health–Western Pacific shed light on cancer inequalities affecting Indigenous Peoples and offer valuable insights for policy makers.
{"title":"Tackling health inequalities in Indigenous Peoples","authors":"","doi":"10.1016/s2468-2667(25)00200-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00200-2","url":null,"abstract":"Aug 9th marked the International Day of the World's Indigenous Peoples—a moment to reflect on the profound inequalities affecting Indigenous Peoples worldwide. Representing 476 million people across more than 90 countries, Indigenous Peoples today are arguably among the most disadvantaged and vulnerable groups of people. With worse health outcomes than non-Indigenous populations and a substantially lower life expectancy, Indigenous Peoples suffer considerable health inequalities—shaped by historical injustices, persistent structural, economic, and cultural barriers, and inequitable health systems. A series of papers published this month in <em>The Lancet Public Health</em> and <em>The Lancet Regional Health–Western Pacific</em> shed light on cancer inequalities affecting Indigenous Peoples and offer valuable insights for policy makers.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"70 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851307","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}
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