https://www.ijhpm.com/ International Journal of Health Policy and Management en daily 1 Tue, 01 Dec 2026 00:00:00 +0330 Tue, 01 Dec 2026 00:00:00 +0330 https://www.ijhpm.com/article_4871.html The systematic destruction of academic infrastructure, termed scholasticide, has been normalised across the Eastern Mediterranean Region (EMR) over more than two decades. The doctrine has operated through two coexisting modalities: the targeted assassination of individual scholars and the physical destruction of institutions, escalating in scale from selective killings and partial looting to the dismantling of entire academic systems. Drawing on evidence from several EMR countries, we describe a causal cascade through which acute military strikes and chronic structural exclusion, including sanctions, platform over-compliance, and visa barriers, produce generational health workforce depletion, disrupt core public health functions, and cause population-level health harms. We argue that academic institutions constitute a distinct, upstream structural determinant of population health whose destruction is an attack on health systems, not merely on education. We propose five categories of action, implemented through standing regional and international mechanisms, to protect academic infrastructure across the EMR whenever and wherever it is attacked. https://www.ijhpm.com/article_4882.html This editorial examined the enduring ties between medicine and political power, highlighting how the World Medical Association (WMA) arose in response to recurring ethical crises involving physicians. Created after the Second World War alongside new international institutions, the WMA aimed to protect professional autonomy and defend medical neutrality. Over the decades, it has acted as an ethical counterbalance within global health governance, especially through collaboration with the World Health Organization (WHO). Yet history shows that political pressures have repeatedly compromised medical practice, generating dual-loyalty dilemmas, human rights violations, and scandals that erode public trust. The WMA has sometimes responded firmly—suspending national associations, issuing statements during conflicts, or challenging unethical state policies—though its actual influence remains contested. Internal political divisions have often slowed or limited its actions. Today’s (ie, mid-March 2026) severe degradation of health systems in conflict zones reinforces the need to renew core ethical principles through collective responsibility and vigilance. https://www.ijhpm.com/article_4853.html Background  The Kirkpatrick model is commonly used as a systematic approach to evaluate training programs, although its application to health sciences experiential learning programs is not well-established. To inform the use of the Kirkpatrick model in the evaluation of the Canadian Institutes of Health Research’s (CIHR’s) Health System Impact Fellowship National Cohort Training Program (HSIF NCTP), we examined its application in post-secondary health sciences programs. Methods  Using the Joanna Briggs Institute’s updated methodology for scoping reviews, we searched CINAHL, EMBASE, ERIC, MEDLINE, PsycINFO, and Web of Science for studies published from 2017 to 2023 that focused on health sciences experiential learning programs held at universities and reported on at least one level of the Kirkpatrick model (ie, reaction, learning, behavior, results). We extracted data on study characteristics and reported outcomes for each of the Kirkpatrick model levels. Results  After deduplication, we screened 755 titles and abstracts, we reviewed 97 full texts, and we included 34 studies in our scoping review. Many studies reported outcomes at the reaction or learning levels followed by the behaviour and results levels. Across levels, despite identifying several areas of improvement, learners typically reported favourable perceptions, increased confidence and knowledge, improved performance, and organizational improvements. Conclusion  The Kirkpatrick model is a widely used and highly adaptable evaluation model that has been successfully used to evaluate a range of post-secondary health sciences programs. Despite its wide use, evaluators using the Kirkpatrick model should use more robust methodologies to capture long-term behaviour and results associated with the programs. Future work should focus on evaluating a broader spectrum of programs such as doctoral- and postdoctoral-level experiential learning programs and underrepresented healthcare professions such as psychologists and dieticians. Integration of behaviour change and implementation science methodologies within the broader educational evaluation literature is also needed. https://www.ijhpm.com/article_4872.html Background  Approximately 20% of the total healthcare expenditure in high-income countries is spent on low-value care, ie, care that is unnecessary, potentially harmful, or provides marginal health benefits to patients. Demand for lowvalue care is considered a multifactorial, complex problem, as a multitude of factors have been associated with low-value care use. However, there is limited knowledge on how these factors interrelate and lead to demand for low-value care. Therefore, the aim of this study was to explore and map the factors and their relations contributing to patients’ demand for low-value care using a complex systems approach. Methods  Two group model building (GMB) sessions on the topic of low-value care were organised with experts from the Netherlands. Each session’s transcript was thematically analysed, resulting in one causal loop diagram (CLD) per session. These CLDs included determinants, relations between these determinants and feedback loops. Finally, the CLDs were synthesised into one CLD combining the insights from both sessions. Results  The final CLD consisted of 42 factors influencing demand for low-value care. It includes biomedical factors, cognitive biases, socio-cultural factors, economic factors, emotions, knowledge-related factors, factors related to the interaction with the provider, and preferences and expectations. By mapping the relations between these factors, we identified 59 connections and nine reinforcing feedback loops potentially influencing demand for low-value care. Conclusion  The CLD provides insight into factors, mechanisms and feedback loops influencing patients’ demand for low-value care. It highlights perceived insecurity as a central driver that influences multiple other factors and eventually affects patients’ demand for low-value care. These central factors influencing multiple other factors may be potential leverage points for policies aiming to reduce demand for low-value care. Further research is required to clarify the relative importance of the identified factors, relationships, and feedback loops to determine effective leverage points.  https://www.ijhpm.com/article_4855.html Background  South Korea faces significant healthcare challenges due to its rapidly aging population, necessitating alternative care models to hospital-based systems. In response, home healthcare has emerged as a promising strategy to support aging in place while maintaining care continuity and system sustainability. Methods  This literature review examines home healthcare in South Korea through the lens of healthcare access, quality, and cost, which are the three dimensions of the “Iron Triangle.” Online databases were used to identify papers published from 2010 to 2025, from which 39 documents were selected which examine the impact of home healthcare in South Korea, specifically in terms of access, quality, or cost. Results  Results indicate that home healthcare effectively addresses healthcare access disparities, especially for elderly and disabled populations, by overcoming geographic and mobility barriers through integrated care models and remote technologies. Quality of care is enhanced through patient-centered approaches, multidisciplinary collaboration, and proactive home visits, leading to improved clinical outcomes and higher patient satisfaction. Economically, home healthcare demonstrates potential cost savings by reducing hospitalizations and emergency care usage, particularly for patients with chronic conditions and high utilization patterns. Conclusion  Sustainability remains contingent upon effective reimbursement and resource allocation policies. Policy implications include expanding healthcare infrastructure, investing in caregiver training, adopting advanced technologies to maximize the effectiveness of home healthcare, and promoting a sustainable and equitable healthcare system in South Korea. Strategic integration of home healthcare within national insurance and long-term care frameworks will be essential to realizing its full system-level benefits. https://www.ijhpm.com/article_4873.html Background  Financial relationships between the medical device industry and healthcare providers have raised concerns about conflicts of interest (COIs). However, these relationships remain poorly characterized in Japan, despite the country’s large medical device market, which was valued at ¥4.41 trillion ($33.3 billion) as of 2021. This study examined the scale, composition, and temporal patterns of payments from the medical device industry and evaluated current transparency practices. Methods  We analyzed publicly disclosed payment data from 117 medical device companies predominantly affiliated with the Japan Federation of Medical Devices Associations (JFMDA) from 2019 to 2022. Payment categories included research and development, academic research support, lecture and consulting fees, information-provision–related expenses, and other payments to healthcare professionals (HCPs) and healthcare organizations (HCOs). We assessed payment magnitude, category composition, company-level concentration, year-to-year changes, and disclosure transparency using an adapted proforma previously applied to European pharmaceutical payment data. Results  Total payments amounted to $942.3 million over four years. Academic research support expenses constituted the largest share (33.0%, $310.7 million), followed by information provision–related expenses (25.2%, $237.5 million) and research and development expenses (21.7%, $204.8 million). Payments were highly concentrated, with the top 10 companies accounting for approximately 58% of total amounts. Using 2019 as the pre-pandemic baseline, total payments declined by 30.2% in 2020 and remained below pre-pandemic levels in 2021 (-24.0%), before partially recovering in 2022 (-11.6%). Category-specific trends diverged during the pandemic, with consulting, lecturing, and manuscript-related fees exceeding pre-pandemic levels by 2022, while information provision–related expenses remained substantially reduced. Transparency was limited: 78.6% of companies disclosed payment data with limited standardization, searchability, or data download functionality. Conclusion  This multi-year analysis revealed substantial financial relationships between the medical device industry and healthcare stakeholders in Japan, alongside persistent shortcomings in transparency of disclosures. Introducing legally mandated disclosure would improve oversight and align Japan’s system with international best practices. https://www.ijhpm.com/article_4861.html Background The uneven distribution of physicians between urban and rural areas remains a significant public health challenge. Rural clinical placements during medical training are increasingly viewed as a potential lever for enhancing the appeal of rural areas. The aim of this systematic review, supported by a meta-analysis, was to evaluate the real impact of rural placements on medical graduates’ decisions to practice in rural locations. Methods A systematic search was conducted across four databases (PubMed, Embase, Web of Science, and Cochrane Library) covering the data available up to June 2024. Included studies evaluated the impact of rural clinical placements on the professional practice location of medical students or early-career physicians. A random-effects meta-analysis was performed to estimate the relative risk (RR) of rural practice. Additional variables analyzed included practice duration, placement length, participants’ rural background, their satisfaction with the placement, and their stated intention to practice in a rural area. Results A total of 62 studies were selected, with 28 contributing to the meta-analysis, encompassing over 330 000 participants. The pooled analysis showed that students who completed a rural placement were more than twice as likely to establish practice in a rural area compared to their non-exposed peers (RR = 2.683; 95% CI [confidence interval]: 2.255–3.192). This effect was further amplified by factors such as rural background, extended placement duration, and a satisfactory placement experience. A key strength of this review is that it synthesizes actual workforce outcomes rather than relying solely on stated intentions. Conclusion Rural clinical placements have a significantly positive impact on the rural practice decisions of earlycareer physicians, particularly when these placements are of extended duration, well-structured, and accessible. Rural placements should be offered both to students from rural backgrounds, who consistently show the strongest effect, and to urban students who may develop an increased interest in rural practice when exposed to long, immersive placements. These findings support the integration of rural placements into a global policy aimed at achieving a more equitable geographic distribution of healthcare professionals. Although the effectiveness of rural placements is already recognized in international frameworks such as the World Health Organization (WHO) guidelines, their implementation remains uneven across countries. https://www.ijhpm.com/article_4874.html Background Corporate political activity (CPA) refers to practices through which commercial actors seek to influence public policy and prioritise their commercial interests. While extensively documented internationally, little empirical evidence exists for Portugal. This study provides the first systematic analysis of the CPA of the food industry in Portugal.Methods We conducted a systematic document analysis, following a protocol developed by INFORMAS (International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support), a network that monitors food environments. This was triangulated with semi-structured interviews and illustrated through two policy examples. Twenty-five food industry actors were selected based on market share, trade association membership, and relevance to policy debates. Publicly available materials (January 2022–December 2023) were collected and coded using Ulucanlar’s CPA framework, distinguishing framing and action strategies. Data were triangulated with 18 interviews conducted between July and December 2024 with informants from academia, government, industry, civil society, public health, and the media.Results We identified 534 examples of framing and 799 examples of action strategies. Framing was dominated by portrayals of corporations as “good actors” aligned with health, sustainability, and national development. Action strategies focused on reputational management, corporate social responsibility (CSR), and the displacement of public health roles. Legal obstruction and overtly adversarial tactics were absent. Large multinational manufacturers and major retailers accounted for the highest number of coded CPA examples, with trade associations also represented among actors engaging in policy-related activities. Interviewees confirmed these patterns and expressed concerns over informal access to policy-makers, weak state capacity, and reliance on corporate-led initiatives.Conclusions The food industry in Portugal primarily relies on reputational and co-regulatory strategies, with limited evidence of overtly confrontational tactics. These findings are consistent with a form of institutionalised influence in which corporate actors engage closely with public authorities and participate in governance processes in ways that may shape the direction and scope of public health policy. https://www.ijhpm.com/article_4842.html Pancreatic cancer remains one of the deadliest malignancies, with a persistently low five-year survival rate. The Recalcitrant Cancer Research Act (RCRA) of 2012 is one example of legislation aimed at accelerating research in highmortality cancers. This study examines long-term trends in federal funding and clinical trial sponsorship for pancreatic cancer over a 20-year period, spanning before and after the RCRA. We conducted a retrospective analysis of National Cancer Institute (NCI) funding data and pancreatic cancer clinical trials registered on ClinicalTrials.gov between 2003 and 2022. Linear regression with pre- and post-2013 comparisons evaluated changes over time. NCI support for pancreatic cancer increased 3.5-fold – from $78 million in 2003 to $250 million in 2022 (inflation-adjusted). The annual growth rate rose from $7.4 million per year before 2013 to $12.2 million per year after 2013. The share of the NCI’s budget allocated to pancreatic cancer also rose from 0.9% to 3.4%, with no significant shift in slope after 2013 (P = .98). Federally-funded clinical trials declined sharply before 2013, decreasing by 2.8% per year, and then stabilized after 2013, with a nonsignificant slope of –0.95% per year (interaction P = .06). Meanwhile, industry-sponsored trials grew substantially, increasing from 30% to nearly 75%, increasing by 2.0% per year after 2013. Findings were consistent in logistic regression models. These findings suggest that while federal investment in pancreatic cancer research has grown, the expansion of clinical trials has been driven largely by industry, suggesting that federal investment has likely been directed toward foundational and preclinical research. Strengthening public-private collaboration and maintaining federal engagement will be critical to ensuring that research advances align with patient-centered goals. https://www.ijhpm.com/article_4876.html Background Unnecessary hospitalizations undermine the efficient use of healthcare resources and may expose patients to preventable safety risks. This study aimed to develop a computerized screening tool for identifying potentially inappropriate adult inpatient admissions using nationwide health insurance claims data in South Korea.Methods We conducted a retrospective cross-sectional study using the Health Insurance Review and Assessment Service-National Inpatient Sample (HIRA-NIS) (2017–2019) to develop and assess a claims-based hospitalization appropriateness screening tool (HAST) for adult admissions. Based on the adult hospitalization clinical service criteria from the Appropriateness Evaluation Protocol (AEP), we selected only those criteria directly observable in claims data and operationalized them using standardized electronic data interchange codes. The final tool included nine criteria and episodes meeting none of these criteria were classified as potentially inappropriate admissions (PIAs). HAST was assessed through a single-round of expert review for content validity, mortality-based known-groups comparison, andconvergent validity against selected SQLape diagnostic groups. Logistic regression models were applied to identify factors associated with PIA.Results The final tool comprised nine screening criteria: (1) receiving general anesthesia, (2) admission to intensive care unit (ICU), (3) receiving hospice care, (4) childbirth, (5) continuous monitoring of vital signs, (6) receiving arterial blood gas analysis (ABGA), (7) application of mechanical ventilator, (8) receiving intravenous injections, and (9) receiving intramuscular injections. Across analytic specifications, 17.5% to 19.2% of admissions were classified as PIAs. PIAs were more frequent among adults aged 20–39 years, females, National Health Insurance (NHI) beneficiaries, and patients admitted to small facilities with fewer than 100 beds.Conclusion HAST offers a feasible, reproducible, and scalable method for monitoring the appropriateness of hospital admissions using routinely collected administrative data. It can be used for large-scale surveillance to support health policy evaluation and system-level quality improvement. https://www.ijhpm.com/article_4863.html Organizational policies or protocols have been recommended as a potential means of improving sex trafficking services. Therefore, we examined the role of organizational policies or protocols on service providers’ perceptions of challenges in responding to sex trafficked persons. Data were collected using an online, anonymous, national survey between February and August 2023. The healthcare, social, and community service providers surveyed were asked to what extent they agreed or disagreed with the statements, “There are challenges that prevent me from providing the appropriate care, support, or services to sex trafficked persons” and “There are organizational policies or protocols in my place of work that provide guidance on how to respond to sex trafficked persons.” The analysis included 553 respondents, of whom almost three quarters (72.6%) perceived challenges and less than half (44.9%) reported the availability of organizational policies or protocols. Respondents who worked in an organization with policies or protocols were less likely than those who did not to report challenges in responding to sex trafficked persons (40.9% vs. 55.3%, unadjusted odds ratio = 0.56, P = .003; adjusted odds ratio = 0.64, 95% CI = 0.42, 0.96, P = .03). Our findings highlight the importance of implementing organizational policies or protocols that provide guidance on and facilitate the delivery of appropriate care, support, and services to sex trafficked persons. This may better position service providers to address the serious physical, sexual, and mental health sequalae sex trafficked persons experience. https://www.ijhpm.com/article_4877.html Background While the overall impact of pooled drug procurement on drug procurement has been evaluated, little is known about how healthcare institutions’ pre-policy procurement composition is associated with heterogeneous post-policy procurement responses. This study addresses this gap under China’s National Volume-Based Procurement (NVBP) policy.Methods We used monthly procurement data from January 2018 to December 2020 from four provinces in China, covering both pre- and post-policy periods, as the NVBP policy was implemented in January 2020. Outcomes were procurement volumes, measured as the number of defined daily doses (DDDs), of NVBP-covered drugs (bid-winning and non-winning products) and their clinically substitutable alternatives. All healthcare institutions in the selected provinces were included and stratified by (1) their pre-policy share of bid-winning products among NVBP drugs and (2) their pre-policy share of NVBP drugs among both NVBP and alternative drugs, to assess institutional heterogeneity. Interrupted time series (ITS) analysis was conducted to assess the immediate (level) and long-term (slope) post-policy changes.Results Procurement volumes of bid-winning products increased substantially following the policy (level change: 1275%, P < .01), with smaller increases observed among healthcare institutions with higher pre-policy bid-winning shares (eg, highest-share subgroup: 441%, P < .01), consistent with uniform procurement targets. Although overall procurement of alternative drugs remained stable, healthcare institutions with higher pre-policy NVBP shares experienced significant increases, with level changes of up to 1010.9%, suggesting substitution driven by financial losses. In contrast, healthcare institutions with lower NVBP shares saw notable declines (level change: −34.8% to −65.2%), possibly reflecting demand-side substitution toward lower-priced NVBP drugs.Conclusion Findings highlight that in pooled procurement, procurement behaviour is shaped more by regulatory enforcement and financial incentives than by price-driven demand. Strengthening guidance and oversight of supplier behaviour remains essential to realizing the full benefits of pooled procurement reforms. https://www.ijhpm.com/article_4828.html Background  Between 2010 and 2019 in Thailand, hospital admissions due to toxic effects of non-medicinal substances (International Classification of Diseases 10th Revision [ICD-10] codes: T51-T65) ranged from 59.78 to 87.47 per 100 000 population. The objective of this study was to estimate the costs of non-medicinal poisoning from healthcare provider perspective, and identify factors associated with the costs in Thailand for the year 2020. Methods  This was a prevalence-based cost-of-illness study conducted from healthcare provider perspective, analysing data from five hospitals (four regional and one provincial) across the Central, North, and Northeast regions of Thailand. We included all patients diagnosed with non-medicinal poisoning (ICD-10 codes: T51-T65) during the fiscal year 2020. Direct medical costs were calculated from hospital databases, estimating the cost per outpatient/emergency visit and the cost per hospital admission. Multiple regression analysis was used to determine the factors affecting these costs. All total costs were converted to international dollar (Int$) for 2020. Results  A total of 3260 patients were included (2472 outpatient visits and 788 admissions). The mean age was 39 years, with 51% being male. The mean cost per outpatient visit was Int$ 47, and the mean cost per admission was Int$ 896. Key factors significantly associated with higher costs included patient type (outpatient vs admission), length of stay (LOS), age, insurance scheme, diagnosis group, and the presence of comorbidities. Conclusion  This study provided critical, updated data that can inform health policy by emphasizing the economic burden of non-medicinal poisoning. These findings underscore the need for strengthening poisoning prevention and early intervention services and offer essential data for conducting future economic evaluation studies of relevant interventions in Thailand. https://www.ijhpm.com/article_4879.html Background Although accountability interventions to strengthen adolescent sexual and reproductive health (ASRH) service delivery in marginalized urban neighbourhoods are on the rise, evidence on the underlying mechanisms and context conditions is scarce. We analysed the strategies of two grassroots organizations in India that support adolescent agency in sexual and reproductive health (SRHR) to identify the mechanisms and context conditions in which they work.Methods We used realist evaluation (RE) and a case study design with two sites in Delhi and Mumbai. We used Margaret Archer’s structure-agency-culture (SAC) framework to deepen the analysis of context and of the temporal dynamics of the intervention.Results We found that the organizations used five strategies: (1) mobilization of girls and young women, (2) raising critical consciousness, (3) supporting self-organization and emergent collective action, (4) documenting lived realities and engagement with local governance actors. Organizational and relational mechanisms triggered include trustbuilding in the community and with parents, which enables support, fosters a group identity, and provides a safe space for peer exchange. Enhancing reflexivity, self-efficacy and a sense of place among adolescent girls, the intervention stimulates emergent collective action within the neighbourhood, which in turn contributes to build consensus and enforce accountability with local and sub-national governance actors. We considered causal mechanisms to be historicallygrounded in practices preceding current ones, and we adopted a view on “context” that includes a longer-term temporal dimension.Conclusion The refined programme theory confirms that organizations will simultaneously engage in consensusoriented and agonistic strategies with state actors in their efforts to achieve social change. https://www.ijhpm.com/article_4829.html Background  In October 2023, Bangladesh introduced a free, single-dose human papillomavirus (HPV) vaccine for girls aged 9–14 through its national vaccination program to prevent cervical cancer, the second most common cancer among Bangladeshi females, caused by the HPV. Although vaccine hesitancy was not a significant issue before the COVID-19 pandemic, experiences from that pandemic and global literature suggest that the population’s uptake of this vaccine may face barriers due to concerns related to reproductive health, fertility, and cultural and religious beliefs. This is particularly relevant in a country where Islam is the state religion, 91% of the population is Muslim, and religious leaders hold significant influence over public opinion. Methods  Building upon the recently developed Integrative Public Policy Acceptance (IPAC) framework, this qualitative study explores the factors shaping religious leaders’ support for the HPV vaccine informing their potential role in promoting it. Semi-structured interviews with leaders from Bangladesh’s five main Islamic traditions were thematically analysed using NVivo 14 with inductive and deductive coding. Results  Islamic religious leaders’ varying support for HPV vaccinations in Bangladesh was influenced by their limited awareness of cervical cancer, as well as their religious and social concerns about ingredients, side effects and a fear of promoting promiscuity. Political ideologies also played a significant role, as leaders were less supportive of the program when they perceived the government as ideologically opposed to the beliefs or practices of their specific religious tradition. Conclusion  The study’s contribution to the IPAC framework highlights the importance of political consensus in policy acceptance, explaining how partisanship and ideological differences impact public policy compliance. The findings underscore the need for health systems in Muslim majority countries to engage with religious authorities, build political inclusivity and consensus, and align health policies with religious and cultural values. https://www.ijhpm.com/article_4881.html Background Performance measurement systems (PMSs) have become an essential component of health system reforms globally and are increasingly used to assess, reward and improve provider performance. While PMSs can be valuable tools for achieving desired health outcomes, their effectiveness depends on how they are designed, implemented, and used within complex multilevel governance structures. There is evidence that PMSs may also have unintended negative consequences. Drawing on new empirical evidence, the present study examines the consequences of PMSs implemented in multi-level governance systems through the analysis of the Italian National Healthcare Service (INHS), which exemplifies a decentralised health system with multiple levels of governance.Methods The study employed a mixed methods approach combining quantitative and qualitative methods to examine the functional and dysfunctional consequences of PMSs in the INHS across three governance levels: (i) State-Regions, (ii) Regions-healthcare organisations, and (iii) Healthcare organisations-healthcare professionals.Results We identified three key functional consequences. First, PMSs drive improvement by facilitating benchmarking, advocacy, and collaboration. Second, quantifying activities and services improves objectivity and transparency. Third, national PMSs provide a comprehensive view of performance across multiple dimensions and provide a more holistic understanding of how different aspects of the system interact. We confirmed previously reported dysfunctional consequences of PMSs found in other health systems and identified three new dysfunctional consequences in the INHS: Measurement Overload, Misconsideration, and Exploitation.Conclusion Based on our analysis and existing literature, we propose ten key factors for strengthening performance measurement in the INHS. While this study offers novel evidence on the functional and dysfunctional consequences of PMSs in the Italian system, our research is context-specific, and the applicability of these factors to other multi-level health systems remains an area for future empirical testing. https://www.ijhpm.com/article_4831.html Background  The alcohol industry builds engagement with United Nations (UN) organisations to enhance its corporate image and influence policy, supported by the UN’s endorsement of public-private partnerships (PPPs). However, the extent of the alcohol industry’s relationships with the UN remains unclear due to limited reporting. Methods  We searched the websites of 57 UN-affiliated entities and 18 transnational alcohol corporations (TNACs) for evidence of partnerships or relationships between the UN and the alcohol industry. We summarised the UN entities and TNACs involved in formal partnerships, membership of alliances or stakeholder networks, financial contributions, sponsorship of programmes or projects, sponsorship of events, event participation, and personal relationships with conflicts of interest. Results  We identified examples of all the above relationships between various UN entities and the world’s largest TNACs, including an alcohol industry donation towards the World Health Organization (WHO) Foundation, which was created to maximise private sector donations to WHO. The focus of these engagements aligned closely with the alcohol industry’s corporate social responsibility (CSR) initiatives, including drink-driving prevention, education, sustainability, and philanthropy. These activities frequently involved support for low- and middle-income countries (LMICs) and women, which are emerging markets for the TNACs. Sponsorship and participation in intergovernmental events allowed the TNACs privileged access to policy-makers. Limited disclosure by UN entities meant that our findings provided an incomplete picture of relationships with the alcohol industry. Conclusion  The UN’s wide-ranging relationships with the TNACs highlight the power of these large corporations in building political influence and the UN’s failure to acknowledge the alcohol industry’s conflicting interests with health. These relationships undermine WHO’s mandate to promote health, placing the integrity and impartiality of the UN system at risk. On top of adequate resources from member states and enhanced transparency measures, the UN requires effective safeguards against alcohol industry influence, in line with those for the tobacco industry. https://www.ijhpm.com/article_4875.html https://www.ijhpm.com/article_4837.html Background  Reimbursement decisions for new health interventions focus on maximizing health gains, with limited attention to who benefits from these gains or the impact on income related health inequalities. This study aimed to examine the preferences of Dutch citizens regarding the distribution of health gains of new interventions across income groups. Methods  A discrete choice experiment (DCE) was completed by 614 Dutch adults. Respondents were presented with 12 choice tasks. In each choice task, they were asked to choose between two health interventions that differed on the following attributes: total healthy life years gained, distribution of healthy life years gained across income groups, additional costs in terms of health insurance premium increases and whether the intervention was curative or preventive. Preferences were estimated using multinomial logit (MNL) models, relative attribute importance, willingness-to-pay, and willingness-to-trade total health gains. Preference heterogeneity was examined using latent class (LC) analyses. Results  Respondents found the distribution of health gains by income the most important attribute in their decision between health interventions (relative importance [RI] = 40.5%, 95% CI: 38.3%–42.7%). Overall, respondents preferred an equal distribution of healthy life years gained across income groups (βhigher income groups = -1.427, 95% CI: -1.547–-1.307; βlower-income groups = -0.315, 95% CI: -0.395–-0.235). A health intervention should yield 14 283 (95% CI: 10 463–18, 102) additional healthy life years or reduce the yearly health insurance premium by €39.96 (95% CI: €29.03–€50.89) if it mainly favors lower-income groups. Preventive interventions were generally preferred over equally effective or more effective curative interventions (βprevention = 0.270, 95% CI: 0.204–0.336). While preferences displayed a similar direction across LCs, the classes differed in the RI assigned to the attributes. Conclusion  Our findings suggest societal support for interventions that prioritize preventive programs over equally effective or more effective curative interventions and prioritize interventions that provide equal benefits across different income groups. https://www.ijhpm.com/article_4878.html https://www.ijhpm.com/article_4840.html Background  Delays in medical care can be especially critical for individuals with multiple chronic conditions (MCCs). The United States and Taiwan, with vastly different healthcare systems, offer contrasting contexts for access to care. This study aims to examine the relationship between MCCs, delayed medical care and hospitalization in the US and Taiwan. Methods  This analysis used data from the US National Health Interview Survey (NHIS) 2021 (n = 29 482) and the Taiwan Social Change Survey (TSCS) 2021 health module (n = 1604). We estimated multivariable logit regression models and calculated differential effects of MCCs status (no chronic conditions, one chronic condition, MCCs) on outcomes. Precision measures were estimated with delta method. All analyses for the US population incorporated applicable complex survey design and weighting, and for the Taiwan population incorporated weighting when appropriate. Results  Compared to those with no chronic conditions, individuals in the US with one chronic condition (2.0 percentagepoints, P < .001) or MCCs (3.6 percentage-points, P < .001) had a higher likelihood of delayed care due to costs. In Taiwan, delayed care was less likely among individuals with one chronic condition (5.6 percentage-points, P = .08) or MCCs (9.5 percentage-points, P = .02), compared to individuals with no chronic conditions. Furthermore, individuals with MCCs or one chronic condition are associated with higher hospitalization in both the US (6.1 percentage-point, P < .001; 1.6 percentage-point, P = .001, respectively) and Taiwan (15.7 percentage-point, P < .001, 3.8 percentage-point, P = .08, respectively), although the differential effect of one chronic condition in Taiwan did not reach statistical significance. Conclusion  Analyzing data from two national health systems, this analysis shows differing relationships between MCC status and delayed care, suggesting a possible bidirectional effect. As both regions undergo reforms—US efforts to improve coordination and Taiwan’s rising risk of fragmented care—these findings offer insights relevant to policymakers and health system leaders beyond each country’s context. https://www.ijhpm.com/article_4880.html https://www.ijhpm.com/article_4844.html Background  Unhealthy diets drive high rates of non-communicable diseases. Many food environments are dominated by foods high in fat, salt, and sugar (HFSS). Supermarkets are a predominant source of groceries, and the relationships between retailers and their suppliers determine the foods displayed on their shelves. The disproportionate display of less healthy foods suggests that existing regulatory frameworks are sub-optimal for public health. We aimed to investigate the nature of relationships between supermarkets and their suppliers in the UK, and their implications for dietary public health. Methods  We undertook secondary analysis of in-depth interviews with UK retailers and suppliers (n = 19), using inductive and deductive approaches to thematic analysis, underpinned by our quest to understand how food retailing drives less healthy diets. Codes and themes were generated and refined, then mapped diagrammatically and are presented in an explanatory narrative. Results  Large suppliers are critical to the supplier-retailer relationship, dominating category management and supermarket shelves. The relationship brings mutual benefits for supplier and retailer. Category managers from large suppliers engender indebtedness among retailers by building rapport and trust, and investing financially and materially in retailers. Reciprocity by retailers is enacted with preferential contracts and the award of leading roles in category management (“category captaincy”). Large suppliers thus gain competitive advantage, with preferential access to premium shelf space, driving greater sales. Important positive reinforcing feedback loops maintain the relationship, described as a “virtuous circle.” Yet, there are also countering forces, which act as negative feedback loops. Conclusion  Where the retailer-supplier relationship involves the largest manufacturers, it drives the product mix and volumes on supermarket shelves, resulting in a disproportionate dominance of the largest, processed food brands. The nature of this relationship is likely a key factor preventing movement towards an overall healthier food offer to consumers and remains a public health concern. https://www.ijhpm.com/article_4845.html Background  Since 2009, China has implemented a chronic disease management program within primary healthcare (PHC) institutions in response to challenges posed by an aging population. However, the effectiveness of the program has been reported as mixed, likely due to variations in PHC physicians’ efforts and the support they received from the health system and community. This multi-sector engagement was conceptualized as management intensity in this study, and its impact on the program’s effectiveness was evaluated. Methods  This study analyzed 60 885 patients under the chronic disease management program in Yuhuan, Zhejiang province, as of 2023. Management intensity, the primary predictor, was quantified by township-level residual measured based on patients’ length of follow-up after eliminating patient demographics. This approach removed the portion of follow-up length attributable to individual characteristics, leaving the residual serving as a purified exposure variable for management intensity. The outcome measures included outpatient visits, inpatient admissions, outpatient and inpatient expenses, and glycemic and blood pressure (BP) control status. Data sources included chronic disease management registration records, service records of follow-up, and electronic medical records. A two-level mixed-effects regression model was then used to examine how management intensity affected the outcomes. Results  Each unit increase in management intensity corresponded to 0.21 more PHC outpatient visits and 0.15 fewer hospital outpatient visits. Meanwhile, higher management intensity was also associated with increased utilization of PHC inpatient services (odds ratio [OR]: 0.98, 95% CI: 0.97-0.98) and decreased utilization of hospital inpatient services (OR: 1.24, 95% CI: 1.18-1.29). Conclusion  Greater management intensity correlated with better health outcomes and higher utilization of PHC services. Since multi-sector engagement strongly affected how intensively chronic diseases were managed, it was imperative for health systems and communities to actively participate in and strengthen the program by supporting physicians. https://www.ijhpm.com/article_4846.html Background  Public organizations in healthcare are progressively adopting digital tools to disseminate information regarding the benefits of screening. Nevertheless, no research has hitherto been conducted to investigate the link between the website-based health communications and cancer screening uptake. This study addresses this gap by assessing whether health communications conveyed via the websites of local health organizations improve adherence to breast and cervical cancer screening. Methods  We performed thematic content analysis of 97 websites belonging to Italian health organizations based on the OSEC-p model. This latter was developed to measure the compliance of prevention-oriented health communication with the effectiveness requirements indicated in the model. Next, correlation and regression analyses were performed to examine the relationship between the average regional OSEC-p scores and the regional breast and cervical cancer screening adherence rates reported by the National Centre for Screening Monitoring in 2022. Results  The findings show that the prevention-oriented health communication via health organizations’ websites can explain the 45% of the variance in female cancer (breast and cervical) screening uptake. Patient engagement tools and information on preventive cancer initiatives are key web-based communication elements that enhance cancer screening adherence. Conclusion  This exploratory study is one of the first to highlight the importance of digital health communications for improving cancer screening and public health. It offers insights both for national health policy-makers to optimize health economics through screening campaigns and health organizations managers to enhance the compliance of health communication on websites with the effectiveness requirements defined in the OSEC-p model. https://www.ijhpm.com/article_4847.html Background  The Shared Team Efforts Leading to Adherence Results (STELAR) program is a multifaceted quality improvement intervention directed at hospital clinicians to improve stroke care. In a stepped-wedge cluster trial (N = 9 hospitals, Australia), STELAR achieved a 17% improvement in adherence to prioritized clinical indicators (composite outcome). We report the critical success factors and challenges that influenced change in care delivery. Methods  STELAR included two externally facilitated workshops; (i) feedback of national registry data to identify practice gaps and prioritize indicators; (ii) barrier assessment and action plan development (2017-2018). Hospitals appointed a site coordinator, and identified local change champions. Two months of remote-support followed to implement action plans. The process evaluation included workshop observations (N = 18), document review, satisfaction surveys (N = 51), and semi-structured interviews (external facilitator, N = 9 clinician site coordinators). Qualitative data were mapped to an implementation framework before inductive thematic analysis. Quantitative data were analysed descriptively, with all data triangulated. Results  Critical success factors included delivery by knowledge translation experts, external facilitation support/nudging to maintain staff engagement at hospitals, and the use of evidence to self-select prioritized indicators. Involving multidisciplinary staff in action planning and supporting local change champions to lead the implementation fostered capacity building. Reported challenges related to insufficient time when focusing on several prioritized indicators simultaneously within a limited timeframe and having to address strategies that involved working with different clinicians or hospital departments. Staff workload and availability and lack of medical buy-in and management support during the process were wider organizational challenges reported. Conclusion  Despite the identified challenges imposed by the limited implementation period, STELAR’s multifaceted attributes underpinned the overall strong positive change in quality of stroke care. Implications for wider adoption include involvement of knowledge translation experts with ongoing support for capacity building, and allowing greater time to work through implementation strategies.  https://www.ijhpm.com/article_4849.html Background Drug shortages are a persistent global challenge. In South Korea, shortages occur within a distinct context characterized by high import dependence, inflexible pricing structures, and a hospital-centric distribution system. This study examined how frontline pharmacists and policy stakeholders perceive the structural causes of drug shortages across policy, supply-chain, and frontline pharmacy practice levels.Methods We employed a sequential mixed-methods design to triangulate institutional perspectives with frontline realities, comprising six focus group interviews (FGIs) (n = 35) with policy stakeholders and a national web-based survey of 223 licensed pharmacists. Qualitative data explored institutional perspectives on structural causes and policy responses, whereas survey data quantified recent shortage experiences, impacts on patient care, and perceived causes.Results Qualitative findings indicated that stakeholders attributed shortages to structural vulnerabilities, including unprofitable drug prices, dependence on imported raw materials, and distribution rigidities. These perceptions were supported by survey findings and aligned with frontline pharmacists’ reported experiences: 97.3% of pharmacists experienced shortages in the past three months, most frequently involving cold medicines and analgesics. Respondents identified raw material shortages (51.1%) and supply chain imbalances (17.5%) as primary drivers. Although pharmacists used coping strategies such as drug substitution, these adaptations were associated with substantial patient inconvenience (49.3%) and increased pharmacist workload (23%), indicating that individual-level responses are insufficient to address systemic failures.Conclusion Drug shortages in Korea reflect systemic vulnerabilities compounded by distribution constraints rather than temporary disruptions. To address these perceived barriers, we propose a graded policy approach: short-term measures should prioritize administrative flexibility and information sharing, medium-term measures should focus on reforming pricing incentives, and long-term measures should strengthen supply chain sovereignty. https://www.ijhpm.com/article_4852.html Background  Local councils in Australia, established by state governments, are responsible for delivering services, implementing policies, and enforcing regulations that impact community health and well-being. Partnerships between local governments and health agencies can provide a valuable opportunity to advance initiatives to improve health and well-being of communities. This paper explores findings from four case studies of such partnerships in south-west Sydney, Australia. Methods  Semi-structured qualitative interviews with 25 key stakeholders were conducted as part of a realist evaluation of these partnerships, focusing on factors at functional, organisational, individual, and external levels that influence their success. Results  The findings provide real-world insights into the enablers and barriers of effective intersectoral partnerships. While the interview data generally align with existing literature and the theory of change developed in earlier research phases, key context-specific differences emerged. The interviews reiterated the need for structural support of the partnerships (in the case studies, through a context specific, locally tailored memorandum of understanding [MoU]) however, structures alone were insufficient, partnerships required “actors” to enable implementation (the partnership officers). Beyond the MoU and partnership officers, wider supports provided by partner organisation through governance, management and workplans were also essential. Stakeholders expressed strong support for these partnerships, citing positive outcomes and the importance of their continuation. However, persistent challenges include sectoral interests and institutional silos that hinder collaboration. The findings underscore the complexity of expecting councils to adopt a health-focused mandate or vice versa. Conclusion  The study highlights that partnerships, facilitated through MoUs and joint officer appointments, are effective in driving impactful health initiatives. Nevertheless, overcoming organisational silos requires ongoing leadership support and mandates that emphasize the importance of these partnerships. This research emphasizes the critical role of structured collaborations in addressing health determinants and reducing potential inequities within communities. https://www.ijhpm.com/article_4856.html Background  Diabetic retinopathy (DR) is a major microvascular complication of diabetes. Given its growing global burden and research inequities, we examined how national DR burden and socioeconomic factors relate to research interest (RI) in DR across low- and middle-income countries (LMICs) and high-income countries (HICs). Methods  We retrieved peer-reviewed DR articles published between 2018 and 2022 from Scopus. Spearman’s correlation test and multivariable linear regression were used to assess the associations between the independent variables: (a) socioeconomic factors, including health expenditure per capita purchasing power parity (PPP), current health expenditure (% of gross domestic product [GDP]), research and development (R&D) index, and human development index (HDI); (b) age-standardized years lived with disability (YLDs) rates of DR-related moderate (moderate vision impairment, MVI) and severe vision impairment (SVI) and blindness; and (c) disability-adjusted life years (DALYs) rate for diabetes, with our outcome variable, DR RI, calculated as the ratio of the number of DR publications in the field of medicine and life sciences to the whole output in the same field and country. Sensitivity analyses (2020-2022 RI vs. 2018-2019 burden) were conducted to address temporality. Results  In HICs, after adjustment for socioeconomic factors and DR-specific burden (MVI, SVI, or blindness, modeled separately), the diabetes DALY rate was the only variable independently associated with RI: MVI (β = 0.56, 95% CI: 0.16 to 0.95), SVI (β = 0.57, 95% CI: 0.19 to 0.94), and blindness (β = 0.61, 95% CI: 0.21 to 1.02). In LMICs, no significant relationships were found between RI and MVI, SVI, blindness or diabetes DALY rates. These findings remained consistent in sensitivity analyses. Conclusion  Our research demonstrates that there is a lack of significant correlation between research efforts and the burden of DR, particularly among LMICs, which may highlight the need to strengthen research infrastructure and realign national health research priorities. https://www.ijhpm.com/article_4857.html Background Establishing research partnerships can help close the research-practice gap. The Integrated Knowledge Translation Guiding Principles were developed in a spinal cord injury research context as a resource to facilitate research partnerships. Research funders play a significant role in the spinal cord injury research system. However, how fundersdefine, require, evaluate, support research partnerships is rarely reported. This study identified spinal cord injury research funders in Canada and the United States, identified their approaches to supporting research partnerships, and explored organizational perspectives of principles of partnership. Methods An environmental scan was conducted through five steps: (1) identifying spinal cord injury research organizations that funded the greatest number of spinal cord injury research publications in Canada and the United States between 2017 and 2022; (2) identifying one funding program related to research partnerships of each funder; (3 extracting online information of the programs; (4) interviewing funder informants; and (5) descriptive and deductive content analysis. The five steps were completed between April 2022 and September 2024. An additional data collection was conducted in July 2025 on a relevant National Institutes of Health funding program.Results Sixteen organizations and seventeen partnership-supportive programs were identified. Six programs defined partnerships as researchers and research users engaging throughout the research process. Eleven programs required applicants to describe the partnership in applications and explicitly stated their peer review evaluation criteria. The programs supported research partnerships through remuneration for partners’ engagement (n = 6), facilitating connections between researchers and potential partners (n = 3), and helping applicants prepare applications (n = 4). The programs had few strategies to evaluate awarded partnerships post-grant. Three descriptive categories emerged from the interviews: (1) Varied support for research partnerships; (2) Minimal capacity for partnership evaluation postgrant; and (3) Need for tools and resources to further support research partnerships. Conclusion Differences existed in how spinal cord injury research funders in Canada and the United States defined, required, evaluated, and supported research partnerships. The results provided an initial landscape of funders’ role in the spinal cord injury research system and may inform strategic efforts to optimizing meaningful engagement in a broader health research context. https://www.ijhpm.com/article_4862.html Background Many countries are defining health benefits packages to progress toward universal health coverage (UHC). Cost estimates are required to ensure packages are affordable and implementable. However, a gap persists between global costing tools and recommendations informing package design and the way services are defined for country-level implementation. To address this, we developed the first health systems-wide costing tool and approach based on the World Health Organization (WHO) UHC Compendium database, which provides structured service definitions and data to facilitate country-level contextualisation and implementation. This paper presents our tool and approach through a proof-of-concept study in Kyrgyzstan. Methods We developed a tool in Microsoft Excel that estimates normative economic costs for over 500 UHC Compendium services using a combination of bottom-up and top-down approaches. Resource use was derived from UHC Compendium metadata, supplemented with publicly available and country-specific data sources to inform input prices and population in need estimates. In Kyrgyzstan, all secondary data were validated and contextualised with national experts. We produced high-level cost estimates for 424 services identified as relevant for Kyrgyzstan and refined estimates for 181 priority services selected by country stakeholders. Sensitivity analyses investigated variations in personnel, medicine and overhead costs and currency fluctuations. Results Delivering all 424 services at current utilisation levels, or low levels of utilisation for services not yet implemented, would cost an estimated US$ 186.97 per capita annually. Providing the 181 priority services would cost US$ 74.41 per capita at current utilisation levels and US$ 189.44 per capita if scaled to full (100%) utilisation. Costs were driven primarily by personnel and medicines. Sensitivity analyses showed costs ranging from US$ 58.76 to 90.05 per capita. Conclusion This study demonstrates the feasibility of using UHC Compendium data to generate country-specific, service-level cost estimates for benefits package design. Other countries can adapt our tool and approach to design affordable and implementable packages in support of UHC goals. https://www.ijhpm.com/article_4865.html Background  Chinese medical teams (CMTs) have long been a component of global health engagement in Africa, yet their effectiveness within national health systems remains under-examined. Methods  Drawing on Bardosh’s socio-anthropological framework of global health delivery, this qualitative study examines how CMTs function within Ghana’s public healthcare sector. Participants were purposively selected from key institutions in Ghana, including the Ministry of Health (MoH), two tertiary hospitals, and one district hospital hosting CMTs. Eighteen semi-structured interviews were conducted with Ghanaian clinicians, hospital administrators, national policy-makers, and Chinese medical staff. Policy-relevant documents from 2009 to 2024 were reviewed to supplement and triangulate the findings. Results  Based on Bardosh’s five domains, the analysis identifies several factors influencing programme effectiveness: the placement and facility-level integration of CMTs (terrain of intervention); cultural and linguistic disconnects affecting patient engagement (community agency); short-term rotations and fragmented collaboration with local staff (field staff strategies); limited adaptability and utilisation of donated medical technologies (socio-materiality); and weak institutional coordination and policy alignment (governance). Two additional themes—patient-centred care and continuity of healthcare delivery—emerged as important dimensions shaping the perceived value and limitations of the CMT model. The findings suggest that effectiveness is shaped not only by operational or resource-related factors but also by the extent to which foreign medical interventions are socially embedded, locally responsive, and institutionally aligned. Conclusion  These findings provide insights for the design of international health partnerships seeking to strengthen public health systems in low-resource settings through more participatory, coordinated, and locally embedded models of delivery. https://www.ijhpm.com/article_4868.html Background  Teleconsultation services grew significantly in France during the COVID-19 pandemic. Reimbursed teleconsultations increased by a hundredfold between 2019 and 2021, establishing it as an emerging healthcare delivery modality. However, medication dispensing patterns following teleconsultations remain largely unexplored. This study aimed to characterize post-teleconsultation medication dispensing patterns between 2021 and 2023. Methods  A retrospective cohort study was conducted using data from the French health database. The study included all teleconsultations conducted that resulted in at least one medication dispensing event (TLCs) between January 1, 2021, and June 30, 2023. We described patient demographics, prescriber characteristics, and dispensed medication. Results  During the study period, 11 202 364 TLCs (34.3%) out of 33 853 911 resulted in medication dispensing. Among these 11 202 364 TLCs, the patient population predominantly comprised females (64.4%), individuals without long-term medical conditions (86.4%), with a mean age of 42.2 years (SD ± 20.8). Teleconsultations were mainly conducted by liberals’ physicians (86.8%) and health centre-employed practitioners (12.1%). The use of teleconsultation platforms increased fivefold between the first semesters 2021 (4.2%) and 2023 (28.2%). Teleconsultations resulted in medications targeting the nervous system (53.1%), digestive system (28.3%), and respiratory system (21.8%). Two contexts of dispensing emerged: dispensing with chronic indication (42.8% of TLCs) characterized by a long median time and several dispensing, and dispensing with an acute indication (55.6%), characterized by single dispensing with a 0-1 day between teleconsultation and dispensing. Conclusion  One third of the teleconsultations resulted in medication dispensing, mainly for young, urban patients with good access to care, in contrast to the objective as described in the French Law. Dispensing patterns revealed two distinct modalities, acute symptomatic and chronic disease management. Certain classes of drugs dispensed (antibiotics, opioids, benzodiazepines) may raise questions about appropriate dispensing practices in teleconsultations. https://www.ijhpm.com/article_4870.html Background  Amidst growing pressures on primary care services in England, the Pharmacy First (PF) scheme was introduced in 2024 to enable community pharmacists (CPs) to manage seven common conditions, including supplying antibiotics, where appropriate, according to patient group directions (PGDs). PF aims to increase timely access to care, reduce general practitioner (GP) workloads, and address health inequalities in terms of access to primary healthcare. This paper, part of a wider evaluation of PF, aims to describe and explain the factors affecting its development and early implementation. Methods  Semi-structured (n = 31) qualitative interviews were conducted with policy-makers, representatives of national community pharmacy and general practice bodies and frontline CPs and GPs in England. Analysis was guided by a framework combining Walt and Gilson’s “Policy Triangle” and the Consolidated Framework for Implementation Research (CFIR). Results  The study identified a range of factors shaping PF development and implementation. These included policy design complexity, stakeholder engagement, political priorities, and contextual pressures such as funding constraints and workforce shortages. Pharmacists welcomed the clinical upskilling opportunity, while GPs voiced concerns about patient safety and duplication of work. A lack of public awareness, inadequate training access (particularly for independent pharmacies and locum CPs), and poor interoperability between community pharmacy and general practice information systems further hindered rollout. Policy “layering,” with limited consideration of the implications for existing community pharmacy clinical services and the absence of a phased implementation strategy caused confusion among GPs and patients. Conclusion  PF illustrates both the potential and challenges of expanding clinical roles in community pharmacy through national policy. Despite political backing and sector-wide engagement, its implementation faced structural, financial, and communication barriers. Realising its full potential requires workforce and integrated information infrastructure, sustainable funding, and clear inter-professional communication and information sharing between general practice and community pharmacy. https://www.ijhpm.com/article_4833.html Efforts to reduce the healthcare sector’s carbon footprint and greenhouse gas (GHG) emissions have brought increased attention to the adoption of the circular economy (CE) in recent years. These efforts aim to lower carbon-intensive products while improving efficiency, waste reduction, and healthcare resilience. Soares et al conducted a scoping review examining CE applicability in healthcare and identified strategies to enhance its implementation. In this commentary paper, a novel abstract text mining (ATM) approach is introduced as a complement to the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Using this approach, the search terms employed by Soares et al were expanded, article abstracts were extracted, and scope areas were mapped with the assistance of a well-established machine learning technique—latent Dirichlet allocation (LDA) topic modeling. Comparison of the ATM results with those reported by Soares et al revealed three additional scope areas: alternative treatment pathways, pharmaceutical footprint reduction, and the utilization of emerging technologies. https://www.ijhpm.com/article_4834.html This commentary draws on findings from Hoogervorst et al1 to underscore the urgent need for internationally coordinated medical device registries, addressing the fragmentation and inconsistency currently limiting their utility in Europe. It advocates for registries governed by academic specialty societies to ensure scientific integrity, transparency, and clinical relevance. Such registries can significantly enhance post-market surveillance, support regulatory compliance and accelerate real-world evidence (RWE) generation. The importance of standardized data collection, regular outcome reporting, and contributor recognition to foster engagement and improve data quality is highlighted. By complementing randomized controlled trials (RCTs), registries can detect rare adverse events, inform clinical guidelines and drive innovation. Actionable recommendations for governance, data harmonization and interoperability are given, emphasizing that now is the time for academic societies to lead this transformation for the benefit of patients and healthcare systems globally. https://www.ijhpm.com/article_4835.html In a world still grappling with exploring the underlying dynamics of challenges confronting human resources for health (HRH), how must the HRH research and planning ensue in conflict-affected settings (CAS)? Onvlee and colleagues undertake a scoping review to respond to this important question, using the World Health Organization’s (WHO’s) Health Labour Market (HLM) framework, to leverage upon available evidence. This commentary appraises the conceptual and methodological contributions of the review, while questioning the suitability of HLM to analyse HRH challenges in disrupted health systems. It argues that CAS-specific HRH planning exacts frameworks and approaches more attuned to political economy, contextual fragility, and structural inequalities, which shape healthcare workers’ vulnerabilities and responses in CAS. The commentary identifies five gap questions for future scholarship, calling for intersectionality-driven, politically informed and context-specific research approaches for HRH evidence, transcending supply and demand framing of HRH, to inform HRH policies in conflict-affected and fragile settings. https://www.ijhpm.com/article_4839.html The review stands out for its methodological rigour, clear results, and frank recognition of its limitations. However, the picture proposed by it is incomplete. Two aspects of great consequence are discussed in this commentary as a complement to the review. First, the political agency of human resources for health (HRHs) must always be considered. Among them, many take sides in a variety of roles, overt or not, as militants, activists, supporters, and researchers. Second, without including the informal practices adopted by HRH to survive and deliver in hostile environments, the health labour market cannot be understood. Arguably, these two key dimensions were not prominent in the review because the HRH literature prefers to focus on formal technical aspects easier to study and more likely to be published. Some of the reasons behind their neglect are suggested by this commentary, which concludes with a few remarks about how this drawback might be corrected. https://www.ijhpm.com/article_4850.html Attacks on healthcare are increasing globally, often with impunity and limited accountability with profound impacts on healthcare workers, the populations they serve and the wider health system, with effects that last well beyond the end of hostilities. Healthcare workers face impacts both on their personal and professional lives, with additional strains on their families which can lead them to emigrate, even where they may hold idealistic resolve to remain. This exodus (as well as the killing or detention) of their colleagues, places strains on the remaining healthcare workers and health system at a time when needs are at their highest. The cessation of such attacks, the naming of perpetrators and enforcing legal accountability are essential. To mitigate the long-term impacts on the health system, policies which build resilience into the production, distribution, retention, and demand components of health labour market (HLM) dynamics must be implemented in ways which are contextualised and dynamic. https://www.ijhpm.com/article_4858.html Hoogervorst et al systematically reviewed European cardiovascular and orthopaedic medical device registries to assess their preparedness for regulatory decision-making. The authors found high heterogeneity between data sources, limited transparency, and incomplete patient/procedure data, hindering cross-registry comparisons and regulatory reliability. Despite these limitations, registries remain essential for post-marketing surveillance, as exemplified by the case of “Metal on Metal” hip implants. In this commentary, we highlight emerging or ongoing initiatives focused on improving real-world evidence for medical devices, such as the UK’s Medical Devices Outcomes Registry (MDOR), which seeks to address current limitations by developing a centralised database with linkage to electronic health records (EHRs). Parallel initiatives, including Sentinel, Data Analytics and Real-World Interrogation Network (DARWIN EU®), National Evaluation System for Health Technology (NEST), and Guidance and Tools for Real-World Evidence Generation and Use for Decision-Making in Europe (GREG), seek to strengthen real-world evidence through common data models (CDMs) and federated analytics. Specifically, NEST and GREG focus on enhancing real-world data methods and guidelines for medical devices and drug-device combinations. Overall, all these initiatives represent major progress towards more robust and transparent systems for medical device surveillance. https://www.ijhpm.com/article_4859.html Karami and colleagues’ scoping review proposes a conceptual framework for age-friendly health systems based on Van Olmen’s 10-element model. The scoping review mapped existing literature on health service delivery for older adults using Arksey and O’Malley’s methodology. They generated a framework that prioritizes person- and family-centered care to reduce harm, improve satisfaction, and enhance value. Key components include strong governance, trained multidisciplinary teams, integrated service delivery across settings, and active involvement of older adults and caregivers in decision-making. The framework aligns with existing age-related models like PRISMA (Program of Research to Integrate the Services for the Maintenance of Autonomy) and the Universal Model of Family-Centered Care. Future research should focus on operationalizing and implementing core components of Karami’s framework. Co-design is an emerging methodological approach used to develop models of care. It can be used to formally engage older adults, families, and professionals to operationalize core components of Karami’s framework with the goal of improving health service delivery for our aging population. https://www.ijhpm.com/article_4867.html Global geopolitical conflicts, pandemics, the climate crisis or rising inequities within and between countries alongside other intersecting crises all impede the pursuit of healthier societies. This commentary highlights gaps in how framing and measurement approaches reflect narrower biomedical conceptualizations of health. These gaps also relate to whether and how power is analysed, and how interventions that contribute to the (re)building of healthier societies are designed, implemented and evaluated. Dominant measurement approaches in health that prioritize individual measurement of problems and solutions at the expense of whole-of-society intersectoral interventions, and their governance are among some of the reasons. More holistic and explicit measurement equity and well-being (as opposed of disease) are required. Theory-informed research that interrogates values, social norms and ideologies, power asymmetries and that centres the study of complex context-sensitive policy and program interventions should inform future inquiries. https://www.ijhpm.com/article_4836.html https://www.ijhpm.com/article_4864.html https://www.ijhpm.com/article_4830.html https://www.ijhpm.com/article_4832.html https://www.ijhpm.com/article_4838.html https://www.ijhpm.com/article_4841.html https://www.ijhpm.com/article_4843.html https://www.ijhpm.com/article_4851.html https://www.ijhpm.com/article_4854.html https://www.ijhpm.com/article_4860.html https://www.ijhpm.com/article_4869.html https://www.ijhpm.com/article_4848.html https://www.ijhpm.com/article_4866.html https://www.ijhpm.com/article_4883.html