Khan MW, Vallbona-Vistós M, Cavet M
… +2 more, Vilahur N, Turner MC
Eur J Public Health
· 2026 Mar · PMID 41934224
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Occupational exposure to cancer risk factors is an important avoidable cause of cancer. The European Agency for Safety and Health at Work (EU-OSHA) conducted a Workers' Exposure Survey (WES) on cancer risk factors to inc...Occupational exposure to cancer risk factors is an important avoidable cause of cancer. The European Agency for Safety and Health at Work (EU-OSHA) conducted a Workers' Exposure Survey (WES) on cancer risk factors to increase knowledge on the prevalence and circumstances of exposure to 24 known cancer risk factors and on workplace prevention strategies in Europe. This manuscript focusses on the human health and social care work activities (HeSCare) sector, one of the largest occupational sectors in Europe. WES includes 24 402 telephone interviews from 2022 to 2023 on workers in Finland, France, Germany, Hungary, Ireland, and Spain. WES uses the Occupational Integrated Database Exposure Assessment System (OccIDEAS) where probable exposure to selected cancer risk factors during the last working week was automatically estimated based on workers' answers to detailed sets of questions adapted to the EU context. There were 3041 workers affiliated with the HeSCare sector and almost two-thirds (65.3%) were female. A total of 29.5% of workers were probably exposed to one or more of the included cancer risk factors and 7.8% to two or more. The most common exposures among those considered were to ionizing radiation (7.4%), diesel engine exhaust emissions (6.2%), solar ultraviolet radiation (6.1%), formaldehyde (5.2%), and benzene (4.8%). The most frequent exposures estimated to occur at a high level in HeSCare were formaldehyde (2.3%) and ethylene oxide (2.0%). WES provides valuable sector-specific data about exposure to the most common cancer risk factors in occupational settings in Europe.
Mushkat T, Greenberg R, Isakov O
… +4 more, Hayek S, Raskas H, Ben-Shachar S, Berliner-Senderey A
Eur J Public Health
· 2026 Mar · PMID 41921970
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Psychologically Informed Reminder Messages (PIRMs) may promote health-behavior change, but their impact on preventive genetic screening is unclear. Due to low adherence to a screening program, Clalit Health Services init...Psychologically Informed Reminder Messages (PIRMs) may promote health-behavior change, but their impact on preventive genetic screening is unclear. Due to low adherence to a screening program, Clalit Health Services initiated an intervention to encourage BRCA1/2 carrier screening in July 2022. This observational study assesses the effectiveness of the intervention in encouraging screening and its spillover effect on related healthcare utilization, focusing on Ashkenazi Jewish females aged 25-50 with no relevant cancer history. Patients were randomly assigned to receive one of five PIRMs. Four PIRMs utilized different psychological strategies, while the fifth served as a control. The effectiveness of the intervention on screening adherence was assessed using a regression discontinuity analysis. A Cox regression assessed the effectiveness of the four PIRMs compared to the control. Spillover effects on healthcare utilization were evaluated using logistic regressions. The intervention showed a positive correlation with increased adherence to screening (β = 0.37, 95% CI: 0.01-0.72). The "Barrier Remover" PIRM emphasized ease (hazards ratio = 1.09, 95% CI: 1.02-1.16), while the "Health Control" PIRM focused on autonomy (hazards ratio = 1.07, 95% CI: 1.01-1.14), both indicating greater effectiveness than the control. The findings suggest a positive short-term spillover effect of the "Health Control" PIRM on healthcare utilization compared to the control (odds ratio = 1.16, 95% CI: 1.04-1.29). PIRMs effectively increased BRCA1/2 carrier screening adherence, demonstrating a scalable, low-cost intervention to improve preventive healthcare uptake. The effect varied by the psychological strategies, highlighting the potential of tailored behavioral interventions to enhance public health.
Duquenne P, Samieri C, Chambaron S
… +10 more, Feron G, Brindisi MC, Kesse-Guyot E, Berthy F, Léger D, Galan P, Hercberg S, Touvier M, Andreeva VA, Fezeu LK
Eur J Public Health
· 2026 Mar · PMID 41921969
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Sleep disorders and, to a lesser extent, anxiety disorders, have been studied independently for their association with weight status. However, these mental disorders are highly comorbid. We investigated the prospective a...Sleep disorders and, to a lesser extent, anxiety disorders, have been studied independently for their association with weight status. However, these mental disorders are highly comorbid. We investigated the prospective associations of anxiety, insomnia, and anxiety-insomnia comorbidity with obesity risk in general-population adults. Enrollees in the ongoing NutriNet-Santé cohort were selected if they had anxiety (Spielberger's State-Trait Anxiety Inventory [STAI-T], 2013-16) and insomnia data (sleep questionnaire, 2014), were without obesity at baseline, and had body mass index (BMI) data during follow-up. Four baseline morbidity groups were modeled: neither insomnia nor anxiety (reference), high anxiety only (STAI-T ≥ 40), insomnia only, comorbid anxiety, and insomnia. The associations between each of these morbidity groups and incident obesity (BMI ≥30 kg/m2) were assessed using adjusted Cox proportional hazards models. Among 23 797 participants, anxiety, insomnia, and comorbid anxiety and insomnia were present in 21%, 6%, and 7% of men, respectively, and in 29%, 8%, and 14% of women, respectively. Mean follow-up was 6.2 ± 2.0 years. An adjusted significant association between anxiety-insomnia comorbidity and incident obesity was found in men (HR = 1.71, 95% CI: 1.06-2.76) but not in women (HR = 1.00, 95% CI: 0.77-1.30) or in the full sample (HR = 1.12, 95% CI: 0.89-1.42). No associations were observed between anxiety alone or insomnia alone and incident obesity. This large prospective study advances public health knowledge about multimorbidity by suggesting a prospective, sex-specific association between anxiety-insomnia comorbidity and increased risk of new-onset obesity. Upon replication, the findings could help inform obesity prevention programs.
Staal IIE, Manshanden N, Schreuder A
… +6 more, Vermeulen MJ, van den Akker CHP, Buurman M, van Drongelen K, Velzel J, Bouwmeester-Landweer MBR
Eur J Public Health
· 2026 Mar · PMID 41921968
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Breastfeeding is acknowledged as the optimal source of nutrition for newborns. Data from 2018 indicated a downwards trend in breastfeeding in the Netherlands. Our primary aim was to assess the current prevalence of breas...Breastfeeding is acknowledged as the optimal source of nutrition for newborns. Data from 2018 indicated a downwards trend in breastfeeding in the Netherlands. Our primary aim was to assess the current prevalence of breastfeeding, formula feeding, and combination feeding. Additionally, we explored factors influencing maternal feeding choices. A cross-sectional survey study was conducted from 2 November 2023 to 2 December 2023. Dutch parents of infants were recruited via Youth Health Care services and online channels, who completed a structured questionnaire on feeding practices, sociodemographic factors, and reasoning. A total of 4803 questionnaires were filled in, of which 215 (4.5%) were excluded because the child was older than 1.5 years or no feeding information was provided. Among mothers, 64% (2949/4588) initiated exclusive breastfeeding after birth, declining to 53% (2329/4385) at 1 month, 49% (1586/3260) at 3 months, and 33% (679/2083) at 6 months. The primary reason for initiating breastfeeding was the belief that breastfeeding is healthier for the baby (2053/3207, 64.0%). When breastfeeding was discontinued, the predominant reason was insufficient milk supply or fear thereof (352/1260, 27.9%). Of 756 mothers who stopped earlier than planned 73.1% (553/756) felt disappointed. High maternal education, home delivery, and first skin-to-skin contact duration of at least 1 hour were positively associated with exclusive breastfeeding. Targeted interventions and standardized data collection are needed to improve breastfeeding support and enable consistent monitoring of trends over time.
Schrempft S, Chevalier C, Antille D
… +3 more, Dumont R, Guessous I, Nehme M
Eur J Public Health
· 2026 Mar · PMID 41916336
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Population trends in cognitive performance have been mixed, and few studies included data following the COVID-19 pandemic. We examined 20-year cognitive performance trends, and the contribution of modifiable dementia ris...Population trends in cognitive performance have been mixed, and few studies included data following the COVID-19 pandemic. We examined 20-year cognitive performance trends, and the contribution of modifiable dementia risk factors. We used repeated cross-sectional survey data from 2005 to 2025. Adults aged 50 to 75 years completed the clock drawing test (N = 6902, 51% women). We calculated the updated LIfestyle for BRAin health (LIBRA2) index. Analyses used linear regression models. Cognitive performance declined over time [β (95% CI), -0.11 (-0.14 to -0.09), P <.001]. Higher LIBRA2 scores were associated with poorer cognitive performance [-0.08 (-0.11 to -0.05), <.001]. The decline in cognitive performance remained significant after adjustment for the LIBRA2 and its components. There was a small but significant decline in cognitive performance between 2005 and 2025. Well-known dementia risk factors did not fully explain the decline. Further research is needed to identify contributing factors, including the impact of digitalisation on society.
Lacalaprice D, Scarsi N, Gianfagna F
… +3 more, Paladini A, Boccia S, Pastorino R
Eur J Public Health
· 2026 Mar · PMID 41915858
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Understanding the environmental impact of food consumption is essential for addressing climate change and water scarcity. This study investigates the carbon and water footprints (WFs) of dietary habits in Italy, identify...Understanding the environmental impact of food consumption is essential for addressing climate change and water scarcity. This study investigates the carbon and water footprints (WFs) of dietary habits in Italy, identifying sociodemographic and dietary determinants influencing these impacts. We conducted a cross-sectional analysis using data from the nationally representative Italian National Food Consumption Survey (INRAN-SCAI) 2005-06, which included 2831 participants. Daily food intake was multiplied by environmental coefficients from the SU-EATABLE LIFE database to estimate carbon (kg CO2 eq) and water (l) footprints. We used multiple regression models to assess associations between environmental indicators and individual characteristics, including age, sex, education, body mass index, geographical area, and adherence to the Mediterranean diet (MD). The mean daily carbon footprint (CF) was 3.53 kg CO2 eq, and the mean WF was 3331 l. Animal-based food groups were the main contributors to both footprints, particularly meat, which accounted for 6.87% of the total CF and 27.54% of the total WF, and dairy products, contributing 20.0% to CF and 21.3% to WF. Higher adherence to the MD was associated with lower carbon (9.84 vs 11.01 kg CO2 eq) and WFs (9356.0 vs 10 348.3 l). Multiple analysis showed this association remained significant for both carbon (β = -0.239) and WFs (β = -206.4), independent of energy intake. Animal-based foods and specific sociodemographic factors substantially influence the environmental impact of diet. Promoting Mediterranean-style, plant-based diet through targeted policies for specific populations could enhance environmental sustainability.
Mygind L, Johnstone A, Kryeziu AR
… +29 more, Billet B, Nyström CD, Sandseter EB, Mäestu E, Lemberg GM, Cante G, Dodd H, Brazo-Sayavera J, Jarani J, Maciaszek K, Rentzou K, Bølling M, Bloemen MAT, Mannello M, Bradwell M, Löf M, Kangas M, Leather M, Bergin M, Bezjak N, Bakalár P, Salaj S, Morrison SA, Siklander S, Veiga-Seijo S, Popovic S, Csányi T, Morgenthaler T, Bentsen P
Eur J Public Health
· 2026 Mar · PMID 41903331
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Outdoor play (OP) is strongly associated with human health, development, and wellbeing, yet modern lifestyles and changing environments increasingly restrict opportunities for OP. The state of OP in Europe is not well un...Outdoor play (OP) is strongly associated with human health, development, and wellbeing, yet modern lifestyles and changing environments increasingly restrict opportunities for OP. The state of OP in Europe is not well understood, as there is limited alignment among researchers, practitioners, and policymakers in defining, researching, or promoting opportunities for OP within communities and across Europe more broadly. This study aims to offer a comprehensive assessment of the European OP system by mapping its core elements-terminology, research, practice, and policy. This mixed-methods study collected data through expert-elicitation from countries across Europe, with particular focus on traditionally underrepresented regions. Although there has recently been more emphasis on the health benefits of OP, conceptual and ontological differences relating to OP continue to challenge any consistent harmonization or cross-country comparison processes. Based on these observations, we formulate actions to strengthen the OP system across Europe, including enhancing monitoring, promoting supportive policy, and leveraging international, cross-disciplinary forums. Coordinated researcher and practitioner networks can identify priorities, support mission-driven projects, and inform Europe-level policies to expand OP opportunities and drive positive, resilient continental health outcomes.
Belgodère L, Leleu C, Bacon T
… +9 more, Daynes P, Decoene C, Feugier P, Mazet R, Vial T, Vignot S, Benkebil M, Oualikene-Gonin W, Maison P
Eur J Public Health
· 2026 Mar · PMID 41903330
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Drug shortages are a growing public health issue, unevenly impacting therapeutic classes. Despite variations in drug consumption across populations, the consequences of these shortages on different patient groups remain...Drug shortages are a growing public health issue, unevenly impacting therapeutic classes. Despite variations in drug consumption across populations, the consequences of these shortages on different patient groups remain insufficiently characterized. This study investigated age and sex profiles of patients consuming the therapeutic classes most commonly affected by drug shortages in France. The age and sex risk of shortage exposure were estimated in a nationwide retrospective study of French patients between 2014 and 2023, using data from the French drug shortage notification system and the national health insurance for the entire French population. Over 10 years, 17 505 drug shortage reports were recorded, 60.8% involving cardiovascular, nervous system, and anti-infective agents. Significantly higher mean percentages of consumers for drugs concerned by shortage reports per 1000 were observed in ≥60-year-old patients for 12 of the 14 therapeutic classes, compared to 20-59-year-old patients (P = .002). Younger population was more significantly concerned by anti-infective agents (11.2 vs 9.2, P = .002), respiratory system (1.8 vs 1.5, P = .002), and sensory organ (0.7 vs 0.6, P = .002) classes. Significantly higher mean percentages of consumers for drugs concerned by shortage reports per 1000 were observed for all Anatomical Therapeutic Chemical 1st level classes in women (P = .002), but agents acting on the renin-angiotensin system were higher for men (2.32 vs 2.02; P = .002). Our exploratory results suggest that a population-level approach is essential to understand how shortages affect different groups and exacerbate health inequalities.
Gvinianidze K, Bakhturidze G, Abuladze T
… +5 more, Dekanosidze A, Sturua L, Gegenava V, Tarasenko Y, Ciobanu A
Eur J Public Health
· 2026 Mar · PMID 41903329
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Adolescent tobacco and nicotine product (TNP) use remains a public health concern, with emerging gender convergence and rising e-cigarette use among females. We examined gender-specific trends in Georgian adolescents alo...Adolescent tobacco and nicotine product (TNP) use remains a public health concern, with emerging gender convergence and rising e-cigarette use among females. We examined gender-specific trends in Georgian adolescents alongside national tobacco control policies and social context. We analyzed nationally representative Global Youth Tobacco Survey data from Georgia (2014, 2017, and 2023) for youth aged 11-17 to estimate the prevalence and patterns of current TNP use in the context of tobacco-related advertising and promotion, secondhand smoke, and national policy, via a policy review. Adjusted prevalence estimates were derived using post-estimation predictive margins after fitting multinomial logistic regression models. From 2014 to 2023, current TNP use declined among boys but increased among girls, particularly in exclusive e-cigarette use. The percentages reporting no current TNP use increased among boys from 77.4% to 85.6% (P < .01), but declined among girls from 92.1% to 88.1% (P = .04). By 2023, exclusive e-cigarette use was more prevalent among girls than boys. Across sexes, exposure to pro-tobacco advertising and promotion and secondhand smoke declined. Exposure to anti-tobacco promotion peaked in 2017 and receded by 2023. The policy review documented strengthened measures, alongside gaps in oversight of digital marketing and newer products, including e-cigarettes. Georgia's tobacco control policies have contributed to reduced TNP use among boys and a less permissive social environment. Rising e-cigarette use among girls is concerning. Policies should close regulatory gaps, enhance enforcement, and address evolving product and marketing developments to prevent TNP uptake and protect adolescents from tobacco-related harms.
Mackowiak MM, Hoyer A, Piedboeuf-Potyka K
… +3 more, Neuhäuser M, Kuss O, Tönnies T
Eur J Public Health
· 2026 Mar · PMID 41873882
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Diabetes negatively impacts productivity, but the extent to which socio-economic factors influence this effect is unknown. This study examines how diabetes duration affects labour force participation and sick leave in Ge...Diabetes negatively impacts productivity, but the extent to which socio-economic factors influence this effect is unknown. This study examines how diabetes duration affects labour force participation and sick leave in Germany, focusing on socio-economic differences. We used self-reported data collected between 2009 and 2021 from the German Socio-Economic Panel Study, a longitudinal household survey. People with prevalent diabetes at baseline were excluded. To estimate the causal effect of diabetes duration on the outcomes, we employed marginal structural regression models for repeated measures, using stabilized inverse-probability-of-treatment-and-censoring weights to adjust for informative censoring, time-fixed (sex, age, socio-economic position, migration background) and time-varying confounding (body mass index, physical activity frequency, smoking status, previous outcome). We included interaction terms to assess diabetes-related productivity losses by subgroups of socio-economic position, sex, age and migration background. The analysis consisted of 35 906 observations from 18 456 individuals for the outcome labour force participation and 12 469 observations from 7244 individuals for the outcome sick leave days. A five-year increase in diabetes duration was associated with a labour force participation shortfall of 13.8% (95% confidence interval: 5.8; 21.1) and an increase of 6.8 sick leave days (-5.4; 19.0). Effects were more pronounced among individuals in lower socio-economic position and diminished with increasing socio-economic position. Diabetes-associated productivity losses predominantly affect people in low socio-economic position, reflecting a dual burden of higher diabetes prevalence and larger productivity losses.
Jonsson E, Elling DL, Landberg J
… +3 more, Helgesson M, Lundin A, Thern E
Eur J Public Health
· 2026 Mar · PMID 41865263
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While alcohol's health effects are well documented, less is known about how health influences alcohol use and whether this varies by socioeconomic position (SEP). This study investigated the association between health-re...While alcohol's health effects are well documented, less is known about how health influences alcohol use and whether this varies by socioeconomic position (SEP). This study investigated the association between health-related quality of life (HRQoL), mental health, and alcohol use, and whether SEP moderates these associations. Baseline data from 7097 participants in the 2010 Stockholm Public Health Cohort were used. The exposures were HRQoL and mental health (good, moderate, poor); Outcomes (2014) were heavy episodic drinking (HED: ≥5 units/≥2 times/month) and heavy drinking (men: ≥21 units/week; women: ≥14 units/week). Logistic regression estimated odds ratios (OR), with interaction assessed using relative excess risk of interaction (RERI) and attributable proportion (AP). Joint exposure analyses used good health and high SEP as the reference group. Compared with good HRQoL, moderate (OR: 1.26, 95% CI: 1.02-1.56) and poor HRQoL (OR: 1.39, 95% CI: 1.08-1.78) were associated with higher odds of heavy drinking. Moderate HRQoL and low SEP had increased odds of HED (OR: 1.48, 95% CI: 1.02-2.15) and heavy drinking (OR: 1.62, 95% CI: 1.01-2.60), with evidence of additive interaction (RERI: 0.79; AP: 0.49). Mental health findings were less consistent: good mental health and low SEP was associated with increased HED (OR: 1.35), while moderate mental health and intermediate SEP was associated with decreased HED (OR: 0.66). Findings suggest a dose-response relationship between HRQoL and self-reported heavy drinking and an interaction between moderate HRQoL and low SEP. Associations with mental health were weaker and inconsistent.
Oehlke SM, Goreis A, Lozar A
… +4 more, Klinger D, Plener PL, Zeiler M, Kothgassner OD
Eur J Public Health
· 2026 Mar · PMID 41861144
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Long COVID (LC) is a heterogeneous, multisystem condition that persists beyond the acute phase of SARS-CoV-2 infection. Psychological symptoms are highly prevalent and may influence the course and severity of LC. However...Long COVID (LC) is a heterogeneous, multisystem condition that persists beyond the acute phase of SARS-CoV-2 infection. Psychological symptoms are highly prevalent and may influence the course and severity of LC. However, their specific role within the broader symptom structure remains insufficiently understood. This study applied a psychological network approach to examine how psychological factors contribute to the overall symptom structure of LC and to identify central and bridging variables that may serve as promising targets for intervention. A sample of 283 individuals with LC (nfemale = 235, nmale = 47, ndiverse = 1; age: M = 39.48, SD = 13.29) completed an online survey assessing post-viral physical symptoms and psychological factors, including depression, anxiety, COVID-19-related traumatic stress, and lack of self-efficacy. A regularized partial correlation network was estimated based on ten variables. The network revealed a dense degree of connectivity, with psychological factors integrated into the broader symptom structure. Depression emerged as the most central variable. Cardiovascular and respiratory symptoms, neurological symptoms, and depression served as key bridge variables. Lack of self-efficacy showed moderate associations with COVID-19-related traumatic stress and anxiety. Female gender was linked to greater gastrointestinal symptom burden, while older age was associated with more pronounced cardiovascular and respiratory symptoms. This study underscores the central role of psychological factors-particularly depression-as key targets for intervention in LC. By advancing the understanding of factors shaping health outcomes in LC, our findings support the integration of psychological approaches into the clinical management of affected individuals.
Cylus J, Thomson S, Habicht T
… +1 more, Evetovits T
Eur J Public Health
· 2026 Mar · PMID 41859920
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Global and regional commitments to universal health coverage emphasize reducing financial hardship due to out-of-pocket payments for health care. Despite this, many countries continue to rely on user charges-either to ra...Global and regional commitments to universal health coverage emphasize reducing financial hardship due to out-of-pocket payments for health care. Despite this, many countries continue to rely on user charges-either to raise revenue or reduce demand-especially under fiscal pressure. We conducted a narrative review of academic literature on the theoretical basis for and empirical effects of user charges in health systems. This was complemented by recent case studies from Slovenia, Estonia, and Cyprus, selected to illustrate diverse approaches to user charge policy under fiscal constraints. Common arguments in favour of user charges are that they can mitigate excess health care consumption and generate revenues. However, evidence suggests they often deter necessary care and lead to financial hardship, especially for low-income groups. Country case studies reveal varied approaches towards user charges in the context of fiscal pressure: Estonia increased co-payments despite prior efforts to improve financial protection; Slovenia eliminated user charges by introducing a flat levy to generate additional revenue; and Cyprus dramatically reduced its reliance on out-of-pocket payments by increasing public spending on health. Growing fiscal pressure may tempt countries to implement or increase user charges. However, doing so without adequate protective mechanisms can increase financial hardship, poverty and unmet health needs. Policymakers should prioritize pre-payment mechanisms and equity-oriented safeguards to ensure sustainable, fair and affordable access to health care. Continuous monitoring of financial hardship remains essential to inform policy decisions.
Eur J Public Health
· 2026 Mar · PMID 41859919
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Through its activities and energy consumption, the healthcare sector contributes to environmental degradation and climate change. With rising healthcare demands, the adoption of sustainable models has become increasingly...Through its activities and energy consumption, the healthcare sector contributes to environmental degradation and climate change. With rising healthcare demands, the adoption of sustainable models has become increasingly urgent. Circular economy (CE) principles-Reduce, Reuse, Recycle, and Recover-offer a strategic framework to minimize waste and resource use while enhancing system resilience. A narrative review was conducted using Medline (PubMed) and Web of Science, covering literature from January 2015 to June 2025. Studies were selected based on relevance to CE principles in healthcare, including case studies, reviews, and original research. The review identified diverse interventions aligned with CE principles, including reducing low-value care and energy consumption, optimizing surgical trays, promoting reusable medical devices, enhancing waste segregation, and recovering energy from non-recyclable waste. Case studies from various countries highlight both environmental and economic benefits, such as lower CO2 emissions, cost savings, and greater operational efficiency. However, challenges remain, including limited climate literacy, regulatory gaps, and insufficient leadership. Applying CE principles in healthcare can significantly reduce environmental impact while supporting high-value care and financial sustainability. Broader adoption requires systemic policy support, stakeholder engagement, and integration of environmental metrics into clinical and procurement decisions.
Koivusalo M, Valentine N, Williams C
… +2 more, Ollila E, Kokkinen L
Eur J Public Health
· 2026 Mar · PMID 41859918
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The Health in All Policies (HiAP) approach has been the main focus for intersectoral action for health and heath equity but has proved challenging as result of other political and economic priorities of governments and t...The Health in All Policies (HiAP) approach has been the main focus for intersectoral action for health and heath equity but has proved challenging as result of other political and economic priorities of governments and the multilevel nature of policymaking. This article explores the role of HiAP in changing politics and policy context. The article takes a critical appraisal on how HiAP has been conceptualized and used to compare concepts associated with HiAP. It assesses the limits and potential for the use and application of different concepts drawing from a realist evaluation in understanding why, how, and for whom and in what context they work for HiAP. Illustrative case studies focus on the substance and provide examples from work with Ministries of Finance, Employment and Education. HiAP can be seen as a flexible overarching approach, which provides scope for action through several concepts and practices for intersectoral work. The comparison shows that definitions matter to the practice of HiAP concerning priorities, ideological premises, and level of governance. Ministries of Finance are crucial for action on equity and social determinants of health. HiAP requires understanding of health policy priorities and competences and capacities in public health and health systems governance as well as in analysis of politics, power, and different contexts of policymaking under multilevel governance. While HiAP aims to ensure health priorities in decision-making of all policies, if and how this is realized, is a political choice.
Eur J Public Health
· 2026 Mar · PMID 41859917
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Amidst low trust in public institutions, policy makers and scholars have proposed using the health system to help rebuild trust in other institutions. One potential mechanism to do so is linking the health system with pu...Amidst low trust in public institutions, policy makers and scholars have proposed using the health system to help rebuild trust in other institutions. One potential mechanism to do so is linking the health system with public programs, e.g. simple referrals, shared financing, or delivering social services via the health system. While other reviews have examined the technical aspects of such linkages, few have examined the political calculus involved. We conducted a narrative review of the academic and grey literature on the relationship between health and trust in public institutions, as well as political considerations when integrating health systems and social programs, including the attitudes, concerns, and constraints of beneficiaries, stakeholders (e.g. service providers), and political actors. For beneficiaries, attitudes about the health system are associated with attitudes about public institutions, and linking the health system to less popular public programs has been shown to increase engagement in the latter. However, unsuccessful handoffs and administratively burdensome social programs can alienate beneficiaries. Stakeholders are often eager to partner in linkages but can become frustrated by redundant roles and uncoordinated financing. For political actors, embedding social services in the health system may be logistically easier than maintaining standalone programs, but it may also result in weaker long-term public support. Thus, linking health systems and public programs can produce mutual "co-benefits" when done well. At the same time, policy makers must consider the political trade-offs inherent in the linkage. Future research should directly test whether these linkages causally impact broader social outcomes, such as political trust.
Eur J Public Health
· 2026 Mar · PMID 41859916
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This article examines how public procurement of pharmaceuticals can serve as a tool to advance both access to medicines and industrial development, in line with the Health in All Policies (HiAP) and Health for All Polici...This article examines how public procurement of pharmaceuticals can serve as a tool to advance both access to medicines and industrial development, in line with the Health in All Policies (HiAP) and Health for All Policies (HfIAP) agendas. We draw on four illustrative, purposefully selected cases-the pneumococcal Advance Market Commitment, emergency procurement of the Ebola vaccine, Operation Warp Speed for the accelerated production of coronavirus disease 2019 (COVID-19) vaccines, and Brazil's Partnerships for Productive Development. Through configurative analysis, we identify distinct procurement models and assess their contributions to health and industrial objectives. The analysis highlights several procurement models: anticipatory, reactive, emergency-driven, innovation-enabling, and capability-building. These cases demonstrate how procurement can generate co-benefits across Sustainable Development Goals (SDGs) 3 (health) and 9 (industry, innovation, infrastructure), while also revealing implementation gaps and structural constraints. Realizing the potential of procurement as a dual health-industrial tool requires linking it to capability-building, tailoring instruments to local and industrial contexts, and confronting structural asymmetries that limit national ownership. By treating procurement not as an administrative task but as an industrial strategy, governments can better operationalize HiAP/HfIAP and make progress toward more equitable and sustainable health innovation systems.