This systematic review mapped how social, commercial, political, and digital determinants of health have evolved during society's digital transformation. Analyzing 204 studies from 13,804 records (MEDLINE, Embase, Web of Science) published since 2018, supplemented by expert recommendations and recent literature searches, researchers identified 127 related health determinants across four domains: digital (37), social (33), commercial/economic (33), and political (24). Through thematic analysis and a two-round consensus process, 30 determinants (23.6%) were identified as requiring urgent policy attention. The findings provide a comprehensive framework for understanding how digitalization influences health outcomes through policy decisions, individual behaviours, and broader societal factors, offering insights for addressing these complex, interconnected determinants within the modern digital ecosystem. The study highlights the need for targeted policy interventions to address emerging health challenges in an increasingly digitalized society.
Equity in Health
This cross-sectional study examined the combined effects of smoking and alcohol consumption on hypertension among 4,372 adults in rural Uganda's Mukono and Buikwe districts. Among participants, 23% had high blood pressure. Results showed smokers had 1.36 times higher risk of hypertension than non-smokers, while moderate drinkers had 1.45 times and heavy drinkers 2.53 times higher risk than non-drinkers. Notably, the combination of smoking and heavy drinking produced an additive effect, with combined users showing 45% higher odds of hypertension than the sum of individual risks. These findings suggest the need for integrated interventions targeting both smoking and heavy drinking to reduce hypertension in rural Uganda.
This paper compared, using network analysis, the network structures of Internet addiction and mental health symptoms among university students in China and Malawi, to provide insights into culturally sensitive prevention and intervention strategies. The prevalence of internet addiction and mental health was significantly higher in China than Malawi. In Malawi, the strongest edges were school work, job performance and a sense of worthlessness. The central nodes were daily work, suffering, fantasizing and loss of interest. In China, the strongest edges were neglected household, neglected partner and difficulties with daily work suffering. The central nodes were trouble thinking, unhappiness, and inability to 'play a useful part'. Bridge symptoms varied between the countries, with functional impairments being more prominent in Malawi and emotional disturbances in China. The study highlights significant differences in the network structures of internet addiction and mental health between China and Malawi. This underscores the importance of culturally sensitive mental health interventions. In Malawi, addressing functional impairments related to academic and work performance is crucial, while in China, interventions should focus on emotional and relational aspects.
This mixed-methods study compared health districts with and without armed conflict exposure in South Kivu, DRC, using the Kruk index framework. Through document review, stakeholder interviews, and Likert scale questionnaires, researchers identified essential resilience components including prior knowledge of strengths/weaknesses and crisis risks, plus community and non-health actor involvement. The conflict-affected district implemented additional mechanisms including armed forces involvement, mobile clinics, warning systems, and displaced persons monitoring. Findings emphasize that health districts need better resourcing during stable periods to build capacity for crisis resilience, enabling improved care quality and disturbance management.
This study analyzed child malnutrition trends and determinants using Kenya Demographic Health Survey data (2014-2022), examining stunting, underweight, and wasting in children under five. Analysis showed increased socioeconomic inequality in malnutrition between 2014-2022, particularly affecting the poorest households. Key risk factors for stunting included child's age, household poverty, and sex, while underweight and wasting were associated with mother's age, child's sex, and socioeconomic status. Residence specifically influenced wasting risk. Socioeconomic status proved the strongest predictor of health inequality, though its effectiveness as a screening tool for stunting was moderate (sensitivity 67.4%, specificity 50.6%). Findings highlight the need for interventions that address both immediate health risks and underlying socioeconomic factors to improve child nutrition outcomes equitably.
When global outbreaks of disease are declared ‘over’, what, when and for whom is an end ‘the end’ and what happens after? How do declarations of ends shape personal experiences of crises, ongoing access to care, health and obligations? Global health is defined by narratives of a clearly discernible and singular end. Official announcements of ‘the end’, however, are often arbitrary and unstable. Furthermore, they can distract from important counter-narratives and undermine social, environmental, political and epistemic justice when those ‘left behind’ are excluded from discussions of whether the end has been achieved, or is achievable, and if so when and how. Today, uncertain trajectories, the ‘slow violence’ of environmental degradation, passive attrition of many diseases, and drug resistances question ideas of a singular extinction event and finality. Drawing on an interdisciplinary approach involving historians, sociologists, epidemiologists, psychologists, bioethicists, literary and legal scholars, philosophers and policymakers, this research has two synergistic empirical and normative aims: 1. to explore lived experiences of time and temporality of endings of crises, to capture counter-narratives and their implications for future practices, responses and policies, and 2. to provide an account of the moral and ethical obligations and responsibilities of global health institutions in the aftermaths of crises to health. From detailed comparative research in three countries, including ethnographic, cognitive time-perception and archival methodologies, the authors foreground the people, places, processes and policies to capture everyday experiences of endings and aftermaths in context.
This community-based case-control study identified determinants of teenage pregnancy in Malawi. It used secondary data from the 2015-16 Malawi Demographic and Health Survey from all 28 districts of Malawi. Data on 3435 participants 20-24 years old were analysed. In multivariable analyses: no teenage marriage; secondary education; higher education; richest category of wealth index, use of contraception, domestic violence by father or mother were found to be significant factors in teenage pregnancy. The authors recommend that the government sustain and expand initiatives that increase protection from teenage pregnancy, reinforce the implementation of amended marriage legislation, introduce policies to improve the socioeconomic status of vulnerable girls and increase contraceptive use among adolescent girls before their first pregnancy.
Equity is at the core and a fundamental principle of achieving the family planning (FP) 2030 Agenda. However, the conceptualization, definition, and measurement of equity remain inconsistent and unclear in many FP programs and policies. This paper documents the conceptualization, dimensions and implementation constraints of equity in FP policies and programs in Uganda, through. a review of literature and key informant interviews with 25 key stakeholders in 2020. A limited number of documents had an explicit definition of equity, which varied across documents and stakeholders. The definitions revolved around universal access to FP information and services, with limited focus on equity. The dimensions most commonly used to assess equity were either geographical location, or socio-demographics, or wealth quintile. Almost all the key informants noted that equity is a very important element, which needs to be part of FP programming. However, implementation, client and policy constraints were observed to continue to hinder its implementation in FP programs in Uganda.
Engaging with communities in informal settlements presents opportunities to mitigate the health impacts of climate change, but government investment is also needed. Around one third of the estimated 4.5 billion urban dwellers worldwide use pit toilets or septic tanks, which are normally the first to be overwhelmed in floods, spreading excrement and the pathogens it carries into the environment. Climate change is likely to exacerbate the challenges faced in cities. According to UN-Habitat, “cities are growing faster than governments can build the necessary institutional capacity to better plan and manage urban growth." in the absence of progress on urban investment, planning and management, one suggested way of addressing inequitable exposure to climate risk is to engage with the communities most affected. Not only are community members motivated to initiate risk mitigation measures, they also typically have the best understanding of their surroundings, including the makeup of the local population, and areas most likely to flood.
This theme issue of the Bulletin of the World Health Organization shows how health inequities affect many areas, both at national and global scale. The papers discuss health inequity and its root causes, and offer promising solutions. Challenges include national statistics not capturing health inequity among vulnerable populations such as Indigenous people, refugees and migrant workers, including migrant health workforce. However, good practices exist. For example on paper reports on local Indigenous communities successfully managing primary health-care clinics, that can be scaled up and replicated. Overall, the issue editors observe that rectifying global health inequity requires multidimensional interventions and decisive government leadership at the macro-policy level, collaboration with affected populations at the micro-operational level and accelerating progress towards UHC.