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With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency. In response to these issues, the UCL-Lancet Commission on Migration and Health was convened to articulate evidence-based approaches to inform public discourse and policy. The Commission undertook analyses and consulted widely, with diverse international evidence and expertise spanning sociology, politics, public health science, law, humanitarianism, and anthropology. The result of this work is a report that aims to be a call to action for civil society, health leaders, academics, and policy makers to maximise the benefits and reduce the costs of migration on health locally and globally. The outputs of our work relate to five overarching goals that we thread throughout the report. First, we provide the latest evidence on migration and health outcomes. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health. Migrants generally contribute more to the wealth of host societies than they cost. Our Article shows that international migrants in HICs have, on average, lower mortality than the host country population. However, increased morbidity was found for some conditions and among certain subgroups of migrants, (eg, increased rates of mental illness in victims of trafficking and people fleeing conflict) and in populations left behind in the location of origin. Currently, in 2018, the full range of migrants’ health needs are difficult to assess because of poor quality data. We know very little, for example, about the health of undocumented migrants, people with disabilities, or lesbian, gay, bisexual, transsexual, or intersex (LGBTI) individuals who migrate or who are unable to move. Second, we examine multisector determinants of health and consider the implication of the current sector-siloed approaches. The health of people who migrate depends greatly on structural and political factors that determine the impetus for migration, the conditions of their journey, and their destination. Discrimination, gender inequalities, and exclusion from health and social services repeatedly emerge as negative health influences for migrants that require cross-sector responses. Third, we critically review key challenges to healthy migration. Population mobility provides economic, social, and cultural dividends for those who migrate and their host communities. Furthermore, the right to the highest attainable standard of health, regardless of location or migration status, is enshrined in numerous human rights instruments. However, national sovereignty concerns overshadow these benefits and legal norms. Attention to migration focuses largely on security concerns. When there is conjoining of the words health and migration, it is either focused on small subsets of society and policy, or negatively construed. International agreements, such as the UN Global Compact for Migration and the UN Global Compact on Refugees, represent an opportunity to ensure that international solidarity, unity of intent, and our shared humanity triumphs over nationalist and exclusionary policies, leading to concrete actions to protect the health of migrants. Fourth, we examine equity in access to health and health services and offer evidence-based solutions to improve the health of migrants. Migrants should be explicitly included in universal health coverage commitments. Ultimately, the cost of failing to be health-inclusive could be more expensive to national economies, health security, and global health than the modest investments required. Finally, we look ahead to outline how our evidence can contribute to synergistic and equitable health, social, and economic policies, and feasible strategies to inform and inspire action by migrants, policy makers, and civil society. We conclude that migration should be treated as a central feature of 21st century health and development. Commitments to the health of migrating populations should be considered across all Sustainable Development Goals (SDGs) and in the implementation of the Global Compact for Migration and Global Compact on Refugees. This Commission offers recommendations that view population mobility as an asset to global health by showing the meaning and reality of good health for all. We present four key messages that provide a focus for future action.

Background Adolescent mental health disorders contribute significantly to the global disease burden. The estimates suggest that in 2019, one in seven adolescents experienced mental illness (166 million in total, 89 million boys and 77 million girls). The COVID-19 pandemic has exacerbated these numbers. Despite their severity, mental illnesses are often underdiagnosed and untreated, contributing to high global suicide rates. In Tanzania, where 23.1% of the population is aged 10–19 years, there is a notable absence of comprehensive programs to address adolescent mental health challenges. Limited infrastructure and awareness worsen this phenomenon, with common conditions like depression and alcohol use often not recognised as illnesses. Additionally, in environments affected by poverty and climate change, adolescent mental health issues are particularly pronounced, yet research and resources dedicated to this population remain insufficient. Recognizing these gaps, our study aimed to investigate determinants of mental well-being among adolescents in urban and rural Tanzania. Methods A cross-sectional survey was conducted from March to April 2021, targeting in-school adolescents in the Morogoro and Mwanza regions of Tanzania. The sample consisted of 489 adolescents aged 10 to 19 years. A self-administered questionnaire was used to collect data covering sociodemographic characteristics, socioeconomic status, violence, and mental well-being, measured through the WHO-5 Wellbeing Index. Data were analysed using Stata version 17, employing descriptive statistics, Cronbach’s α, confirmatory factor analysis, and bivariate and multivariable analysis to explore associations and factors influencing adolescent mental well-being. Results Out of 489 adolescents, the majority were aged 14 years and older, 270 (55.2%), with a nearly equal distribution between males and females. A significant portion of participants, 382 (78.1%), had good mental health. Experience of hunger within the past 12 months (aOR = 0.37, 95% CI: 0.26–0.51, p  < 0.001), experience of parental violence (aOR = 0.45, 95% CI: 0.36–0.56, p  < 0.001), mother being a head of household (aOR = 0.82, 95% CI: 0.79–0.85, p  < 0.001) or someone else (aOR = 0.38, 95% CI: 0.23–0.62, p  < 0.001) were among the factors significantly associated with adolescent mental well-being. The internal consistency measure for the WHO-5 Wellbeing Index was 0.77, confirming the reliability of this instrument. Conclusion The findings highlight that the majority of adolescents exhibited good mental health. However, social conditions such as hunger, exposure to parental violence, and maternal headship of household were negatively associated with well-being. Early, targeted interventions addressing these factors are critical to safeguarding adolescent mental health and preventing long-term consequences on both physical and psychological well-being, which may affect future life opportunities.

This article assesses a 10-month co-created universal school-based mental health (SBMH) promotion initiative for adolescents (10–19). The study combined quantitative and qualitative components. Pre- and post-intervention surveys were conducted in four schools in Tanzania (n = 400 baseline, 488 endline, with 100 intervention participants at both) and eight schools in Vietnam (n = 1,036 baseline, 893 endline and 436 in panel). In each country, ~90 qualitative interactions (interviews and focus groups) were held at baseline and endline with adolescents, parents, teachers and service providers (total = ~180). In Tanzania, multivariate analysis indicated significant gains among intervention participants relative to peers. Emotional literacy rose 9.5% (p = 0.007; d = 0.57). Attitudes toward help-seeking (p = 0.021; d = 0.50) and prosocial behaviors (p = 0.043, d = 0.38) also improved Active coping increased 15.6% (p = 0.006; d = 0.55). In Vietnam, emotional literacy increased 5.3% (p = 0.012, η2 = .019), and positively, emotion-focused coping declined 14.4% (p = 0.032, η2 = .015). Qualitative evidence reinforces these findings, and suggested spillover effects for nonparticipants. Overall results indicate that co-created universal SBMH initiatives can improve adolescent well-being and offer viable alternatives to limited adolescent-focused mental health services in LMICs.

OP 18: Mental Health 1, B304 (FCSH), September 4, 2025, 13:30 - 14:30 Background While there is significant literature on migration journeys, the focus is often economic or political, while mental health (MH) along these corridors is less explored. There is increasing awareness of the need to address MH issues. This review aimed to explore the MH of South Asian migrants to the UK and Gulf Countries (GCC) at all stages of their migration journey and what interventions exist to support their needs. Methods Following PRISMA-ScR guidelines, a systematic scoping review was conducted across EMBASE, PsycInfo, Cochrane, PubMed, and Web of Science for empirical papers discussing the MH of South Asian migrants (Bangladesh, Nepal, Pakistan, India, Sri Lanka, Afghanistan) to the UK or GCC (UAE, Saudi Arabia, Qatar, Kuwait, Oman, Bahrain). Results From 11868 records retrieved, 28 studies met the inclusion criteria; over a third of these were published pre-2005 (n = 11). MH vulnerabilities among South Asian migrants were consistently high, with reported prevalence of depression and anxiety. Challenges varied by ethnicity and gender, with differences seen in condition prevalence, symptom presentation, reporting, and referrals. Context-specific challenges emerged: Gulf-based studies (n = 10) highlighted employment-related stressors such as long hours, low pay, unsafe conditions, and workplace abuse, while UK-based studies (n = 18) focused on community belonging, cultural adaptation, and disparities in service use. Among children, a longer duration of stay was linked to reduced vulnerabilities. Importantly, no tailored MH interventions for migrants were identified in either the UK or the Gulf States. Conclusion South Asian migrants face distinct and intersecting MH risks across the migration journey, yet lack tailored interventions in both the UK and GCC. Addressing these challenges requires co-designed, culturally-adapted interventions that span the life course and account for gender, ethnicity, and context. A shift from documenting vulnerabilities to implementing actionable, inclusive care strategies is urgently needed.

Marginal in status a decade ago, cash transfer programs have become the preferred channel for delivering emergency aid or tackling poverty in low- and middle-income countries. While these programs have had positive effects, they are typical of top-down development interventions in that they impose on local contexts standardized norms and procedures regarding conditionality, targeting, and delivery. This book sheds light on the crucial importance of these contexts and the many unpredicted consequences of cash transfer programs worldwide - detailing how the latter are used by actors to pursue their own strategies, and how external norms are reinterpreted, circumvented, and contested by local populations.

There is a growing understanding that strong health systems are crucial to sustain progress. Health systems, however, are complex and much of their success depends on factors operating at different levels and outside the health system, including broader governance and political commitment to health and social development priorities. Recognizing these complexities, this article offers a pragmatic approach to exploring the drivers of progress in maternal and child health in Mozambique, Nepal and Rwanda. To do this, the article builds on a semi-systematic literature review and case study findings, designed and analysed using a multi-level framework. At the macro level, governance with effective and committed leaders was found to be vital for achieving positive health outcomes. This was underpinned by clear commitment from donors coupled by a significant increase in funding to the health sector. At the meso level, where policies are operationalized, inter-sectoral partnerships as well as decentralization and task-shifting emerged as critical. At micro (service interface) level, community-centred models and accessible and appropriately trained and incentivized local health providers play a central role in all study countries. The key drivers of progress are multiple, interrelated and transversal in terms of their operation; they are also in a constant state of flux as health systems and contexts develop. Without seeking to offer a blueprint, the study demonstrates that a ‘whole-system’ approach can help elicit the key drivers of change and potential pathways towards desirable outcomes. Furthermore, understanding the challenges and opportunities that are instrumental to progress at each particular level of a health system can help policy-makers and implementers to navigate this complexity and take action to strengthen health systems. On se rend de plus en plus compte qu’il est essentiel de disposer de systèmes de santé solides pour continuer à progresser. Cependant, les systèmes de santé sont complexes et une bonne part de leur succès dépend de facteurs intervenant à différents niveaux et même en dehors du système de santé, notamment une vision plus large de la gouvernance et un plus grand engagement politique en faveur de la santé et des priorités de développement social. Tout en reconnaissant ces complexités, le présent article propose une approche pragmatique dans le cadre de l’analyse des facteurs de progrès de la santé maternelle et infantile au Mozambique, au Népal et au Rwanda. Pour ce faire, l’article s’appuie sur une revue semi-systématique de la littérature et des résultats des études de cas, conçus et analysés à l’aide d’un cadre multi-niveau. Au niveau macro, la gouvernance fondée sur des leaders efficaces et engagés est essentielle pour obtenir des résultats positifs dans le domaine la santé. Cette vision est soutenue par un ferme engagement des donateurs, se traduisant par un accroissement notable des financements en faveur du secteur de la santé. Au niveau méso, où les politiques sont opérationnelles, les partenariats intersectoriels ainsi que la décentralisation et la délégation des t âches se révèlent être des facteurs déterminants. Au niveau micro (interface de service), les modèles axés sur la communauté et des prestataires locaux accessibles, bien formés et motivés, jouent un rôle central dans tous les pays étudiés. Les principaux facteurs de progrès sont multiples, interdépendants et transversaux dans le cadre de leur fonctionnement; ils sont également en constante mutation au fur et à mesure que les systèmes et les contextes de santé évoluent. Sans prétendre offrir un modèle, l’étude démontre qu’une approche «intégrée» peut générer d’importants facteurs de changement et ouvrir les voies susceptibles de nous mener vers les résultats souhaités. En outre, la bonne compréhension des défis et des opportunités qui permettent d’évoluer dans chaque niveau particulier d’un système de santé, peut aider les décideurs et les responsables de la mise en œuvre à se frayer une voie dans ce dédale et à prendre des mesures susceptibles de renforcer les systèmes de santé. 人们逐渐认识到强健的卫生体系对于持续发展至关重要。但 是, 卫生体系较为复杂, 其成功大多取决于不同层级的因素, 甚至卫生体系之外的因素, 包括更广泛的治理、政治对健康的 投入和社会发展的优先事项。我们认识到上述复杂性, 提出了 一种实用主义方法, 以此研究莫桑比克、尼泊尔和卢旺达孕产 妇和儿童健康进展的驱动因素。本文以半系统综述和个案研 究为基础, 采用多层次框架进行设计和分析。在宏观层次上, 由有效且致力于健康的领导人治理是实现积极健康结果的关 键。其基础是捐助者的支持和卫生部门的资金显著增加。在 中观层次, 即政策实施的层次, 部门间合作、分权和任务转移 是关键。在微观层次, 即服务层次, 以社区为中心的模式, 以 及可及的、适当培训且受到激励的本地卫生服务提供者在所 有研究国家均起着核心作用。项目进展有多个关键的驱动因 素, 相互联系, 相互作用；同时随着卫生体系和环境发展处于 持续的变化状态。本研究显示, ”全系统”方法有助于明确驱动 变化和发展路径从而达到预期结果的关键因素。此外, 了解卫 生体系各个层级有助于发展的挑战和机遇, 可以帮助决策者和 实施者把握卫生体系的这一复杂性, 采取行动强化卫生体系。 Existe una creciente comprensión de que los sistemas de salud fuertes son cruciales para sostener el progreso. Los sistemas de salud, sin embargo, son complejos y gran parte de su éxito depende de factores que operan a diferentes niveles y fuera del sistema de salud, incluyendo un compromiso más amplio de gobernanza y políticas con las prioridades de salud y desarrollo social. Reconociendo estas complejidades, este artículo ofrece un enfoque pragmático para explorar los impulsores del progreso en la salud materna e infantil en Mozambique, Nepal y Ruanda. Para hacer esto, el artículo se basa en una revisión semisistem ática de la literatura y en los hallazgos del estudio de casos, diseñados y analizados usando un marco de niveles múltiples. A nivel macro, la gobernanza con líderes efectivos y comprometidos se consideró vital para lograr resultados positivos en salud. Esto es respaldado por un claro compromiso de los donantes, junto con un aumento significativo de la financiación para el sector de la salud. En el nivel meso, donde las políticas son puestas en operación, las asociaciones intersectoriales, así como la descentralización y el cambio de tareas emergieron como puntos críticos. A nivel micro (interfaz de servicio), los modelos centrados en la comunidad y los proveedores de salud locales accesibles y debidamente capacitados e incentivados desempeñan un papel central en todos los países estudiados. Los principales impulsores del progreso son múltiples, interrelacionados y transversales en cuanto a su funcionamiento; ellos también se encuentran en un estado de cambio constante a medida que se desarrollan los sistemas y contextos de salud. Sin pretender ofrecer un modelo, el estudio demuestra que un enfoque de “todo el sistema” puede ayudar a obtener los principales impulsores del cambio y las posibles vías hacia resultados deseables. Además, comprendiendo los desafíos y las oportunidades que son fundamentales para avanzar en cada nivel particular de un sistema de salud puede ayudar a los responsables de la formulación de políticas y los ejecutores a navegar por esta complejidad y a tomar medidas para fortalecer los sistemas de salud.

In post-war societies adolescents occupy liminal spaces - where social, political, economic, spatial and biological boundaries are still fluid and undetermined - and present a particular challenge for post-war communities as well as service providers. Drawing on a study from two war-affected villages in Sri Lanka, this paper examines the multi-faceted challenges that adolescents face in communities attempting to retain and redefine boundaries, identities, and social and moral regulation in a post-war context. It explores the dynamics of post-war change, especially in the social and moral regulation of sexuality, and its implications for adolescent girls and boys grappling with biological and social transformation - from internalizing gender norms to taking on adult economic roles. A second key concern of this paper is to underline how the post-war political economic context within which their communities are embedded shapes adolescents' negotiation with personal and social transformation. A third key concern is to highlight the legacies of war in the form of surveillance, silences and complex psychosocial problems that adolescents are confronted in post-war contexts and the risk of cycles of inter-generational violence. Finally, the paper examines the role and relevance of formal services in areas such as education, reproductive health, community mobilization, or psychosocial support in the lives of adolescents. It also considers the often overlooked but fundamental support from families and communities in bolstering the resilience of adolescents as they go through this challenging life phase in difficult and complex circumstances.

Adaptive and adequately resourced health systems are necessary to achieve good health outcomes in post-conflict settings, however domains beyond the health system are also critical to ensure broader wellbeing. This paper focuses on the importance of psychosocial support services for adolescent girls in fragile contexts. Its starting point is that adolescence is a pivotal time in the life course but given the physical, cognitive and emotional changes triggered by the onset of puberty, it can also be a period of heightened sensitivity and vulnerability to trauma, social isolation, bullying by peers, a lack of supportive adults and gender-based and sexual violence. Our findings highlight why humanitarian and biomedical approaches in their current form are inadequate to address these complexities. Drawing on qualitative fieldwork (consisting of in-depth and key informant interviews as well as group discussions in Gaza, Liberia and Sri Lanka involving a total of 386 respondents across the three countries), we argue that going beyond biomedical approaches and considering the social determinants of health, including approaches to tackle discriminatory gendered norms and barriers to service access, are critical for achieving broader health and wellbeing. While all three case study countries are classified as post-conflict, the political economy dynamics vary with associated implications for experiences of psychosocial vulnerabilities and the service environment. The study concludes by reflecting on actions to address psychosocial vulnerabilities facing adolescent girls. These include: tailoring services to ensure gender and age-sensitivity; investing in capacity building of service providers to promote service uptake; and enhancing strategies to regulate and coordinate actors providing mental health and psychosocial support services.

The introduction of technology, particularly mobile phones, in the mediation of commercial sex work (CSW) has meant that sex work is expanding from traditional venue based (such as through hotels and massage parlors) work to freelance sex work. It has also changed the face-to-face negotiation in commercial sex work to negotiations mediated online or by phone. Apart from a few programmes, interventions largely use establishments as entry points for their programming and are therefore excluding many girls and women who engage in CSW through personal contacts or facilitated by social media. This article is based on a two-year qualitative study in four districts of Nepal, in Delhi (India), and the Indo-Nepal border in eastern Nepal. It gives a short overview of the girls and their life in the adult entertainment sector (AES), which is the main entry point for CSW, and discusses how technology is increasingly used to mediate CSW. Based on our findings, which show that technology is displacing establishment-based CSW in Nepal, we argue that to ensure that we do not leave girls behind, programmes and interventions targeting venues where girls engage in CSW should re-consider their strategies for reaching girls working in the AES.

Intimate partner violence (IPV) is still rampant in Bangladesh despite a strong national legal framework and a range of governmental as well as non-governmental initiatives to tackle violence against women and girls (VAWG). This paper explores the influence of social norms on the persistence of IPV in Bangladesh as well as a possible backlash occurring despite progress in many areas in relation to tackling VAWG. Qualitative data were collected through 40 key informant interviews, 21 in-depth interviews with survivors of IPV and with married men, 11 focus group discussions and seven intergenerational trios, in two districts of Bangladesh and in Dhaka in 2016. With appropriate consent, interviews were recorded, transcribed and translated from Bengali to English and coded using MAXQDA software. A thematic analysis was then carried out on the coded segments. Findings from our study sample suggest that despite increased awareness of their rights, women and girls still face social norms that create barriers to attaining these rights. Effective governmental and NGO programming might, according to study respondents, result in backlash by men, leading also to changing forms of IPV. Our findings also suggest that increased access to economic resources may not always be protective, while increased education, mobility and access to new technology may be increasing IPV behind closed doors. We argue that the tenacity of the discriminatory gender norms that underlie the attitudes and behaviours of people in Bangladesh is a critical factor for understanding why, despite progress in many areas, IPV persists.