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Background Ischemic heart disease (IHD) remains a leading cause of mortality and morbidity globally. This study aims to evaluate the trends in IHD burden across different socioeconomic regions using data from the Global Burden of Disease Study 2021 (GBD 2021) and to understand the impact of the metabolic risk factors on these trends. Methods Data from GBD 2021 was analyzed to evaluate the global age-standardized death rates (ASDR) and disability-adjusted life years (ASRDALYs) linked to IHD. Key metabolic risk factors evaluated included high systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDLc), fasting plasma glucose (FPG), and body mass index (BMI). Temporal trends were assessed using estimated annual percentage changes (EAPCs), with further analysis by age, sex and socio-demographic index (SDI). Results Resource-abundant regions showed notable reductions in ASDR and ASRDALYs, largely due to effective management of SBP and LDLc, resulting in an EAPC of -3.43 (95% CI: -3.32, -3.53). In contrast, resource-limited regions, particularly among males, experienced stagnation or even increases in IHD burden. The EAPC of ASDR in low-, low-middle-, and middle-SDI regions ranged from − 0.12 (95% CI: -0.04, -0.19) to 0.16 (95% CI: 0.09, 0.23). Among males, the values ranged from 0.22 (95% CI: 0.14, 0.29) to 0.55 (95% CI: 0.47, 0.62). The increase in IHD burden in these regions was primarily driven by rising levels of FPG and BMI. Younger populations (15–49 years) were disproportionately affected, showing increasing exposure to these metabolic risks. Conclusion Regional disparities in IHD burden persist, primarily driven by metabolic risk factors. Resource-abundant regions have benefitted from effective control of SBP and LDLc, whereas resource-limited regions face growing challenges, especially related to FPG and BMI. The use of secondary data from the GBD 2021 database provides a comprehensive global perspective but may not fully capture local variations in disease burden. Targeted public health strategies and early interventions are essential to reduce the growing IHD burden in these vulnerable populations.

Background In the context of tuberculosis elimination, social protection seeks to mitigate multiple forms of vulnerability experienced by people affected by the disease, addressing both biological and social factors and directly targeting the social determinants of health. However, in Brazil, the absence of standardized conceptual tools and process indicators to assess the operationalization and implementation of intersectoral actions and services related to social protection for tuberculosis control highlights the need for an instrument capable of evaluating how the social protection network functions for people affected by tuberculosis. Methods This methodological study was conducted in Brazil to develop and validate an instrument comprising indicators for measuring and assessing the implementation of social protection actions for people affected by tuberculosis. In the first stage, a literature review and document analysis were carried out, resulting in the development of a Logic Model to guide the construction of the Evaluative Matrix. The second stage involved content validation of the matrix using the Delphi method, with the aim of reaching satisfactory Content Validity Indices (CVI > 0.80) through expert consensus. Nine experts participated in the first round and seven in the second. Results The Evaluative Matrix was validated with satisfactory CVI scores, demonstrating significant expert consensus. It offers a comprehensive mapping of the national landscape of social protection for people affected by tuberculosis. The instrument comprises 20 evaluative categories and 53 indicators, each with defined parameters and data sources, distributed across 11 subdimensions derived from four main dimensions of the Logic Model: (I) the right to health; (II) the right to social assistance; (III) the right to social security; and (IV) shared responsibilities. Conclusions This study presents an innovative evaluation tool to support managers and decision-makers in designing and improving social protection strategies within health policies for people affected by tuberculosis, while accounting for diverse local contexts. It aims to accelerate progress toward tuberculosis elimination by addressing poverty and other social determinants, and by protecting the human rights of people with tuberculosis and their families.

Background Healthcare inequities pose a substantial challenge to achieving universal health coverage, particularly in low- and middle-income countries (LMICs). The Chinese government implemented Hierarchical Medical System (HMS) to optimize resource allocation and improve healthcare access. This study aimed to evaluate the impact of HMS on healthcare utilization and the inequities. Methods This study utilized longitudinal data from the China Family Panel Studies (CFPS) conducted in 2012, 2014, 2016, and 2018, which included a final sample of 105,335 individuals. A multiple-period difference-in-differences method was employed to explore the impact on outpatient and inpatient utilization across socioeconomic dimensions. The concentration Index and the horizontal inequity index (HI) were used to assess inequities in healthcare utilization. Additionally, a decomposition analysis was performed to identify the contributors to inequalities. Results HMS demonstrated significant negative impacts on both outpatient and inpatient utilization (OR = 0.825, SE = 0.058; OR = 0.869, SE = 0.071, respectively), with a short-term decline in outpatient services and a lasting reduction in inpatient services. The heterogeneity tests revealed a pronounced impact in central and rural areas. The results indicated pro-poor inequities in outpatient utilization and pro-rich inequities in inpatient utilization. HMS reduced inequalities and inequities in healthcare utilization, particularly for outpatient services. HI in inpatient services increased in the initial year but decreased after 2 years of HMS. The decomposition analyses identified the primary contributors as economic level and health status. While the economic level exacerbated inequalities, health insurance and higher educational attainment mitigated inequalities in healthcare utilization. Conclusion HMS had an unintended impact on decreasing healthcare utilization in China. HMS improved equity in outpatient utilization, it faced challenges in enhancing equity in inpatient utilization. Policymakers should prioritize strengthening primary care infrastructure in central and rural areas, ensuring affordable healthcare models, reinforcing educational attainment, and expanding health insurance coverage to promote equity in healthcare utilization. These findings provide crucial insights for guiding equitable healthcare reform in LMICs and advancing progress toward the Sustainable Development Goals.

Income-health gradients vary in societies with diverse cultures and healthcare access levels, and generalized trust in unknown resources of health services may play a crucial role in these gradients. Multilevel models using a sample of 152,501 respondents from 89 societies are conducted to investigate the mediation effect of generalized trust in the correlation between relative income and self-rated health globally, and the moderating role of healthcare access in the association between relative income and self-rated health. Results show that individuals’ relative income significantly and positively predicts their generalized trust, which in turn significantly and positively predicts their self-rated health. In countries and regions with higher levels of healthcare access and quality, a higher level of relative income is positively correlated with increased self-rated health. This study theoretically contributes to the literature on income-health relationships by capturing medical resource access and individual characteristics. Specific policy recommendations include fostering generalized trust, improving healthcare education, and expanding telemedicine.

Background Disability-adjusted life years (DALYs) are widely used to prioritize public funding for science, technology and innovation (ST&I) in health. In universal systems such as Brazil’s Unified Health System (SUS), however, allocation decisions may also incorporate broader political and social considerations. Objective: To assess whether Brazilian public ST&I funding for neglected tropical diseases (NTDs) and Zika (2006–2019) aligned with disease burden measured by DALYs, and to examine how observed funding patterns reflect political commitments to health equity and innovation in the Global South. Methods Cross-sectional analysis of national research calls (2006–2019). Actual disbursements were compared with expected values proportional to the DALY distribution for each disease. Associations between DALYs and funding were evaluated using Spearman correlation. Results High-burden diseases—including tuberculosis, Chagas disease and schistosomiasis—received less funding than expected, while Zika and leprosy obtained disproportionately higher investments. Overall, the correlation between DALYs and funding was weak and not statistically significant; a significant negative trend emerged within a subgroup of major NTDs. Conclusions DALYs did not operate as the sole criterion guiding Brazil’s ST&I funding. Political urgency, social mobilization and SUS operational priorities influenced allocation, indicating that ST&I functions not only as a technical instrument but also as a political strategy to reduce health inequities and foster context‑appropriate innovation for vulnerable populations in the Global South.

Background Medical students are particularly vulnerable to acquiring various health conditions due to the nature of their education but often hesitate to consult doctors and resort to self-managing their illnesses. This study aims to examine the healthcare-seeking behaviors and barriers among medical students in Egypt. Methods This cross-sectional study involved a convenience sample of 1,535 medical students from 12 public universities across Egypt. Data on healthcare-seeking behaviors, barriers, and associated factors were collected using an online survey distributed through official university channels and social media platforms. Logistic regression analysis was used to identify factors associated with consulting a doctor when experiencing health problems. Results Only 52.2% of participants reported consulting doctors when ill. Participants from rural backgrounds (COR = 0.69, CI: 0.51–0.93), those facing barriers to healthcare (COR = 0.80, CI: 0.66–0.98), with less than sufficient income (COR = 0.61, CI: 0.46–0.81), or a non-working mother (AOR = 0.76, CI: 0.58–0.99) were less likely to consult a doctor. In contrast, participants with more than sufficient income (COR = 1.35, CI: 1.02–1.78), a parent in healthcare (AOR = 13.18–17.31, CI: 6.87–36.35), or who exercised regularly (AOR = 1.48, CI: 1.09–2.01) were more likely to consult a doctor. A substantial proportion of students reported relying on past experiences with the illness (54.1%), using the Internet (46.8%), and self-diagnosing (36.2%). The most common reported barriers to seeking healthcare were lack of time (29.2%), long wait times (22.7%), and academic concerns (12%). A history of feeling uncomfortable or discriminated against when seeking healthcare was reported by 19.5% of participants. Conclusion Many medical students in Egypt engage in self-diagnosis and self-management rather than consulting doctors when ill. Addressing healthcare barriers is crucial for encouraging appropriate care-seeking behaviors within this population.

Background Transgender people are more likely to experience heightened risks of physical and psychological distress and tend to report a poorer quality of life compared to the general population. This study aimed to determine the quality of life and self-esteem, health-seeking behaviour, and to explore the lived experiences among transgender women. Methods Using the snowball sampling technique, 73 transgender women were included in this mixed-methods study. Quantitative data were collected through the Short-Form-12 (SF-12) and the Rosenberg Self-esteem Scale (RSES). Maximum variation sampling was employed to select 10 participants for the qualitative component, aiming to gain in-depth insights into their personal experiences and health-seeking behaviours. Appropriate descriptive and inferential statistics were applied for analysis. A thematic analysis approach was used to represent qualitative findings. Results The mean age of the participants was 30.93 (SD = 4.70) years. Findings revealed that participants had poor mental (Mean µ = 38.80) and physical (Mean µ = 38.08) health. The cohort demonstrated a notably high level of self-esteem (Mean µ = 30.93 ± 4.70). A substantial proportion (76.7%) of participants experienced discrimination or mistreatment while seeking healthcare services, stating unfavorable experiences (19.2%) and strongly unsatisfied (5.5%), whereas more than half (56.2%) avoided giving any opinions. From the qualitative analysis, three major themes emerge: discovering my true identity as transgender person , survival in a world of discrimination , violence , and trauma , and struggle with economic , professional , and legal challenges. Conclusions In our study, participants reported lower mental and physical health, experienced discrimination, and had negative perceptions while accessing health services. The study carries important implications for the development of inclusive and high-quality healthcare services to ensure transgender people’s access to and utilization of healthcare.

Background HIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention strategy, recommended by the World Health Organization since 2015. However, in South America, its adoption has been uneven, reflecting structural, political, and socio-cultural inequalities. This study maps and analyzes national PrEP policies across 13 South American countries through an intersectional lens, identifying challenges and opportunities for more equitable HIV prevention strategies. Methods We conducted a documentary survey of national PrEP-related policies, clinical guidelines, regulations, and public communications from Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, French Guiana, Paraguay, Peru, Suriname, Uruguay, and Venezuela. Searches were performed on institutional websites in Portuguese, Spanish, English, and French using predefined keywords. In the absence of official policy documents, information was collected from media and civil society sources. Data from 118 documents were coded and analyzed using iterative summative content analysis, integrating intersectionality theory to assess how policies address (or neglect) structural inequalities. Results Ten countries have formal national PrEP policies (Argentina, Brazil, Chile, Colombia, Ecuador, Guyana, French Guiana, Paraguay, Peru, Uruguay), with Brazil pioneering implementation in 2017. Three countries (Bolivia, Suriname, Venezuela) lack comprehensive national guidelines. Most countries recommend daily oral PrEP; on-demand dosing is approved in fewer contexts, often with restrictions. Long-acting injectable cabotegravir has been approved only in Brazil, French Guiana, and Peru, but remains largely unavailable. Geographic coverage ranges from national to highly localized models. Prioritized groups include men who have sex with men, transgender women, sex workers, serodifferent couples, and, in some countries, people who use drugs. Policy formulation involves ministries of health, academia, international organizations, and, variably, civil society. However, inclusion of marginalized populations and integration of intersectional approaches remain limited. There are inequalities in the incorporation of social markers of difference in PrEP policies across the region, with greater emphasis on sexuality, gender, class, and health conditions, and limited attention to race/ethnicity, territory, generation, and disability. Conclusion PrEP policy adoption in South America demonstrates significant heterogeneity, shaped by intersecting social, political, and institutional factors. While the region has made notable advances, access remains uneven, with structural barriers such as stigma, regulatory gaps, and geographic inequities limiting impact. Incorporating intersectional perspectives into policy design and implementation is essential to ensure that PrEP – in all its modalities – is accessible as a right to health, addressing differences across multiple social, geographic, and economic dimensions.

Background Understanding the psychological distance (PD) of health professionals toward climate change is essential to promote effective climate action and informed health policy. While climate change poses a global health threat requiring urgent collaboration, limited cross-national research exists on health professionals’ perspectives, particularly on how they perceive PD in relation to climate change. Objective This study aims to provide initial insights into how health professionals perceive climate change across different countries, focusing on key factors influencing PD, including personal experiences, uncertainty, perceptions, information environments, global interconnectedness, and climate-resilient infrastructure. Methods This research employed an exploratory mixed-methods approach, combining descriptive surveys and in-depth semi-structured interviews with 18 early-to-mid-career health professionals from 12 countries. This design facilitated a nuanced exploration of the dimensions of PD—temporal, spatial, social, and uncertainty-related—by integrating quantitative data with qualitative insights to uncover emerging trends and hypotheses. Results Findings reveal diverse perceptions of PD among health professionals, shaped by contextual factors such as exposure to extreme weather, information environments, and infrastructure development. These results challenge the oversimplified view that professionals in developing countries consistently perceive climate change impacts as more distant, underscoring the need for localized understandings of PD. Conclusion Assessing PD requires consideration of its diverse dimensions to inform effective climate-related behaviors and interventions. Tailored communication strategies reflecting unique national and regional contexts are essential to engage health professionals, enabling them to drive climate discourse and policy advocacy. This study highlights the potential of the early-to-mid-career health professionals in bridging the gap between public awareness and climate action. Their unique position enables them to drive long-term climate adaptation and policy implementation, fostering both global and localized solutions to climate challenges.

Background The COVID-19 pandemic exposed critical gaps in healthcare infrastructure across developing countries, highlighting the need for scalable solutions to improve quality of life (QoL). This study investigates the asymmetric impact of Information and Communication Technologies (ICT) on Healthcare Expenditure (HCE) and the Human Development Index (HDI) across seven South Asian countries, where under-resourced healthcare systems coexist with rapid digital adoption. Methods We use data from 2005 to 2023 and employ Fully Modified Ordinary Least Squares (FMOLS) and Dynamic Ordinary Least Squares (DOLS) techniques. ICT is measured through an aggregate index of mobile subscriptions, internet users and broadband connections. Results The results reveal that: (1) ICT serves as a significant catalyst for aggregate Quality of Life, evidenced by positive effects on the HDI and HCE; (2) While ICT improves male human development (HDIM), its insignificant long run cointegration with female specific development (HDIF) confirms structural barriers persist despite aggregate progress in South Asia; (3) Moderation analysis highlights critical disparities, with ICT diffusion through male populations enhancing overall human development 7.5 percent more effectively than through female populations; (4) Urban contextualized ICT yields 7.3 percent stronger human development gains and 9.0 percent higher health expenditure impacts relative to rural diffusion; (5) Mediation analysis demonstrates that although ICT increases out of pocket health spending, these expenditures subsequently improve HDI; (6) ICT exhibits insignificant integration with maternal mortality, yet reduced maternal mortality independently elevates HDI. Conclusions These findings necessitate gender- and geography-responsive ICT strategies, spatially balanced ICT infrastructure investment, and health financing safeguards to align South Asia’s technological transformation with sustainable development goals 3 and 5, ensuring digital dividends foster inclusive wellbeing.