This study estimates productivity losses resulting from intellectual decrement due to paediatric lead exposure in low- and middle-income countries (LMICs). The published literature on blood lead levels in LMICs was reviewed and summarised. Intelligence Quotient decrement and consequent productivity losses were calculated for a one-year cohort of 5-year-old children in each country. We calculated the present value of lifetime earnings as the discounted average earning potential for workers in a specific economy. Blood lead level (BLL) data for children were available for 39 countries and could be interpolated for additional 82 countries, resulting in 121 countries in the final analysis. Total lead-attributable productivity losses in LMICs ranged from USD 305 billion in our high discount scenario to USD 499 billion in our low discount scenario for each one-year cohort of 5-year-old children (2019 USD). As a share of GDP, these costs ranged from 0.7 to 4.2% by region, depending on discount scenario used. Total economic impacts were generally consistent with previous estimates and further validate those efforts with a substantially expanded dataset. Differences in the findings resulted primarily from the use of a more conservative dose–response model in the present study. Improved reporting of BLLs is essential and could be facilitated through a centralised registry of study results.

As the UNCITRAL Working Group III is deliberating on an appellate mechanism for investor-state dispute settlement (ISDS), this article analyzes the debate surrounding the necessity and feasibility of such an appellate mechanism. It highlights the political and practical issues in establishing such an appellate mechanism, drawing on its comparison with the WTO Appellate Body. Emphasizing the need to balance the interests of developed and developing countries, this article argues that the absence of a structured method in the existing proposals to evaluate equal representation and fairness in the institutional design for the appellate mechanism poses significant challenges. The article makes specific proposals to address such challenges as the financial burden on developing countries, the risk of procedural delays, and the requirement for impartial and diverse tribunal composition. These considerations underscore the critical need to balance party autonomy with centralized oversight and ensure that procedural reforms do not unintentionally disadvantage developing nations.

Modern Western diets, characterised by a substantial proportion of kilocalories derived from ultra-processed foods (UPF), have been associated with systemic inflammation. This study examines the association between UPF consumption and inflammation, assessed through alterations in C-reactive protein (CRP) concentrations, among Brazilian adolescents. This is a cross-sectional study involving a sub-sample of 6316 adolescents aged 12–17 years, participants in the Study of Cardiovascular Risk in Adolescents (ERICA), from seven capitals in Brazil. Dietary intake was assessed using a 24-hour recall, and foods were categorised based on their degree of processing according to the NOVA classification. UPF consumption was then divided into quartiles. For CRP evaluation, blood samples were collected after a 12-hour fasting period and categorised as > 3 mg/l, indicating low-grade inflammation. Poisson regression models with robust variance were employed to assess the association between UPF consumption and high CRP concentrations. High UPF consumption (highest quartile, ≥ 44·9 % kcal/d) was slightly associated with a higher prevalence of CRP after adjusting for potential confounders (prevalence ratio = 1·039; 95 % CI: 1·006, 1·073), compared with those in the lowest quartile of UPF consumption. However, when evaluating different groups of UPF separately (such as sugary beverages, processed meats and sweets), the previous association was no longer observed. These findings suggest a modest association between overall UPF consumption and early indicators of unhealthy low-grade inflammation in adolescents. Further experimental and cohort studies are necessary to clarify the role of UPF in inflammatory processes.

People with severe mental illness (SMI) are at greater risk of obesity, cardiovascular disease and diabetes than the general population, due to a higher prevalence of health risk behaviours. Research is needed to inform tailored interventions to improve the health behaviours (diet, physical activity and sleep) of people with SMI in South Asia as these behaviours are closely linked to obesity. The study aimed to explore the barriers and facilitators to healthy diet, physical activity and good sleep among individuals with SMI. A qualitative design was employed using photovoice, semi-structured interviews and focus group discussions. Participants included 16 people with SMI, 16 caregivers and 17 health professionals in Bangladesh and Pakistan. Data were analysed thematically, informed by the socio-ecological framework. A complex interplay of individual, familial and societal factors influenced these health behaviours. Individual factors include knowledge, beliefs and mental health limitations. Caregivers play a crucial role in influencing behaviour. At the societal level, gender expectations, financial constraints and religious influences significantly impact these behaviours. The insights from this research can inform tailored interventions for this vulnerable group and highlight the need for integrated services, financial support and improved urban planning.

This study examines the heterogeneous effects of economic freedom on human capital accumulation across 83 developing countries between 2000 and 2018. Employing a range of econometric techniques including quantiles via moments regression, the analysis explores both average and distributional impacts of economic freedom on human capital, disaggregated by gender and employment status. The findings reveal that economic freedom positively influences human capital development, with stronger effects in countries with lower human capital levels. Among the five dimensions of economic freedom, freedom to trade internationally, legal systems, and property rights are most strongly associated with human capital accumulation. The results also indicate that women and employed individuals benefit more from economic freedom, highlighting its potential to reduce gender disparities and enhance labour productivity. These findings underscore the importance of institutional reforms promoting economic freedom as a pathway to human capital development in developing economies.

Youth depression is a critical target for early intervention due to its strong links with adult depression and long-term functional impairment. In low- and middle-income countries (LMICs) like the Philippines, limited epidemiological data hampers mental health service planning for youth. This study analyzed nationally representative survey data from 2013 (n = 19,178) and 2021 (n = 10,949) to estimate the prevalence of moderate to severe depressive symptoms (MSDS) among Filipinos aged 15–24 years, using the 11-item version of the Center for Epidemiologic Studies Depression Scale. Survey-weighted analyses revealed that MSDS prevalence more than doubled from 9.6% in 2013 to 20.9% in 2021. The rise was most pronounced among females (10.8% to 24.3%), non-cisgender or homonormative individuals (9.7% to 32.3%), youth with primary education or less (10.8% to 26.5%), youth from economically disadvantaged households (10.6% to 25.1%) and youth who were separated, widowed or divorced (18.3% to 41.3%). Disparities in MSDS also widened over time, with some groups bearing a disproportionate burden. These findings underscore the need to expand accessible, high-quality mental health services for youth in LMICs, such as the Philippines. Continued monitoring and targeted interventions are essential to address the rising burden of depression, particularly among underserved and disproportionately affected groups.

In low- and middle-income countries, fewer than 1 in 10 people with mental health conditions are estimated to be accurately diagnosed in primary care. This is despite more than 90 countries providing mental health training for primary healthcare workers in the past two decades. The lack of accurate diagnoses is a major bottleneck to reducing the global mental health treatment gap. In this commentary, we argue that current research practices are insufficient to generate the evidence needed to improve diagnostic accuracy. Research studies commonly determine accurate diagnosis by relying on self-report tools such as the Patient Health Questionnaire-9. This is problematic because self-report tools often overestimate prevalence, primarily due to their high rates of false positives. Moreover, nearly all studies on detection focus solely on depression, not taking into account the spectrum of conditions on which primary healthcare workers are being trained. Single condition self-report tools fail to discriminate among different types of mental health conditions, leading to a heterogeneous group of conditions masked under a single scale. As an alternative path forward, we propose improving research on diagnostic accuracy to better evaluate the reach of mental health service delivery in primary care. We recommend evaluating multiple conditions, statistically adjusting prevalence estimates generated from self-report tools, and consistently using structured clinical interviews as a gold standard. We propose clinically meaningful detection as ‘good-enough’ diagnoses incorporating multiple conditions accounting for context, health system and types of interventions available. Clinically meaningful identification can be operationalized differently across settings based on what level of diagnostic specificity is needed to select from available treatments. Rethinking research strategies to evaluate accuracy of diagnosis is vital to improve training, supervision and delivery of mental health services around the world.

The urgency to tackle climate change has placed sustainable development at the centre of recent trade related debates. An emerging consensus is that trade should be considered and can be used as means to achieve sustainable development goals. As the circumstances are changing, one issue to be addressed is how to adjust trade negotiations which used to be the main approach to pursuing market opening and liberalization with the support of the theory of comparative advantage. In this context, this paper examines trade negotiations on environmental services by focusing on developing countries' participation. Environmental services and related trade play a critical role in achieving environmental and sustainable development goals. Nevertheless, developing countries' participation in environmental services trade negotiations has been limited. By analysing the reasons behind such limited participation and assessing some new approaches, this paper attempts to explore how environmental services trade negotiations could be adapted to better engage developing countries and serve Sustainable Development Goals.

The paper investigates the gender-driven disparities in total factor productivity (TFP) between women-owned enterprises (WOEs) and male-owned enterprises (MOEs) across 30 developing countries. Utilizing firm-level data from the World Bank Enterprise Surveys, the study addresses biases in previous gender literature by employing a semi-parametric technique to more accurately measure TFP. The results reveal a significant TFP gap, with WOEs being 5.5% to 6.7% less productive than MOEs, even after controlling for key firm characteristics like age, innovation, human capital, and ownership status. The study attributes this productivity disparity primarily to financial obstacles faced by WOEs, which hinder their ability to innovate and capitalize on opportunities. The lack of access to credit leads to a misallocation of capital, excluding equally efficient women entrepreneurs from financial resources that could stimulate productivity. Contrary to some assumptions, the study finds no evidence that WOEs underperform in sectors with high financial dependence, suggesting that WOEs are not inherently inefficient in their use of capital. Our findings provide causal evidence as we control for selectivity bias in the TFP-WOEs nexus by identifying exogenously the factors that affect financial constraints and innovation.

Wearable technology and daily diaries offer insights into everyday behaviors that can further health research and treatment globally. However, the use of these methodologies outside of high-income settings has been limited. We conducted two pilot studies that enrolled 60 young women in the urban slums of Kampala, Uganda to understand design considerations associated with using wearable technology and daily diaries in this context. Each participant in the pilot studies was asked to wear a wearable activity tracker and complete daily diary questionnaires for 5 days. Based on our experiences, we identified several lessons that may be beneficial to others interested in implementing wearable technology and daily self-reports in their research and interventions, particularly when working in low-resource contexts. We discuss the importance of designing solutions tailored to the available resources, building validation for the most critical measures, investing in data management efforts and providing transparent and culturally accessible information to participants. Examples from our study are provided. These lessons may reduce the barriers and improve data quality for future researchers and practitioners interested in using these data collection methods globally.

Given the rate of advancement in predictive psychiatry, there is a threat that it outpaces public and professional willingness for use in clinical care and public health. Prediction tools in psychiatry estimate the risk of future development of mental health conditions. Prediction tools used with young populations have the potential to reduce the worldwide burden of depression. However, little is known globally about adolescents’ and other stakeholders’ attitudes toward use of depression prediction tools. To address this, key informant interviews and focus group discussions were conducted in Brazil, Nepal, Nigeria and the United Kingdom with 23 adolescents, 45 parents, 47 teachers, 48 health-care practitioners and 78 other stakeholders (total sample = 241) to assess attitudes toward using a depression prediction risk calculator based on the Identifying Depression Early in Adolescence Risk Score. Three attributes were identified for an acceptable depression prediction tool: it should be understandable, confidential and actionable. Understandability includes depression literacy and differentiating between having a condition versus risk of a condition. Confidentiality concerns are disclosing risk and impeding educational and occupational opportunities. Prediction results must also be actionable through prevention services for high-risk adolescents. Six recommendations are provided to guide research on attitudes and preparedness for implementing prediction tools.