In the decade since the first edition of Global Health Law was published, the world has moved incrementally towards global health with justice, at least by one basic metric: life expectancy has edged up globally, with more rapid gains in low- than high-income countries. But to look around the world, global health with justice still seems a distant dream. Health gaps between people in rich and poor countries remain shocking and unconscionable—as do health inequities within countries. The pandemic also gave salience to profound health injustices—from injustices in access to lifesaving vaccines to gaping disparities in morbidity and mortality based on income, race, and national origin. So did the Trump administration’s decision to pause, and then slash, foreign assistance, bringing an end to lifesaving programs around the world. Guided by the overarching theme of justice, these reflections canvass the history of global health law as a field and discuss developments and challenges in the field across four core themes: multilateralism; equitable distribution of the benefits of scientific advancement; global health law for the poly-crises; and human rights and equity.

Dietary habits, particularly vegetable consumption, play a crucial role in preventing noncommunicable diseases. However, despite international guidelines advocating daily vegetable intake, adherence remains low across many populations. As a result, more focused efforts to boost vegetable consumption at the population level are essential. This study aimed to assess the impact of a health communication campaign (HCC) in City A, which combined information dissemination and incentives to promote vegetable consumption. In 2021, a new app-based vegetable quiz was introduced as part of the ongoing campaign, which had been implemented since 2017. Participants earned 10 points per correct quiz answer, which could be redeemed for product certificates, with a maximum of 30 points. To evaluate the effectiveness of the quiz, we analysed vegetable intake data from 786 quiz users. A multiple regression analysis was conducted to consider factors such as sex, age, body mass index, pre-campaign points, prior vegetable intake, and frequency of food recording during the campaign. We ensured robustness of the results by analysing data from 605 individuals whose vegetable intake had been tracked one year earlier, during a non-incentivized version of the campaign. The results demonstrated that participants who completed all three quizzes consumed 10.7% more vegetables than non-participants. Year-over-year comparisons further showed a significant increase in vegetable intake among frequent quiz participants compared to the previous year, highlighting the positive impact of gamified quizzes on vegetable consumption. These findings suggest that incentivized HCC, especially those incorporating gamification elements, can be highly effective in encouraging healthier eating habits.

Over the last decade, the USA experienced an unprecedented opioid crisis. While there are myriad causes for this crisis, here we examine how social capital shapes the public’s demand for opioids and the government’s responses to the crisis. First, we posit that communities with higher levels of social capital are associated with lower rates of opioid use/abuse. Second, we posit that higher levels of social capital will be associated with a more robust public response in providing necessary resources to address substance abuse resulting in lower rates of drug-related deaths. Using county-level data from the USA, we find support for an indirect relationship where social capital is associated with higher levels of community support for drug treatment, which, in turn, is associated with lower drug-related deaths and deaths of despair.

The presence of pesticide residues in food products, particularly milk, poses significant public health risks, especially in developing regions where agricultural practices often involve extensive pesticide use. This study aimed to assess the levels of pesticide contamination in milk collected from agro-pastoral cattle settlements in Niger State, Nigeria, and evaluate the associated health risks for both children and adults. Milk samples were systematically collected and analyzed using Gas Chromatography-Mass Spectrometry (GC-MS) to detect and quantify the concentrations of various pesticides, including organophosphates, organochlorines, and herbicides.

The detected pesticides included Dichlorvos, β-Hexachlorocyclohexane, Malathion, DDT, and Dieldrin, among others, with Dichlorvos and β-Hexachlorocyclohexane showing the highest concentrations. Using the Estimated Daily Intake (EDI) model, we calculated the potential health risks associated with the consumption of contaminated milk for different age groups. The results indicated that children were particularly at risk, with EDI values exceeding the Acceptable Daily Intake (ADI) for certain pesticides, such as Dieldrin, leading to a risk ratio of 1.288. In contrast, adults showed a lower risk, with EDI values generally within safe limits.

The findings underscore the urgent need for stricter pesticide regulation, enhanced monitoring of pesticide residues in livestock products, and the adoption of sustainable agricultural practices such as Integrated Pest Management (IPM) to mitigate the public health risks. This study highlights the vulnerability of children to pesticide exposure through dairy consumption and calls for immediate intervention to safeguard food safety and protect public health.

In longer-form writing with Larry Gostin, especially on global health, I have been particularly struck by how careful he is not to lose the narrative voice, especially of the vulnerable. He truly believes that these stories are “on loan” to us, and that there is an almost holy reverence and devotion we owe to the lives of those whose stories we tell.

Despite its relative invisibility to most people living in the urban Asia-Pacific, endemic malaria occurs across the region. The unique character of Asian-Pacific malaria includes a serious problem of drug resistance, dominance of a particularly difficult species to control and treat, and another that normally dwells in monkeys but often infects humans. Most nations in the region with endemic malaria have called for its elimination by the year 2030. Meeting that ambitious goal will require mobilizing technical and financial resources, and social and political will. Malaria is a formidable foe fully capable of defeating halfhearted efforts to eliminate it.

We present a large scale study where a nationally representative sample of 1000 participants were asked to make real purchases within an online supermarket platform. The study captured the effect of price changes, and of the signposting of such changes, for breakfast cereals and soft drinks. We find that such taxes are an effective means of altering food purchasing, with a 20% rate being sufficient to make a significant impact if (and only if) the tax is signposted. Signposting represents a complementary “nudge” policy that could enhance the impact of the tax, though its effectiveness depends on the product category.

Despite significant public health investments, rural India’s sanitation challenges persist, raising questions about effective intervention strategies. This study investigates the influence of participation in social schemes on household sanitation behaviours, specifically toilet adoption and soap usage. Using panel data from the India Human Development Survey (2004–05 and 2011–12), a Linear Probability Model with Propensity Score Matching is employed to address potential selection bias. Results indicate that scheme participation increases toilet adoption by 45.5% and soap usage by 13.8%, with effects varying by socio-economic status, demographic characteristics, and local infrastructure. Particularly strong impacts are observed among historically disadvantaged communities, suggesting that social schemes can effectively reduce sanitation inequities. The spillover effect on soap usage indicates these interventions may catalyse broader hygiene behaviour changes. The findings highlight the value of social schemes in improving rural sanitation practices and offer insights for future programme design.

Kawasaki disease is a childhood vasculitic disorder that has a special predilection for coronary arteries. Kawasaki disease has been reported from all regions of the world, with an increasing incidence in several countries. Kawasaki disease is now the most common cause of acquired heart disease in children all over the world. However, it is concerning that the estimated vast majority of Kawasaki disease cases in low- and middle-income countries are not getting diagnosed and treated. The World Health Organization acknowledges cardiovascular disease in their priority of actions. The World Health Organization is invited to acknowledge the reality of Kawasaki disease in its list of cardiovascular diseases and take steps to facilitate the diagnosis and treatment of Kawasaki disease, especially in low- and middle-income countries. It is a disease of public health importance and needs urgent prioritisation by the World Health Organization.

Epidemic preparedness requires clear procedures and guidelines when a rapid risk assessment of a communicable disease threat is requested. In an evaluation of past risk assessments, we found that modifications to existing guidelines, such as the European Centre for Disease Prevention and Control’s (ECDC) rapid risk assessment operational tool, can strengthen this process. Therefore, we present alternative guidelines, in which we propose a unifying risk assessment terminology, describe how the risk question should be phrased by the risk manager, and redefine the probability and impact dimension of risk, including a methodology to express uncertainty. In our approach, probability refers to the probability of the introduction of a disease into a specified population in a specified time period, and impact combines the magnitude of spread and the severity of the health outcomes. Based on the collected evidence, both the probability of introduction and the magnitude of spread are quantitatively expressed by expert judgements, providing unambiguous risk assessment. We advise not to summarize the risk by a single qualification as ‘low’ or ‘high’. These alternative guidelines, which are illustrated by a hypothetical example on mpox, have been implemented at Statens Serum Institut in Denmark and can benefit other public health institutes.

The COVID-19 pandemic response made extraordinary demands on the public health workforce. In response to national studies and local observations about trauma in public health personnel, the Arizona Department of Health Services (ADHS) broadened the scope of their Health Emergency Operations Center (HEOC) Safety Officer position to include not only physical, but mental, emotional, and workplace health and safety. The new Health and Safety Officer (HSO) began in August 2022 and served through the end of the COVID-19 activation. The HSO advocated for staff, counseled HEOC leadership, and validated leadership’s prioritization of the health and wellness of HEOC staff. The impact of the HSO was felt within the HEOC and beyond, and this position should be considered a cost-effective, meaningful intervention in all jurisdictions to protect public health personnel. The HSO position is now a permanent part of the ADHS HEOC.