Women’s odds of obesity nearly 5 times higher than men’s in the region
And obesity 3 times more likely in those with tertiary level education

Female sex and higher education are significantly linked to the escalating prevalence of obesity and overweight in Africa, finds one of the largest and most detailed analyses of body weight trends in the region, published in the open access journal BMJ Global Health.

Women’s odds of obesity in Africa are 5 times greater than those of men’s, while obesity is 3 times more likely in those with tertiary level education than in those with lower levels, the findings indicate.

The global prevalence of overweight and obesity has more than doubled over the past 4 decades. In 2022, 2.5 billion adults were overweight, representing 43% of all the world’s adults, and 890 million were living with obesity, note the researchers.

While recent research suggests that the rate of increase in overweight and obesity may be slowing in high income countries, it seems to be speeding up in low- and middle-income countries, where around two thirds of those living with obesity now reside, they explain.

Africa is particularly vulnerable because of its fragile healthcare systems, limited resources, socioeconomic complexities, urbanisation and sparse public health policies, they add.

The researchers wanted to explore the extent of overweight and obesity in Africa, and capture 20 year trends (2003-22).

They analysed data from 54 nationally and regionally representative STEPS (STEPwise approach to non-communicable disease risk factor surveillance) surveys carried out between 2003 and 2022 for 36 of the 47 countries in the World Health Organization (WHO) Africa region—representing three-quarters of the total population and 156 million adults.

Underweight was defined as a BMI of less than 18.5, overweight as a BMI of between 25 and 29.9, and obesity as a BMI of 30 or more.

The surveys captured weekly physical activity levels from low (below the recommended weekly tally) to high (above this) and daily portions of fruits and vegetables consumed (from 0-1 to 4-5).

In all, data were obtained for 198,901 adults with an average age of 36; half were women. Of the countries included in the analysis, 13 were in West Africa, 9 in East Africa, 5 in Southern Africa, 8 in Central Africa and 1 in North Africa (Algeria).

The analysis revealed that the age standardised and weighted prevalence of underweight, overweight, and obesity was 11.5%, just under 18%, and 9%, respectively.

Twenty year trends showed a significant increase in the overall prevalence of obesity from nearly 15.5% in 2003 to nearly 17% in 2022; of underweight from 12% to just under 13%; and a levelling out in the prevalence of overweight (around 18% between 2003 and 2022).

The prevalence of overweight and obesity was, respectively, just under 18% and 9% higher in women (21% and nearly 13.5%) than in men (15% and just over 4.5%).

After adjusting for potentially influential factors, female sex, older age, higher education level, physical inactivity and poor diet were all associated with overweight or obesity.

The odds of overweight and obesity were, respectively, twice as high and almost 5 times as high, in women as they were in men. And those educated to tertiary level were twice as likely to be overweight and nearly 4 times as likely to be obese than those educated to lower levels.

“Taken together, these findings underscore the need for targeted public health interventions that consider the unique socio-cultural and economic contexts affecting women in the WHO African region,” say the researchers.

“Also, the results raise the point that education and awareness campaigns should not solely target individuals with lower education levels, as those with higher education may also require information and support,” they add.

“The present study further underscores the dual burden of malnutrition in the Africa region, showing significant increased trends in both obesity and underweight,” they continue.

The researchers acknowledge various limitations to their findings including that the WHO Africa region does not cover all of the continent, and that no data were available from South Africa, a country with one of the highest rates of overweight and obesity.

Nor did they study potentially influential factors, including cultural norms, accessibility to preventive healthcare, commercial factors, and household income. And the survey focused only on 18–69 year olds, excluding children and older adults.

But they nevertheless conclude: “These findings support the urgent need to intensify preventive health policies and programmes in the WHO African region.”

13/01/2026

Notes for editors
Research: Prevalence, time trends and associated factors of adult overweight and obesity in 36 countries in the WHO African region from 2003 to 2022: a study of 54 WHO STEPS surveys representing 156 million adults Doi: 10.1136/bmjgh-2025-019988
Journal: BMJ Global Health

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf  

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

The post Female sex and higher education linked to escalating prevalence of obesity and overweight in Africa first appeared on BMJ Group.

Greatest risk associated with frequent consumption of locally brewed alcohol
Additive effect of chewing tobacco likely accounts for 60%+ of cases nationwide

Even a low daily intake of alcohol—-just 9 g or around one standard drink—is linked to a 50% heightened risk of mouth (buccal mucosa) cancer in India, with the greatest risk associated with locally brewed alcohol, finds a large comparative study, published online in the open access journal BMJ Global Health.

And when combined with chewing tobacco, it likely accounts for 62% of all such cases in India, the findings suggest.

Mouth cancer is the second most common malignancy in India, with an estimated 143,759 new cases and 79,979 deaths every year. Rates of the disease have risen steadily, and now stand at just under 15 for every 100,000 Indian men, note the researchers.

The primary form of mouth cancer in India is that of the soft pink lining of the cheeks and lips (buccal mucosa). Less than half (43%) of those affected survive 5 or more years, they point out.

As alcohol consumption and tobacco use often go hand in hand, it’s not clear how much each factor individually contributes to mouth cancer risk, especially in India, where the  prevalence of smokeless tobacco use is high, point out the researchers.  Nor have the potential effects of locally brewed alcohol, which is particularly popular in rural communities, been assessed, they add.

To find out more, the researchers compared 1803 people with confirmed buccal mucosa cancer and 1903 randomly selected people free of the disease (controls) from five different study centres between 2010 and 2021. Most of the participants were aged between 35 and 54; nearly half (around 46%) of cases were among 25 to 45 year olds.

Each of the participants provided information on the duration, frequency, and type of alcohol they drank from among 11 internationally recognised drinks, including beer, whisky, vodka, rum and breezers (flavoured alcoholic drinks); and 30 locally brewed drinks, including apong, bangla, chulli, desi daru, and mahua.

Participants were also asked about the duration and type of tobacco use so that the extent of the interaction between alcohol and tobacco on mouth cancer risk could be assessed.

Among the cases, 1019 said they didn’t drink alcohol compared with 1420 among the controls; 781 of the cases said they did drink alcohol compared with 481 of the controls.

The average length of tobacco use was higher for cases (around 21 years) than for the control group (around 18 years). Cases were also more likely to live in rural areas and to drink more alcohol every day: nearly 37 g compared with around 29 g.

Frequent alcohol consumption was associated with a heightened risk of buccal mucosa cancer, with locally brewed drinks associated with the greatest risk.

Compared with those who didn’t drink alcohol, the risk was 68% higher for those who did, rising to 72% for those favouring internationally recognised alcohol types, and to 87% for those opting for locally brewed drinks.

As little as under 2 g a day of beer was associated with a heightened risk of buccal mucosa cancer. And just 9 g a day of alcohol—equivalent to around one standard drink—-was associated with an approximately 50% increased risk.

Concurrent alcohol and tobacco use was associated with a more than quadrupling in risk, such that 62% of all buccal mucosa cancer cases in India are likely attributable to the interaction between alcohol and chewing tobacco, calculate the researchers.

But alcohol was a contributory factor to the heightened risk of mouth cancer irrespective of how long tobacco had been used. Ethanol might alter the fat content of the inner lining of the mouth, increasing its permeability and therefore its susceptibility to other potential carcinogens in chewing tobacco products, explain the researchers.

The findings suggest that more than 1 in 10 cases (nearly 11.5%) of all buccal mucosa cancers in India are attributable to alcohol, rising to 14% in some of the states with a high prevalence of the disease, such as Meghalaya, Assam, and Madhya Pradesh, say the researchers.

Possible contamination with toxins, such as methanol and acetaldehyde, in locally brewed alcohol, might help explain the higher risk associated with these drinks, the manufacture of which is largely unregulated, they suggest.

“The current legal framework for alcohol control in India is complex and involves both central and state laws. Central legislation provides protection of citizens where alcohol is included in the State List under the Seventh Schedule of the Indian Constitution, giving states the power to regulate and control alcohol production, distribution and sale. However, the locally-brewed liquor market is unregulated, with some forms used by participants containing up to 90% alcohol content,” they point out.

They conclude: “In summary, our study demonstrates that there is no safe limit of alcohol consumption for [buccal mucosa cancer] risk…Our findings suggest that public health action towards prevention of alcohol and tobacco use could largely eliminate [buccal mucosa cancer] from India.”

23/12/2025

Notes for editors
Research: Association of alcohol and different types of alcoholic beverages on the risk of buccal mucosa cancer in Indian men: a multicentre case-control study Doi: 10.1136/bmjgh-2024-017392
Journal: BMJ Global Health

External funding: Indian Council of Medical Research

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational case-control study
Subjects: People

The post Low daily alcohol intake linked to 50% heightened mouth cancer risk in India first appeared on BMJ Group.

Over half of Gates Foundation grants to WHO have targeted polio and vaccination; but key WHO priorities like non-communicable diseases and strengthening health systems remain underfunded

The World Health Organization’s (WHO’s) priorities are being skewed by its increasing reliance on donations from organisations such as the Gates Foundation (previously known as the Bill and Melinda Gates Foundation), which must be spent on specific health challenges favoured by the donors, suggests a study published in the journal BMJ Global Health.

Between 2000 and 2024, more than half of the US $5.5 billion donated by the Gates Foundation to WHO was directed toward vaccine-related projects and polio, while relatively little funding was spent on other issues considered to be important by WHO.

The Gates Foundation has become the WHO’s second biggest source of funding in recent years contributing 9.5% of WHO’s revenues between 2010 and 2023. Its largest funder was the United States, but earlier this year the US announced it would withdraw from WHO from January 2026. Germany and the UK were third and fourth largest WHO funders, respectively.

Although it is widely assumed that the Gates Foundation’s financial power allows it to exert influence over WHO’s work programme, little research has been undertaken to track exactly how its grants are spent.

To address this, the authors extracted data from the Gates Foundation website on all its grants to WHO between 2000 and 2024 to determine the number and value of grants, and the diseases, health issues and activities they funded.

Between 2000 and 2024, the Gates Foundation made 640 grants worth US $5.5 billion to WHO. In total 6.4% of all grants made by the Gates Foundation during this period went to WHO.

More than 80% of the Gates Foundation’s grants to WHO (US $4.5 billion) were targeted at infectious diseases and almost 60% (US $3.2 billion) were spent on polio. More than half of the Foundation’s money (US $2.9 billion) was used to fund vaccine programmes and related projects.

Relatively little funding from the Gates Foundation was directed towards non-communicable diseases, strengthening health systems, and broader determinants of health, despite their importance to WHO strategy and global health more generally.

Just US $11.8 million (0.2%) was spent on water and sanitation and US $37.4 million (0.7%) on health systems strengthening. Less than 1% of the Foundation’s funding went towards non-communicable diseases, despite them being responsible for 74% of global deaths with 77% of these deaths occurring in low- and middle-income countries.

WHO’s budget comes from two sources – assessed contributions from member states, calculated according to a country’s wealth and population, plus voluntary contributions or extra-budgetary funding from member states and non-state organisations. Around nine-tenths income comes from voluntary or extra-budgetary funding, and almost all of this money is ‘earmarked’, i.e. given on the condition that it funds activities and projects defined by the donor.

The way WHO is funded limits its ability to fulfil its strategic goals, the authors say.

“Assessed contributions from member states are nowhere near the level needed to fund its strategic priorities, so WHO must rely on earmarked voluntary contributions from donors,” they say. “Consequently, activities and areas that donors favour receive more resources than are required while those they are not interested in do not get enough.”

And the situation could worsen if the United States – WHO’s largest donor – carries through with its threat, announced in January 2025, to withdraw from WHO.

While it is easy to blame major donors like the Gates Foundation for undermining WHO’s independence by pursuing its agenda through WHO, the authors say: “We should not, however, lose sight of the fact that it is the member states’ failure to increase assessed contributions in line with WHO’s needs over the last four decades that has created a situation in which the organisation is forced to rely on voluntary contributions from donors.”

They add: “WHO has asked for more flexible and sustainable funding, warning that without fundamental changes to the way it is financed, it will be unable to achieve its strategic aims. If the member states continue to ignore these exhortations, then WHO will remain vulnerable to the influence of external donors and will struggle to address the full spectrum of contemporary global health challenges.”

28/10/2025

Notes for editors
Research: Who’s leading WHO? A quantitative analysis of the Bill and Melinda Gates Foundation’s grants to WHO, 2000-2024 doi: 10.1136/ bmjgh-2024-015343.
Journal: BMJ Global Health

External funding: None declared.

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf

About the journal
BMJ Global Health is one of 70 journals published by BMJ Group. The title is owned by BMJ. https://gh.bmj.com/

Externally peer reviewed? Yes
Evidence type: Quantitative analysis
Subjects: WHO spending

The post World Health Organization’s priorities shaped by its reliance on grants from donor organisations such as the Gates Foundation first appeared on BMJ Group.

Men more likely than women to report difficulties, although gender divide narrows with age

Countries with the highest reported levels of hearing loss also have the lowest reported use of hearing aids, finds international research published in the open access journal BMJ Global Health.

And men are generally more likely than women to report difficulties with their hearing, although this gender divide narrows with age, the findings show.

An estimated 1.57 billion people—equivalent to 1 in 5 of the world’s population—had hearing loss in 2019. And it’s predicted that it will affect 2.45 billion people by 2050, say the researchers.

Hearing loss is associated with an array of problems in adults. These include depression, loneliness, social isolation, falls and fall-related injuries, postoperative complications, cardiovascular disease, cognitive decline and even death, they point out.

But current accurate measurements of hearing loss are limited by a lack of audiology service provision and the expense of collecting hearing test data, they point out.

To strengthen the evidence base, they analysed self-reported hearing loss and hearing aid use from 8 nationally representative long term studies, representing 28 countries for the period 2001–2021.

These studies were: the Brazilian Longitudinal Study of Ageing (ELSI-Brazil, 2016–20); the China Health and Retirement Longitudinal Study (CHARLS, 2011–18); the Costa Rican Longevity and Healthy Ageing Study (CRELES, 2005–09); the Mexican Health and Ageing Study (MHAS, 2001–21); the South African National Income Dynamics Study (NIDS, 2008–17); the Korean Longitudinal Study of Ageing (KLoSA, 2006–20); the Health and Retirement Study from the USA (HRS, 2002–20); and the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004–15).

Each study collected extensive data on the demographic, socioeconomic, behavioural and health characteristics of their adult participants, most of whom were in their 60s.

Hearing ability was derived from participants reporting whether they used a hearing aid, and how they rated their own hearing, from excellent to poor. The researchers combined these responses to define hearing loss if respondents reported fair or poor hearing, or hearing aid use.

The prevalence of hearing loss varied widely, with the highest reported prevalence in China (65%), and the lowest in South Africa (16.5%).

The four countries with the greatest reported prevalence of hearing loss—China, South Korea, Mexico, and Brazil—also had the lowest levels of hearing aid use, ranging from 1%  of those with reported hearing loss in China to 6% in Brazil.

At the other end of the scale, adults with hearing loss in Northern Europe, the USA, and Western Europe were most likely to report using a hearing aid, ranging from 24% in Western Europe to 39% in Northern Europe.

The responses show that the likelihood of hearing loss increased with age in all countries.

Hearing loss at the oldest ages was reported least in Costa Rica and South Africa, where prevalence barely rose above 40% at ages 85+. But over 50% of 50-54 year-olds in China reported hearing loss, with 80% doing so at the oldest ages.

With the exceptions of China, South Korea, and South Africa, men were significantly more likely than women to report hearing loss at nearly all ages.

But there were international differences in hearing aid use by age and gender. In the regions with the highest use—Northern Europe, USA, Western Europe—this increased linearly in tandem with age.

In Northern Europe, for example, around 13% of 50-54 year old men with hearing loss wore hearing aids, compared with 74% at ages 85+. Use also rose in tandem with increasing age in other parts of Europe, Brazil, and South Korea, although overall levels were low, even at the oldest ages.

In South Africa, the age pattern was reversed. Both older men and older women were less likely to report hearing aid use than their younger counterparts.

Gender differences in hearing loss were greatest in the USA, where men were 1.6 times more likely to report this than women. Men in South Africa, China, and South Korea were also 1.5 times more likely to report wearing a hearing aid, although overall use in China and South Korea was extremely low.

Women in Brazil were more likely than men to wear hearing aids, while gender differences were small or non-existent in Northern and Southern Europe, Costa Rica, Mexico and Western Europe.

In regions with the largest gender differences, men below the age of 70 were up to twice as likely to report hearing loss as women, but this divide narrowed with age. On the other hand, there were little to no gender differences in hearing loss at any age in China, South Africa, and South Korea.

In areas with high hearing aid use (Northern Europe, USA, Western Europe and Israel), younger women were more likely to wear them than younger men. In mid-use regions (Costa Rica, Central and Eastern Europe and Southern Europe), gender differences were inconsistent across age categories.

And although use was low or practically non-existent in South Africa, South Korea, and China, men of nearly all ages in these countries were consistently and significantly more likely to wear them than women.

The researchers acknowledge various limitations to their findings, including the reliance on self-reported measures of hearing loss and hearing aid use rather than objective measurements. And while the study encompassed a diverse number of countries, it was limited to those classified as upper-middle to high-income.

Nevertheless, they suggest that: “the wide range in self-reported hearing loss, from 17% in South Africa to 65% in China, suggests complex interactions between a country’s structural factors, like medical and educational systems, and a host of socio-cultural elements, such as beliefs around stigma, disability, and gender norms.”

They add: “The role of structural systems may be especially pertinent for [low and middle income countries], whose health systems are still developing and where specialty services, such as audiology, have only been recently established.”

But pinpointing the correlation between access and uptake at the international level is complicated, they point out.

“Even in countries with complete or near-complete insurance coverage (eg, Western Europe, Northern Europe), hearing aid uptake remains well below 100%, suggesting that financial access can only tell some of the story,” they write.

02/10/2025

Notes for editors
Research: Gender differences in self-reported hearing loss and hearing aid use: a cross-national comparison Doi:10.1136/ bmjgh-2024-017655
Journal: BMJ Global Health

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf   

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Countries with highest reported levels of hearing loss have lowest use of hearing aids first appeared on BMJ Group.

Efforts to improve handwashing don’t always include basics of access to soap + water
Lack of hand hygiene causes annual 740,000 deaths from diarrhoea or respiratory infections 
But despite global recognition of its importance governments slow to act on hand hygiene

A lack of soap is the most often reported barrier to effective hand hygiene—key to curbing the spread of infection—in shared community spaces, such as households, schools, and public places, finds a systematic review of the available research, published in the open access journal BMJ Global Health.

It found that the barriers most often reported concerned physical opportunity, such as the availability of soap; and  lack of motivation—hand hygiene not prioritised, or not habitual practice, for example. On the other hand, the enablers most often reported aligned with motivation in the form of habitual practice and perceived health risk.

A further systematic found that most of the reported efforts to improve handwashing didn’t always address identified barriers or enablers to ensure behavioural sustainability, nor did they fully consider the fundamental resources needed for hand hygiene, such as soap, water, and handwashing facilities.

“If settings do not already have these critical hand hygiene components in the environment, interventions that seek to improve hand hygiene only through motivation, social pressure, or by increasing knowledge should be reconsidered,” conclude the authors.

The reviews form part of a suite of 5, published in a special supplement to the journal that have informed the World Health Organization (WHO) and UNICEF guidelines on hand hygiene in community settings due to be published October 15 on Global Handwashing Day.

The guidelines were prompted by the many inconsistencies and lack of sound evidence to support some of the recommended practices contained in current handwashing guidance around the globe.

The systematic reviews focus on the effectiveness of methods to remove pathogens from the hands; minimum material requirements; behavioural factors; strategies to improve handwashing; and the effectiveness of government measures.

The review looking at what works best for removing and inactivating pathogens, found that most of the evidence assessed capacity to reduce bacteria; just 4% of studies addressed enveloped viruses, such as flu, HIV, respiratory syncytial virus (RSV), and human coronaviruses, and even fewer focused on other pathogens, such as fungi and protozoa.

Other knowledge gaps included commonly used soap alternatives around the world, such as sand and ash; optimal drying methods; and the impact of microbially contaminated water.

“To formulate strong recommendations for handwashing methods, particularly considering viral pandemic illnesses and community resource restrictions, further research that describes the efficacy and effectiveness of a wider range of methods is critical,” conclude the authors.

In a linked commentary, Joanna Esteves Mills, of WHO’s Water, Sanitation, Hygiene and Health Unit, points out that hand hygiene not only protects health and strengthens community resilience, but it also reduces pressure on health systems by saving resources needed for other health priorities.

It can also curb the need for antibiotic treatment, so reducing the spread of antimicrobial resistance and the associated deaths and health costs, she adds.

Yet “despite international recognition of its importance, global progress on hand hygiene has consistently failed to measure up to political commitments and pledges,” she writes.

“There have been gains—between 2015 and 2024, 1.6 billion people gained access to a basic handwashing facility —but in 2024 1.7 billion people still lacked a handwashing facility with soap and water at home and 611 million had no handwashing facility at all,” she adds, citing the latest figures from the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene .

“Achieving universal access by 2030 [a Sustainable Development Goal] would require a doubling in current rates of progress, rising to 11-fold in least developed countries and 8-fold in fragile contexts. Meanwhile, each year, 740,000 people die of diarrhoea or acute respiratory infections that could have been prevented with hand hygiene,” she points out.

The evidence from all 5 systematic reviews points to 3 core principles, she says:

• Access to soap and water and/or alcohol-based sanitisers are minimum material needs which should be any government’s first priority
• People need to know why, when, and how to clean hands
• An enabling  physical and social environment that encourages and motivates sustained practice. In other words, one that is convenient, attractive, and with facilities that are easy to use and which comply with social norms

While governments and international institutions often mobilise rapidly during disease outbreaks, afterwards, budgets are cut, preparedness plans go dormant, and political attention shifts elsewhere, she says, creating a “cycle of panic and neglect.”

To break this cycle, governments need to strengthen systems that can incorporate hand hygiene into broader health initiatives. But strong leadership will be needed, she insists.

“Most importantly, political leadership requires sufficient investment to deliver change. Although cost-effective and relatively simple, hand hygiene interventions are not always low-cost. In particular, water supply infrastructure requires investment. Governments should not rely on emergency budgets, embedding hand hygiene financing instead in annual health budgets,” she concludes.

16/09/2025

Notes for editors
Supplement landing page: https://gh.bmj.com/pages/hand-hygiene-in-communities
1 Research: Behavioural factors influencing hand hygiene practices across domestic, institutional and public community settings: a systematic review and qualitative meta-synthesis doi:10.1136/ bmjgh-2025-018927
2 Research: Interventions to improve hand hygiene in community settings: a systematic review of theories, barriers and enablers, behaviour change techniques and hand hygiene station design features Doi: 10.1136/bmjgh-2025-018928
3 Research: Efficacy and effectiveness of hand hygiene-related practices used in community settings for removal of organisms from hands: a systematic review Doi: 10.1136/bmjgh-2025-018925
4 Commentary: We have the evidence but governments must now build the systems to deliver on hand hygiene Doi: 10.1136/bmjgh-2024-018930
Journal: BMJ Global Health

External funding: World Health Organization; UK Foreign, Commonwealth & Development Office

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Systematic reviews
Subjects: People

The post Lack of soap most reported barrier to effective hand hygiene in shared community spaces first appeared on BMJ Group.

Call out weaponisation of health and healthcare, medical practitioners urged 
Silence implies complicity in direct contravention of humanitarian law and medical ethics 

The deliberate destruction of health services and systems as an act of war should be termed ‘healthocide’ and medical practitioners should call out and stand firm against this weaponisation of healthcare, insists a thought-provoking commentary published in the open access journal BMJ Global Health.

Silence implies complicity and approval, and undermines international humanitarian law as well as medical and professional ethics, say Dr Joelle Abi-Rached and colleagues of the American University of Beirut, Lebanon.

Although they refer to other conflicts in El Salvador, Ukraine, Sudan, and Syria, the authors focus primarily on the impact of armed conflict on healthcare in Lebanon and Gaza.

Data from Lebanon’s Ministry of Public Health show that between 8 October 2023 and 27 January 2025, 217 healthcare workers were killed by the Israel Defense Forces; 177 ambulances were damaged; 68 attacks on hospitals were recorded; and 237 attacks on emergency medical services took place, they say.

Israel’s military operations in Gaza since October 7, 2023 have resulted in at least 986 medical workers’ deaths: 165 doctors; 260 nurses; 184 health associates; 76 pharmacists; 300 management and support staff; and 85 civil defence workers, they add.

“Both in Gaza and Lebanon, healthcare facilities have not only been directly targeted, but access to care has also been obstructed, including incidents where ambulances have been prevented from reaching the injured, or deliberately attacked,” note the authors.

“What is becoming clear is that healthcare workers and facilities are no longer afforded the protection guaranteed by international humanitarian law,” they add.

Yet faced with such wanton destruction, doctors have done little, the authors suggest.

“These attacks have been met with astounding silence or, at best, terse and often belated statements from American, European, or Israeli medical associations, professional groups, and journals,” they point out.

“Are medical doctors ready to forsake the principle of medical neutrality, first forged amidst the carnage of 19th century wars and profoundly reshaped following the liberation of Nazi death camps in 1945? And if so, at what cost?” they ask.

“As difficult as this question is, it is one that physicians must address as they grapple with the normalisation of healthcare’s weaponisation in a world where warfare has changed dramatically, marked by the use of Artificial Intelligence for mass killing, the reliance on drones and killing robots, the deployment of internationally banned weapons, which carry devastating public health and ecological consequences, and, of course, the looming threat of nuclear weapons,” they write.

The ‘normalisation’ of healthcare attacks has increased alarmingly over the past few years, say the authors. “But what we are witnessing today is more pernicious than mere normalisation of such attacks, something that could be described as ‘healthocide’: the deliberate killing and/or destruction of health services and systems for ideological purposes.”

Normalising or excusing healthocide sets a dangerous precedent, the authors argue, as it emboldens future violators and erodes the principle of medical neutrality, which is essential for ensuring impartial and humane care during conflict.

“Medical neutrality is not ‘apolitical’; for us it means standing with humanity, social justice, and health-enabling policies, they add.

The actions medical practitioners must take include advocating for enforcement of justice and international humanitarian law; and documenting and exposing abuses to medical neutrality by both state and non-state actors, insist the authors.

“Rather than passively observe the erosion and normalisation of the weaponisation of health and healthcare, [we call] for critical reflection and decisive action, underscoring that silence implies complicity, approval, or the toleration of double-standards — all of which stand in clear opposition to international humanitarian law and medical deontology [ethics],” they conclude.

05/08/2025

Notes for editors
Commentary: Healthocide and medical neutrality: a call for action and reflection Doi: 10.1136/ bmjgh-2024-018656
Journal: BMJ Global Health

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf   

Externally peer reviewed? Yes
Evidence type: Opinion
Subjects: People

The post New term for systematic, deliberate attacks on healthcare as acts of war: ‘healthocide’ first appeared on BMJ Group.

Especially as data show tourist numbers increasing despite advent of weight loss drugs

Medical tourism for bariatric and weight reduction surgery needs urgent regulation to protect recipients’ health, especially as the data show that tourist numbers are increasing despite the advent of weight loss drugs, say experts in a commentary published online in BMJ Global Health.

The high prevalence of obesity coupled with healthcare resource constraints and increased globalisation have resulted in more people accessing obesity treatment abroad, amid the rapid growth of services to meet this demand, note Dr Jessica McGirr of the Obesity Research and Care Group RCSI University of Medicine and Health Sciences, Dublin, Ireland and Imperial College London, and colleagues.

Despite its size, this industry is largely unregulated, point out the authors. Although reliable data are in short supply, the wider medical tourism industry is worth more than U$400 billion annually, with anticipated year on year growth of 25%, they highlight.

And while it’s anticipated that access to weight loss drugs may curb some of the demand for weight reduction surgery, the numbers of medical tourists in search of bariatric surgery continues to rise, particularly as this is often cheaper overseas, they add.

The out-of-pocket cost for this type of surgery done privately in the UK is around £10, 000–£15,000, but £2500–£4500 in countries, such as Turkey, they say.

The largest global survey to date of providers of bariatric and weight reduction surgery shows that most patients (71%) self-refer. They may therefore not have appropriate medical indication to undergo major surgery: ineligibility for this type of surgery in their home country is often cited by patients as a reason for accessing it overseas, say the authors.

And there are other risks in opting for this type of surgery overseas, they suggest. Providers may not always be clear about the potential complication rates; there’s no preoperative and long-term nutritional, psychological, or other medical follow-up; and there’s often no multidisciplinary care, which is integral to appropriate case selection, they argue.

“When considering adverse outcomes, including anastomotic [surgical tissue join in the gut] leakage, sepsis, and even death, equally concerning is the absence of regulation to ensure that only accredited procedures are performed by appropriately qualified providers,” they highlight.

“Further concern arises in the context of medical tourism ‘packages’ in which patients are offered multiple procedures within the same trip,” which are often accompanied by financial incentives, they add.

And there are also ethical issues to consider, they point out. They highlight the results of a provider survey, showing that nearly a third of respondents believed the consent process was “inappropriate” while 14% believed that patients were personally responsible for surgical complications.

“The need to regulate the [bariatric and metabolic tourism] industry to mitigate these safety, ethical, and legal risks for patients is essential,” urge the authors.

The financial and resource impacts of dealing with postoperative complications in returning medical tourists–and in those countries offering this type of surgery—of disinvesting in public health services to boost private sector trade, raise ethical questions, they add.

The current situation “highlights the need for transnational collaboration among all sectors to implement regulation,” explain the authors, suggesting that bodies, such as the World Trade Organisation, the World Health Organization, and the European Union, among others, should be involved in a global forum designated with this task.

They conclude: “This unregulated industry presents opportunity for quicker access to effective treatment for individuals with obesity but carries potential safety, ethical, and legal risks.

“The economy and healthcare resources of both home and destination countries may benefit financially from [bariatric and metabolic tourism], but the potential for unintended negative consequences and widening health inequity are significant.

“Establishing regulation through transnational collaboration is essential to protect health and health equity.”

16/07/2025

Notes for editors
Commentary: Bariatric and metabolic surgery medical tourism: the compelling need for regulation through transnational collaboration Doi: 10.1136/bmjgh-2025-019546
Journal: BMJ Global Health

Externally peer reviewed? Yes
Evidence type: Opinion
Subjects: People

The post Medical tourism for bariatric/weight reduction surgery needs urgent regulation first appeared on BMJ Group.

Uttar Pradesh, Bihar, Maharashtra, West Bengal account for almost half of all such births

Despite overall progress in bringing down low birthweight numbers across India over the past 30 years, rates remain stubbornly high in certain states, with Uttar Pradesh, Bihar, Maharashtra, and West Bengal, accounting for almost half of all such births, finds research published in the open access journal BMJ Global Health.

Low birthweight is important, because it often signals underlying maternal health issues and poor nutrition as well as the child’s future cognitive development and susceptibility to chronic conditions in later life, note the researchers.

While some states have made rapid progress in bringing down the prevalence of low birthweight, others have found it more difficult, they add.

To try and build an accurate picture of progress across the country over the past 30 years, the researchers drew on data for women and girls aged 13 or 15 to 49 in five waves of the nationally representative National Family Health Survey spanning the period 1992–3 to 2019–21. Low birthweight was defined as less than 2500 g.

Of the total 626,087 live births during the study period, 165,073 (26.5%) newborns weren’t weighed and the information was missing for 20,814 (just over 3%); and 440,200 (just over 70%) were weighed. The size of 614,428 (98%) was subjectively assessed by the mother.

The number of recorded births rose from 48,959 in 1993 to 232,920 in 2021. And the proportion of these babies who were weighed increased over time, resulting in 7,992 being included in the analysis in 1993 (16%) to 209,266 in 2021 (90%). 

The state-level average prevalence of low birthweight fell across the 5 surveys from 25% in 1993 and 1999; to 20% in 2006; 17% in 2016; and 16% in 2021. And the overall prevalence of low birthweight across India fell by 8 percentage points from 26% in 1993 to 18% in 2021. 

The greatest prevalence of low birthweight in 1993 was observed in Rajasthan (48%) and Chhattisgarh (42%) while the lowest was observed in Mizoram (6%) and Nagaland (11%). 

In 2021, the greatest prevalence was observed in Punjab (22%) and the union territory of Delhi (22%) while the lowest prevalence was observed in Mizoram (4%), Nagaland (5%), and Manipur (7%). 

The 2019–21 survey suggests that there were 4.2 million low birthweight babies in a single year in India. Just four states—Uttar Pradesh (858,000), Bihar (430,000), Maharashtra (399, 000, and West Bengal (318, 000)—accounted for almost half (47%) of all these births. 

The figures suggest a degree of convergence, where states with greater prevalence in 1992–93 experienced faster falls.

The 2021 survey also indicated that in a single year 2.5 million children were born smaller than average size, as assessed by their mothers. 

The largest number were born in the same four states as those with a high prevalence of low birthweight: Uttar Pradesh (462, 000); Bihar (318, 000); Maharashtra (261,000); and West Bengal (208,000), accounting for 50% of such births.

For both low birthweight and smaller than average size babies, the 2021 survey showed that these children were considerably more likely to be born to women with little or no formal education and from the poorest households.

“Low birth weight is likely to be more prevalent among non-weighed children since weighing correlates strongly with healthcare infrastructure and being born in a health facility. Also, low socioeconomic status is linked to both lack of access to healthcare and low birth weight,” explain the researchers.

“The insights from data spanning nearly three decades shed light on both promising progress and enduring challenges. Our results point to a general decline in the prevalence of low birth weight and convergence between states over time,” they suggest. 

“However, the levels and specific numbers should be interpreted with caution due to data quality issues, particularly low levels of recorded birthweight in the older surveys,” they caution. 

They conclude: “Despite the overall progress, the persistence of high prevalence of low birth weight in certain states highlights the need for ongoing efforts to address maternal and neonatal health disparities. Despite improvements, data collection at healthcare facilities must also be further enhanced, to provide quality data for decision making across India.”

17/06/2025

Notes for editors

Research: Trends in low birth weight across 36 states and union territories in India, 1993-2021 Doi 10.1136/bmjgh-2024-016732
Journal: BMJ Global Health

External funding: Bill & Melinda Gates Foundation

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf  

Externally peer reviewed? Yes
Evidence type: Observational; survey data
Subjects: People

The post Despite overall progress, low birthweight rates still high in certain Indian states first appeared on BMJ Group.

World Health Innovation Summit (WISH) 2024

BMJ Group partnered with the Qatar Foundation to support the World Health Innovation Summit (WISH) 2024, a leading global health event that brings together policymakers, researchers, and healthcare professionals. Under the theme “Humanising Health: Conflict, Equity, and Resilience,” the summit explored how health systems can address inequality, respond to crises, and strengthen healthcare resilience worldwide.

As part of this collaboration, BMJ Group produced a series of global health podcasts, expert interviews, videos, and research papers designed to share evidence-based solutions and human stories that put people at the centre of health policy and practice.

Scroll down to explore the full collection of WISH 2024 podcasts, videos, and papers, and discover how we can build more equitable and resilient health systems for all.

Read

The BMJ Opinion

Overlooked global health priority

Improving access and tackling inequities in palliative care globally would help to reduce preventable suffering, write Anna Peeler, Oladayo Afolabi, and Richard Harding

Millions of people around the world live and die with virtually no access to pain and symptom relief.1 We have failed to tackle this preventable suffering in people with life limiting illness, and the problem will continue to worsen as populations age and the burdens of non-communicable diseases and multimorbidity grow. Palliative care is neglected as a global health priority, and health systems around the world must better prepare to meet the growing need.

By 2060, 48 million people will die each year with serious health related suffering, an 87% increase from 2016. Moreover, 83% of these deaths will occur in low and middle income countries (LMICs) where access to adequate health services, palliative care, and essential medicines can be severely limited. Read more >>

We need to do more to keep antibiotics working

Tuberculosis is a preventable and curable disease that continues to devastate the most vulnerable, including migrant and refugee communities in the shadows of global crises

According to the World Health Organization’s global tuberculosis report, TB is one of the world’s deadliest infectious killers, claiming 1.25 million lives (including 161,000 deaths among people with HIV) and causing 10.8 million people to become ill in 2023. Refugees, migrants, and other displaced people are disproportionately vulnerable to tuberculosis, facing compounded risks such as inadequate healthcare, unsafe living conditions, and legal and social barriers.2 Only through unified and decisive action can we prevent further ill health and loss of life from TB.

Globally, around a billion people—equivalent to one in every eight people—have experienced migration or forced displacement. Although not all refugees and migrants are vulnerable, the scale of the vulnerable population is staggering. For example, in the first half of 2024, over 120 million people had been forcibly displaced because of persecution, conflict, violence, or human rights violations and other disruptive events. This includes 46 million refugees and other people in need of international protection, 72.1 million internally displaced people, and 8 million asylum seekers.

TB rates among refugees, asylum seekers, and displaced communities can be up to 130 times higher than those among populations within host countries, underscoring the urgent need for targeted interventions in these communities. Confronting these intersecting crises requires resolute political commitment, crossborder collaboration, and bold, targeted investments. Read more >>

The international community is failing to protect healthcare in armed conflict

Regular attacks on health facilities, workers, and patients in conflicts are a devastating reality

Since 2018, the World Health Organization (WHO) has documented over 7400 attacks on healthcare in armed conflict across 21 countries and territories. WHO defines an attack on healthcare as any act of verbal, physical violence, obstruction, or threat of violence that interferes with the availability, access, and delivery of curative or preventive health services during emergencies. That translates to an average of three attacks a day, every day. The attacks have killed almost 2500 health workers, patients, and bystanders—one a day. To prevent and mitigate attacks on healthcare— one of the most disturbing aspects of today’s conflicts—we need renewed political, legal, diplomatic, and programmatic efforts.

Attacks on healthcare are a global problem. While reporting is not exhaustive, most attacks over the past seven years have occurred in the occupied Palestinian territory, Ukraine, Democratic Republic of Congo, Myanmar, Afghanistan, and Syria.1 Despite clear prohibitions under international law, not one person has been held accountable for any of the over 7400 attacks documented by WHO. Historically, only a handful of cases have led to charges and prosecution.

The message is clear—current laws, accountability mechanisms, and diplomatic efforts are proving ineffective at protecting healthcare in conflict.2 Impunity is the rule. And the public health implications are stark—attacks on healthcare severely disrupt access to life saving and essential health services for some of the most vulnerable communities.

Urgent, collective action is required to tackle this problem that represents a terrible stain on our conscience. A major new report—In the Line of Fire: Protecting Health in Armed Conflict—analyses the situation in detail.3 It proposes a series of concrete, actionable recommendations that, if consistently implemented, chart a course to preventing and mitigating attacks on healthcare in conflict. Read more >>

Unified response is needed to tackle tuberculosis among refugees and migrants

Tuberculosis is a preventable and curable disease that continues to devastate the most vulnerable, including migrant and refugee communities in the shadows of global crises

According to the World Health Organization’s global tuberculosis report, TB is one of the world’s deadliest infectious killers, claiming 1.25 million lives (including 161 000 deaths among people with HIV) and causing 10.8 million people to become ill in 2023.1 Refugees, migrants, and other displaced people are disproportionately vulnerable to tuberculosis, facing compounded risks such as inadequate healthcare, unsafe living conditions, and legal and social barriers.2 Only through unified and decisive action can we prevent further ill health and loss of life from TB.

Globally, around a billion people—equivalent to one in every eight people—have experienced migration or forced displacement. Although not all refugees and migrants are vulnerable, the scale of the vulnerable population is staggering. For example, in the first half of 2024, over 120 million people had been forcibly displaced because of persecution, conflict, violence, or human rights violations and other disruptive events. This includes 46 million refugees and other people in need of international protection, 72.1 million internally displaced people, and 8 million asylum seekers.

TB rates among refugees, asylum seekers, and displaced communities can be up to 130 times higher than those among populations within host countries,2 underscoring the urgent need for targeted interventions in these communities. Confronting these intersecting crises requires resolute political commitment, crossborder collaboration, and bold, targeted investments. Read more >>

BMJ Global Health: analysis

Tuberculosis at the crossroads: urgent actions for migrant and refugee health in a turbulent era

Tereza Kasaeva, Kerri Viney, Hannah Monica Dias, Martin van den Boom, Santino Severoni, Josette Najjar-Pellet, Diana Abou Ismail, Sanaa T Al-Harahsheh, Allen Gidraf Kahindo Maina, Poonam Dhavan, Farai Mavhunga, 18 September 2025

Tuberculosis (TB) remains the world’s deadliest infectious disease kiler, affecting the most vulnerable, including refugees and migrants. Their vulnerability is intensified by structural and social barriers that hinder diagnosis and treatment and restrict healthcare access. To put a spotlight on this issue, the WHO in collaboration with the Qatar Foundation launched a technical report on innovative solutions for TB elimination among refugees and migrants at the Seventh World Innovation Summit for Health (WISH) in November 2024. The report proposes 10 policy options and includes seven illustrative case studies to address the issue of TB among refugees and migrants. The global public health landscape has shifted dramatically since the report’s release. Widespread funding cuts for health and development coupled with escalating geopolitical tensions now threaten hard-won public health gains. On the back of an already chronically underfunded TB response, where only 26% of the needed funds were available, both global and local responses to TB are faltering—putting lives, equity and elimination goals at serious risk. While the 2024 WISH report outlined policy actions to address TB among refugees and migrants, shrinking funding for health and development now threatens implementation. Therefore, in this analysis piece, we examine the current and urgent challenge of addressing TB among migrants and refugees framed in the context of three policy actions in the WISH report—namely, political commitment, adequate resourcing and equitable access to healthcare. We argue that sustaining and scaling up efforts to end TB is not optional—it is imperative. Read more >>

Harnessing primary healthcare to reduce the burden of cervical cancer in the Eastern Mediterranean Region

Giuseppe Troisi, Nahla Gafer, Heba Alsawahli, Khalifa Elmusharaf, Matilda Byström, Jihan Azar, Mohamed Afifi, Asmus Hammerich, Hammoda Abu-Odah, Lamia Mahmoud, 8 June 2025

Cervical cancer remains a significant public health challenge in the WHO Eastern Mediterranean Region (EMR), with significant implications for women’s health and sustainable development. Despite being largely preventable, the EMR reported high prevalence of new cases and deaths in 2022. The burden is expected to increase by 2050. Primary healthcare (PHC) offers a cost-effective platform for delivering essential health services, such as human papilloma virus vaccination and early detection and referral programmes, which are crucial for reducing cervical cancer incidence and mortality.

The paper discusses the role of PHC in cervical cancer interventions, showcasing successful examples from EMR countries and examining barriers like resource constraints, sociocultural factors and systemic inefficiencies. It also proposes solutions, such as enhancing infrastructure and human resources, fostering public–private partnerships and adopting innovative screening methods. By addressing these gaps and leveraging PHC’s potential, EMR countries can improve cervical cancer outcomes and promote health equity for girls and women across the region. Read more >>

Confronting global inequities in palliative care

Anna Peeler, Oladayo Ayobami Afolabi, Katherine E Sleeman, Maha El Akoum, Nahla Gafer, Asmus Hammerich, Richard Harding, 16 May 2025

The number of people dying with preventable, serious health-related suffering is rapidly increasing, and international calls for the expansion of palliative care services have been made, such as the World Health Assembly Resolution 67.19, which named palliative care as an essential component of Universal Health Coverage. Despite this, only about 14% of all palliative care need globally is met today, and health systems around the world are unprepared to meet the growing need. Palliative care has been shown to improve patient, caregiver and health-system outcomes and reduce costs for many populations and contexts. Geographic, social, cultural and health-literacy related inequities in access to and quality of palliative care services persist.

We provide evidence-based recommendations which require immediate, coordinated action to improve progress towards achieving equitable access to high-quality palliative care for all. These include but are not limited to ensuring every country has palliative care codified into national health policy; providing evidence-based, basic palliative care education and training for all non-specialist healthcare workers; empowering and facilitating community action in research and service development; and ensuring that all essential palliative care medicines are available for those who need them. Unless urgent, evidence-based, coordinated action is taken, countries, health systems, and communities will fail to meet the growing palliative care demand, and millions of people around the world will experience preventable suffering. Read more >>

The post Humanising health: conflict, equity, and resilience first appeared on BMJ Group.

..to curb global toll taken by the disease, especially in the rest of Africa and Asia
High levels of aflatoxin contamination in dietary staples of maize and peanuts
With one of the highest rates of liver cancer in Africa, Ghana represents critical case study

There’s an urgent need to quantify the role of fungal toxins (aflatoxins), found on agricultural crops, such as maize and peanuts (groundnuts), in the escalating rates of liver cancer in Ghana, as well as elsewhere in Africa and Asia, concludes a commentary published in the open access journal BMJ Global Health.

Maize and peanuts are dietary staples in many Asian and African countries. And with one of the highest rates of liver cancer in Africa, at 16/100,000 of the population. Ghana represents a critical case study in furthering international understanding of the link between aflatoxins and the rising global toll taken by liver cancer, say the authors.

Aflatoxins are produced primarily by Aspergillus flavus and Aspergillus parasiticus, which thrive in warm humid conditions, and can occur at any point during harvest and storage.

There are several known risk factors for liver cancer, explain the authors. These include chronic infection with hepatitis B and C viruses—the prevalence of which is high in Ghana—liver cirrhosis, heavy drinking and smoking, and genetic and metabolic conditions, such as diabetes and obesity.

While the International Agency for Research on Cancer (IARC) has classified naturally occurring aflatoxins as Group 1 human carcinogens, no study to date has specifically assessed the contribution of aflatoxin exposure to the high incidence of primary liver cancer in Ghana, despite the high consumption of foods contaminated with these toxins and the prevalence of hepatitis, point out the authors.

The Ghanaian government has taken several steps to curb contamination and public exposure to aflatoxins. These include promoting good agricultural practices, improved storage methods, solar drying techniques, pest control, regular monitoring of food and feed products, and raising public awareness of the hazards of aflatoxin exposure, note the authors.

But without solid evidence, it’s difficult to understand the exact extent of the exposure and its impact on public health, they add.

For example, few large scale epidemiological studies involving different demographic groups, geographic regions, and rural and urban populations in Ghana, have been carried out. And the combined effects of multiple risk factors on liver cancer development are still poorly understood, say the authors.

Improved surveillance and monitoring systems are needed to assess the effectiveness of current aflatoxin control measures in the country. And better understanding of socioeconomic and cultural factors could inform safer food practices at the household and community levels, they suggest.

“This research is vital to informing targeted interventions, refining existing policies, and ultimately reducing the burden of liver cancer in the country,” insist the authors.

If these research gaps are plugged, the benefits will be felt not only in Ghana, but elsewhere, including many countries in Sub-Saharan Africa and Asia, they add.

“Ghana can better protect its population from the deadly consequences of aflatoxin exposure and contribute to global efforts to curb the growing burden of liver cancer,” they write, highlighting that liver cancer ranks among the leading causes of cancer-related deaths worldwide.

There were over 700,000 deaths from liver cancer reported in 2022 alone, with the toll taken by the disease projected to keep on rising: between 2020 and 2040, new cases are expected to rise by 55%, with associated deaths increasing by more than 56%, emphasise the authors.

11/06/2025

Notes for editors
Commentary: Aflatoxin exposure and primary liver cancer in Ghana Doi 10.1136/bmjgh-2024-017626
Journal: BMJ Global Health

External funding: None declared

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf  

Externally peer reviewed? Yes
Evidence type: Opinion
Subjects: People

The post Urgent need to quantify role of fungal toxins in rising liver cancer rates in Ghana first appeared on BMJ Group.