The gambling industry tends to frame gambling harms as a matter of personal responsibility, which is implicit in their messages like ‘gamble responsibly’ or ‘take time to think’. Jurisdictions such as Australia and the UK are replacing industry messages with a range of independently designed ones, like in tobacco warning labels. Counter-industry messages have been proposed to challenge industry narratives, e.g., ‘gambling products are designed to be addictive’. Here we tested 10 potential counter-industry messages among UK gamblers (N = 4,094) using a mixed-methods approach. Results showed that the three best-performing messages came from existing counter-industry campaigns. Participants believed the messages and agreed that they were relevant to people experiencing gambling harm. Participants experiencing higher levels of harm tended to see the messages as more personally relevant to them. Free-text analysis showed that ‘gambling products are designed to be addictive’ received the most positive responses, and also that personal responsibility views were widespread among participants. Messages randomly shown later in the experiment were appraised more positively, suggesting that counter-industry messaging may become more effective when its core message is repeated in multiple ways. Continual design and testing will contribute to the development of best approaches and inform future implementation.

Public health research faces challenges in recruiting hard-to-reach populations, including socioeconomically disadvantaged groups. This study evaluated whether machine learning (ML) algorithms developed using data from a general population could predict indices of diet quality among a socioeconomically disadvantaged group. Data from 5367 adults (77.5% females) in the NutriQuébec project and on 122 variables potentially associated with dietary intakes were used. Dietary intakes were measured using a validated web-based 24-h recall. Participants were categorized by fifths of a deprivation score based on income, education, and material and social deprivation. Participants in the first 4 fifths were assigned to the general NutriQuébec sample (n= 4180) and those above the 5th quintile formed the high deprivation sample (n= 1187). Three indices of diet quality defined as “high” or “low” were used: vegetable and fruit consumption (VFC, ≥5.0 reference amounts [RA]/day), “other foods” consumption, i.e. foods not recommended in Canada’s Food Guide 2019 (OFC, >5.0 RA/day), and overall diet quality measured using the Healthy Eating Food Index-2019 (HEFI-2019, >48.9 points). The algorithms developed and tested in the general NutriQuébec sample predicted high VFC, OFC and HEFI-2019 with accuracies of 0.60 (95%CI:0.58-0.62), 0.58 (95%CI:0.56-0.60) and 0.61 (95%CI:0.59-0.63), respectively. In the high deprivation sample, the algorithms predicted the diet quality indices with comparable accuracies (VFC, 0.69, 95%CI:0.67-0.71; OFC, 0.56, 95%CI:0.54-0.58; HEFI-2019, 0.66, 95%CI:0.65-0.67). ML algorithms trained to predict three diet quality indices in the general NutriQuébec sample were applicable to a sample with high deprivation. Additional studies should further evaluate applicability to other underrepresented groups.

This article examines the historical transformation of childhood vaccination in the Netherlands between 1872 and 1959. It analyses how vaccination was reframed from an individual parental responsibility to a collective practice through the establishment of the ‘Rijksvaccinatieprogramma’ (National Immunisation Programme). I analyse this historical trajectory as a case of ‘public health atomism’, a strategy that achieves collective health by prioritizing individual health outcomes and local action. Rather than relying on top-down state mandates, the ‘Rijksvaccinatieprogramma’ was a consequence of co-operation between general practitioners, municipal health officials, civil society organisations, and volunteers. Drawing from published medical sources, parliamentary records, and material from local and national archives, this article provides a detailed historical account of how local governance and autonomy shaped vaccination practices, highlighting the role of the ‘entgemeenschap’ (vaccination community) as a key organisational model for situated collaboration. As such, it revisits childhood vaccination as an archetypical example of biopolitical state intervention, demonstrating how localised, flexible co-operation was instrumental in integrating vaccination into Dutch society.

Dr. C. Norman Coleman initiated the establishment of a working group within the Administration for Strategic Preparedness and Response (ASPR), U.S. Department of Health and Human Services, to explore ways in which federal planning and guidance could better foster effective and efficient nuclear detonation response, with initial attention to cytokine use in the public health and medical response. Dr. Coleman recognized the difference between planning guidance (what to do) and a strategy (how to do it). He developed actionable strategies to improve our nation’s nuclear preparedness, including scarce resources triage protocols,1 cytokine and evacuation priorities,2 and the Exposure And Symptom Triage (EAST) tool.3 Despite his absence and in his spirit, this working group, nicknamed “The Solutions Lab,” is continuing the work on actionable strategies for nuclear preparedness.

Cet article examine la problématique de la grossophobie en discutant de ses racines comme de ses impacts sur les personnes qui en sont victimes ainsi que sa manifestation au sein du droit. Il explore plus précisément comment le droit et les politiques publiques peuvent perpétuer la stigmatisation des corps, notamment à travers les interventions en matière de saine alimentation. L’étude se concentre sur l’approche environnementale adoptée au Québec pour promouvoir une alimentation saine, en interrogeant sa capacité à éviter la stigmatisation individuelle. S’appuyant sur le cadre théorique des Fat Studies, l’article expose l’argumentation politique des Fat Studies, présente le cadre normatif québécois destiné à la création d’environnements favorables à la saine alimentation, et examine la place accordée au poids corporel dans les politiques publiques québécoises liées à la saine alimentation dans le but d’offrir une perspective critique sur les approches actuelles en santé publique ainsi que leurs impacts sur la perception sociétale de la grosseur.

Experts step into global governance most prominently in times of crisis. But if crisis governance at international organizations (IOs) involves the construction of specific temporal horizons, how do these horizons affect the constitution of expert authority? This article argues that expertise produced under such conditions – to meet a demand for ‘timely’ knowledge – differs substantively from other kinds of expertise. Crisis governance thus contributes in notable ways to the pluralization of expertise. The article examines this phenomenon in the case of the relatively recent proliferation of rapid response mechanisms (RRMs). By examining the making and implementation of RRMs at two major IOs – the World Health Organization and the World Food Programme – the article offers a new understanding for how RRMs have become part of institutional repertoires of expertise. Based on this, it contends that RRM-based timeliness claims a shift in expert knowledge production from credentialed individuals to infrastructures and standardized procedures; second, they prioritize large homogenous datasets over consultation and contestation among different experts; and third, they streamline expert selection such that experts are recruited from existing intra-institutional pools rather than third parties. Jointly, these shifts speed up monitoring and reaction capabilities, but also risk eroding important checks on expert overconfidence.

Medical shelters are frequently utilized after major disasters to care for displaced individuals with severe mobility limitations and chronic medical conditions that may be inadequately addressed in general population sheltering. A retrospective chart review was conducted on 680 patients served in state-operated Medical Needs Shelters (MNS) in Louisiana following three major hurricanes from 2020 to 2021. The authors aimed to produce a descriptive analysis of the degree and variety of medical complexity of patients within the shelters to guide future shelter planning. Data illustrate demographic characteristics, clinical attributes, and outcomes among shelter patients. Patients were found to have numerous medical comorbidities, often with serious concomitant neuropsychiatric, cardiovascular, and pulmonary conditions. The shelter population was highly dependent on nursing staff for medication management and activities of daily living. They also had high utilization of respiratory therapies, hemodialysis, and wound care. Clinically significant events (e.g., falls, mental status changes, vital sign abnormalities), often resulting in transport to local hospitals, occurred in approximately 20% of all patient stays. Limitations of the study include suspected underreporting of disease prevalence and the study’s retrospective approach. Public health planners should consider the clinical needs of this population when designing strategic and tactical approaches to mass care for medically vulnerable individuals. Future research might examine which factors place individuals at higher risk for decompensation within a medical shelter.

Throughout the twentieth century, senior roles in UK public health were reserved for doctors. Local authority medical officers of health were replaced in 1974 by NHS community physicians and from 1989 by medical directors of public health. Over the last decade of the century, an increasingly vocal group of non-medical public health professionals sought to break the glass ceiling that restricted them from advancing to senior roles; although they received encouragement from some leaders within the Faculty of Public Health Medicine, there was also significant resistance from many members. A number of factors came together around the year 2000, which culminated in a ground-breaking decision by the English Department of Health to allow non-medical appointments as directors of public health and consultants in public health in the NHS, with the then Secretary of State memorably declaring it was time to ‘take public health out of the ghetto’. At the same time, the leadership of the Faculty of Public Health Medicine overcame opposition from some of its members and opened its training, examinations, and membership to non-medical candidates. By the early 2020s, half of the renamed Faculty of Public Health members were from backgrounds other than medicine as well as 90% of directors of public health in England. This paper explores the complex history behind this unprecedented opening of a medical specialty to non-medical membership, the factors that enabled it, and the continuing legacy of tensions and inequalities within an occupation that is both a medical specialty and a multidisciplinary profession.

Iodine deficiency is now a significant public-health concern in the UK. Data from the National Diet and Nutrition Survey (NDNS; 2019–2023) shows that several population groups are now classified as mildly iodine deficient, including women of childbearing age. This is a change from previous NDNS data where these groups were iodine sufficient. As iodine is needed for thyroid-hormone production, which are essential for brain development, iodine deficiency prior to, and during, pregnancy may have implications for child cognition – including lower IQ. However, the evidence base for the health effects of mild deficiency is not as strong as in severe deficiency. The WHO recommends salt iodisation to control iodine deficiency in a population, but such a policy was never introduced in the UK and iodised salt is not widely available. While UK milk is rich in iodine and is the principal source, the rise in popularity of plant-based milk alternatives may increase the risk of iodine deficiency. It may be necessary to give personalised advice to those with low iodine intake, but identify those at risk is challenging owing to a lack of a biomarker for iodine in an individual. Population-wide approaches may be required in the UK – for example, fortification of bread with iodised salt or mandatory iodine fortification of plant-based dairy alternatives. This review will critically discuss (i) the data on iodine deficiency in the UK (ii) the evidence base for the health implications of mild deficiency and (iii) the potential public-health solutions.

How do democratic states induce citizens to comply with government directives during times of acute crisis? Focusing on the onset of the Covid‐19 pandemic in France, I argue that the tools states use to activate adherence to public health advice have predictable and variable effects on citizens’ willingness to change their routine private behaviours, both because of variation in their levels of restrictiveness but also because of differences in people's political motivations to comply with them. Using data collected in March 2020, I show that people's reports of changes in their behavioural routines are affected by the signals governments send, how they send them and the level of enforcement. I find that a nationally televised speech by President Macron calling for cooperative behaviour and announcing new restrictions elevated people's willingness to comply. Moreover, while co‐partisanship with the incumbent government increased compliance reports before the President's primetime television address, presidential approval boosted reports of compliance after.

Persistent concerns about loneliness and social isolation in later life have prompted increasing attention to the social and environmental factors that enable or constrain connection. Yet, while previous research has identified community and societal determinants of social connection, little is known about how these factors interact dynamically with individual and interpersonal circumstances to shape older adults’ lived connection experiences. This study addresses this knowledge gap by examining how older Australians perceive and experience environmental influences on their social connectedness, and how factors across multiple ecological levels work together to create or hinder opportunities for connection. Four focus groups were conducted with 15 participants, aged 60 years and over, from metropolitan and regional areas in New South Wales, Australia, to explore how participants described the role of different factors in their connection experiences. Participants identified a range of influences across individual, interpersonal, community and societal levels, including meaningful roles, community spaces, local businesses and transport accessibility. Three patterns of cross-level interaction were revealed: the interplay between personality and community infrastructure; the multi-level role of digital technology; and the cascading influence of policy frameworks shaping community participation opportunities. By uncovering how factors interact dynamically across social-ecological levels, this study advances understanding of the contexts that foster or constrain social connection in later life. The findings contribute to ongoing debates in social gerontology by demonstrating that loneliness and social isolation are best addressed through coordinated, multi-level interventions that align individual, community and policy environments to promote healthy ageing in place.