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A Scalable Model to Improve Cancer Care for Older Adults

Individuals aged 70 years and older account for more than 40% of patients with cancer in the US and 25% of those with incident cancers. Yet older adults have been largely neglected by cancer research and care improvement efforts. Less than 3% of older patients with cancer are enrolled in oncology clinical trials, and the landscape of treatments received by older adults is not well understood. Comorbid conditions, frailty, and resource limitations can necessitate modifications to cancer treatments and render older patients more vulnerable to complications. Moreover, many may be ineligible for or choose to forgo anticancer therapy and therefore see oncology practitioners infrequently—despite experiencing symptoms and conditions that require ongoing management. These complexities beg for scalable strategies to monitor and support older adults with cancer.

[Series] Strengthening nationally led approaches to new product introduction for HIV prevention

As the pipeline of new HIV prevention technologies (including long-acting injectables, vaginal rings, antibody infusions, and, potentially, vaccines) expands careful planning is needed to ensure these innovations are effectively and equitably introduced within public health systems. Such planning is particularly important because the introduction and scale-up of HIV prevention tools has historically been hampered by insufficient national ownership, implementation in pilot settings that do not reflect the realities of broader public health systems, insufficient community engagement, and fragmentation across financing, regulatory pathways, and service delivery domains.

[Series] Enhancing HIV prevention through systematic community engagement, learning, and response

Successful uptake of existing and new HIV prevention interventions demands meaningful, systematic, and participatory engagement integrated across the conception, design, implementation, and assessment phases of programming. Despite proven impact of community engagement, it remains chronically underfunded and is often not conducted consistently or as part of harmonised national policy and practice, causing gaps that are likely to worsen in the current funding environment. Systematic models of community engagement—from peer-led outreaches to community-led monitoring and advisory boards—strengthen trust, responsiveness, and accountability.

[Series] Global HIV prevention is not on track: how a health systems approach can promote sustainable progress in African countries

The expansion of the global HIV response has led to substantial reductions in mortality and new infections over the past two decades. Yet, despite these gains, rates of new HIV infections remain much higher than projected, resulting in long-term consequences for controlling the epidemic. Challenges include siloed delivery approaches shaped by the demands and priorities of external funding, lack of integrated data systems for prevention, unaddressed structural risks, and limited community and multisectoral engagement.

[Comment] Due south: navigating volatile health research landscapes

Unprecedented changes to the availability and structure of health funding, specifically from the USA, have had substantial impacts on research programmes, collaborations, and, most importantly, vulnerable populations in low-income and middle-income countries. For nearly three decades, South Africa has served as a crucial location for HIV and other infectious disease research, and in the process, produced internationally recognised experts in the field.1 Although South African health research, and similar programmes in low-income and middle-income countries, have benefitted substantially from international grant support, through deep and organic collaborations with US partners, the disruption in funding requires urgent rethinking to ensure the long-term sustainability of health research in South Africa and beyond.

[Comment] The future of HIV prevention in southeast Asia

HIV remains a public health threat globally, particularly in Asia and the Pacific, which was estimated to be home to 16·9% of 40·8 million people living with HIV worldwide in 2024.1 The region contributed 23·1% of all new HIV infections; however, of 8 million users of pre-exposure prophylaxis (PrEP) worldwide less than 5% live in Asia and the Pacific.2 Effective and sustainable implementation of prevention may prove challenging, but past experience and robust community-led approaches might pave the way for southeast Asia.

[Comment] HIV prevention for young African women is about choice

By the end of 2024, an estimated 8 million people had initiated pre-exposure prophylaxis (PrEP),1 including approximately 2 million people in sub-Saharan Africa since 2022.2 Young African women are a high priority for HIV prevention because of their persistently high HIV incidence despite increased frequency of HIV testing of African men, linkages to antiretroviral therapy (ART) when positive, and viral suppression among their male partners. Although uptake of daily oral PrEP by young women, including in South Africa, has increased substantially in the past several years, adherence and persistence are suboptimal,3 in part due to challenges with daily pill-taking, societal attitudes about young women's sexual activity, anticipated or experienced stigma from taking an antiretroviral for HIV prevention, and fear of rejection by partners and family if they learn about their PrEP use.

[Editorial] A sustainable future for HIV prevention

This issue includes three papers of a six-paper Series on Sustainable HIV Prevention in Africa, co-published with The Lancet Global Health. When this Series was conceived in 2024, the journal's editors hoped it would provide a roadmap to help transitioning from fragmented, siloed, and donor-led HIV prevention programmes—which typify access to HIV prevention in many settings—to programmes led by national governments and driven by communities. These new approaches should be integrated within robust health systems, providing access to diverse products to all who would benefit.

[Personal View] Priority setting for environmentally sustainable health care: emerging approaches to fair resource allocation

Priority setting in health care is a research and practice area at the intersection of medicine, ethics, and economics, which aims to systematically and transparently evaluate the value for money of health services to support fair resource allocation. Three widely accepted principles for fair priority setting are cost-effectiveness, priority to the worse off, and financial risk protection, with a wide range of other contested criteria. Conceptualising and navigating potential synergies and trade-offs between competing goals, and clearly communicating the values at stake, are the central tasks of priority setting.

[Personal View] Safeguarding natural ecosystems can protect population health: advancing approaches to bridge the health–ecology divide

Human health stands to benefit from a deeper understanding of the mechanisms by which ecosystems affect health and wellbeing. However, achieving this understanding requires overcoming conceptual and practical challenges in both public health and ecology. Despite growing recognition of the importance of natural ecosystems for human health, the health sector has yet to fully integrate this ever-growing body of evidence to inform policy and practice. Substantial conceptual differences underpin the disciplinary divide between health and ecology.

[Review] Microplastic and nanoplastic pollution and associated potential disease risks

Microplastics and nanoplastics (MNPs) are emerging pollutants widely dispersed in the environment, with humans primarily exposed through ingestion and inhalation. Although their biological effects are being increasingly studied, their potential effect on human health and disease risk remains uncertain. This Review summarises evidence on potential disease risks of human exposure to MNPs, while highlighting key limitations and research gaps. Evidence suggests that MNP exposure might elevate the risk of various diseases, including metabolic, respiratory, cardiovascular, neuroendocrine, hepatic, renal, and skin disorders, as well as infectious diseases, cancer, and ageing-related disorders.

[Review] Inclusion of wellbeing impacts of climate change: a review of literature and integrated environment–society–economy models

Climate change has broad and deep impacts on people’s wellbeing; yet, these dynamics are largely excluded from integrated environment–society–economy (ESE) models. In this Review, we provide an overview of climate change–wellbeing impact pathways and explore which of these pathways have been quantified or modelled, or both. We assessed literature reviews and meta-analyses to describe how climate change affects specific wellbeing outcomes and which of these relationships are robust and amenable to parametrisation.

[Articles] Prenatal phenol exposure and child behaviour: insights into the hypothalamic–pituitary–adrenal axis from two prospective mother–child cohorts

Prenatal exposure to phenols might influence early behavioural development, with sex-specific patterns. There was no strong evidence of mediation by maternal steroid hormones, suggesting the involvement of alternative pathways in the biological effects of phenols. Together with previous findings, these results highlight the need for stricter regulation of these compounds to reduce prenatal exposure.

[Articles] Projections of future mortality risk in older adults from high-tide flooding in coastal areas of the USA: an economic modelling study

The cost of premature mortality in older adults is greater in magnitude than other modelled effects of climate-induced high-tide flooding (eg, value of lost time due to traffic delays). Results suggest further action is needed to (1) identify and protect components of road networks critical for emergency access, (2) build additional, more accessible critical care delivery facilities, and (3) manage the retreat of vulnerable populations to areas with better access to critical care facilities.

[Articles] Wildfire-specific fine particulate matter and preterm birth: a US ECHO Cohort analysis

In a prospective cohort, we observed increased odds of preterm birth associated with wildfire PM2·5 exposure in the western USA, with findings suggesting an exposure–response relationship for increasing exposure intensity and duration. Preterm birth was also associated with exposure to smoke days in mid-to-late pregnancy at the national level. For practice and policy, these findings support the need for public health interventions aimed at reducing exposure to wildfire smoke during pregnancy.