A multinational Delphi consensus to end the COVID-19 public health threat.

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

Managing government debt.

To construct a stochastic version of [R. J. Barro, J. Polit. Econ. 87, 940-971 (1979)] normative model of tax rates and debt/GDP dynamics, we add risks and markets for trading them along lines suggested by [K. J. Arrow, Rev. Econ. Stud. 31, 91-96 (1964)] and [R. J. Shiller, Creating Institutions for Managing Society's Largest Economic Risks (OUP, Oxford, 1994)]. These modifications preserve Barro's prescriptions that a government should keep its debt-gross domestic product (GDP) ratio and tax rate constant over time and also prescribe that the government insure its primary surplus risk by selling or buying the same number of shares of a Shiller macro security each period.

Trends in U.S. public confidence in science and opportunities for progress.

In recent years, many questions have been raised about whether public confidence in science is changing. To clarify recent trends in the public's confidence and factors that are associated with these feelings, an effort initiated by the National Academies' Strategic Council for Research Excellence, Integrity, and Trust (the Strategic Council) analyzed findings from multiple survey research organizations. The Strategic Council's effort, which began in 2022, found that U.S. public confidence in science, the scientific community, and leaders of scientific communities is high relative to other civic, cultural, and governmental institutions for which researchers regularly collect such data. However, confidence in these institutions has fallen during the previous 5 years. Science's decline, while real, is similar to or less than that in the other groups. A recent study goes into greater detail by exploring public views of science. From these data, we observe that many of the surveyed U.S. public question the extent to which scientists share their values or overcome personal biases when presenting conclusions. At the same time, large majorities agree on certain types of actions that they want scientists to take. For example, 84% respond that it is "somewhat important" or "very important" for scientists to disclose their funders. Ninety-two percent (92%) offer the same responses to scientists "being open to changing their minds based on new evidence." Collectively, these data clarify how the U.S. public views science and scientists. They also suggest actions that can affect public confidence in science and scientists in the years to come.

Improve how science advice is provided to governments by learning from "experts in expert advice".

During the Coronavirus Disease 2019 (COVID-19) pandemic, science advisory mechanisms did not always live up to expectations. What practical steps can the expert community take to improve advisory mechanisms in an emergency?

Is hate speech detection the solution the world wants?

The machine learning (ML) research community has landed on automated hate speech detection as the vital tool in the mitigation of bad behavior online. However, it is not clear that this is a widely supported view outside of the ML world. Such a disconnect can have implications for whether automated detection tools are accepted or adopted. Here we lend insight into how other key stakeholders understand the challenge of addressing hate speech and the role automated detection plays in solving it. To do so, we develop and apply a structured approach to dissecting the discourses used by online platform companies, governments, and not-for-profit organizations when discussing hate speech. We find that, where hate speech mitigation is concerned, there is a profound disconnect between the computer science research community and other stakeholder groups-which puts progress on this important problem at serious risk. We identify urgent steps that need to be taken to incorporate computational researchers into a single, coherent, multistakeholder community that is working towards civil discourse online.

Toward healthy and sustainable diets for the 21st century: Importance of sociocultural and economic considerations.

Four years after the EAT-Lancet landmark report, worldwide movements call for action to reorient food systems to healthy diets that respect planetary boundaries. Since dietary habits are inherently local and personal, any shift toward healthy and sustainable diets going against this identity will have an uphill road. Therefore, research should address the tension between the local and global nature of the biophysical (health, environment) and social dimensions (culture, economy). Advancing the food system transformation to healthy, sustainable diets transcends the personal control of engaging consumers. The challenge for science is to scale-up, to become more interdisciplinary, and to engage with policymakers and food system actors. This will provide the evidential basis to shift from the current narrative of price, convenience, and taste to one of health, sustainability, and equity. The breaches of planetary boundaries and the environmental and health costs of the food system can no longer be considered externalities. However, conflicting interests and traditions frustrate effective changes in the human-made food system. Public and private stakeholders must embrace social inclusiveness and include the role and accountability of all food system actors from the microlevel to the macrolevel. To achieve this food transformation, a new "social contract," led by governments, is needed to redefine the economic and regulatory power balance between consumers and (inter)national food system actors.

Assessing the costs of ozone pollution in India for wheat producers, consumers, and government food welfare policies.

We assess wheat yield losses occurring due to ozone pollution in India and its economic burden on producers, consumers, and the government. Applying an ozone flux-based risk assessment, we show that ambient ozone levels caused a mean 14.18% reduction in wheat yields during 2008 to 2012. Furthermore, irrigated wheat was particularly sensitive to ozone-induced yield losses, indicating that ozone pollution could undermine climate-change adaptation efforts through irrigation expansion. Applying an economic model, we examine the effects of a counterfactual, "pollution-free" scenario on yield losses, wheat prices, consumer and producer welfare, and government costs. We explore three policy scenarios in which the government support farmers at observed levels of either procurement prices (fixed-price), procurement quantities (fixed-procurement), or procurement expenditure (fixed-expenditure). In pollution-free conditions, the fixed-price scenario absorbs the fall in prices, thus increasing producer welfare by USD 2.7 billion, but total welfare decreases by USD 0.24 billion as government costs increase (USD 2.9 billion). In the fixed-procurement and fixed-expenditure scenarios, ozone mitigation allows wheat prices to fall by 38.19 to 42.96%. The producers lose by USD 5.10 to 6.01 billion, but the gains to consumers and governments (USD 8.7 to 10.2 billion) outweigh these losses. These findings show that the government and consumers primarily bear the costs of ozone pollution. For pollution mitigation to optimally benefit wheat production and maximize social welfare, new approaches to support producers other than fixed-price grain procurement may be required. We also emphasize the need to consider air pollution in programs to improve agricultural resilience to climate change.

Norm-violating rhetoric undermines support for participatory inclusiveness and political equality among Trump supporters.

Over the last decade, the United States has seen increasing antidemocratic rhetoric by political leaders. Yet, prior work suggests that such norm-violating rhetoric does not undermine support for democracy as a system of government. We argue that, while that may be true, such rhetoric does vitiate support for specific democratic principles. We test this theory by extending prior work to assess the effects of Trump's norm-violating rhetoric on general support for democracy as well as for the principles of participatory inclusiveness, contestation, the rule of law, and political equality. We find that Trump's rhetoric does not alter attitudes toward democracy as a preferred system but does reduce support for inclusiveness and equality among his supporters. Our findings suggest that elite rhetoric can undermine basic principles of American democracy.

14-Carbon demonstrates that some illegal ivory is being taken from government stockpiles.

The 14-carbon in animal tissues records the time that the tissues are formed; since the 1960s, using the "bomb curve" for 14C, the age of animal death can be determined accurately. Using animal tissue samples of known collection and formation dates for calibration, we determine the age of ivory samples from four ivory seizures made by law enforcement agencies between 2017 and 2019. The 14C measurements from these seizures show that most ivory in the illegal wildlife trade is from animals from recent poaching activities. However, one seizure has a large fraction of ivory that is more than 30 y old, consistent with markings on the tusks indicating they were derived from a government stockpile.

Threatened Species Initiative: Empowering conservation action using genomic resources.

Globally, 15,521 animal species are listed as threatened by the International Union for the Conservation of Nature, and of these less than 3% have genomic resources that can inform conservation management. To combat this, global genome initiatives are developing genomic resources, yet production of a reference genome alone does not conserve a species. The reference genome allows us to develop a suite of tools to understand both genome-wide and functional diversity within and between species. Conservation practitioners can use these tools to inform their decision-making. But, at present there is an implementation gap between the release of genome information and the use of genomic data in applied conservation by conservation practitioners. In May 2020, we launched the Threatened Species Initiative and brought a consortium of genome biologists, population biologists, bioinformaticians, population geneticists, and ecologists together with conservation agencies across Australia, including government, zoos, and nongovernment organizations. Our objective is to create a foundation of genomic data to advance our understanding of key Australian threatened species, and ultimately empower conservation practitioners to access and apply genomic data to their decision-making processes through a web-based portal. Currently, we are developing genomic resources for 61 threatened species from a range of taxa, across Australia, with more than 130 collaborators from government, academia, and conservation organizations. Developed in direct consultation with government threatened-species managers and other conservation practitioners, herein we present our framework for meeting their needs and our systematic approach to integrating genomics into threatened species recovery.

Three world wars: Fiscal-monetary consequences.

Directed by a consolidated government budget constraint, we compare US monetary­fiscal responses to World Wars I and II and the War on COVID-19.

Defining and conceptualising the commercial determinants of health.

Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors-notably the largest transnational corporations-are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so. Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests. This power imbalance leads to policy inertia; although many policy solutions are available, they are not being implemented. Health harms are escalating, leaving health-care systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the wellbeing of future generations, development, and economic growth.

The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action.

Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.

Governments policy measures to address obesity among adults: a scoping review of the global evidence.

BACKGROUND: Obesity epidemic is one of the greatest challenges in public health in modern societies. This study aimed to address the main gap by reviewing the effectiveness of nutritional policy measures implemented globally by governments to reduce obesity prevalence among adults. METHODS: We developed a scoping review by searching Ovid Medline, PubMed, and Embase from May 5, to July 12, 2022 for papers published in English between Jan 1, 2002 and May 1, 2022. Eligible papers included adults older than 18 years and focused on obesity prevention strategies. No restrictions on study design or geographic location were applied. The search terms included "obesity", "health policy", "government regulation", and "obesogenic environment". FINDINGS: 17 articles were eligible for this scoping review across seven countries (USA, UK, France, Mexico, Colombia, Chile, and India). The identified studies were observational, cross-sectional, and systematic reviews, with the majority published in the USA and the UK within the past 5 years. Policies were categorised into three groups: food and beverages taxes (n=6), food labelling (n=6) and national campaigns (n=5). Most policies showed a small magnitude change in obesity reduction metrics such as body-mass index (BMI) and weight outcome (n=10). Two studies found that food labelling did not significantly change weight status. Two other studies targeting national campaigns showed a reduction in risk for obesity and overweight. However, the sugar tax demonstrated promising results compared with all other policies when the tax levy tier was increased. Three studies reported that a higher tax increase was correlated with a greater decline in obesity prevalence when increasing the tax up to 20%. INTERPRETATION: Our findings inform recommendations for policy makers of how other countries have implemented and evaluated their food policies. It can also encourage food industries to reformulate their products and promote population health. The limited number of settings included in this study is a main limitation of the review. Further investigation of the tax equity is needed. FUNDING: None.

Exploring Parental Incarceration, US Government Support Programs, and Child Health and Well-Being: A National Cross-Sectional Study.

OBJECTIVES: To describe relationships between parental incarceration and child health and flourishing-a measure of curiosity, resilience, and self-regulation-and to identify government programs that moderate this relationship. METHODS: Using the National Survey of Children's Health data from 2016 through 2019 for children 6-17 years old, we estimated associations with logistic regression between parental incarceration and overall health and flourishing, adjusting for child, caregiver, and household factors. We secondarily examined physical health (asthma, headaches), mental health (attention deficit disorder/attention deficit hyperactivity disorder, depression), developmental needs (learning disability, special educational plan use), and educational (missing ≥11 school days, repeated grade) outcomes. We performed interaction analyses to determine whether government program participation (eg, free/reduced lunch, cash assistance) moderated relationships between parental incarceration and child outcomes. RESULTS: Children with parental incarceration accounted for 9.3% of the sample (weighted n = 4 400 000). Black, American Indian/Alaska Native, and multiracial children disproportionately experienced parental incarceration. Parental incarceration was associated with worse health (aOR, 1.31; 95% CI, 1.11-1.55) and higher odds of not flourishing (aOR, 1.66; 95% CI, 1.46-1.89). Physical health, mental health, developmental issues, and educational needs were also associated with parental incarceration. Participation in free and reduced lunch moderated the relationships between parental incarceration and general health and flourishing, and cash assistance moderated the association between parental incarceration and flourishing. For each, parental incarceration had an attenuated association with health among people who participated in government programs. CONCLUSIONS: Parental incarceration is disproportionately experienced by Black and Indigenous children and associated with worse child health and well-being. Government support program participation may mitigate negative associations between parental incarceration and child outcomes.

Climate risks in urban areas.

Engaging with communities in informal settlements presents opportunities to mitigate the health impacts of climate change, but government investment is also needed. Gary Humphreys reports.

Addressing tobacco industry influence in tobacco-growing countries.

Protecting policy-making from tobacco industry influence is central to effective tobacco control governance. The inclusion of industry actors as stakeholders in policy processes remains a crucial avenue to corporate influence. This influence is reinforced by the idea that the tobacco industry is a legitimate partner to government in regulatory governance. Addressing the influence of the tobacco industry demands a focus on the government institutions that formalize relationships between industry and policy-makers. Industry involvement in government institutions is particularly relevant in tobacco-growing countries, where sectors of government actively support tobacco as an economic commodity. In this paper, we discuss how controlling tobacco industry influence requires unique consideration in tobacco-growing countries. In these countries, there is a diverse array of companies that support tobacco production, including suppliers of seeds, equipment and chemicals, as well as transportation, leaf buying and processing, and manufacturing companies. The range of companies that operate in these contexts is particular and so is their engagement within political institutions. For governments wanting to support alternatives to tobacco growing (Article 17 of the Framework Convention for Tobacco Control), we illustrate how implementing Article 5.3, aimed at protecting tobacco control policies from tobacco industry interference, is fundamental in these countries. Integrating Article 5.3 with Article 17 will (i) strengthen policy coherence, ensuring that alternative livelihood policies are not undermined by tobacco industry interference; (ii) foster cross-sector collaboration addressing both tobacco industry interference and livelihood development; and (iii) enhance accountability and transparency in tobacco control efforts.

Éviter que l'élaboration de politiques soit influencée par l'industrie du tabac est essentiel pour assurer une gestion efficace de la lutte antitabac. L'inclusion d'acteurs de l'industrie comme parties prenantes des processus législatifs demeure l'un des principaux leviers employés par les sociétés. Cette influence est renforcée par l'idée que l'industrie du tabac constitue un partenaire légitime du gouvernement dans le domaine de la gouvernance réglementaire. Pour lutter contre l'ingérence du secteur, il faut se concentrer sur les institutions gouvernementales qui officialisent les relations entre l'industrie et les responsables politiques. L'implication de l'industrie dans les institutions publiques est surtout observée dans les pays producteurs de tabac, où certains niveaux de gouvernement soutiennent activement le tabac en tant que bien économique. Dans le présent document, nous abordons le fait qu'une lutte contre l'influence de l'industrie du tabac requiert une attention particulière dans les pays producteurs, où un large éventail d'entreprises encouragent la production de tabac: approvisionnement en semences, équipements et produits chimiques, mais aussi transport, achat des feuilles, transformation et fabrication. La variété des entreprises œuvrant dans de tels contextes est spécifique, tout comme leur engagement au sein des organes politiques. Pour les gouvernements qui souhaitent privilégier les alternatives à la production de tabac (selon l'article 17 de la Convention-cadre pour la lutte antitabac), nous montrons à quel point l'application de l'article 5.3, qui vise à protéger les politiques de lutte antitabac contre l'ingérence de l'industrie, est fondamentale dans ces pays. Intégrer l'article 5.3 dans l'article 17 permettra (i) de renforcer la cohérence des politiques en vigueur, afin que les politiques relatives à des activités de remplacement ne soient pas contrecarrées par l'industrie du tabac; (ii) de favoriser la collaboration entre les secteurs pour lutter contre l'influence de l'industrie tout en développant des moyens de subsistance; et enfin, (iii) d'accroître la responsabilisation et la transparence dans les efforts menés dans la lutte antitabac.

Proteger la formulación de políticas contra la influencia de la industria tabacalera es fundamental para una gobernanza eficaz del control del tabaco. La inclusión de los actores de la industria como partes interesadas en los procesos políticos sigue siendo una vía crucial para la influencia corporativa. Esta influencia se ve reforzada por la idea de que la industria tabacalera es un asociado legítimo del gobierno en la gobernanza reglamentaria. La lucha contra la influencia de la industria tabacalera exige centrarse en las instituciones gubernamentales que formalizan las relaciones entre la industria y los responsables de formular políticas. La participación de la industria en las instituciones gubernamentales es especialmente relevante en los países productores de tabaco, donde algunos sectores del gobierno apoyan activamente el tabaco como un bien económico. En este documento, se analiza cómo el control de la influencia de la industria tabacalera requiere una consideración especial en los países productores de tabaco. En estos países, existe una gran variedad de empresas que apoyan la producción de tabaco, incluidos los proveedores de semillas, equipos y productos químicos, así como las empresas de transporte, de compra de hojas y de procesamiento y fabricación. La variedad de empresas que operan en estos contextos es particular y también lo es su compromiso dentro de las instituciones políticas. Para los gobiernos que desean apoyar alternativas al cultivo de tabaco (es decir, el artículo 17 del Convenio Marco para el Control del Tabaco), se ilustra cómo la aplicación del artículo 5.3, destinado a proteger las políticas de control del tabaco de la interferencia del tabaco, es fundamental en estos países. La integración del artículo 5.3 con el artículo 17 (i) reforzará la coherencia política, asegurando que las políticas de medios de vida alternativos no se vean perjudicadas por la interferencia de la industria tabacalera; (ii) fomentará la colaboración intersectorial al abordar tanto la interferencia de la industria tabacalera como el desarrollo de los medios de vida; y (iii) mejorará la rendición de cuentas y la transparencia en los esfuerzos de control del tabaco.

The Pitfalls of Ascribing Moral Agency to Corporations: Public Obligation and Political and Social Contexts in the Commercial Determinants of Health.

Policy Points Government and civil society should be held more accountable for creating food and beverage regulatory policies rather than assigning moral agency to the food and beverage industry. Nutrition policymaking institutions should ensure civil society's ability to design regulatory policy. Government policymaking institutions should be isolated from industry interference.

Trend analysis and prediction of gonorrhea in mainland China based on a hybrid time series model.

BACKGROUND: Gonorrhea has long been a serious public health problem in mainland China that requires attention, modeling to describe and predict its prevalence patterns can help the government to develop more scientific interventions. METHODS: Time series (TS) data of the gonorrhea incidence in China from January 2004 to August 2022 were collected, with the incidence data from September 2021 to August 2022 as the validation. The seasonal autoregressive integrated moving average (SARIMA) model, long short-term memory network (LSTM) model, and hybrid SARIMA-LSTM model were used to simulate the data respectively, the model performance were evaluated by calculating the mean absolute percentage error (MAPE), root mean square error (RMSE), and mean absolute error (MAE) of the training and validation sets of the models. RESULTS: The Seasonal components after data decomposition showed an approximate bimodal distribution with a period of 12 months. The three models identified were SARIMA(1,1,1) (2,1,2)12, LSTM with 150 hidden units, and SARIMA-LSTM with 150 hidden units, the SARIMA-LSTM model fitted best in the training and validation sets, for the smallest MAPE, RMSE, and MPE. CONCLUSIONS: The overall incidence trend of gonorrhea in mainland China has been on the decline since 2004, with some periods exhibiting an upward trend. The incidence of gonorrhea displays a seasonal distribution, typically peaking in July and December each year. The SARIMA model, LSTM model, and SARIMA-LSTM model can all fit the monthly incidence time series data of gonorrhea in mainland China. However, in terms of predictive performance, the SARIMA-LSTM model outperforms the SARIMA and LSTM models, with the LSTM model surpassing the SARIMA model. This suggests that the SARIMA-LSTM model can serve as a preferred tool for time series analysis, providing evidence for the government to predict trends in gonorrhea incidence. The model's predictions indicate that the incidence of gonorrhea in mainland China will remain at a high level in 2024, necessitating that policymakers implement public health measures in advance to prevent the spread of the disease.