The need for a planetary approach to healthcare is widely recognised at national and international levels. Social prescribing is becoming an increasingly popular strategy for meeting contemporary social, physical and mental health needs as well as tackling health inequalities. As this is a relatively new and emerging healthcare intervention, a comprehensive and accurate understanding of its impact is essential to support continued improvements in care, develop strategies for scale-up and delivery and justify further funding and investment. Nature-based Social Prescribing (NBSP) has unique potential to affect animal and environmental outcomes as well as human health. The One Health perspective can be used to operationalise and evaluate NBSP. This article presents the Nature-based Social Prescribing Impact Pathways (NaBSPIP) framework, which can be used to guide NBSP design and evaluation to leverage maximum benefit for humans, animals and the environment that we share.

In response to the short-term political cycles that govern law-making, there is growing international attention to the obligations owed to future generations. Within the diverse approaches there is often a single, temporally defined inequality; that is, between now and a depleted future. While inequality is imagined between generations, these generations are often constructed as homogenous. This elides not just contemporary inequalities, but that these injustices are caused by historically rooted inequalities that current planetary threats are likely to deepen. In response, we centre health inequalities which illustrate the complex temporalities and structural causes of inequalities. We argue for a focus on eco-social and embodied generations to better understand – and respond to – inequalities past, present and future. We apply this focus to the Capabilities Approach as an example of the work needed to better articulate what is owed to present and future generations to secure justice and inform future-oriented law-making.

Real knowledge emerges from “impossible” worldviews. Or, put differently, it is possible to accept knowledge that is produced by people whose ontological presuppositions–their baseline assumptions about the nature of reality–one entirely rejects. How can this fact be accommodated, not by advancing a wishful post-dualism, dangerous post-secularism, or implausible ontological relativism, but by working within the tradition of secular political philosophy so that indigenous knowledge, too, can be a basis for public policy and collective action in secular societies? Via a reframing Amazonian multinaturalist perspectivism–which has so inspired post-dualist civilizational critiques–as a social theory of health and illness that informs contemporary Western epidemiology’s struggles to theorize the distribution of health and illness in mass society, this article advances a general approach to recognizing knowledge that has been developed on the other side of boundaries of ontological difference. It argues that the accuracy or efficacy of any particular indigenous knowledge-practice implies the generative potential as theory of the ontological presuppositions that facilitated the knowledge-practice’s evolution. Combining the ontological turn’s interest in the innovativeness of indigenous concepts with a proposal for superseding its incommensurable worlds and abandonment of the aspiration to more-than-local knowledge, the article shows that indigenous ideas and their underlying ontologies are more than generic alternatives to inspire Western civilizational renewal, and opens a path to their legitimization as actionable knowledge in the terms of secular public reason.

Poor dietary patterns leading to poorer health and increased health care use have affected people living in disadvantaged economic circumstances in the UK for decades, which many fear will be exacerbated due to the UK's current so-called ‘cost of living crisis’. The voices of experts by experience of those health and social inequalities are not routinely included in health improvement intervention development in relation to obesity prevention policy and programmes. Obesity is highly correlated with food insecurity experience in high-income country contexts (where food insecurity data are routinely collected) and is similarly socially patterned. Using a health equity lens, this review paper highlights qualitative research findings that have revealed the perspectives and direct experiences of people living with food insecurity, or those others supporting food-insecure households, that shed light on the role and influence of the socio-economic contextual factors food-insecure people live with day-to-day. Insights from qualitative research that have focused on the granular detail of day-to-day household resource management can help us understand not only how food insecurity differentially impacts individual household members, but also how behavioural responses/food coping strategies are playing into pathways that lead to avoidable ill health such as obesity, diabetes and other chronic health conditions, including mental health problems. This review paper concludes by discussing research and policy implications in relation to food-insecure households containing people with chronic health conditions, and for pregnant women and families with infants and very young children living in the UK today.

COVID-19 impacts population health equity. While mRNA vaccines protect against serious illness and death, little New Zealand (NZ) data exist about the impact of Omicron – and the effectiveness of vaccination – on different population groups. We aim to examine the impact of Omicron on Māori, Pacific, and Other ethnicities and how this interacts with age and vaccination status in the Te Manawa Taki Midland region of NZ. Daily COVID-19 infection and hospitalisation rates (1 February 2022 to 29 June 2022) were calculated for Māori, Pacific, and Other ethnicities for six age bands. A multivariate logistic regression model quantified the effects of ethnicity, age, and vaccination on hospitalisation rates. Per-capita Omicron cases were highest and occurred earliest among Pacific (9 per 1,000) and Māori (5 per 1,000) people and were highest among 12–24-year-olds (7 per 1,000). Hospitalisation was significantly more likely for Māori people (odds ratio (OR) = 2.03), Pacific people (OR = 1.75), over 75-year-olds (OR = 39.22), and unvaccinated people (OR = 4.64). Length of hospitalisation is strongly related to age. COVID-19 vaccination reduces hospitalisations for older individuals and Māori and Pacific populations. Omicron inequitably impacted Māori and Pacific people through higher per-capita infection and hospitalisation rates. Older people are more likely to be hospitalised and for longer.

What is the value of including vulnerable people in risk regulation decision-making in the European Union (EU)? This article examines a distinctive approach employed by the European Medicines Agency (EMA): public hearings integrated within safety reviews of medicinal products. The article presents findings from a case study of the EMA’s public hearing on Quinolone antibiotics, which was included by the EMA as part of a review process that led to significant tightening of regulatory restrictions on the prescribing of this class of antibiotics. The article argues that the public hearing enabled a group of patients who had been victims of a debilitating toxicity syndrome associated with Quinolone antibiotics to criticise the existing scientific evidence base around the safety of Quinolone. Deploying the quantitative Discourse Quality Index and an interpretive analytical approach, the article shows how patients challenged the evidence base in a manner that was efficacious in advancing knowledge in this area of risk regulation. When physically staged alongside interventions by professional experts, the article argues that patients facilitated a process of “negotiation” of expertise, leading professional representatives to propose methods of coordination in order to integrate the patients’ qualitative evidence of their suffering with the toxicity syndrome. Ultimately, this process led to the EMA proposing more stringent future guidelines for the prescription of Quinolone antibiotics in the EU.

Maternal nutrition is essential for optimal health and well-being of women and their infants. This review aims to provide a critical overview of the evidence-base relating to maternal weight, obesity-related health inequalities and dietary interventions encompassing the reproductive cycle: preconception, pregnancy, postnatal and interpregnancy. We provide an overview of UK data showing that overweight and obesity affects half of UK pregnancies, with increased prevalence among more deprived and minoritised ethnic populations, and with significant health and cost implications. The existing intervention evidence-base primarily focuses on the pregnancy period, where extensive evidence demonstrates the power of interventions to improve maternal diet behaviours, and minimise gestational weight gain and postnatal weight retention. There is a lack of consistency in the intervention evidence-base relating to interventions improving pregnancy health outcomes, although there is evidence of the potential power of the Mediterranean and low glycaemic index diets in improving short- and long-term health of women and their infants. Postnatal interventions focus on weight loss, with some evidence of cost-effectiveness. There is an evidence gap for preconception and interpregnancy interventions. We conclude by identifying that interventions do not address cumulative maternal obesity inequalities and overly focus on individual behaviour change. There is a lack of a joined-up approach for interventions throughout the entire reproductive cycle, with a current focus on specific stages (i.e. pregnancy) in isolation. Moving forward, the potential power of nutritional interventions using a more holistic approach across the different reproductive stages is needed to maximise the benefits on health for women and children.