Pub Date : 2026-09-04DOI: 10.1016/S2468-2667(26)00160-X
Alexander Moses, Sidney Siyuan Guo, Lisa Wood, Ollie Jay, Timothy English
Extreme heat is intensifying globally and disproportionately harms people experiencing homelessness, who face continuous exposure and limited capacity to access cooling. We reviewed the literature on heat-protection interventions that report findings for people experiencing homelessness. Only 12 studies met the inclusion criteria, indicating a sparse and heterogeneous evidence base mainly from high-income countries (USA, Canada, and Australia). No eligible studies were identified from Europe despite substantial heat events in the region. Interventions included cooling centres and cooled public spaces (eg, air-conditioned community halls and libraries), outreach and preparedness programmes (eg, education and weather-preparedness kits), and makeshift shelter modifications (eg, tent shading and ventilation), with housing and temporary accommodation discussed as structural protection. Access barriers to cooled spaces were common (eg, transport constraints and rules restricting belongings or pets), and some participants relied on self-directed cooling strategies (eg, travelling on public transport) rather than services. Evaluations reported qualitative implementation outcomes and physiological and exposure outcomes, with limited clinical-outcome reporting, constraining inference about effects on heat-related morbidity or mortality. Future research should prioritise co-designed, hybrid models that combine accessible cooling centres and cooled public spaces with outreach and low-cost mobile or distributed cooling (eg, electric fans and water dousing), evaluated using standardised implementation metrics and broad health endpoints.
{"title":"Heat-health interventions for people experiencing homelessness.","authors":"Alexander Moses, Sidney Siyuan Guo, Lisa Wood, Ollie Jay, Timothy English","doi":"10.1016/S2468-2667(26)00160-X","DOIUrl":"https://doi.org/10.1016/S2468-2667(26)00160-X","url":null,"abstract":"<p><p>Extreme heat is intensifying globally and disproportionately harms people experiencing homelessness, who face continuous exposure and limited capacity to access cooling. We reviewed the literature on heat-protection interventions that report findings for people experiencing homelessness. Only 12 studies met the inclusion criteria, indicating a sparse and heterogeneous evidence base mainly from high-income countries (USA, Canada, and Australia). No eligible studies were identified from Europe despite substantial heat events in the region. Interventions included cooling centres and cooled public spaces (eg, air-conditioned community halls and libraries), outreach and preparedness programmes (eg, education and weather-preparedness kits), and makeshift shelter modifications (eg, tent shading and ventilation), with housing and temporary accommodation discussed as structural protection. Access barriers to cooled spaces were common (eg, transport constraints and rules restricting belongings or pets), and some participants relied on self-directed cooling strategies (eg, travelling on public transport) rather than services. Evaluations reported qualitative implementation outcomes and physiological and exposure outcomes, with limited clinical-outcome reporting, constraining inference about effects on heat-related morbidity or mortality. Future research should prioritise co-designed, hybrid models that combine accessible cooling centres and cooled public spaces with outreach and low-cost mobile or distributed cooling (eg, electric fans and water dousing), evaluated using standardised implementation metrics and broad health endpoints.</p>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":" ","pages":""},"PeriodicalIF":26.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-09-01Epub Date: 2026-07-24DOI: 10.1016/S2468-2667(25)00251-8
Andrea Krüsi, Jennie Pearson, Zahra Stardust, Stefan Baral, Jules Kim, Tyne Baynton Cairns, Kirstin Kielhold, Magda Lopes Queta, Fatou Drame, Shira Goldenberg
Sex workers remain overwhelmingly excluded from occupational health and safety (OHS) protections due to continued criminalisation and stigmatisation of sex work. In this Series paper, we examine evidence on sex workers' OHS using an adapted OHS framework. Our findings show how criminalisation undermines comprehensive OHS practices across legislative contexts, but despite criminalisation, sex workers adopt innovative, community-driven strategies to safeguard OHS and place a strong emphasis on community mobilisation and mutual aid. Decriminalisation markedly improves working conditions and facilitates the development of sex worker-led official OHS guidelines. In contrast, legalisation can perpetuate many of the OHS barriers associated with criminalisation. OHS presents novel opportunities to create safer workplaces and advance the health and human rights of sex workers. Implementing OHS practices designed and led by sex workers with local expertise in their specific work environments is a crucial next step in advancing the health, safety, and labour rights of sex workers globally.
{"title":"Towards occupational health and safety in sex work.","authors":"Andrea Krüsi, Jennie Pearson, Zahra Stardust, Stefan Baral, Jules Kim, Tyne Baynton Cairns, Kirstin Kielhold, Magda Lopes Queta, Fatou Drame, Shira Goldenberg","doi":"10.1016/S2468-2667(25)00251-8","DOIUrl":"10.1016/S2468-2667(25)00251-8","url":null,"abstract":"<p><p>Sex workers remain overwhelmingly excluded from occupational health and safety (OHS) protections due to continued criminalisation and stigmatisation of sex work. In this Series paper, we examine evidence on sex workers' OHS using an adapted OHS framework. Our findings show how criminalisation undermines comprehensive OHS practices across legislative contexts, but despite criminalisation, sex workers adopt innovative, community-driven strategies to safeguard OHS and place a strong emphasis on community mobilisation and mutual aid. Decriminalisation markedly improves working conditions and facilitates the development of sex worker-led official OHS guidelines. In contrast, legalisation can perpetuate many of the OHS barriers associated with criminalisation. OHS presents novel opportunities to create safer workplaces and advance the health and human rights of sex workers. Implementing OHS practices designed and led by sex workers with local expertise in their specific work environments is a crucial next step in advancing the health, safety, and labour rights of sex workers globally.</p>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":" ","pages":"e715-e726"},"PeriodicalIF":26.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-09-01Epub Date: 2026-07-24DOI: 10.1016/S2468-2667(25)00220-8
Carmen H Logie, Shira Goldenberg, Julien Brisson, Frannie MacKenzie, Martin Nguyen, Luissa Vahedi, Jennie Pearson, Nataliia Isaieva, Fairy Abdulghani, Agata Dziuban, Yigit Aydinalp, Stefan Baral, Amaya Perez-Brumer
Sex workers face compounding social and health inequities driven by multiple stigmas-social processes of devaluation that reduce access to power, resources, and opportunities. In this Series paper, we review the evidence and report that structural, interpersonal, and internalised stigma profoundly shape sex workers' health by undermining access to health and human rights, with well documented impacts on sexual health, mental wellbeing, safety, and access to justice. Furthermore, stigma within communities and health, social, workplace, and legal systems often intersect to drive health inequities, social exclusion, and legal harms experienced by diverse sex workers globally. Despite these challenges, sex workers actively negotiate and resist the effects of stigma through peer support, advocacy, and community building, highlighting their agency and resilience. Decriminalisation, community mobilisation and empowerment, and rights-affirming health care are evidence-based strategies to reduce stigma and promote the health, safety, and rights that are urgently needed to optimise health and wellbeing for sex workers across the globe.
{"title":"Intersecting stigma as a fundamental barrier to the health and wellbeing of sex workers.","authors":"Carmen H Logie, Shira Goldenberg, Julien Brisson, Frannie MacKenzie, Martin Nguyen, Luissa Vahedi, Jennie Pearson, Nataliia Isaieva, Fairy Abdulghani, Agata Dziuban, Yigit Aydinalp, Stefan Baral, Amaya Perez-Brumer","doi":"10.1016/S2468-2667(25)00220-8","DOIUrl":"10.1016/S2468-2667(25)00220-8","url":null,"abstract":"<p><p>Sex workers face compounding social and health inequities driven by multiple stigmas-social processes of devaluation that reduce access to power, resources, and opportunities. In this Series paper, we review the evidence and report that structural, interpersonal, and internalised stigma profoundly shape sex workers' health by undermining access to health and human rights, with well documented impacts on sexual health, mental wellbeing, safety, and access to justice. Furthermore, stigma within communities and health, social, workplace, and legal systems often intersect to drive health inequities, social exclusion, and legal harms experienced by diverse sex workers globally. Despite these challenges, sex workers actively negotiate and resist the effects of stigma through peer support, advocacy, and community building, highlighting their agency and resilience. Decriminalisation, community mobilisation and empowerment, and rights-affirming health care are evidence-based strategies to reduce stigma and promote the health, safety, and rights that are urgently needed to optimise health and wellbeing for sex workers across the globe.</p>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":" ","pages":"e691-e702"},"PeriodicalIF":26.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-09-01Epub Date: 2026-07-24DOI: 10.1016/S2468-2667(25)00307-X
Katherine Rucinski, Mary Anne Roach, Anna Shapiro, Yigit Aydinalp, Kaitlyn Atkins, Joseph G Rosen, Karina Bravo Neira, Niki Lovisa, Trajche Janushev, Stefan Baral, Shira Goldenberg
Stark health inequities persist for sex workers globally-particularly in the areas of mental health, sexual and reproductive health, and harm reduction. To inform this Series paper we reviewed epidemiological studies published over the past decade to describe the burden of key health outcomes among sex workers and associated factors contributing to these disparities. Within the mental health literature, we estimate at least one in four and as many as four in five sex workers experience depression. Within sexual and reproductive health literature, at least one in three sex workers are estimated to experience an unmet need for contraception. Using a Health Equity framework, we contextualise evidence gaps related to these health areas across multiple levels of influence (eg, systems of power, relationships and networks, physiological pathways, and individual factors) and offer recommendations to advance an agenda of health equity for sex workers in future research and programmes. Priority programme and policies include upholding the autonomy and dignity of sex worker communities, ensuring the inclusion of gender diverse populations in research, addressing structural determinants of health, and fostering meaningful community engagement and collaboration.
{"title":"Health inequities faced by sex workers.","authors":"Katherine Rucinski, Mary Anne Roach, Anna Shapiro, Yigit Aydinalp, Kaitlyn Atkins, Joseph G Rosen, Karina Bravo Neira, Niki Lovisa, Trajche Janushev, Stefan Baral, Shira Goldenberg","doi":"10.1016/S2468-2667(25)00307-X","DOIUrl":"10.1016/S2468-2667(25)00307-X","url":null,"abstract":"<p><p>Stark health inequities persist for sex workers globally-particularly in the areas of mental health, sexual and reproductive health, and harm reduction. To inform this Series paper we reviewed epidemiological studies published over the past decade to describe the burden of key health outcomes among sex workers and associated factors contributing to these disparities. Within the mental health literature, we estimate at least one in four and as many as four in five sex workers experience depression. Within sexual and reproductive health literature, at least one in three sex workers are estimated to experience an unmet need for contraception. Using a Health Equity framework, we contextualise evidence gaps related to these health areas across multiple levels of influence (eg, systems of power, relationships and networks, physiological pathways, and individual factors) and offer recommendations to advance an agenda of health equity for sex workers in future research and programmes. Priority programme and policies include upholding the autonomy and dignity of sex worker communities, ensuring the inclusion of gender diverse populations in research, addressing structural determinants of health, and fostering meaningful community engagement and collaboration.</p>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":" ","pages":"e680-e690"},"PeriodicalIF":26.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-09-01Epub Date: 2026-07-24DOI: 10.1016/S2468-2667(25)00323-8
Claire E Broad, Elizabeth Mc Guinness, Victoria Holt, Rachel Stuart, Pippa Grenfell, Luz Marina Llangari-Arizo, Raven Bowen, Shira Goldenberg, Lucy Platt
Violence against sex workers can be substantial, with severe physical and mental health consequences. In this Series paper, we review the global evidence on violence prevention and support interventions by and for sex workers, and focus on violence reduction, mental health, and access to services. We found that peer-reviewed evidence focused on client-perpetrated violence, whereas non-peer-reviewed evidence focused on broader human rights abuses and police violence. The central involvement of sex workers in intervention design and delivery resulted in improved engagement and effectiveness in terms of reducing violence. Interventions that reduced violence from clients did not affect intimate partner violence, and vice versa. Peer networks strengthen agency through collective safety planning, information sharing, and emotional support, yet access is limited for migrant and street-based sex workers. Broader stakeholder engagement-including from police, policy makers, health and social services, and third parties such as managers and security-is essential for addressing structural determinants of violence, although reliance upon these same stakeholders can reinforce systems that perpetuate violence. Addressing violence requires interventions that recognise the diverse forms and perpetrators of violence, alongside broad structural reforms to tackle its root causes.
{"title":"Violence prevention and support interventions for sex workers.","authors":"Claire E Broad, Elizabeth Mc Guinness, Victoria Holt, Rachel Stuart, Pippa Grenfell, Luz Marina Llangari-Arizo, Raven Bowen, Shira Goldenberg, Lucy Platt","doi":"10.1016/S2468-2667(25)00323-8","DOIUrl":"10.1016/S2468-2667(25)00323-8","url":null,"abstract":"<p><p>Violence against sex workers can be substantial, with severe physical and mental health consequences. In this Series paper, we review the global evidence on violence prevention and support interventions by and for sex workers, and focus on violence reduction, mental health, and access to services. We found that peer-reviewed evidence focused on client-perpetrated violence, whereas non-peer-reviewed evidence focused on broader human rights abuses and police violence. The central involvement of sex workers in intervention design and delivery resulted in improved engagement and effectiveness in terms of reducing violence. Interventions that reduced violence from clients did not affect intimate partner violence, and vice versa. Peer networks strengthen agency through collective safety planning, information sharing, and emotional support, yet access is limited for migrant and street-based sex workers. Broader stakeholder engagement-including from police, policy makers, health and social services, and third parties such as managers and security-is essential for addressing structural determinants of violence, although reliance upon these same stakeholders can reinforce systems that perpetuate violence. Addressing violence requires interventions that recognise the diverse forms and perpetrators of violence, alongside broad structural reforms to tackle its root causes.</p>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":" ","pages":"e703-e714"},"PeriodicalIF":26.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-18DOI: 10.1016/s2468-2667(26)00148-9
Lisa Kent, Steven Wambua, Megha Singh, Ayodele Opatola, Robin Alexander, Gillian Santorelli, Siang Ing Lee, Luciana Rocha Pedro, Amaya Azcoaga-Lorenzo, Katherine Phillips, Colin McCowan, Sinead Brophy, Catherine Nelson Piercy, Mairead Black, Dermot O’Reilly, Zoe Vowles, Holly Hope, Kathryn Abel, Rachel Plachcinski, Ngawai Moss, Krishnarajah Nirantharakumar, Kelly-Ann Eastwood, Beck Taylor, Christine Damase-Michel, Christopher Yau, Helen Dolk, Jonathan Kennedy, Krishna Gokhale, Louise Locock, Maria Loane, Richard Riley, Stephanie Hanley
{"title":"Antenatal outcomes for women with multiple long-term conditions in pregnancy: a UK-wide retrospective cohort study","authors":"Lisa Kent, Steven Wambua, Megha Singh, Ayodele Opatola, Robin Alexander, Gillian Santorelli, Siang Ing Lee, Luciana Rocha Pedro, Amaya Azcoaga-Lorenzo, Katherine Phillips, Colin McCowan, Sinead Brophy, Catherine Nelson Piercy, Mairead Black, Dermot O’Reilly, Zoe Vowles, Holly Hope, Kathryn Abel, Rachel Plachcinski, Ngawai Moss, Krishnarajah Nirantharakumar, Kelly-Ann Eastwood, Beck Taylor, Christine Damase-Michel, Christopher Yau, Helen Dolk, Jonathan Kennedy, Krishna Gokhale, Louise Locock, Maria Loane, Richard Riley, Stephanie Hanley","doi":"10.1016/s2468-2667(26)00148-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(26)00148-9","url":null,"abstract":"","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"27 1","pages":"e665-e679"},"PeriodicalIF":50.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148755098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-18DOI: 10.1016/s2468-2667(26)00167-2
Mathieu Boniol, Khassoum Diallo
{"title":"Beyond global counts: making health workforce estimates actionable and equitable","authors":"Mathieu Boniol, Khassoum Diallo","doi":"10.1016/s2468-2667(26)00167-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(26)00167-2","url":null,"abstract":"","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"375 1","pages":"e584-e585"},"PeriodicalIF":50.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148755097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-18DOI: 10.1016/s2468-2667(26)00144-1
Emily Bourke, Ralph Maddison, Tony Blakely
{"title":"The burden of low physical activity in Australia: a comprehensive comparative risk assessment","authors":"Emily Bourke, Ralph Maddison, Tony Blakely","doi":"10.1016/s2468-2667(26)00144-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(26)00144-1","url":null,"abstract":"","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"16 1","pages":"e642-e649"},"PeriodicalIF":50.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148755100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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