Saroj Jayasinghe

Background: Dysregulated brain aging leads to dementia in some older adults. South Asia is one of the most populous regions of the world with a rapidly growing older adult population. Yet, very few studies have focused on quantifying the status and risk factors driving aging-related conditions such as dementia in this part of the world. Objectives: We explored multiple sources of global health data to quantify and compare all-cause dementia indices in South Asian countries. Design: Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka were considered. Population statistics and dementia as a priority area were examined using US Census Bureau and World Health Organization Global Dementia Observatory data. Crude and age-standardized rates (ASR) of dementia incidence, deaths and disability-adjusted life years (DALYs) were extracted and analyzed from the Global Burden of Disease (GBD) 2019 Study. Results: Our analysis reiterated that there are limited resources dedicated to dementia in this region. Sri Lanka and Afghanistan had the highest dementia crude rates and age-standardized rates, respectively [Crude DALYs, Sri Lanka = 321.52 (132.12–736.58); ASR DALYs, Afghanistan = 432.72 (179.01–1001.95)]. The burden of dementia in some South Asian countries was comparable to estimated global averages, and was largely driven by population aging. Analyses of available data on known biological, behavioral, environmental and disease risk factors in the region highlighted the role of metabolic dysregulation in dementia. Conclusions: Our preliminary analysis of available global health data highlights an emerging need for resources for dementia prevention and care in South Asia. There is also a critical need for future longitudinal follow-up studies focusing on dementia that are well-designed and can be harmonized with other dementia-related studies. We describe a roadmap for designing them—taking into account cultural, economic, public health and population aging dynamics that may be uniquely applicable to South Asian countries.

The COVID-19 pandemic – and the inconsistent government responses it revealed – has made the institutionalisation of robust Science Advice to Policymakers (SAP) an urgent imperative. Barring exceptions such as initiatives by the International Network for Governmental Science Advice, very few training programmes aim to develop capacity of policy makers, especially in the Global South. In response to these needs, the National Academy of Sciences of Sri Lanka and the Association of Academies and Societies of Sciences in Asia (AASSA), conducted a project titled Institutionalising Science Advice to Governments. Its key objectives was to develop an appropriate framework to understand the process of institutionalisation of SAP. The Colombo Framework so developed integrated four clusters: the SAP process; guiding values and principles; supporting institutional and legislative structures; and evaluating SAP. It was validated by experts and used for designing a questionnaire to assess current SAP practices across AASSA member countries which enabled data gathering on the diversity of models of SAP, their challenges and best practices. The framework also helped structure an international workshop to share country-level situation analyses, formulate roadmaps for implementation and build consensus on the relevance of institutionalising SAP. The latter culminated in the Colombo Declaration, urging governments to strengthen science–policy engagements. Short-term and long-term feedback from participants indicated high utility of the framework for understanding and operationalising SAP in diverse contexts. The framework offers a systematic approach for countries, especially in the Asia-Pacific region, to institutionalise SAP and for scientists to gain in-depth understanding of the process.

Countries in the WHO’s South-East Asia Region (SEAR) have made significant progress in training healthcare workers. However, concerns remain about the quality and competencies of these workers, particularly in areas such as people-centred care and empathy. There is evidence that integrating the humanities into medical education and training could address these concerns and further enhance the quality of primary care. We aimed to study the role of medical humanities in medical education across the SEARO through a scoping review, focusing specifically on the role of the arts (e.g., visual and performance arts) in medical education. A published scoping methodology was used, without quality-based exclusion, to ensure comprehensive coverage. We included empirical qualitative or mixed-method studies from PubMed (January 2010–June 2024) focusing on undergraduate medical students in the WHO South-East Asia Region countries. Additional articles and grey literature were identified via reference screening. Data were extracted using a standardised form, with dual-reviewer screening and senior investigator arbitration. We found that several medical schools have integrated diverse art forms (e.g., narrative writing, literature, visual art, drama, cinema, music, photography) into their curricula through modules, electives, or mandatory structured teaching programs, typically in the first academic year. Informal volunteer groups, formal medical humanities units, or dedicated departments organised these. While short-term positive impacts were reported, evidence of long-term impacts was limited. It is timely for health professional education institutions and organisations such as the WHO Regional Office for South-East Asia to support a more coordinated effort to integrate the humanities into health professional education- drawing on locally relevant arts and cultural traditions while reducing the lingering influence of less relevant colonial and foreign models. Regulatory authorities should guide the introduction of humanities into curricula to foster more people-centered healthcare professionals who are empathic and compassionate.

As human microbiome research is globalizing, it raises ethical concerns regarding the European and North American dominance in the field, which may reproduce a colonial bias and perpetuate inequities in global health research and outcomes. We suggest disentangling this ethical quandary into three main concerns: 1) scientific bias toward European and North American populations; 2) limited meaningful community inclusion, participation, and ownership, and 3) scant significant inclusion of diverse global researchers. We then formulate three recommendations for their resolution, deploying co-laboration —joint labor of diverse partners in generating synergies between diverse disciplines, cultures, and knowledges around shared concerns—and co-laborative science —a form of citizen science based on such synergies between diverse partners—to guide meaningful inclusive, participatory, and ethical human microbiome research. To conclude, we promote a programmatic list for putting co-laborative ethical science into practice, benefiting global communities, individuals, and researchers alike and decolonizing and improving health worldwide.

Wars have multiple complex effects on population health. Countries suffer extensively from disruptions to their societies, economies, and environment. Understanding the pathways of disruption helps to adapt and mitigate the catastrophic effects of war. We used a previously published 12-dimensional framework on the health impacts of war to derive pathways of influence under three phases. The first phase, before overt aggression, includes economic sanctions, trade wars, and embargoes, often combined with covert military action and disrupted supply chains, infrastructure, and health services. The second phase of overt aggression has multiple direct and indirect effects on health: ( a ) morbidity and mortality; ( b ) population displacements with psychosocial implications; ( c ) opportunity costs from military expenditures often reversing economic growth and widening inequalities; ( d ) environmental degradation; ( e ) air and soil pollution from explosives; ( f ) destroyed infrastructure include housing, basic amenities, and health infrastructure; ( g ) destroyed arable land, deforestation, and loss of biodiversity; ( h ) and contamination of water sources. The third phase occurs during peace negotiations and when peace appears and consists of long-term effects. The latter includes transgenerational impacts on human well-being. Considering the wide health, social, and environmental implications of wars lasting for generations, we reiterate the call for an “end to all wars.”