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Abstract Background Antibiotic resistance (ABR) has emerged as a major threat to health. Properly informed decisions to mitigate this threat require surveillance systems that integrate information on resistant bacteria and antibiotic use in humans, animals, and the environment, in line with the One Health concept. Despite a strong call for the implementation of such integrated surveillance systems, we still lack a comprehensive overview of existing organizational models for integrated surveillance of ABR. To address this gap, we conducted a scoping review to characterize existing integrated surveillance systems for ABR. Methods The literature review was conducted using the PRISMA guidelines. The selected integrated surveillance systems were assessed according to 39 variables related to their organization and functioning, the socio-economic and political characteristics of their implementation context, and the levels of integration reached, together with their related outcomes. We conducted two distinct, complementary analyses on the data extracted: a descriptive analysis to summarize the characteristics of the integrated surveillance systems, and a multiple-correspondence analysis (MCA) followed by a hierarchical cluster analysis (HCA) to identify potential typology for surveillance systems. Results The literature search identified a total of 1330 records. After the screening phase, 59 references were kept from which 14 integrated surveillance systems were identified. They all operate in high-income countries and vary in terms of integration, both at informational and structural levels. The different systems combine information from a wide range of populations and commodities -in the human, animal and environmental domains, collection points, drug-bacterium pairs, and rely on various diagnostic and surveillance strategies. A variable level of collaboration was found for the governance and/or operation of the surveillance activities. The outcomes of integration are poorly described and evidenced. The 14 surveillance systems can be grouped into four distinct clusters, characterized by integration level in the two dimensions. The level of resources and regulatory framework in place appeared to play a major role in the establishment and organization of integrated surveillance. Conclusions This study suggests that operationalization of integrated surveillance for ABR is still not well established at a global scale, especially in low and middle-income countries and that the surveillance scope is not broad enough to obtain a comprehensive understanding of the complex dynamics of ABR to appropriately inform mitigation measures. Further studies are needed to better characterize the various integration models for surveillance with regard to their implementation context and evaluate the outcome of these models.

Abstract Introduction The wildlife trade is an important arena for intervention in the prevention of emerging zoonoses, and leading organisations have advocated for more collaborative, multi-sectoral approaches to governance in this area. The aim of this study is to characterise the structure and function of the network of transnational organisations that interact around the governance of wildlife trade for the prevention of emerging zoonoses, and to assess these network characteristics in terms of how they might support or undermine progress on these issues. Methods This study used a mixed methods social network analysis of transnational organisations. Data were collected between May 2021 and September 2022. Participants were representatives of transnational organisations involved in the governance of wildlife trade and the prevention of emerging zoonoses. An initial seed sample of participants was purposively recruited through professional networks, and snowball sampling was used to identify additional participants. Quantitative data were collected through an online network survey. Measures of centrality (degree, closeness, and betweenness) were calculated and the network’s largest clique was identified and characterised. To understand the extent to which organisations were connected across sectors, homophily by sector was assessed using exponential random graph modelling. Qualitative data were collected through semi-structured interviews. The findings from the quantitative analysis informed the focus of the qualitative analysis. Qualitative data were explored using thematic analysis. Results Thirty-seven participants completed the network survey and 17 key informants participated in semi-structured interviews. A total of 69 organisations were identified as belonging to this network. Organisations spanned the animal, human, and environmental health sectors, among others including trade, food and agriculture, and crime. Organisation types included inter-governmental organisations, non-governmental organisations, treaty secretariats, research institutions, and network organisations. Participants emphasised the highly inter-sectoral nature of this topic and the importance of inter-sectoral work, and connections were present across existing sectors. However, there were many barriers to effective interaction, particularly conflicting goals and agendas. Power dynamics also shaped relationships between actors, with the human health sector seen as better resourced and more influential, despite having historically lower engagement than the environmental and animal health sectors around the wildlife trade and its role in emerging zoonoses. Conclusion The network of transnational organisations focused on the governance of wildlife trade and the prevention of emerging zoonoses is highly multi-sectoral, but despite progress catalysed by the COVID-19 pandemic, barriers still exist for inter-sectoral interaction and coordination. A One Health approach to governance at this level, which has gained traction throughout the COVID-19 pandemic, was shared as a promising mechanism to support a balancing of roles and agendas in this space. However, this must involve agreement around equity, priorities, and clear goal setting to support effective action.

Abstract Background Corruption exists at all levels of our global society and is a potential threat to food security, food safety, equity, and social justice. However, there is a knowledge gap in the role and impact of corruption within the context of the global food system. We aimed to systematically review empirical literature focused on corruption in the global food system to examine how it is characterized, the actors involved, its potential impacts, and the solutions that have been proposed to address corruption in the food system. Methods We used a systematic scoping review methodology. Terms combining corruption and the food system were searched in Scopus, PubMed, Web of Science, PsycInfo and Econlit, in October 2021. Two screeners applied a priori selection criteria to screen the articles at the title and abstract and full-text levels. Data was extracted into a charting form and thematically synthesized to describe the types of corruption in the food system, the actors involved, how corruption impacts the food system, and potential solutions. Sankey diagrams and narrative summaries were developed to summarize the included studies and findings. Results From the 238 included records, five main types of corruption were identified in the global food system: bureaucratic corruption, fraud, bribery, organized crime, and corporate political activity. These different types of corruption spanned across various food system areas, from policy and governance structures to food environments, and involved a wide range of actors. More powerful actors like those in public and private sectors tended to instigate corruption in the food system, while community members and primary producers tended to be impacted by it. The impacts of corruption were mostly negative and corruption was found to undermine food system governance and regulatory structures; threaten health, safety, and food security; and lead or contribute to environmental degradation, economic loss, erosion of trust, social inequities, and decreased agricultural productivity. While solution-oriented literature was limited, the essential role of strong governance, use of technology and predictive modelling methods to improve detection of corruption, and organizational approaches to problem solving were identified. Conclusion Our review findings provide researchers and policymakers with a comprehensive overview of corruption in the global food system, providing insights to inform a more holistic approach to addressing the issue. Addressing corruption in the food system is an essential element of supporting the transition to a more healthy, equitable and sustainable global food system.

Background Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policy-makers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy.Methods We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by October 13, 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS.Results 4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decisionmaking; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use.Conclusion This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policy-making, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.

Abstract Background Emerging infectious diseases of zoonotic origin present a critical threat to global population health. As accelerating globalisation makes epidemics and pandemics more difficult to contain, there is a need for effective preventive interventions that reduce the risk of zoonotic spillover events. Public policies can play a key role in preventing spillover events. The aim of this review is to identify and describe evaluations of public policies that target the determinants of zoonotic spillover. Our approach is informed by a One Health perspective, acknowledging the inter-connectedness of human, animal and environmental health. Methods In this systematic scoping review, we searched Medline, SCOPUS, Web of Science and Global Health in May 2021 using search terms combining animal health and the animal-human interface, public policy, prevention and zoonoses. We screened titles and abstracts, extracted data and reported our process in line with PRISMA-ScR guidelines. We also searched relevant organisations’ websites for evaluations published in the grey literature. All evaluations of public policies aiming to prevent zoonotic spillover events were eligible for inclusion. We summarised key data from each study, mapping policies along the spillover pathway. Results Our review found 95 publications evaluating 111 policies. We identified 27 unique policy options including habitat protection; trade regulations; border control and quarantine procedures; farm and market biosecurity measures; public information campaigns; and vaccination programmes, as well as multi-component programmes. These were implemented by many sectors, highlighting the cross-sectoral nature of zoonotic spillover prevention. Reports emphasised the importance of surveillance data in both guiding prevention efforts and enabling policy evaluation, as well as the importance of industry and private sector actors in implementing many of these policies. Thoughtful engagement with stakeholders ranging from subsistence hunters and farmers to industrial animal agriculture operations is key for policy success in this area. Conclusion This review outlines the state of the evaluative evidence around policies to prevent zoonotic spillover in order to guide policy decision-making and focus research efforts. Since we found that most of the existing policy evaluations target ‘downstream’ determinants, additional research could focus on evaluating policies targeting ‘upstream’ determinants of zoonotic spillover, such as land use change, and policies impacting infection intensity and pathogen shedding in animal populations, such as those targeting animal welfare.

One Health is recognized as an increasingly important approach to global health. It has the potential to inform interventions and governance approaches to prevent future pandemics. Successfully implementing the One Health approach in policy will require active engagement from the public, which begs the question: how aware is the public of One Health? In this study, we examine the level and distribution of One Health awareness among the general public in China using a survey conducted in Beijing (n = 1820). We distinguish between awareness of the term of “One Health” versus awareness of the core set of ideas – the interconnection between the health of people, animals, and the environment. Our analysis shows that 40% of respondents reported that they have heard of the term, but more than double the number indicated that they recognize the core idea of interconnection between people, animals, and the environment. Specifically, about 83% of the respondents said that they believe people's health is closely connected to animal health and 86% believe people's health is closely connected to plant and environmental health. Multiple regression analysis indicates that women, younger people, and individuals with a higher level of education show higher levels of One Health awareness than their counterparts. Being aware of the term is associated with higher recognition of the core ideas. Policymakers and health practitioners should consider these findings when designing public awareness campaigns and educational initiatives to promote One Health principles.

Introduction The increasing incidence of pathogen transmission from animals to humans (zoonotic spillover events) has been attributed to behavioural practices and ecological and socioeconomic change. As these events sometimes involve pathogens with epidemic or pandemic potential, they pose a serious threat to population health. Public policies may play a key role in preventing these events. The aim of this review is to identify evaluations of public policies that target the determinants of zoonotic spillover, examining approaches taken to evaluation, choice of outcomes measures and evidence of effectiveness. Our approach to identifying and analysing this literature will be informed by a One Health lens, acknowledging the interconnectedness of human, animal and environmental health.Methods and analysis A systematic scoping review methodology will be used. To identify articles, we will search Medline, SCOPUS, Web of Science and Global Health in May 2021 using search terms combining animal health and the animal–human interface, public policy, prevention and zoonoses. We will screen titles and abstracts and extract data according to published guidelines for scoping reviews. All evaluations of public policies aiming to prevent zoonotic spillover events will be eligible for inclusion. We will summarise key data from each study, mapping policies along the spillover pathway and outlining the range of policies, approaches to evaluation and outcome measures. Review findings will provide a useful reference for researchers and practitioners, outlining the state of the evaluative evidence around policies to prevent zoonotic spillover.Ethics and dissemination Formal ethical approval is not required, because the study does not involve primary data collection. The findings of this study will be disseminated through a peer-reviewed publication, presentations and summaries for key stakeholders.

Background: FAO/WHO have encouraged national governments to create food-based dietary guidelines (FBDGs) to support healthy diets. However, little is known about the extent to which food supply composition aligns with FBDGs, thereby structurally supporting or undermining population-level adherence. It is also unclear how this alignment has evolved over time. The aim of this study was to determine to what extent the global food supply aligns with FBDGs, and to examine historical trends. Methods: Descriptive time series analysis of food supply alignment (FSA), 1961–2013. FSA was characterised as a ratio dividing country-level food supply data by FBDG across four food groups: fruit and vegetables (FV); sugar (SU); fish and seafood (FS); and red and processed meat (RP). FBDG data was collected from guidance produced by international bodies, and from countries with published FBDGs. The food supply was estimated using yearly FAOSTAT data. A population-weighted average of this ratio was created for all countries included in the analysis, and stratified by region and country income. Findings: FBDGs from 89 countries were included. Of those, 80% had country guidelines for FV, 34% for SU, 44% for FS, and 21% for RP. FSA (1.0 = perfect alignment) based on global guidelines showed a higher supply than recommended for FV (1.2), SU (1.2) and RP (1.1). FSA based on country guidelines showed a lower supply than recommended for FV (0.9) and a higher supply than recommended for SU (2.3), RP (2.3) and FS (1.4). FSA also showed substantial differences in levels and trends across region and country income. Interpretation: As of 2013, food supplies were not aligned with national and international FBDGs and misalignment persisted across five decades with subtantial variation in trends based on geography and country income. The long running nature of these trends suggest that the transition toward sustainable and healthful food systems represent a signifiant global challange. Additionally, acknowledging the degree of misalignment between macro-level structural factors, such as the composition of the food supply, in relation to national or global food policy aims may further aid efforts for population level adherence.

Introduction Given the complex causal origins of many non-communicable diseases (NCDs), and the complex landscapes in which policies designed to tackle them are made and unfold, the need for systems thinking and complexity science (STCS) in developing effective policy solutions has been emphasised. While numerous methods informed by STCS have been applied to the policy process in NCD prevention, these applications have not been systematically catalogued. The aim of this scoping review is to identify existing applications of methods informed by STCS to the policy process for NCD prevention, documenting which domains of the policy process they have been applied to.Methods and analysis A systematic scoping review methodology will be used. Identification: We will search Medline, SCOPUS, Embase and Web of Science using search terms combining STCS, NCD prevention and the policy process. All records published in English will be eligible for inclusion, regardless of study design. Selection: We will screen titles and abstracts and extract data according to published guidelines for scoping reviews. In order to determine the quality of the included studies, we will use the approach developed by Dixon-Woods et al, excluding studies identified as fatally flawed, and determining the credibility and contribution of included studies. Synthesis: We will identify relevant studies, summarising key data from each study and mapping applications of methods informed by STCS to different parts of the policy process. Review findings will provide a useful reference for policy-makers, outlining which domains of the policy process different methods have been applied to.Ethics and dissemination Formal ethical approval is not required, as the study does not involve primary data collection. The findings of this study will be disseminated through a peer-reviewed publication, presentations and summaries for key stakeholders.

Abstract Background Evidence suggests eating home-prepared food (HPF) is associated with increased dietary quality, while dietary quality varies across socio-demographic factors. Although it has been hypothesised that variation in HPF consumption between population sub-groups may contribute to variation in dietary quality, evidence is inconclusive. This study takes a novel approach to quantifying home-prepared food (HPF) consumption, and describes HPF consumption in a population-representative sample, determining variation between socio-demographic groups. It tests the association between HPF consumption and dietary quality, determining whether socio-demographic characteristics moderate this association. Methods Cross-sectional analysis of UK survey data (N = 6364, aged≥19; collected 2008–16, analysed 2018). High dietary quality was defined as ‘DASH accordance’: the quintile most accordant with the Dietary Approaches to Stopping Hypertension (DASH) diet. HPF consumption was estimated from 4-day food diaries. Linear regressions were used to determine the association between HPF consumption and socio-demographic variables (household income, education, occupation, age, gender, ethnicity and children in the household). Logistic regression was used to determine the association between HPF consumption and DASH accordance. Interaction terms were introduced, testing for moderation of the association between HPF consumption and DASH accordance by socio-demographic variables. Results HPF consumption was relatively low across the sample (Mean (SD) % of energy consumption = 26.5%(12.1%)), and lower among white participants (25.9% v 37.8 and 34.4% for black and Asian participants respectively, p

Abstract Background Despite inconclusive evidence, the idea that a lack of home food preparation and skills is a limiting factor in achieving a healthy diet is widespread. Cooking skills interventions proliferate, and several countries now mention cooking in their dietary guidelines. The aim of this study was to determine whether substantial consumption of home-prepared food is necessary for high dietary quality by exploring whether individuals can eat healthily while eating little home-prepared food. The diets of these individuals were characterised, and socio-demographic characteristics and prevalence of obesity were also explored. Methods Cross-sectional analysis of UK dietary survey data with objectively measured height and weight and a 4-day food diary for each participant was conducted. A subsample (N = 1063, aged ≥19 years) with a high dietary quality (determined using a score derived from the Dietary Approaches to Stopping Hypertension (DASH) diet) was analysed. Within this, participants were grouped as either high or low home preparation based on the proportion of energy derived from home-prepared food. Regression models were used to determine whether and how those in the high and low home preparation groups differed in terms of socio-demographic characteristics, DASH score, energy intake, prevalence of obesity, and dietary composition. Results The low home preparation group included 442 participants, while 621 participants were in the high home preparation group. The low home preparation group were more likely to be older and white, and less likely to have a degree level education. After adjustment for socio-demographic characteristics, there were no differences in DASH score, energy intake or obesity prevalence between the groups. After adjustment, the low home preparation group consumed more fruit (30.8 additional g/day, 95% CI 5.5–56.1), more low-fat dairy foods (24.6 additional g/day, 95% CI 1.7–47.5) and less red meat (10.4 fewer g/day, 95% CI 4.3–16.6), but also more sugar (11.6 additional g/day, 95% CI 7.5–15.6) and sodium (107.8 additional mg/day, 95% CI 13.8–201.8). Conclusion Home food preparation should not be presented as a prerequisite to a high quality diet. The public health community should recognise the existence of a set of food practices which allows individuals to achieve a healthy diet with little contribution from home-prepared food, and make space for it in the design of their policies and interventions.

Background: Increased time spent on home food preparation is associated with higher diet quality, but a lack of time is often reported as a barrier to this practice. We compared time use in individuals who do more versus less foodwork (tasks required to feed ourselves and our households, including home food preparation). Methods: Cross-sectional analysis of the UK Time Use Survey 2014–15, participants aged 16+ (N = 6143). Time use over 24 h was attributed to seven compositional parts: personal care; sleep; eating; physical activity; leisure screen time; work (paid and unpaid); and socialising and hobbies. Participants were categorised as doing no, ‘some’ (