Digital health literacy higher in lower-income countries, 30-country survey finds

CUNY Graduate School of Public Health and Health Policy

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New York, NY | April 28, 2026: A cross-national survey of 31,000 adults in 30 countries finds that digital health literacy is highest in low- and middle-income countries and lowest in high-income countries, challenging assumptions that national wealth translates into stronger digital skills. The study, the first to examine how adults judge quality health information across this many countries, also documents wide variation in acceptance of AI-generated health content and in which sources people rely on for credible information.

The study was led by researchers at the CUNY Graduate School of Public Health and Health Policy (CUNY SPH) with collaborators at the Barcelona Institute for Global Health (ISGlobal), the University of Alabama, and Baraka Impact Finance / Drugs for Neglected Diseases initiative (DNDi) in Geneva. The work was conducted in support of the Nature Medicine Commission on Quality Health Information for All research agenda.

Across countries, medical providers were the most frequently endorsed source of trusted health information (40.7%), closely followed by verification through multiple sources (31.2%). Government sources were named by 21.6% of respondents, and only 6.5% pointed to family or friends. Trust in providers was notably lower in Russia (14.6%) than elsewhere.

Acceptance of AI-generated health information varied widely. Globally, 58.3% of respondents said they would be likely to accept it, but the range was substantial: above 75% in China, India, Pakistan, and Indonesia, and below 50% in Canada, Poland, Switzerland, Italy, France, the UK, Australia, Belgium, Russia, Sweden, and Japan. Younger adults and those with post-secondary education were more receptive than older respondents.

“Digital skill is not a function of national wealth,” says Assistant Professor Rachael Piltch-Loeb, the study’s lead author. “Some of the highest digital health literacy in our data was in countries where social media has become a primary route to health information. The patterns we see also suggest that the same message will not work everywhere, and that public health communicators need to plan for clarity, transparent sourcing, and format diversity rather than assume audiences are interchangeable.”

Format and channel preferences differed sharply across age and country groups. Combined text-and-image formats were the dominant preference globally (range 41.4% to 84.7%), but video-only formats were preferred by 26.2% to 41.7% of respondents in Egypt, India, and Pakistan. Social media was the leading channel for 36.1% of respondents ages 18 to 29, compared with 10.6% of those 60 and older. Older respondents relied more on healthcare-based channels such as clinic brochures and patient information leaflets.

Across all countries, respondents valued health information that is easy to access, easy to understand, and clearly identifies its source. Government approval and endorsement by a known medical provider were rated less important on average. The authors note that strategies designed for high-income, institution-led communication environments may not transfer to settings where social media and AI-mediated content are already shaping how people encounter health information.

The survey was conducted online between August 29 and September 8, 2025, and included adults ages 18 and older from Australia, Belgium, Brazil, Canada, China, Ecuador, Egypt, France, Germany, Guatemala, India, Indonesia, Italy, Japan, Kenya, Mexico, Nigeria, Pakistan, Peru, the Philippines, Poland, Russia, South Africa, South Korea, Spain, Sweden, Switzerland, Turkey, the United Kingdom, and the United States. Stratified quota sampling was used within each country, and country samples were weighted to national population benchmarks for age, gender, education, and region.

Media contact:

Ariana Costakes
Communications Editorial Manager
ariana.costakes@sph.cuny.edu

About CUNY SPH

The CUNY Graduate School of Public Health and Health Policy (CUNY SPH) is committed to promoting and sustaining healthier populations in New York City and around the world through excellence in education, research, and service in public health and by advocating for sound policy and practice to advance social justice and improve health outcomes for all.

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Journal

Nature Health

DOI

10.1038/s44360-026-00102-4 

Method of Research

Survey

Article Title

A Global Survey on Trust and Literacy in Health Information

Article Publication Date

28-Apr-2026

 

Orange County residents take pragmatic view on immigration

New UCI-OC Poll reveals broad support for immigration’s benefits, selective enforcement backing, sharp partisan divides

University of California - Irvine

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A new poll released today by UC Irvine's School of Social Ecology finds that Orange County residents hold broadly positive but carefully qualified views on immigration, reflecting the county’s deep ties to immigrant communities and its status as one of the nation’s most politically balanced — or “purple” — counties.

The UCI–OC Poll, conducted in partnership with TrueDot from March 24–31, surveyed 1,202 Orange County adults in English and Spanish. The survey says:

• Nearly 40% of Orange County residents were raised by two foreign-born parents, and more than one-third report personally knowing someone who is undocumented. 
• More residents say immigration helps the country (44%) than hurts it (27%) while 21% say its effects balance out. 
• Large majorities say immigration fills essential low-wage jobs (76%), enriches civic life (67%), attracts high-skilled workers (56%), and creates new businesses and jobs (53%). 
• By more than a 2:1 margin, Independents believe the benefits of immigration outweigh the costs.

“What we see in Orange County is a public that resists simple characterization,” said Jon B. Gould, dean of the UCI’s School of Social Ecology and director of the UCI-OC Poll. “Residents broadly recognize the benefits of immigration and support integrating many undocumented immigrants into society, but they also draw clear lines around enforcement and policy design. This is a pragmatic county.”

On policy, residents favor a measured approach: 

• A clear majority (67%) supports a pathway to legal status for undocumented immigrants over deportation, while 72% support automatic deportation for those convicted of violent crimes. 
• Support for deportation drops sharply for non-violent offenders (23%), the unemployed (16%), and recent arrivals (11%).

There is broad cross-partisan agreement that U.S. veterans who are undocumented should never be deported, according to the poll. Views diverge, however, on DACA recipients, employed individuals, and parents of U.S. citizens, with Democrats and Independents more likely than Republicans to extend those protections.

Selective support for enforcement

Orange County residents draw clear distinctions among enforcement policies. Majorities oppose several high-profile measures associated with President Donald Trump’s administration, including:

• immigration enforcement at schools and hospitals (27% support), 
• denying asylum applications at the border (33%), 
• ending birthright citizenship (36%), and 
• deploying the military in deportation efforts (37%).

By contrast, strong majorities support cracking down on human trafficking (81%) and limiting immigration from countries deemed dangerous or unstable (61%).

“The data tell us that Orange County residents are not simply for or against enforcement — they are making careful distinctions,” Gould said. “They will support targeted enforcement when it addresses clear threats like human trafficking, but they draw the line at policies they view as overly broad or severe.”

Public opinion on immigration institutions is mixed.

Nearly two-thirds of residents oppose the recent actions of U.S. Immigration and Customs Enforcement (ICE), yet a narrow majority also opposes abolishing the agency.

At the local level, 47% of residents support state and local governments refusing to cooperate with federal deportation efforts, while 57% say it is acceptable for religious institutions to decline to assist. A slight majority (51%) supports local sanctuary policies, with opposition concentrated among Republican, older and White residents.

Residents strongly oppose immigrant detention centers in their neighborhoods across all political groups, while views on housing recently arrived immigrants locally are more divided: 44% in favor and 39% opposed overall, with Democrats and Republicans holding sharply contrasting views.

Strong partisanship

Partisanship remains the strongest predictor of immigration attitudes throughout the poll. Democrats overwhelmingly express positive views, while Republicans are more likely to see immigration as harmful. Sixty percent of OC residents disapprove of President Trump's performance on immigration overall, with disapproval falling slightly to 55% specifically on border issues.

For the first time in recent national polling trends, Democrats (34%) and Republicans (32%) are rated roughly equal in their handling of immigration.

“Partisanship is the loudest signal in this data, but it is not the only one,” Gould noted. “Lived experience — shaped by age, race and community ties — also plays a meaningful role in how Orange County residents think about immigration. That is what makes this county, and this poll, so instructive for understanding where the American public truly stands.”

About the UCI-OC Poll

The UCI-OC Poll, which is supported by a grant from the John Randolph Haynes and Dora Haynes Foundation, provides reliable survey data on issues confronting Orange County residents. It also brings business leaders together with elected officials and community members to discuss workable responses to these problems. Whether the challenges concern housing, education, the business climate, sustainability, transportation, crime or many other topics, area leaders are better equipped to navigate the local environment and respond if they have reliable, timely data on the attitudes, priorities and opinions of county residents and a neutral place and convener to consider them. Learn more at the UCI-OC Poll website.
— Mimi Ko Cruz

 

Hasanuddin University study reveals insights for climate resilience in smallholder cacao farms

Multi-layered shade systems can improve soil health and plant physiology in cacao agroforestry under climate stress

Hasanuddin University

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Researchers from Hasanuddin University, Indonesia report that using a mix of shade trees, including coconut, banana, and Gliricidia sepium, can boost cacao growth through improved plant–leaf–soil interactions and climate resilience of cacao plants.

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Credit: EverJean from Openverse via Flickr Image source link: https://openverse.org/image/116c3f3b-90da-476e-941b-d1f27d9947fc

Chocolate is one of the world’s most widely consumed foods. It is made from cacao beans grown by millions of smallholder farmers globally. High-quality cacao beans require optimal growing conditions, which are essential for producing good-quality chocolates. However, growing climate variability such as rising temperatures, unpredictable rainfall, and prolonged dry spells, are making it harder to maintain healthy crops and stable yields. Indonesia, the world’s third largest cacao producer, is facing the brunt of these challenges, which are directly impacting cacao production.

To address these challenges, a team of researchers led by Professor Risma Neswati from the Department of Soil Sciences at Hasanuddin University, Indonesia, carried out a field study in South Sulawesi, Indonesia, where cacao farming is widely practiced. They investigated different types of shade trees—trees planted alongside crops to provide partial cover from direct sunlight—namely, coconut, banana, and Gliricidia sepium, and evaluated various combinations of these trees alongside two high-yielding cacao clones (MCC 02 and Sulawesi 2), to assess their impact on soil–plant–leaf relationships and how they help cacao plants cope with climate stress. “We studied different shade trees and how they affected the soil, plant health, and the growth of cacao plants,” explains Prof. Neswita. Their findings were published in Volume 100 of Agroforestry Systems on March 11, 2026.

After analyzing different combinations of trees, the researchers found that integrating a mix of shade trees works better compared to using just one type or no shade at all. The study demonstrated that these mixed, layered shade systems, consisting of coconut, banana, and G. sepium, not only improved the soil quality through enrichment of important nutrients, such as nitrogen, but also boosted the soil’s ability to retain them. It also helped create a more stable microenvironment under the trees, thereby protecting the cacao plants from direct exposure to extreme heat and helping retain moisture.

Additionally, these shaded systems also improved plant physiology through increased levels of chlorophyll in the plants, resulting in healthier leaves. Researchers note that this helped provide a better control over water loss, which is critical during dry periods. Notably, these strategies led to stronger plant growth and consistent early fruit development. When comparing the growth of cacao trees under different environments, trees under mixed shade grew taller, developed wider canopies, and produced more young fruits than those without shade. “We found that different cacao varieties require different levels of shade. While some perform best under denser shade, others grow better with slightly more sunlight,” notes Prof. Neswita. In this way, farmers can improve yields by matching cacao varieties with suitable shade systems.

The authors emphasize that, in addition to planting shade trees, proper management through spacing and pruning can make cacao farms more resilient to climate stress. In addition, keeping fallen leaves on the ground as natural mulch can also help maintain soil fertility and moisture. The findings also support global efforts toward the United Nations Sustainable Development Goals, particularly those focused on sustainable agriculture and climate action.

While the results are promising, researchers note that more studies are needed across different regions and seasons to better understand how these shade systems can be applied to improve yields worldwide. Overall, the findings highlight the value of simple, nature-based solutions by showing how soil, plants, and the environment work together. This approach offers a practical pathway for building climate-resilient cacao farms and improving future production.

 

***

Reference
DOI: https://doi.org/10.1007/s10457-026-01444-4  

 

About Hasanuddin University, Indonesia
Hasanuddin University (Universitas Hasanuddin or Unhas) is one of Indonesia’s largest autonomous universities, located in Makassar. Established on September 10, 1956, and named after Sultan Hasanuddin of the Gowa Kingdom, the university has grown into a major center for higher education with 17 faculties, including medicine, engineering, law, agriculture, and natural sciences. Its origins date back to 1947 with an economics faculty linked to the University of Indonesia. Today, Unhas focuses on advancing science, technology, arts, and culture, with a strong emphasis on the Indonesian Maritime Continent, aiming to develop innovative and globally competitive graduates.
Learn more, here: https://www.unhas.ac.id/about/

 

About Professor Risma Neswati from Hasanuddin University, Indonesia
Dr. Risma Neswati is a Professor and Head of the Department of Soil Science, Faculty of Agriculture, Hasanuddin University, Indonesia. She holds a Ph.D. in Soil Science, and her research focuses on soil fertility, land evaluation, agroforestry, and climate-resilient agriculture. She also works on soil conservation and GIS-based land assessments. Till date, Dr. Neswati has authored more than 65 scientific publications, and her work contributes to improving sustainable land management and agricultural productivity in Indonesia.

 

Funding information
The authors gratefully acknowledge the Indonesian Education Scholarship (Beasiswa Pendidikan Indonesia, BPI), The Center for Higher Education Funding and Assessment (PPAPT), the Indonesia Endowment Fund for Education Agency (LPDP), and the Ministry of Higher Education, Science, and Technology of the Republic of Indonesia for support to the doctoral scholarship publication programme (contract No. 00912/J5.2.3/BPI.06/9/2022).

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Journal

Agroforestry Systems

DOI

10.1007/s10457-026-01444-4 

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

Multistrata shade structures soil–leaf–physiology coupling and enhances climate resilience in smallholder cacao hedgerows

 

Canadian nephrologist shares common-sense, patient-centered solutions to transplant inequities

International Society for Heart and Lung Transplantation

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Speaking today at the 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT) Jagbir Gill, MD, Associate Professor of Medicine in the Division of Nephrology at the University of British Columbia (UBC), shared practical strategies for reducing disparities in access to transplantation.

“Transplant access should mean that every potentially eligible patient has a real chance to receive one,” said Dr. Gill. “Right now, we know that’s not happening—especially for Indigenous peoples and other underserved groups.”

Drawing on years of research regarding accessing kidney transplantation and his work with Indigenous communities in Canada, Dr. Gill said inequities in transplant care are not inevitable, but rather the result of systems that weren’t designed with cultural safety in mind.

Dr. Gill and his colleagues demonstrated that access to kidney transplantation was consistently more challenging for Indigenous patients in Canada.

“There are barriers at every stage of the workup and follow-up process,” said Dr. Gill, a past president of the Canadian Society of Transplantation.

These disparities are rooted in a long history of systemic racism, such as the residential school system—a government-funded, church-run program that forcibly removed Indigenous children from their families begun in the late 19th century, which has resulted in a profound and enduring lack of trust in healthcare institutions. Geography can add another layer of obstacles.

“Many Indigenous communities are located in remote or rural regions far from transplant centers and local services on reserve often rely on nurses or visiting physicians and do not offer specialized transplant care,” he said. “The result is a system in which the people who need the most support face the highest logistical and emotional barriers.”

From Description to Action

Dr. Gill stressed that simply documenting inequities is no longer enough. “We’ve spent years describing the problem. The real question now is: what actions can we take within the parts of the system we can control?”

Rather than imposing top-down fixes, his team has co-developed practical solutions with Indigenous patients, families, and community leaders. Key elements of their approach include co-designed education, providing culturally safe spaces, and navigation support.

Storytelling instead of pamphlets

By consulting with the Indigenous community, Dr. Gill’s team learned that traditional written materials had little impact. In response, they developed videos featuring Indigenous patients who have gone through the living donation process and kidney transplantation, including prominent and respected community members. The well-received videos are now central to their education strategy.

Culturally safe care and sacred spaces

The team integrated an Indigenous wellness liaison into its transplant program to support patients in culturally appropriate ways, including facilitating spiritual practices or ceremonies. To foster a sense of safety and respect, patient education sessions and group discussions are held in a designated sacred space within the hospital, rather than in conventional clinical rooms.

Nurse navigators and coordinated workups

Research revealed that missed appointments weren’t a result of non-adherence, but rather the result of transportation and logistical hurdles, such as traveling long distances to healthcare facilities, lost wages, and a lack of childcare.

To help patients overcome these obstacles, programs schedule transplant workups as a single, carefully planned visit for remote patients, with the help of a dedicated nurse navigator who coordinates tests and appointments.

Lessons for Heart and Lung Transplantation

Dr. Gill told the ISHLT audience that the principles guiding these interventions translate directly to heart and lung transplantation, where the same structural, cultural, and geographic challenges apply. Patients must travel to the same tertiary centers, stay for complex recoveries, and navigate long-term follow-up. Similarly, the same issues of trust, racism, and representation exist in other marginalized communities globally—including Black and Latino populations in the United States and Canada.

“The same practical strategies that we’ve deployed to increase access to kidney transplants among the Indigenous population could help heart and lung programs close gaps in access,” he said.

A Model That Can Be Expanded

Dr. Gill closed by emphasizing that while his team started with the Indigenous population, the same model can and should be extended to other under-resourced groups, including non-Indigenous patients in rural areas and those facing financial hardship.

“The goal is not to just create a special track for a select few, but to ensure that those most in need are cared for in a way that ensures equity and apply our learnings to improve care for everyone,” he said.

The annual meeting and scientific sessions of ISHLT are being held from 22–25 April at the Metro Toronto Convention Centre in Toronto, ON, Canada.

END

ABOUT ISHLT

The International Society for Heart and Lung Transplantation (ISHLT) is a not-for-profit, multidisciplinary, professional organization dedicated to improving the care of patients with advanced heart or lung disease through transplantation, mechanical support, and innovative therapies via research, education, and advocacy. ISHLT members focus on transplantation and a range of interventions and therapies related to advanced heart and lung disease.

 

Reimagining heart transplant allocation worldwide

International Society for Heart and Lung Transplantation

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Today at the 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT), Eileen Hsich, MD, of the Cleveland Clinic, outlined a bold vision for the future of heart transplantation that moves beyond national borders to address global inequities in organ allocation.

In her talk, Dr. Hsich argued that persistent disparities in access to heart transplantation—and the underutilization of donor hearts—demand a rethinking of current allocation systems.

Moving Toward Heart Allocation on a Global Scale

“Across the world, there is a fundamental mismatch between the number of patients waiting for a heart transplant and the number of transplants performed,” said Dr. Hsich, Professor of Medicine and Medical Director for Heart Transplantation at the Cleveland Clinic. “If we want to reduce waitlist deaths and improve equity, we need to rethink how we allocate and utilize donor hearts, potentially on a global scale.”

Data presented from ISHLT and United States-based registries highlight ongoing disparities. Socioeconomic status plays an increasing role, with lower-income patients experiencing higher waitlist mortality and reduced access to transplantation.

“These disparities reflect the difference between equality and equity,” Dr. Hsich said. “True equity requires that the population receiving transplants matches the population in need. That’s not just equal access, but appropriate access.”

Wealthier countries perform significantly more heart transplants than lower-income regions, despite similar or greater need. Countries like Canada demonstrate an effective alignment between transplant rates and waitlist demand.

To improve utilization of available organs, Dr. Hsich said emerging tools such as the Donor Utilization Score (DUS) can help identify donor hearts suitable for transplantation.

“We already have tools to better assess donor heart quality,” she said. “The next step is ensuring we use as many viable hearts as possible.”

Technologies Enable Donor Organs to Remain Viable Longer

Advances in organ preservation and transport offer the potential for donor organs to travel further distances to where they’re most needed. Technologies such as normothermic machine perfusion and cold oxygenated perfusion are continually lengthening the time donor organs can be kept viable, thereby enabling international travel.

Dr. Hsich pointed to a recent transatlantic transplant case in which a donor heart was successfully transported from the West Indies to Paris and implanted in a 70-year-old recipient who recovered well and was discharged within 30 days.

“This is no longer theoretical, it’s already happening,” she said. “The question is whether we are ready to scale it.”

A global allocation system, she noted, would not be unprecedented. International registries such as DKMS have successfully facilitated more than 125,000 bone marrow transplants worldwide, demonstrating the feasibility of cross-border organ matching.

However, significant challenges remain. A global heart transplant system would require international cooperation, financial sustainability, regulatory oversight, and agreement on ethical principles such as reciprocity and fairness.

“Globalization raises important ethical questions,” Dr. Hsich said. “We must ensure that any system promotes equity, maintains quality, and delivers strong outcomes for patients everywhere.”

ISHLT Uniquely Positioned to Lead Global Allocation Efforts

She suggested that ISHLT is uniquely positioned to lead such an effort, given its global membership, scientific expertise, and existing registry infrastructure.

“With the right governance and collaboration, we can build an international system that reduces disparities and ensures no viable donor heart goes unused,” she said.

The annual meeting and scientific sessions of the ISHLT are being held from 22–25 April at the Metro Toronto Convention Centre in Toronto, ON, Canada.

END

ABOUT ISHLT

The International Society for Heart and Lung Transplantation (ISHLT) is a not-for-profit, multidisciplinary, professional organization dedicated to improving the care of patients with advanced heart or lung disease through transplantation, mechanical support, and innovative therapies via research, education, and advocacy. ISHLT members focus on transplantation and a range of interventions and therapies related to advanced heart and lung disease.

 

‘Chameleon’ bees change color with the weather

Queen Mary University of London

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A sweat bee in the wild (photo by Jeremiah Bender who retains the copyright on this images. This may be used in any article in association with this story). 

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Credit: A sweat bee in the wild (photo by Jeremiah Bender who retains the copyright on this images. This may be used in any article in association with this story).

Some bees really do change colour with the weather, according to new research that shows humidity can temporarily alter the shimmering hues of certain species.

In a study published today in Biology Letters, scientists led by Dr Madeleine Ostwald of Queen Mary University of London found that moisture in the air can cause sweat bees to change colour — and then change back again when conditions dry out.

Sweat bees are known for their bright, metallic greens and blues. Until now, reports that their colours could shift have been anecdotal. This new research provides the first experimental proof.

The team studied museum specimens of a North American sweat bee, Agapostemon subtilior. When the bees were placed in dry air, they appeared deep blue. But when humidity increased, they took on a warmer, copper‑green colour. Once dried again, the bees returned to blue.

Unlike most animals, whose colours come from pigments, these bees get their colour from microscopic structures on their bodies that reflect and scatter light at particular wavelengths. The same effect creates the iridescent feathers of hummingbirds and the shifting skin colours of cuttlefish.

In some animals, these tiny structures swell slightly when exposed to moisture, causing them to reflect redder colours. The researchers believe a similar process may be happening in bees, although more work is needed to fully understand the mechanism.

The scientists also looked at colour changes in the wild. By analysing hundreds of public photos from the citizen science app iNaturalist, they compared bee colour with local humidity levels. While many factors influence a bee’s appearance, the team found that bees in drier areas tended to look bluer — matching the lab results.

Interestingly, older museum specimens showed the strongest colour changes. The researchers think this may be because bees’ outer shells slowly degrade over time, allowing moisture to enter more easily.

The findings suggest this colour‑changing effect could be common among bees, which display a wide range of shimmering colours and live in environments ranging from deserts to rainforests.

Insects use colour for many reasons, including temperature control, communication, and camouflage. Whether these subtle colour shifts affect how bees behave or survive is still unknown.

Dr Madeleine Ostwald, Lecturer in Ecology, Conservation & Biodiversity at Queen Mary said: “When people think of bees, they often picture drab, brown honey bees. In reality, bees are incredibly diverse and colourful — and we’re only just starting to understand how their appearance reflects the climate they live in.”

She added: “Most people associate colour‑change with animals like chameleons that actively control it. These bees aren’t choosing to change colour — it’s happening passively, simply in response to the humidity around them. That adds a whole new layer of mystery to why these colours evolved in the first place.”

 

The study was carried out with researchers Leslie Cervantes Rivera, Jorge De La Cruz and Katja Seltmann from the Cheadle Center for Biodiversity and Ecological Restoration at the University of California, Santa Barbara.

 

“Humidity induces structural colour change and contributes to biogeographic colour variation in sweat bees” will be published on 00.05 BST April 22, 2026 in Biology Letters

 

A sweat bee in San Diego County, California. Image from iNaturalist taken by Karen Fraser (user “fraskar”) https://www.inaturalist.org/observations/272490405, CC0. 

Credit

Image from iNaturalist taken by Karen Fraser (user “fraskar”) https://www.inaturalist.org/observations/272490405, CC0.

Journal

Biology Letters

Article Title

Humidity induces structural colour change and contributes to biogeographic colour variation in sweat bees

Article Publication Date

22-Apr-2026