Belt and Road Medical doi: 10.12345/brm.2026.002

Authors: Yu Chen

Background. Out-of-pocket health spending exceeding 10% of household budget rose globally from 9.6% in 2000 to 13.5% in 2019, with women in low- and middle-income countries (LMICs) facing disproportionate financial risk from maternal and reproductive health services. Regional disparities and gaps in financial protection remain poorly characterised for women’s health specifically. Methods. We conducted a cross-national scoping review following the PRISMA extension for Scoping Reviews (PRISMA-ScR) and the methodological framework of Arksey and O’Malley, synthesising 29 verified sources: six official global monitoring reports and databases, 20 peer-reviewed empirical studies, and three methodological and gender-financing references. A two-step search strategy was employed: a women-focused search (825 records) and a supplementary general-population CHE search (2,282 records) to ensure capture of macro-level evidence with gender-disaggregated analysis. Evidence was identified from PubMed, Web of Science, Embase, and Scopus using PICOS criteria: women in LMICs (Population), women’s health-related out-of-pocket payments (Exposure), catastrophic health expenditure (CHE) at ≥10%/≥25% of household expenditure or ≥40% capacity-to-pay or non-food expenditure (Outcome), and quantitative study designs (Study). Results. Country-level CHE incidence amongst women seeking obstetric care ranged from 12.0% (Sierra Leone, 10% threshold) to 50% (Iran, 40% non-food threshold) , with Kenya reporting 26.4% amongst out-of-pocket payers. Insurance coverage amongst women of reproductive age varied from 0.4% to 57.9% across five African countries. Free maternal health care reduced CHE from 66.1% to 12.0% in Sierra Leone, whilst community-based health insurance showed protective but inconsistent effects (adjusted odds ratio 0.69 at the 10% threshold). Regional disparities were pronounced at both macro and country levels. Conclusions. Women’s health-related CHE in LMICs is substantial, unequally distributed, and driven by weak prepayment mechanisms, low insurance coverage, and absent fee exemptions. Gender-responsive universal health coverage—including explicit maternal service fee exemptions and region-differentiated financing—is urgently needed. These findings are bounded by geographical concentration of evidence in sub-Saharan Africa and heterogeneity in CHE definitions.

Belt and Road Medical doi: 10.12345/brm.2026.003

Authors: Hongtao Jia

Background. Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, and Central Asia has undergone a rapid epidemiological transition since the 1990s. Up-to-date, country-specific estimates of the NCD burden across the five Central Asian republics are scarce. Methods. We extracted data from the Global Burden of Disease Study 2023 (GBD 2023) for Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan, covering the period 1990–2023. We analysed deaths and disability-adjusted life-years (DALYs), reported as counts and age-standardised rates per 100,000 population, for all NCDs combined and for four major cause groups (cardiovascular diseases, neoplasms, chronic respiratory diseases, and diabetes and kidney diseases), stratified by sex. Results. In 2023, NCDs caused 369,331 deaths (50.7% more than in 1990) and 16.0 million DALYs across the five countries, accounting for 78.8–84.2% of all-cause deaths. Age-standardised NCD death rates declined between 1990 and 2023 in four countries (Kazakhstan −32.4%, Kyrgyzstan −29.9%, Turkmenistan −12.2%, Uzbekistan −16.6%) but rose in Tajikistan (+4.1%). Cardiovascular diseases remained the dominant component (46.8–65.7% of NCD deaths). Diabetes and kidney diseases showed the largest relative increases in age-standardised death rates in four of five countries (+52.9% to +78.0%). Age-standardised death rates were consistently higher in men than in women. Conclusions. Although age-standardised NCD mortality declined in most of the region, the absolute NCD burden continues to grow, driven by population growth and ageing, and the rising burden of cardiometabolic disease — particularly diabetes — warrants targeted prevention. Tajikistan, the only country with a rising age-standardised NCD death rate, requires intensified policy attention.

Belt and Road Medical doi: 10.12345/brm.2026.004

Authors: Yongpan Liu

Background: The Belt and Road Initiative (BRI) has progressively incorporated a health agenda through the Health Silk Road (HSR), while the Gulf Cooperation Council (GCC) states pursue ambitious health-system transformation within their national development visions. Yet the regional healthcare landscape and its interface with the HSR have rarely been examined as an integrated whole. Methods: This narrative review synthesised peer-reviewed literature, official statistics, and policy documents on the six GCC states published between 2014 and 2026. Sources included PubMed/MEDLINE, Web of Science, the World Health Organization, the World Bank, and national policy documents. Results: GCC health systems combine population outcomes among the most favourable in the world with a substantial noncommunicable disease burden, heavy reliance on expatriate health professionals, and marked institutional diversity. Cooperation under the BRI has progressed across hospital construction, medical device trade, vaccine localisation, digital health, and human resource development. Structural complementarities are strongest in chronic disease management, medical tourism, digital health, traditional Chinese medicine, and public-private partnerships, whereas regulatory divergence, data governance, and professional qualification recognition barriers persist. Conclusions: Institutionalised cooperation, mutual recognition of standards, and joint research represent the most promising pathways for realising the substantial potential of China-GCC health collaboration.

Belt and Road Medical doi: 10.12345/brm.2026.005

Authors: WEN LIU

Background: Chinese immigrants are among the largest Asian immigrant groups in the United States, yet their health is shaped by three sequential thresholds—visa medical screening, health insurance access, and chronic disease outcomes—seldom described jointly from official aggregate data. Methods: We synthesized aggregate statistics from the National Health Interview Survey (2019–2023), the U.S. Department of State Report of the Visa Office FY2024, CDC medical-screening guidance and surveillance, and Migration Policy Institute and Kaiser Family Foundation compilations. A recent non-citizen Chinese immigrant was defined as a foreign-born, noncitizen Chinese adult residing in the United States for fewer than 10 years. Weighted estimates, proportions, and 95% confidence intervals were abstracted as published; no causal inference was attempted. Results: Tuberculosis was confirmed in 0.7%–0.8% of immigrants and refugees examined in 2014–2019, and mainland-born Chinese applicants received 36,021 numerically limited immigrant visas in FY2024. Uninsurance among Chinese immigrants (6%) equaled the U.S.-born rate and was one third of the rate among all immigrants (18%), with private coverage at 68%. Yet 10.1% of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) adults had no usual source of care and 4.1% delayed care because of cost. Measured hypertension (41.6%) exceeded self-reported prevalence (21.9%); undiagnosed diabetes affected 5.4% of Asian adults versus 2.7% of non-Hispanic White adults; and colorectal, breast, and cervical screening lagged national averages, with a Chinese-specific colorectal estimate of 50.9%. Conclusions: Despite passing rigorous pre-entry medical screening—tuberculosis was confirmed in only 0.7%–0.8% of examined immigrants and refugees—and achieving insurance coverage comparable to U.S.-born adults (6% uninsured), Chinese immigrants still face cost-related delays in care (4.1%) and suboptimal cancer screening, including a colorectal cancer screening rate of 50.9%. This paradox of high admission selectivity, high coverage, low access, and low early detection reveals structural barriers embedded in U.S. immigration health policy and supports the dual health filter interpretation.

Belt and Road Medical doi: 10.12345/brm.2026.001

Authors: WEN LIU

Background: Geopolitical fragmentation — armed conflict, sanctions, and technological decoupling — threatens the continuity of global medical research. The scholarly infrastructure on which medicine depends (literature databases, evaluation metrics, clinical trial registries, publishing platforms, and research data repositories) is concentrated in a small number of Global North institutions. Disruption of any single node threatens not only research productivity but also regulatory decisions, clinical guidelines, and public health security.Approach: We introduce medical academic sovereignty (MAS) — the capacity of a country or region to independently control the medical scholarly infrastructure essential to research, education, and clinical decision-making — and, to the best of our knowledge, the first systematic framework of its kind. We advance an integrated system of six concepts spanning definition, diagnosis, measurement, solution, operation, and governance: MAS; the Five Single Points of Failure (5SPF); the Medical Academic Sovereignty Index (MASI); the Dual-Track Resilience Framework (DTRF); the Scholarly Interoperability Layer (SIL); and the Trigger Mechanism for Sovereign Switch (TMSS). Findings: Two natural experiments — Russia after 2022 and Iran under sanctions — show how rapidly exclusion can propagate across all five failure nodes. A global survey of regional responses (China, Russia, Latin America, and the Gulf states) reveals a growing yet fragmented landscape of alternatives. An illustrative MASI application demonstrates how the framework supports comparative assessment and preparedness planning. Conclusions: Medical academic sovereignty is not academic autarky but the precondition for sustainable international scientific cooperation. In an era in which academic infrastructure can be weaponised, redundancy, interoperability, and multilingualism are global public health priorities.