Evidence for health humanities: A study from the COVID-19 pandemic

Evidence for health humanities: A study from the COVID-19 pandemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Evidence for health humanities: A study from the COVID-19 pandemic Wenjing Wu, Ruonan Tian, Huaqing Guo, Zhiguang Duan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8926699/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract The global COVID-19 pandemic has exerted unprecedented pressure on public health governance systems, underscoring the need for robust evaluations of public health policy responses. This study examines domestic and international research on public health policy during the COVID-19 crisis, drawing on the Web of Science Core Collection and other major English-language databases, as well as CNKI and related Chinese databases. Using VOSviewer for bibliometric visualisation, and informed by health humanities and crisis life-cycle theory, we conduct a systematic analysis of the intellectual foundations, research hotspots, and evolutionary trajectories of this field. The findings reveal a shared developmental logic in the literature, moving from “upgrading governance systems” to “innovating policy instruments” and “strengthening grassroots capacity” alongside divergent explorations in domains such as digital governance and health equity. The study further identifies convergences and tensions in Chinese and international value orientations regarding pandemic control, illuminates how health humanities perspectives are articulated in responses to public health emergencies, and argues that public health serves as a key vehicle for realizing health humanities ideals. We conclude that future policy design must go beyond a narrow focus on technology and efficiency, embedding the three core dimensions of health humanities—population-wide, whole-of-society, and globally oriented—across all stages of emergency management. Such an approach can support the development of more inclusive and resilient public health systems. Humanities/Cultural and media studies Social science/Cultural and media studies Humanities/Health humanities Humanities/Medical humanities Social science/Social policy Social science/Sociology COVID-19 pandemic public health governance public health policy bibliometric analysis health humanities Figures Figure 1 Figure 2 Figure 3 Figure 4 1 Introduction In 2019, coronavirus disease 2019 (COVID-19) rapidly spread across the globe, with high transmission rates, widespread infection, and significant prevention and control challenges, posing serious threats to public health worldwide. COVID-19 causes damage to the kidneys, heart, brain, and other organs, and induces multiple organ dysfunction syndrome (MODS) (Chih-Cheng Lai et al., 2020 ). In January 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of International Concern (PHEIC) (Xie et al., 2022 ). As at 11 May 2025, a total of 777,825,189 cases had been reported to the WHO worldwide (“COVID-19 cases | WHO COVID-19 dashboard,” n.d.). Historically, the international community has experienced multiple public health emergencies, including severe acute respiratory syndrome (SARS) (Wiersinga Wj et al., 2020). The frequent occurrence of such events highlights critical vulnerabilities in public health infrastructure and exposes significant disparities in health resource allocation and access (Filip et al., 2022 ). Simultaneously, these events reveal the complex intrinsic connections between social, cultural, and spiritual life and public health that have long been recognized in the field of medical humanities (Lewis, 2020 ). This study employs bibliometric analysis methods to conduct thematic analysis, keyword analysis, and other analytical approaches on literature in the public health field during the COVID-19 pandemic, revealing hotspots and developmental trends in public health policy responses (Yang et al., 2020 ). Using an analytical framework that integrates health humanities insights with crisis life-cycle theory, we investigate major research hotspots and trajectories in global and Chinese public health policy scholarship, and reveal the ways in which health humanities are articulated within this body of work (Macnaughton, 2023 ). 2 Analytical framework 2.1 Data sources The English-language literature was retrieved from 11 databases and the Chinese-language literature from six databases, using a unified search strategy and defined time span. Detailed retrieval information is summarized in Table 1. The core search strategy was kept consistent across English- and Chinese-language databases. For the English-language searches, we applied the following Boolean query in the title, abstract, and keyword fields: (“severe acute respiratory syndrome coronavirus 2” OR “coronavirus disease 2019” OR “COVID 19” OR “COVID-19” OR “2019-nCoV” OR “2019 novel coronavirus” OR “SARS-CoV-2” OR “SARS Coronavirus 2”) AND (“public health” OR “public health system” OR “public healthcare”) AND (“policy response” OR “policy responsiveness” OR “policy intervention” OR “crisis response” OR “crisis management”). For the Chinese-language searches, we used equivalent Chinese translations of these terms to capture literature on COVID-19, public health, and policy responses. The literature search covered both English- and Chinese-language publications between 2019 and 2025, with the search conducted as at 25 September 2025. For the English-language corpus, we retrieved 2,611 records, and for the Chinese-language corpus, we retrieved 2,137 records. All records were screened manually based on title, abstract and full text. After removing studies that did not meet the eligibility criteria, 1,025 English-language publications and 399 Chinese-language publications were included in the final dataset for analysis. The inclusion criteria were as follows: 1. Type of publication: original research articles or review papers. 2. Topical relevance: studies that simultaneously addressed COVID-19 (SARS-CoV-2), public health, and policy responses. 3. Publication date: papers published on or before 25 September 2025. The exclusion criteria were: 1. Studies unrelated to the COVID-19 pandemic. 2. Studies related to COVID-19 but outside the public health field, such as work focusing primarily on economic policy, macroeconomic impacts, or other non–public health domains. 3. Studies related to COVID-19 but not concerned with policy responses, such as clinical or pharmacological research (e.g. drug development, clinical treatment trials). 4. Non-research items that did not fit the study’s focus, including conference abstracts, letters, editorials, and similar formats. To ensure the comprehensiveness and consistency of the bibliometric analysis, we conducted a systematic harmonization of near-synonymous keywords before performing the visualisation procedures. The core topic of this study is the COVID-19 pandemic, and both the English and Chinese search strings contained multiple sets of near-synonyms referring to COVID-19 and related terms. Content analysis confirmed that all search terms converged on the 2019 coronavirus disease outbreak as the central research object. For subsequent analysis, semantically equivalent expressions were standardized and merged into unified keyword categories. The detailed procedures for synonym consolidation and term standardization are presented in Table 2. 2.2 Analytical methods This study employed VOSviewer visualisation software for bibliometric analysis. The software visualises relationships between keywords through node size and link thickness, displays literature co-citation networks through different node colors and sizes, and helps to identify research hotspots and trends through keyword clustering methods. Therefore, keywords from the included literature were extracted and subjected to thematic clustering using this software. Research hotspot analysis and trend analysis were conducted to examine the state of research on public health policy responses during the COVID-19 pandemic. 3 Results 3.1 Research Hotspots Using VOSviewer, we extracted and analyzed author keywords and index terms from both the English- and Chinese-language publications. In the English-language corpus, apart from the core terms COVID-19, public health, and policy, the most frequently occurring keywords included infectious diseases (408 occurrences), human (302), country (250), crisis management (223), and article (162). These high-frequency terms suggest a strong emphasis on infectious disease contexts, human populations and national-level analyses, as well as on crisis management as a key dimension of public health policy responses. To identify research hotspots in public health policy responses to the COVID-19 pandemic, we set a minimum keyword occurrence threshold of 5 for English-language publications and 3 for Chinese-language publications, and performed cluster analysis on the high-frequency keywords meeting these criteria. The bibliometric analysis shows that the English-language keyword co-occurrence network comprises 257 nodes grouped into four clusters (Fig. 1 ), while the Chinese-language network consists of 128 nodes organized into three clusters (Fig. 2 ). The clustering results indicate that both networks exhibit a pronounced core–periphery structure, with “COVID-19” serving as the central node in both the English and Chinese networks. All clusters maintain dense co-occurrence links with this core node, underscoring the centrality of COVID-19 in shaping the thematic landscape of public health policy response research. In the English-language keyword clustering map, Cluster 1 (red) focuses on public health emergency management and crisis response. This cluster contains 106 keywords, with “infectious diseases”, “country”, and “crisis management” among the most frequent terms. Centred on “COVID-19” as the core node, the cluster also includes keywords such as “disease transmission”, “hygiene”, and “risk assessment”, indicating sustained attention to transmission pathways, infection control, and interventions targeting hygiene-related behaviours. The presence of terms like “grounded theory” and “safety” further suggests that the basic theoretical frameworks of public health and the design of safety measures have become salient topics in the context of pandemic response. Cluster 2 (green) captures research on individual health behaviours and social responses. It comprises 55 keywords, with “human”, “female”, and “male” as key nodes. This cluster highlights the impacts of the pandemic at the individual and social levels, particularly in relation to mental health and changing social behaviour. High-frequency terms such as “mental health”, “trust”, “vaccine”, and “social support” point to extensive interest in health behaviours, vaccine acceptance, and the role of social support systems. By engaging with psychological well-being and trust mechanisms, this cluster helps illuminate how individuals react and adapt socially during the pandemic. Cluster 3 (blue) focuses on governmental containment policies and health system management. It includes 53 keywords, with “government”, “economic”, and “healthcare policy” as major terms. Research within this cluster underscores the crucial role of government action and health system emergency management in pandemic response, emphasizing topics such as policy design, quarantine and containment strategies, and the allocation and coordination of medical resources. Cluster 4 (yellow) relates to public health research and evidence generation. This cluster contains 43 keywords, prominently featuring “article”, “controlled study”, and “medical research”. It concentrates on the production and assessment of scientific evidence regarding the effectiveness and societal implications of pandemic control measures. Empirical studies in this cluster examine the dynamics of virus transmission, the outcomes of intervention strategies, and the interactions among social behaviour, policy responses, and misinformation. In doing so, the cluster highlights the critical role of research evidence in informing policy decisions and evaluating their broader social impacts. Taken together, the four clusters delineate the main research fronts in public health amid the COVID-19 pandemic at macro-, meso-, micro-, and research-evidence levels. Clusters 1 and 3 articulate the macro-level architecture and operational frameworks of pandemic governance—ranging from crisis management systems to specific health policies—while Clusters 2 and 4 provide micro-level behavioural insights and scientific foundations. This configuration suggests a dynamic feedback loop in which high-level policy design and system management interact with individual behaviours and evolving bodies of evidence, jointly shaping the evolving agenda of public health research in the COVID-19 era. In the Chinese-language keyword clustering map, Cluster 1 (red) focuses on COVID-19 response and public health system development. This cluster comprises 54 keywords, with “epidemic prevention and control”, “response strategies”, and “public hospitals” as the main nodes. It centers on national-level public health governance following the COVID-19 outbreak, emphasizing government-led policy responses at the macro level and efforts to strengthen the public health system. Cluster 2 (green) addresses infectious disease control and vaccination-related behaviour. It comprises 41 keywords, with “COVID-19 vaccine”, “influencing factors”, and “older adults” as prominent nodes. This cluster takes individual and group behaviour as the primary units of analysis, focusing on residents’ vaccination practices, willingness to be vaccinated, and related psychological factors. It links vaccination policies with behavioural outcomes, and frequently employs frameworks such as the Health Belief Model (HBM) to examine the cognitive determinants of vaccination intention. Cluster 3 (blue) concerns emergency management and policy analysis in the context of public health emergencies. It comprises 33 keywords, with “public health emergencies”, “emergency management”, and “mental health” as prominent nodes. The cluster foregrounds the institutional and instrumental dimensions of emergency management, encompassing policy instruments, response mechanisms, and resource allocation. It further spans the policy cycle from formulation and implementation to evaluation and policy recommendations. Overall, Cluster 3 aligns with the domains of governance instruments and public health management. Taken together, the three clusters delineate research in China on COVID-19 public health policy from macro-, micro-, and meso-level perspectives—namely, national policy frameworks, individual behaviour, and governance tools. Cluster 1 provides the overarching contextual and policy framework that structures the other two clusters; Cluster 2 can be seen as a micro-level extension of Cluster 1, focusing on how individuals and specific groups respond within that policy environment; Cluster 3 reflects the institutionalisation of Cluster 1 through concrete emergency management tools and mechanisms. These close, mutually reinforcing linkages among the three clusters point to a multi-level, multi-dimensional research network that characterizes recent scholarship in China on public health policy responses to COVID-19. 3.2 Research Trends The emergence of “burst” keywords within a given period reflects clusters of terms that occur frequently over a short span of time, indicating the topics that researchers focus on during that stage and thus revealing the field’s evolving trends and priorities. In this study, we ordered the keywords within each cluster vertically according to their average year of occurrence, thereby constructing a time-labelled representation. In the resulting visualisation, node colours range from blue to yellow, representing a progression from earlier to more recent research themes. From Fig. 3 , it is evident that international research on COVID-19 in the public health field is concentrated mainly between 2021 and 2023. In the early phase of the pandemic (the blue-purple area in Fig. 3 ), studies focused on topics such as “trauma”, “school closing”, “regulation”, “hospitals”, “emergency care”, “health crisis”, and “patient care”, highlighting government lockdowns, school closures, and other mandatory emergency measures. In the middle phase (green area), the main themes shifted to “crisis management”, “public health policy”, “healthcare system”, and “telemedicine”, indicating a move from discrete emergency interventions toward broader institutional and system-level responses. In the later phase (yellow area), keywords such as “crisis communication”, “policy-making”, “vaccine”, “vaccine hesitancy”, and “misinformation” became prominent, reflecting growing attention to vaccination, policy design and evaluation, and information dynamics. Overall, the temporal evolution of these keywords traces a progression from acute emergency control, to institutional adaptation, and finally to recovery, reconstruction, and resilience-building in public health systems. Figure 4 shows that research on COVID-19 in the public health field is concentrated mainly between 2020 and 2022. In the early phase of the pandemic (the blue-purple area), studies focused on “coronavirus infection”, “infectious diseases”, “antiviral drugs”, “nuclear medicine”, and “traditional Chinese medicine”. This pattern reflects an urgent effort, from medical and epidemiological perspectives, to rapidly identify the pathogen and transmission risks, activate emergency mechanisms and technical tools, and launch an immediate response to the COVID-19 outbreak. In the middle phase (green area), the main themes shift to “epidemic prevention and control”, “public health”, “public hospitals”, and “response strategies”, indicating a move toward system-level governance, with increasing emphasis on multi-actor participation, routine prevention and control, and institutional adjustment. In the later phase (yellow area), research turns to topics such as “the post-pandemic era”, “mental health”, “COVID-19 vaccines”, and “primary healthcare institutions”, signalling a broadening of focus from epidemic control per se to more comprehensive assessments of policies, behaviours, psychological outcomes, and social structures. Overall, the temporal evolution of these keywords reveals a trajectory from rapid medical and epidemiological response, to systematised governance and normalized control, and finally to integrated evaluation and reflection in the post-pandemic context. 4 Discussion 4.1 Humanistic Health Thoughts in Research Hotspots British scholar Paul Crawford and his colleagues contend that health humanities should move beyond the clinical boundaries of traditional medical humanities and, from an interdisciplinary and inclusive perspective, integrate social, cultural and public engagement dimensions, with particular attention to how the arts, narrative and other diverse forms shape health and human flourishing comprehensively (Crawford et al., 2015 ). This line of thinking is further expanded and deepened in the conception of one health humanities, which approaches health from the perspective of human development as a whole and calls for comprehensive, continuous and all-encompassing health promotion and humane care-fair and just for all people-across the full spectrum of human health circumstances and the entire life course (Zhang et al., 2023 ). In the wake of the COVID-19 outbreak, the emergency containment measures adopted by different countries have vividly reflected the three core dimensions of health humanities-all populations, the whole of society, and the global community-thereby underscoring that public health is, in essence, a crucial arena for putting the vision of grand health humanities into practice (Mazinani M and Rude Bj, 2021 ). Public health research during the COVID-19 pandemic vividly reflects the “all populations” dimension of health humanities. In the international clustering results, Cluster 2 directly targets the health behaviours of individuals and specific population groups during the pandemic, spanning age groups from adolescents and adults to older people, and encompassing both men and women. Key themes include mental health, behavioural responses, risk perception and attitudes toward vaccination. In the early stage of the outbreak, population-focused studies concentrated on clinical indicators, using clinical data to capture disease characteristics; in the later stage, attention shifted toward the psychological well-being of different groups and their trust in vaccines. At the policy and practice level, many countries have introduced differentiated prevention and control measures for specific populations, underscoring a population-sensitive approach to infectious disease response. For example, the U.S. Centers for Disease Control and Prevention (CDC) provides tailored guidance for different groups on its official website (CDC, 2025 ). The World Health Organization (WHO) has established dedicated Q&A sections that address the needs of people living with HIV, children, pregnant women and older people (“Question and answers hub,” n.d.), reflecting its long-standing commitment to systematic, diversified and inclusive health strategies for vulnerable populations. In 2020, WHO launched the COVID-19 Vaccines Global Access (COVAX) initiative to accelerate vaccine development and production and to ensure equitable access for low-income countries, thereby embedding the principle of “health for all” in global vaccine allocation (GAVI, n.d.). China has actively participated in this initiative and provided vaccine support to many developing countries. Domestically, China implemented a policy of free COVID-19 vaccination and multiple rounds of inoculation, promoting broad and relatively equitable access to vaccines nationwide. At the same time, the rollout of digital tools such as the health code and travel code aimed to extend universal protection of health rights across the population. Public health research during the COVID-19 pandemic also illustrates the “whole-of-society” dimension of health humanities. This perspective emphasizes that responses to public health emergencies can no longer be confined to the medical system alone, but must involve coordinated action across government, education, media, communities and other societal sectors. In our analysis, Cluster 3 focuses on how social systems and organizations respond to the pandemic, underscoring the importance of collaborative governance and social support in safeguarding health. The World Health Organization (WHO) has long sought to improve health by addressing the social determinants of health, with “Health in All Policies” as a key strategy that explicitly frames health outcomes as the cumulative result of decisions across all policy domains (Scharf Lg et al., 2024). The US Centers for Disease Control and Prevention (CDC) has established a comprehensive, nationwide data system that covers vaccine production, distribution and monitoring (Pearce et al., 2022 ), while Australia has made use of large-scale primary care databases to provide real-time evidence for policy adjustment—both examples highlighting the involvement of multiple sectors and levels within the state apparatus (Deiana G et al., 2021 ). Pandemic response thus depends not only on medical research and governmental action, but also on the coordinated participation of information technology, finance, social services and other fields (Armocida et al., 2020 ). At the research level, international scholarship has tended to focus more on the social behavioural characteristics of individuals and groups, and to stress the application of big data and artificial intelligence in outbreak control and response. Chinese studies, by contrast, have placed greater emphasis on policy institutions and collaborative governance, drawing on theories of holistic governance and emergency management, and using policy text analysis to reveal how public health responses unfolded during the COVID-19 crisis (Ana I Bento et al., 2020 ). These patterns reflect different understandings of “whole-of-society” rooted in distinct research traditions: internationally, a more bottom‑up orientation centred on social behaviour; in China, a stronger top‑down focus on institutional design and policy implementation (Levin and Bradshaw, 2022 ). From the international to the national, and further down to local and community levels, the effective implementation of public health policy ultimately depends on multi-level, multi-actor participation; this reinforces the view that pandemic control is not only a medical challenge but, fundamentally, a matter of public governance (Eccleston-Turner and Upton, 2021 ). Public health research during the COVID-19 pandemic also embodies the global dimension of health humanities, with Cluster 3 pointing toward transnational and globalised health issues. Viruses do not recognize borders, and public health challenges are inherently global: outbreaks, disease transmission and risk assessment are, by their very nature, cross-border phenomena. Cooperation among international organizations and nation-states, cross-sectoral collaborative governance, and the joint participation of social groups and grassroots actors have all helped to enhance the effectiveness of public health governance and to advance the health humanities vision of participation by all and health shared by all. Global vaccine policy offers a particularly salient example. Initiatives such as the COVID-19 Vaccines Global Access (COVAX) facility and the COVID-19 Vaccine Delivery Partnership (CoVDP) emphasize cross-country and cross-institutional cooperation and use multilateral mechanisms to safeguard the interests of low-income countries and high-risk groups, thereby forming a highly integrated ecosystem (Scharf Lg et al., 2024). At the same time, patterns of trust, stress, health behaviour and misinformation have emerged as widely shared features of human conduct across different societies. Attitudes toward COVID-19 vaccines around the world have typically moved through a trajectory from scepticism to greater acceptance and trust (Levin and Bradshaw, 2022 ). Throughout the pandemic, scientific evidence and medical research have been increasingly shared on a global scale: the design of COVID-19 trials, the accumulation of clinical evidence and the processes of academic publishing have all taken shape within a globally co-produced knowledge system. 4.2 Health Humanities Concepts in Pandemic Development In 1966, A. K. Karma first proposed the life cycle theory, distilling the biological “cradle-to-grave” process into a theoretical framework for understanding how research objects emerge, develop and eventually decline (Yuxing Xie and Xianhua Sun, 2025). Fink advanced the notion of a crisis life-cycle, dividing crises into four stages: prodromal, acute, chronic and resolution (Lu et al., 2021 ). Viewed from a temporal perspective, responses to public health emergencies align closely with this crisis life-cycle: moving from incubation to outbreak, then to prolongation and eventual dissipation. The COVID-19 pandemic, in particular, has led the world through three broad phases-emergency control, coordinated recovery and long-term governance-during which public health policy research has been continuously revised, expanded and deepened (Wang M and Wang J, 2024 ). In the emergency control phase, the rapid spread and high uncertainty of COVID-19 meant that the core objective of public health policy was to “halt transmission and save lives” through urgent interventions. Research in this stage primarily focused on public health system preparedness, disease surveillance and risk identification, with key terms such as crisis management, emergency preparedness and epidemic prevention and control featuring prominently. Effective crisis management, rational resource allocation and robust health support were crucial in the early outbreak period. Scholars concentrated on social systems, policy responses and preventive mechanisms in public health, reflecting the long-standing health humanities emphasis on prevention first. In China, during the Wuhan lockdown, national resources were centrally mobilised, a policy of free treatment for all eligible COVID-19 patients (“admitting and treating all who should be admitted”) was implemented, and community-based grid management was used to secure basic livelihoods. In many other countries, digital technologies and science communication campaigns were deployed to encourage compliance with control measures (Tsampasian et al., 2023 ), These responses collectively underscored the ethical bottom line of “life above all” and the emerging consensus that individual behaviour carries responsibility for collective health. Globally, policy implementation helped strengthen public recognition of group health and collective protection as shared values. Public participation gradually came to the fore: in China, neighbourhood committees and volunteers assumed frontline responsibilities in community-level prevention and control, while in the United States, neighbourhood mutual-aid networks played an important role. However, the heavy reliance on voluntary action also led to uneven resource distribution (Belasen et al., 2024 ). In many countries, resources were disproportionately concentrated in major cities, leaving rural areas and vulnerable groups facing significant barriers in accessing medical care and essential supplies. To achieve rapid containment and effectively curb viral transmission, most governments resorted to stringent measures such as lockdowns and social distancing mandates. Across these varied responses, the health humanities principle of prioritizing health and protecting life was powerfully affirmed: in the context of a major public health emergency, safeguarding people’s lives and health is treated as a non-negotiable priority. In the coordinated recovery phase, the spread of COVID-19 gradually slowed, and keywords such as mental health, social isolation and economic recovery emerged as major research foci. Studies indicate that what societies need to restore after the pandemic is not only the economy and health systems, but also a broad spectrum of social and psychological supports. The prominence of terms such as mental health and economic recovery in this period underscores that social and psychological rehabilitation is as crucial as biomedical control in a public health crisis. Lockdown policies during the emergency phase led to a marked increase in psychological problems among people living alone, adolescents and other vulnerable groups, with a particularly notable rise in emotional disorders among young people. In China, family members and community workers provided targeted psychosocial support, while in many high‑income countries, relatively mature counselling and public service systems-traditionally grounded in face-to-face, offline interventions-began to be complemented by emerging forms of online psychological assistance (Pfefferbaum and Van Horn, 2022 ). On the economic front, China advocated “coordinating epidemic prevention and control with economic and social development”, pursuing targeted containment to reduce the impact on everyday life and production. In Europe and North America, governments gradually eased restrictions and promoted the resumption of work and production, reflecting a widely shared humanistic understanding that “health is the foundation of people’s livelihoods, and the economy underpins health”. Policy agendas in this stage also paid increasing attention to vulnerable groups: for example, support measures for small and micro enterprises and older adults in China, and unemployment benefits and priority vaccination schemes in Europe and the United States, all aimed at mitigating health and social inequalities (Chi-Kin Kwan et al., 2021 ). From the perspective of health humanities, this phase highlights the comprehensiveness of physical and mental health: recovery is not limited to treating bodily illness, but also involves restoring psychological well‑being and rebuilding the social conditions that sustain a healthy life. In the long-term governance phase, COVID-19 gradually entered a stage of normalization, and policy goals shifted toward building a resilient public health system, establishing enduring health governance mechanisms, drawing lessons from the crisis and preventing future risks. This is reflected in the frequent appearance of keywords such as policy-making, longitudinal study, healthcare policy and government. Research priorities increasingly moved toward public health policy design, the strengthening of health system resilience, and the provision of long-term health security. Across the literature, resilience is widely regarded as a core capacity for responding to public health crises. Public health systems have undergone an upgrading in their humanistic orientation, combining a preventive focus with the livelihood-related nature of health, emphasizing early intervention and life‑course health management, and placing greater weight on care, dignity and respect in the design of policies and services so as to enhance people’s sense of health gain and overall quality of life (Moolla and Hiilamo, 2023 ). At the preventive level, the notion of “proactive health” has been promoted, with health education and science communication being used to foster autonomous health behaviours among individuals (Gizaw et al., 2022 ). At the livelihood level, attention has turned to the accessibility, equity and inclusiveness of services, with more human‑centred measures introduced for older adults, children, pregnant and postpartum women, persons with disabilities and other groups, signalling a humanistic shift from “disease response” to health promotion (Shete et al., 2025 ). Governance models have also evolved from government‑dominated approaches to collaborative arrangements involving government, society and the public, echoing the idea that citizens themselves are key subjects of health governance (Sandhu et al., 2023 ). Health equity has gradually become a central item on the policy agenda: the differentiated impacts of COVID-19 on various social groups have driven public health evaluation frameworks to incorporate an equity perspective, highlighting the importance of institutional factors. China’s revision of the Law on the Prevention and Treatment of Infectious Diseases as well as its public health emergency legislation, and the WHO’s launch of negotiations on a pandemic accord that explicitly incorporates “equity” into its draft text, both signal heightened domestic and international attention to fairness and cooperation (Shete et al., 2025 ). Overall, this phase of research closely aligns with the health humanities ideal of sustainable health management, emphasizing the use of institutionalized, long-term governance mechanisms to enhance both population health and societal capacity to withstand future crises. 4.3 Limitations Methodologically, bibliometric analysis can objectively depict research trends, but it is limited in its capacity to elucidate the deeper logic of policy texts and to assess implementation outcomes. Subsequent research should integrate qualitative approaches—such as case studies and policy effectiveness evaluations—to deepen and validate the findings derived from bibliometric analysis. 5 Conclusion The COVID-19 pandemic has attracted worldwide attention and generated an extensive body of research. As COVID-19 and other public health emergencies are inherently transnational in nature, they necessarily require global, coordinated responses. Future studies need to pay closer attention to the design of public health policies, the combined effects of different policy instruments, and the construction of long-term governance mechanisms. Emerging technologies such as artificial intelligence (AI) should be more fully integrated into the prediction and early warning of public health emergencies, the optimization of resource allocation, and the simulation and evaluation of intervention effects. At the same time, the pandemic has exposed significant shortcomings in global cooperation, underscoring the need to strengthen and operationalise collaborative mechanisms so as to enhance the fairness of health rights across countries. In addition, research should engage more systematically with the long-term and multidimensional impacts of the pandemic on population health, and incorporate the principles of health humanities—emphasising health equity, social participation and life‑course care—into the formulation and evaluation of public health policies. By doing so, scholars and policymakers can work together to develop a new paradigm of global public health governance that is more resilient, inclusive and human-centred. Declarations Data availability The data used in this study are available from the corresponding author upon reasonable request. Competing interests The author(s) declare no competing interests. Ethical statements This article does not contain any studies with human participants performed by any of the authors. Informed consent This article does not contain any studies with human participants performed by any of the authors. Additional information Correspondence and requests for materials should be addressed to Zhiguang Duan. Funding Declaration This research received no external funding. Author Contribution WJ Wu wrote the main manuscript text, RN Tian was responsible for bibliographic retrieval, HQ Guo was responsible for the data screening and analysis, and ZG Duan was responsible for reviewing and guiding the article. All authors reviewed the manuscript. References Ana I Bento, Thuy Nguyen, Coady Wing, Felipe Lozano-Rojas, Yong-Yeol Ahn, Kosali Simon, 2020. Evidence from internet search data shows information-seeking responses to news of local COVID-19 cases. Proc. Natl. Acad. Sci. U. S. A. 117, 11220–11222. https://doi.org/10.1073/pnas.2005335117 Armocida, B., Formenti, B., Ussai, S., Palestra, F., Missoni, E., 2020. The italian health system and the COVID-19 challenge. Lancet Public Health 5, e253. https://doi.org/10.1016/S2468-2667(20)30074-8 Belasen, A.R., Belasen, A.T., Bass, M., 2024. Tracking the uneven outcomes of COVID-19 on racial and ethnic groups: implications for health policy. J. Racial Ethn. Health Disparities 11, 2247–2255. https://doi.org/10.1007/s40615-023-01692-5 CDC, 2025. Clinical considerations for special populations [WWW Document]. Covid-19. URL https://www.cdc.gov/covid/hcp/clinical-care/considerations-special-groups.html (accessed 7.8.25). Chih-Cheng Lai, Tzu-Ping Shih, Wen-Chien Ko, Hung-Jen Tang, Po-Ren Hsueh, 2020. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int. J. Antimicrob. Agents 55, 105924. https://doi.org/10.1016/j.ijantimicag.2020.105924 Chi-Kin Kwan, Henry Wai-Hang Ling, Johnson Chun-Sing Cheung, Ernest Wing-Tak Chui, 2021. Safeguarding health equality for the disadvantaged during the COVID-19 pandemic: lessons learned for the social work profession. Qual Soc Work 20, 463–469. https://doi.org/10.1177/1473325020973337 COVID-19 cases | WHO COVID-19 dashboard [WWW Document], n.d. . Datadot. URL https://data.who.int/dashboards/covid19/cases (accessed 7.8.25). Crawford, P., Brown, B., Baker, C., Tischler, V., Abrams, B., 2015. Health humanities. Palgrave Macmillan. Deiana G, Azara A, Dettori M, Delogu F, Vargiu G, Gessa I, Arghittu A, Tidore M, Steri G, Castiglia P, 2021. Characteristics of SARS-CoV-2 positive cases beyond health-care professionals or social and health-care facilities. BMC Public Health 21. https://doi.org/10.1186/s12889-020-10093-w Eccleston‐Turner, M., Upton, H., 2021. International collaboration to ensure equitable access to vaccines for COVID‐19: the ACT‐accelerator and the COVAX facility. Milbank Q 99, 426–449. https://doi.org/10.1111/1468-0009.12503 Filip, R., Gheorghita Puscaselu, R., Anchidin-Norocel, L., Dimian, M., Savage, W.K., 2022. Global challenges to public health care systems during the COVID-19 pandemic: a review of pandemic measures and problems. J Pers Med 12, 1295. https://doi.org/10.3390/jpm12081295 GAVI, n.d. COVAX explained [WWW Document]. COVAX explained. URL https://www.gavi.org/vaccineswork/covax-explained (accessed 8.14.25). Gizaw, Z., Astale, T., Kassie, G.M., 2022. What improves access to primary healthcare services in rural communities? A systematic review. BMC Prim Care 23, 313. https://doi.org/10.1186/s12875-022-01919-0 Levin, J., Bradshaw, M., 2022. Determinants of COVID-19 skepticism and SARS-CoV-2 vaccine hesitancy: findings from a national population survey of U.S. adults. BMC Public Health 22, 1047. https://doi.org/10.1186/s12889-022-13477-2 Lewis, B., 2020. Planetary health humanities—responding to COVID times. The Journal of Medical Humanities 42, 3. https://doi.org/10.1007/s10912-020-09670-2 Lu, Y., Liu, T., Wang, T., 2021. Dynamic analysis of emergency inter-organizational communication network under public health emergency: a case study of COVID-19 in hubei province of China. Nat. Hazards (dordr. Neth.) 109, 2003–2026. https://doi.org/10.1007/s11069-021-04908-1 Macnaughton, J., 2023. Does medical humanities matter? The challenge of COVID-19. Med. Humanit. 49, 545–552. https://doi.org/10.1136/medhum-2022-012602 Mazinani M, Rude Bj, 2021. The novel zoonotic coronavirus disease 2019 (COVID-19) pandemic: health perspective on the outbreak. Journal of healthcare quality research 36. https://doi.org/10.1016/j.jhqr.2020.09.004 Moolla, I., Hiilamo, H., 2023. Health system characteristics and COVID-19 performance in high-income countries. BMC Health Serv. Res. 23, 244. https://doi.org/10.1186/s12913-023-09206-z Pearce, C., McLeod, A., Supple, J., Gardner, K., Proposch, A., Ferrigi, J., 2022. Responding to COVID-19 with real-time general practice data in Australia. Int. J. Med. Inf. 157, 104624. https://doi.org/10.1016/j.ijmedinf.2021.104624 Pfefferbaum, B., Van Horn, R.L., 2022. Physical activity and sedentary behavior in children during the COVID-19 pandemic: implications for mental health. Curr. Psychiatry Rep. 24, 493–501. https://doi.org/10.1007/s11920-022-01366-9 Question and answers hub [WWW Document], n.d. URL https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub (accessed 7.8.25). Sandhu, H.S., Otterman, V., Tjaden, L., Shephard, R., Apatu, E., Di Ruggiero, E., Musto, R., Pawa, J., Steinberg, M., Betker, C., 2023. The governance of core competencies for public health: a rapid review of the literature. Public Health Rev. 44, 1606110. https://doi.org/10.3389/phrs.2023.1606110 Scharf Lg, Adeniyi K, Augustini E, Boyd D, Corvin L, Kalach Re, Fast H, Fath J, Harris L, Henderson D, Hicks-Thomson J, Jones-Jack N, Kellerman A, Khan An, McGarvey Ss, McGehee Je, E. Miner C, Moore Lb, Murthy Bp, Myerburg S, Neuhaus E, Nguyen K, Parker M, Pierce-Richards S, Samchok D, Shaw Lk, Spoto S, Srinivasan A, Stearle C, Thomas J, Winarsky M, Zell E, 2024. Monitoring and reporting the US COVID-19 vaccination effort. Vaccine 42 Suppl 3. https://doi.org/10.1016/j.vaccine.2023.12.005 Shete, P.B., Santos, N., Spindler, H., León, T., Petersen, M., Kilpatrick, A.M., Jain, S., Watt, J., Radhakrishna, R., Pan, E., Aragón, T., 2025. Building an agile state-wide research infrastructure to address COVID-19 and emerging threats: insights from an equity-centered public health and academic collaboration in california. Front. Public Health 13, 1549326. https://doi.org/10.3389/fpubh.2025.1549326 Tsampasian, V., Elghazaly, H., Chattopadhyay, R., Debski, M., Naing, T.K.P., Garg, P., Clark, A., Ntatsaki, E., Vassiliou, V.S., 2023. Risk factors associated with post−COVID-19 condition. JAMA Intern. Med. 183, 566–580. https://doi.org/10.1001/jamainternmed.2023.0750 Wang M, Wang J, 2024. Performance evaluation of urban emergency governance: conceptual connotations and empirical research based on the crisis life cycle theory. Eval. Rev. 48. https://doi.org/10.1177/0193841X231215208 Wiersinga Wj, Rhodes A, Cheng Ac, Peacock Sj, Prescott Hc, 2020. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA 324. https://doi.org/10.1001/jama.2020.12839 Xie, X., Lei, P., Liu, L., Hu, J., Liang, P., 2022. Research trends and hotspots of COVID-19 impact on sexual function: a bibliometric analysis based on web of science. Front. Public Health 10, 976582. https://doi.org/10.3389/fpubh.2022.976582 Yang, F., Zhang, S., Wang, Q., Zhang, Q., Han, J., Wang, L., Wu, X., Xue, F., 2020. Analysis of the global situation of COVID-19 research based on bibliometrics. Health Inf. Sci. Syst. 8, 30. https://doi.org/10.1007/s13755-020-00120-w Yuxing Xie, Xianhua Sun, 2025. An overview of the integration and development trends between arts and psychotherapy. Front. Psychol. 16, 1617700. https://doi.org/10.3389/fpsyg.2025.1617700 Zhang, X., Pang, H., Duan, Z., 2023. Educational efficacy of medical humanities in empathy of medical students and healthcare professionals: a systematic review and meta-analysis. BMC Med. Educ. 23. https://doi.org/10.1186/s12909-023-04932-8 Tables Tables 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1Databasesusedforliteratureretrievalandnumberofrecords.jpg Table 1: Databases used for literature retrieval and number of records Table2Keywordcleaningandstandardization.jpg Table 2: Keyword cleaning and standardization Dataanddocumentation.zip Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 10 May, 2026 Reviews received at journal 21 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviews received at journal 14 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor invited by journal 11 Mar, 2026 Editor assigned by journal 06 Mar, 2026 Submission checks completed at journal 04 Mar, 2026 First submitted to journal 20 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8926699","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":620204608,"identity":"dbe98868-a087-45fd-b4d1-ef69f7c54575","order_by":0,"name":"Wenjing Wu","email":"","orcid":"","institution":"Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenjing","middleName":"","lastName":"Wu","suffix":""},{"id":620204609,"identity":"88738e9f-e9e2-47fb-b050-4c05869948c4","order_by":1,"name":"Ruonan Tian","email":"","orcid":"","institution":"Shanxi Medical 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Medical University","correspondingAuthor":true,"prefix":"","firstName":"Zhiguang","middleName":"","lastName":"Duan","suffix":""}],"badges":[],"createdAt":"2026-02-20 14:08:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8926699/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8926699/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106818122,"identity":"2f179f7f-fac3-4fd2-b03a-cbba81dd33e1","added_by":"auto","created_at":"2026-04-13 17:57:56","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":94168,"visible":true,"origin":"","legend":"\u003cp\u003eKeyword clusters of international public health policy responses to COVID-19\u003c/p\u003e","description":"","filename":"Figure1KeywordclustersofinternationalpublichealthpolicyresponsestoCOVID19.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8926699/v1/79b4d1565798a3ee26fdd75f.jpg"},{"id":106818124,"identity":"57c6e7cf-70f5-4b77-bc20-88861f9bef65","added_by":"auto","created_at":"2026-04-13 17:57:56","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":108682,"visible":true,"origin":"","legend":"\u003cp\u003eKeyword clusters of domestic public health policy responses to COVID-19\u003c/p\u003e","description":"","filename":"Figure2KeywordclustersofdomesticpublichealthpolicyresponsestoCOVID19.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8926699/v1/4439c1cbb951da2370297e0a.jpg"},{"id":106960795,"identity":"91737871-e2b9-45dc-b030-5218788f1c74","added_by":"auto","created_at":"2026-04-15 09:23:08","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":95441,"visible":true,"origin":"","legend":"\u003cp\u003eTime-labelled view of international COVID-19 public health policy research\u003c/p\u003e","description":"","filename":"Figure3TimelabelledviewofinternationalCOVID19publichealthpolicyresearch.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8926699/v1/c5b8da0a761b791c4d704812.jpg"},{"id":106818126,"identity":"ac8e9875-e09c-4820-8a52-732f24bb8930","added_by":"auto","created_at":"2026-04-13 17:57:56","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":209531,"visible":true,"origin":"","legend":"\u003cp\u003eTime-labelled view of domestic COVID-19 public health policy research\u003c/p\u003e","description":"","filename":"Figure4TimelabelledviewofdomesticCOVID19publichealthpolicyresearch.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8926699/v1/f4f335e786fa218164f0f7a4.jpg"},{"id":107708707,"identity":"5569bc70-0052-458c-8a29-2a50df46f6ba","added_by":"auto","created_at":"2026-04-24 09:31:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":714488,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8926699/v1/b2fc807a-674e-4f1c-b100-2843ae4b748a.pdf"},{"id":107704893,"identity":"1a01adf6-82be-4855-b7ba-0a9cb350c9b0","added_by":"auto","created_at":"2026-04-24 09:02:51","extension":"jpg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":99565,"visible":true,"origin":"","legend":"\u003cp\u003eTable 1: Databases used for literature retrieval and number of records\u003c/p\u003e","description":"","filename":"Table1Databasesusedforliteratureretrievalandnumberofrecords.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8926699/v1/74dfa18443c62bc5e58e21ff.jpg"},{"id":106818128,"identity":"74d6dcff-c8a3-4278-9172-4e13062f7ac7","added_by":"auto","created_at":"2026-04-13 17:57:57","extension":"jpg","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":47613,"visible":true,"origin":"","legend":"\u003cp\u003eTable 2: Keyword cleaning and standardization\u003c/p\u003e","description":"","filename":"Table2Keywordcleaningandstandardization.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8926699/v1/b3b484337d3cb317007cb6cd.jpg"},{"id":106818125,"identity":"26156a46-fa4c-4a3c-9f3e-17ee2446498f","added_by":"auto","created_at":"2026-04-13 17:57:56","extension":"zip","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":29017036,"visible":true,"origin":"","legend":"","description":"","filename":"Dataanddocumentation.zip","url":"https://assets-eu.researchsquare.com/files/rs-8926699/v1/e1dee638b787005fd7019cd8.zip"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evidence for health humanities: A study from the COVID-19 pandemic","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eIn 2019, coronavirus disease 2019 (COVID-19) rapidly spread across the globe, with high transmission rates, widespread infection, and significant prevention and control challenges, posing serious threats to public health worldwide. COVID-19 causes damage to the kidneys, heart, brain, and other organs, and induces multiple organ dysfunction syndrome (MODS) (Chih-Cheng Lai et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In January 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of International Concern (PHEIC) (Xie et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). As at 11 May 2025, a total of 777,825,189 cases had been reported to the WHO worldwide (\u0026ldquo;COVID-19 cases | WHO COVID-19 dashboard,\u0026rdquo; n.d.). Historically, the international community has experienced multiple public health emergencies, including severe acute respiratory syndrome (SARS) (Wiersinga Wj et al., 2020). The frequent occurrence of such events highlights critical vulnerabilities in public health infrastructure and exposes significant disparities in health resource allocation and access (Filip et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Simultaneously, these events reveal the complex intrinsic connections between social, cultural, and spiritual life and public health that have long been recognized in the field of medical humanities (Lewis, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This study employs bibliometric analysis methods to conduct thematic analysis, keyword analysis, and other analytical approaches on literature in the public health field during the COVID-19 pandemic, revealing hotspots and developmental trends in public health policy responses (Yang et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Using an analytical framework that integrates health humanities insights with crisis life-cycle theory, we investigate major research hotspots and trajectories in global and Chinese public health policy scholarship, and reveal the ways in which health humanities are articulated within this body of work (Macnaughton, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e"},{"header":"2 Analytical framework","content":"\u003cp\u003e\u003cstrong\u003e2.1 Data sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe English-language literature was retrieved from 11 databases and the Chinese-language literature from six databases, using a unified search strategy and defined time span. Detailed retrieval information is summarized in Table 1. The core search strategy was kept consistent across English- and Chinese-language databases. For the English-language searches, we applied the following Boolean query in the title, abstract, and keyword fields: (“severe acute respiratory syndrome coronavirus 2” OR “coronavirus disease 2019” OR “COVID 19” OR “COVID-19” OR “2019-nCoV” OR “2019 novel coronavirus” OR “SARS-CoV-2” OR “SARS Coronavirus 2”) AND (“public health” OR “public health system” OR “public healthcare”) AND (“policy response” OR “policy responsiveness” OR “policy intervention” OR “crisis response” OR “crisis management”). For the Chinese-language searches, we used equivalent Chinese translations of these terms to capture literature on COVID-19, public health, and policy responses.\u003c/p\u003e\n\u003cp\u003eThe literature search covered both English- and Chinese-language publications between 2019 and 2025, with the search conducted as at 25 September 2025. For the English-language corpus, we retrieved 2,611 records, and for the Chinese-language corpus, we retrieved 2,137 records. All records were screened manually based on title, abstract and full text. After removing studies that did not meet the eligibility criteria, 1,025 English-language publications and 399 Chinese-language publications were included in the final dataset for analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were as follows:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Type of publication: original research articles or review papers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Topical relevance: studies that simultaneously addressed COVID-19 (SARS-CoV-2), public health, and policy responses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Publication date: papers published on or before 25 September 2025.\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria were:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Studies unrelated to the COVID-19 pandemic.\u003c/p\u003e\n\u003cp\u003e2. Studies related to COVID-19 but outside the public health field, such as work focusing primarily on economic policy, macroeconomic impacts, or other non–public health domains.\u003c/p\u003e\n\u003cp\u003e3. Studies related to COVID-19 but not concerned with policy responses, such as clinical or pharmacological research (e.g. drug development, clinical treatment trials).\u003c/p\u003e\n\u003cp\u003e4. Non-research items that did not fit the study’s focus, including conference abstracts, letters, editorials, and similar formats.\u003c/p\u003e\n\u003cp\u003eTo ensure the comprehensiveness and consistency of the bibliometric analysis, we conducted a systematic harmonization of near-synonymous keywords before performing the visualisation procedures. The core topic of this study is the COVID-19 pandemic, and both the English and Chinese search strings contained multiple sets of near-synonyms referring to COVID-19 and related terms. Content analysis confirmed that all search terms converged on the 2019 coronavirus disease outbreak as the central research object. For subsequent analysis, semantically equivalent expressions were standardized and merged into unified keyword categories. The detailed procedures for synonym consolidation and term standardization are presented in Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Analytical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed VOSviewer visualisation software for bibliometric analysis. The software visualises relationships between keywords through node size and link thickness, displays literature co-citation networks through different node colors and sizes, and helps to identify research hotspots and trends through keyword clustering methods. Therefore, keywords from the included literature were extracted and subjected to thematic clustering using this software. Research hotspot analysis and trend analysis were conducted to examine the state of research on public health policy responses during the COVID-19 pandemic.\u0026nbsp;\u003c/p\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Research Hotspots\u003c/h2\u003e \u003cp\u003eUsing VOSviewer, we extracted and analyzed author keywords and index terms from both the English- and Chinese-language publications. In the English-language corpus, apart from the core terms COVID-19, public health, and policy, the most frequently occurring keywords included infectious diseases (408 occurrences), human (302), country (250), crisis management (223), and article (162). These high-frequency terms suggest a strong emphasis on infectious disease contexts, human populations and national-level analyses, as well as on crisis management as a key dimension of public health policy responses.\u003c/p\u003e \u003cp\u003eTo identify research hotspots in public health policy responses to the COVID-19 pandemic, we set a minimum keyword occurrence threshold of 5 for English-language publications and 3 for Chinese-language publications, and performed cluster analysis on the high-frequency keywords meeting these criteria. The bibliometric analysis shows that the English-language keyword co-occurrence network comprises 257 nodes grouped into four clusters (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), while the Chinese-language network consists of 128 nodes organized into three clusters (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The clustering results indicate that both networks exhibit a pronounced core\u0026ndash;periphery structure, with \u0026ldquo;COVID-19\u0026rdquo; serving as the central node in both the English and Chinese networks. All clusters maintain dense co-occurrence links with this core node, underscoring the centrality of COVID-19 in shaping the thematic landscape of public health policy response research.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the English-language keyword clustering map, Cluster 1 (red) focuses on public health emergency management and crisis response. This cluster contains 106 keywords, with \u0026ldquo;infectious diseases\u0026rdquo;, \u0026ldquo;country\u0026rdquo;, and \u0026ldquo;crisis management\u0026rdquo; among the most frequent terms. Centred on \u0026ldquo;COVID-19\u0026rdquo; as the core node, the cluster also includes keywords such as \u0026ldquo;disease transmission\u0026rdquo;, \u0026ldquo;hygiene\u0026rdquo;, and \u0026ldquo;risk assessment\u0026rdquo;, indicating sustained attention to transmission pathways, infection control, and interventions targeting hygiene-related behaviours. The presence of terms like \u0026ldquo;grounded theory\u0026rdquo; and \u0026ldquo;safety\u0026rdquo; further suggests that the basic theoretical frameworks of public health and the design of safety measures have become salient topics in the context of pandemic response.\u003c/p\u003e \u003cp\u003eCluster 2 (green) captures research on individual health behaviours and social responses. It comprises 55 keywords, with \u0026ldquo;human\u0026rdquo;, \u0026ldquo;female\u0026rdquo;, and \u0026ldquo;male\u0026rdquo; as key nodes. This cluster highlights the impacts of the pandemic at the individual and social levels, particularly in relation to mental health and changing social behaviour. High-frequency terms such as \u0026ldquo;mental health\u0026rdquo;, \u0026ldquo;trust\u0026rdquo;, \u0026ldquo;vaccine\u0026rdquo;, and \u0026ldquo;social support\u0026rdquo; point to extensive interest in health behaviours, vaccine acceptance, and the role of social support systems. By engaging with psychological well-being and trust mechanisms, this cluster helps illuminate how individuals react and adapt socially during the pandemic.\u003c/p\u003e \u003cp\u003eCluster 3 (blue) focuses on governmental containment policies and health system management. It includes 53 keywords, with \u0026ldquo;government\u0026rdquo;, \u0026ldquo;economic\u0026rdquo;, and \u0026ldquo;healthcare policy\u0026rdquo; as major terms. Research within this cluster underscores the crucial role of government action and health system emergency management in pandemic response, emphasizing topics such as policy design, quarantine and containment strategies, and the allocation and coordination of medical resources.\u003c/p\u003e \u003cp\u003eCluster 4 (yellow) relates to public health research and evidence generation. This cluster contains 43 keywords, prominently featuring \u0026ldquo;article\u0026rdquo;, \u0026ldquo;controlled study\u0026rdquo;, and \u0026ldquo;medical research\u0026rdquo;. It concentrates on the production and assessment of scientific evidence regarding the effectiveness and societal implications of pandemic control measures. Empirical studies in this cluster examine the dynamics of virus transmission, the outcomes of intervention strategies, and the interactions among social behaviour, policy responses, and misinformation. In doing so, the cluster highlights the critical role of research evidence in informing policy decisions and evaluating their broader social impacts.\u003c/p\u003e \u003cp\u003eTaken together, the four clusters delineate the main research fronts in public health amid the COVID-19 pandemic at macro-, meso-, micro-, and research-evidence levels. Clusters 1 and 3 articulate the macro-level architecture and operational frameworks of pandemic governance\u0026mdash;ranging from crisis management systems to specific health policies\u0026mdash;while Clusters 2 and 4 provide micro-level behavioural insights and scientific foundations. This configuration suggests a dynamic feedback loop in which high-level policy design and system management interact with individual behaviours and evolving bodies of evidence, jointly shaping the evolving agenda of public health research in the COVID-19 era.\u003c/p\u003e \u003cp\u003eIn the Chinese-language keyword clustering map, Cluster 1 (red) focuses on COVID-19 response and public health system development. This cluster comprises 54 keywords, with \u0026ldquo;epidemic prevention and control\u0026rdquo;, \u0026ldquo;response strategies\u0026rdquo;, and \u0026ldquo;public hospitals\u0026rdquo; as the main nodes. It centers on national-level public health governance following the COVID-19 outbreak, emphasizing government-led policy responses at the macro level and efforts to strengthen the public health system.\u003c/p\u003e \u003cp\u003eCluster 2 (green) addresses infectious disease control and vaccination-related behaviour. It comprises 41 keywords, with \u0026ldquo;COVID-19 vaccine\u0026rdquo;, \u0026ldquo;influencing factors\u0026rdquo;, and \u0026ldquo;older adults\u0026rdquo; as prominent nodes. This cluster takes individual and group behaviour as the primary units of analysis, focusing on residents\u0026rsquo; vaccination practices, willingness to be vaccinated, and related psychological factors. It links vaccination policies with behavioural outcomes, and frequently employs frameworks such as the Health Belief Model (HBM) to examine the cognitive determinants of vaccination intention.\u003c/p\u003e \u003cp\u003eCluster 3 (blue) concerns emergency management and policy analysis in the context of public health emergencies. It comprises 33 keywords, with \u0026ldquo;public health emergencies\u0026rdquo;, \u0026ldquo;emergency management\u0026rdquo;, and \u0026ldquo;mental health\u0026rdquo; as prominent nodes. The cluster foregrounds the institutional and instrumental dimensions of emergency management, encompassing policy instruments, response mechanisms, and resource allocation. It further spans the policy cycle from formulation and implementation to evaluation and policy recommendations. Overall, Cluster 3 aligns with the domains of governance instruments and public health management.\u003c/p\u003e \u003cp\u003eTaken together, the three clusters delineate research in China on COVID-19 public health policy from macro-, micro-, and meso-level perspectives\u0026mdash;namely, national policy frameworks, individual behaviour, and governance tools. Cluster 1 provides the overarching contextual and policy framework that structures the other two clusters; Cluster 2 can be seen as a micro-level extension of Cluster 1, focusing on how individuals and specific groups respond within that policy environment; Cluster 3 reflects the institutionalisation of Cluster 1 through concrete emergency management tools and mechanisms. These close, mutually reinforcing linkages among the three clusters point to a multi-level, multi-dimensional research network that characterizes recent scholarship in China on public health policy responses to COVID-19.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Research Trends\u003c/h2\u003e \u003cp\u003eThe emergence of \u0026ldquo;burst\u0026rdquo; keywords within a given period reflects clusters of terms that occur frequently over a short span of time, indicating the topics that researchers focus on during that stage and thus revealing the field\u0026rsquo;s evolving trends and priorities. In this study, we ordered the keywords within each cluster vertically according to their average year of occurrence, thereby constructing a time-labelled representation. In the resulting visualisation, node colours range from blue to yellow, representing a progression from earlier to more recent research themes.\u003c/p\u003e \u003cp\u003eFrom Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, it is evident that international research on COVID-19 in the public health field is concentrated mainly between 2021 and 2023. In the early phase of the pandemic (the blue-purple area in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), studies focused on topics such as \u0026ldquo;trauma\u0026rdquo;, \u0026ldquo;school closing\u0026rdquo;, \u0026ldquo;regulation\u0026rdquo;, \u0026ldquo;hospitals\u0026rdquo;, \u0026ldquo;emergency care\u0026rdquo;, \u0026ldquo;health crisis\u0026rdquo;, and \u0026ldquo;patient care\u0026rdquo;, highlighting government lockdowns, school closures, and other mandatory emergency measures. In the middle phase (green area), the main themes shifted to \u0026ldquo;crisis management\u0026rdquo;, \u0026ldquo;public health policy\u0026rdquo;, \u0026ldquo;healthcare system\u0026rdquo;, and \u0026ldquo;telemedicine\u0026rdquo;, indicating a move from discrete emergency interventions toward broader institutional and system-level responses. In the later phase (yellow area), keywords such as \u0026ldquo;crisis communication\u0026rdquo;, \u0026ldquo;policy-making\u0026rdquo;, \u0026ldquo;vaccine\u0026rdquo;, \u0026ldquo;vaccine hesitancy\u0026rdquo;, and \u0026ldquo;misinformation\u0026rdquo; became prominent, reflecting growing attention to vaccination, policy design and evaluation, and information dynamics. Overall, the temporal evolution of these keywords traces a progression from acute emergency control, to institutional adaptation, and finally to recovery, reconstruction, and resilience-building in public health systems.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that research on COVID-19 in the public health field is concentrated mainly between 2020 and 2022. In the early phase of the pandemic (the blue-purple area), studies focused on \u0026ldquo;coronavirus infection\u0026rdquo;, \u0026ldquo;infectious diseases\u0026rdquo;, \u0026ldquo;antiviral drugs\u0026rdquo;, \u0026ldquo;nuclear medicine\u0026rdquo;, and \u0026ldquo;traditional Chinese medicine\u0026rdquo;. This pattern reflects an urgent effort, from medical and epidemiological perspectives, to rapidly identify the pathogen and transmission risks, activate emergency mechanisms and technical tools, and launch an immediate response to the COVID-19 outbreak. In the middle phase (green area), the main themes shift to \u0026ldquo;epidemic prevention and control\u0026rdquo;, \u0026ldquo;public health\u0026rdquo;, \u0026ldquo;public hospitals\u0026rdquo;, and \u0026ldquo;response strategies\u0026rdquo;, indicating a move toward system-level governance, with increasing emphasis on multi-actor participation, routine prevention and control, and institutional adjustment. In the later phase (yellow area), research turns to topics such as \u0026ldquo;the post-pandemic era\u0026rdquo;, \u0026ldquo;mental health\u0026rdquo;, \u0026ldquo;COVID-19 vaccines\u0026rdquo;, and \u0026ldquo;primary healthcare institutions\u0026rdquo;, signalling a broadening of focus from epidemic control per se to more comprehensive assessments of policies, behaviours, psychological outcomes, and social structures. Overall, the temporal evolution of these keywords reveals a trajectory from rapid medical and epidemiological response, to systematised governance and normalized control, and finally to integrated evaluation and reflection in the post-pandemic context.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Humanistic Health Thoughts in Research Hotspots\u003c/h2\u003e \u003cp\u003eBritish scholar Paul Crawford and his colleagues contend that health humanities should move beyond the clinical boundaries of traditional medical humanities and, from an interdisciplinary and inclusive perspective, integrate social, cultural and public engagement dimensions, with particular attention to how the arts, narrative and other diverse forms shape health and human flourishing comprehensively (Crawford et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). This line of thinking is further expanded and deepened in the conception of one health humanities, which approaches health from the perspective of human development as a whole and calls for comprehensive, continuous and all-encompassing health promotion and humane care-fair and just for all people-across the full spectrum of human health circumstances and the entire life course (Zhang et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In the wake of the COVID-19 outbreak, the emergency containment measures adopted by different countries have vividly reflected the three core dimensions of health humanities-all populations, the whole of society, and the global community-thereby underscoring that public health is, in essence, a crucial arena for putting the vision of grand health humanities into practice (Mazinani M and Rude Bj, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePublic health research during the COVID-19 pandemic vividly reflects the \u0026ldquo;all populations\u0026rdquo; dimension of health humanities. In the international clustering results, Cluster 2 directly targets the health behaviours of individuals and specific population groups during the pandemic, spanning age groups from adolescents and adults to older people, and encompassing both men and women. Key themes include mental health, behavioural responses, risk perception and attitudes toward vaccination. In the early stage of the outbreak, population-focused studies concentrated on clinical indicators, using clinical data to capture disease characteristics; in the later stage, attention shifted toward the psychological well-being of different groups and their trust in vaccines. At the policy and practice level, many countries have introduced differentiated prevention and control measures for specific populations, underscoring a population-sensitive approach to infectious disease response. For example, the U.S. Centers for Disease Control and Prevention (CDC) provides tailored guidance for different groups on its official website (CDC, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The World Health Organization (WHO) has established dedicated Q\u0026amp;A sections that address the needs of people living with HIV, children, pregnant women and older people (\u0026ldquo;Question and answers hub,\u0026rdquo; n.d.), reflecting its long-standing commitment to systematic, diversified and inclusive health strategies for vulnerable populations. In 2020, WHO launched the COVID-19 Vaccines Global Access (COVAX) initiative to accelerate vaccine development and production and to ensure equitable access for low-income countries, thereby embedding the principle of \u0026ldquo;health for all\u0026rdquo; in global vaccine allocation (GAVI, n.d.). China has actively participated in this initiative and provided vaccine support to many developing countries. Domestically, China implemented a policy of free COVID-19 vaccination and multiple rounds of inoculation, promoting broad and relatively equitable access to vaccines nationwide. At the same time, the rollout of digital tools such as the health code and travel code aimed to extend universal protection of health rights across the population.\u003c/p\u003e \u003cp\u003ePublic health research during the COVID-19 pandemic also illustrates the \u0026ldquo;whole-of-society\u0026rdquo; dimension of health humanities. This perspective emphasizes that responses to public health emergencies can no longer be confined to the medical system alone, but must involve coordinated action across government, education, media, communities and other societal sectors. In our analysis, Cluster 3 focuses on how social systems and organizations respond to the pandemic, underscoring the importance of collaborative governance and social support in safeguarding health. The World Health Organization (WHO) has long sought to improve health by addressing the social determinants of health, with \u0026ldquo;Health in All Policies\u0026rdquo; as a key strategy that explicitly frames health outcomes as the cumulative result of decisions across all policy domains (Scharf Lg et al., 2024). The US Centers for Disease Control and Prevention (CDC) has established a comprehensive, nationwide data system that covers vaccine production, distribution and monitoring (Pearce et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), while Australia has made use of large-scale primary care databases to provide real-time evidence for policy adjustment\u0026mdash;both examples highlighting the involvement of multiple sectors and levels within the state apparatus (Deiana G et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Pandemic response thus depends not only on medical research and governmental action, but also on the coordinated participation of information technology, finance, social services and other fields (Armocida et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). At the research level, international scholarship has tended to focus more on the social behavioural characteristics of individuals and groups, and to stress the application of big data and artificial intelligence in outbreak control and response. Chinese studies, by contrast, have placed greater emphasis on policy institutions and collaborative governance, drawing on theories of holistic governance and emergency management, and using policy text analysis to reveal how public health responses unfolded during the COVID-19 crisis (Ana I Bento et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These patterns reflect different understandings of \u0026ldquo;whole-of-society\u0026rdquo; rooted in distinct research traditions: internationally, a more bottom‑up orientation centred on social behaviour; in China, a stronger top‑down focus on institutional design and policy implementation (Levin and Bradshaw, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). From the international to the national, and further down to local and community levels, the effective implementation of public health policy ultimately depends on multi-level, multi-actor participation; this reinforces the view that pandemic control is not only a medical challenge but, fundamentally, a matter of public governance (Eccleston-Turner and Upton, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePublic health research during the COVID-19 pandemic also embodies the global dimension of health humanities, with Cluster 3 pointing toward transnational and globalised health issues. Viruses do not recognize borders, and public health challenges are inherently global: outbreaks, disease transmission and risk assessment are, by their very nature, cross-border phenomena. Cooperation among international organizations and nation-states, cross-sectoral collaborative governance, and the joint participation of social groups and grassroots actors have all helped to enhance the effectiveness of public health governance and to advance the health humanities vision of participation by all and health shared by all. Global vaccine policy offers a particularly salient example. Initiatives such as the COVID-19 Vaccines Global Access (COVAX) facility and the COVID-19 Vaccine Delivery Partnership (CoVDP) emphasize cross-country and cross-institutional cooperation and use multilateral mechanisms to safeguard the interests of low-income countries and high-risk groups, thereby forming a highly integrated ecosystem (Scharf Lg et al., 2024). At the same time, patterns of trust, stress, health behaviour and misinformation have emerged as widely shared features of human conduct across different societies. Attitudes toward COVID-19 vaccines around the world have typically moved through a trajectory from scepticism to greater acceptance and trust (Levin and Bradshaw, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Throughout the pandemic, scientific evidence and medical research have been increasingly shared on a global scale: the design of COVID-19 trials, the accumulation of clinical evidence and the processes of academic publishing have all taken shape within a globally co-produced knowledge system.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Health Humanities Concepts in Pandemic Development\u003c/h2\u003e \u003cp\u003eIn 1966, A. K. Karma first proposed the life cycle theory, distilling the biological \u0026ldquo;cradle-to-grave\u0026rdquo; process into a theoretical framework for understanding how research objects emerge, develop and eventually decline (Yuxing Xie and Xianhua Sun, 2025). Fink advanced the notion of a crisis life-cycle, dividing crises into four stages: prodromal, acute, chronic and resolution (Lu et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Viewed from a temporal perspective, responses to public health emergencies align closely with this crisis life-cycle: moving from incubation to outbreak, then to prolongation and eventual dissipation. The COVID-19 pandemic, in particular, has led the world through three broad phases-emergency control, coordinated recovery and long-term governance-during which public health policy research has been continuously revised, expanded and deepened (Wang M and Wang J, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the emergency control phase, the rapid spread and high uncertainty of COVID-19 meant that the core objective of public health policy was to \u0026ldquo;halt transmission and save lives\u0026rdquo; through urgent interventions. Research in this stage primarily focused on public health system preparedness, disease surveillance and risk identification, with key terms such as crisis management, emergency preparedness and epidemic prevention and control featuring prominently. Effective crisis management, rational resource allocation and robust health support were crucial in the early outbreak period. Scholars concentrated on social systems, policy responses and preventive mechanisms in public health, reflecting the long-standing health humanities emphasis on prevention first. In China, during the Wuhan lockdown, national resources were centrally mobilised, a policy of free treatment for all eligible COVID-19 patients (\u0026ldquo;admitting and treating all who should be admitted\u0026rdquo;) was implemented, and community-based grid management was used to secure basic livelihoods. In many other countries, digital technologies and science communication campaigns were deployed to encourage compliance with control measures (Tsampasian et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), These responses collectively underscored the ethical bottom line of \u0026ldquo;life above all\u0026rdquo; and the emerging consensus that individual behaviour carries responsibility for collective health. Globally, policy implementation helped strengthen public recognition of group health and collective protection as shared values. Public participation gradually came to the fore: in China, neighbourhood committees and volunteers assumed frontline responsibilities in community-level prevention and control, while in the United States, neighbourhood mutual-aid networks played an important role. However, the heavy reliance on voluntary action also led to uneven resource distribution (Belasen et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In many countries, resources were disproportionately concentrated in major cities, leaving rural areas and vulnerable groups facing significant barriers in accessing medical care and essential supplies. To achieve rapid containment and effectively curb viral transmission, most governments resorted to stringent measures such as lockdowns and social distancing mandates. Across these varied responses, the health humanities principle of prioritizing health and protecting life was powerfully affirmed: in the context of a major public health emergency, safeguarding people\u0026rsquo;s lives and health is treated as a non-negotiable priority.\u003c/p\u003e \u003cp\u003eIn the coordinated recovery phase, the spread of COVID-19 gradually slowed, and keywords such as mental health, social isolation and economic recovery emerged as major research foci. Studies indicate that what societies need to restore after the pandemic is not only the economy and health systems, but also a broad spectrum of social and psychological supports. The prominence of terms such as mental health and economic recovery in this period underscores that social and psychological rehabilitation is as crucial as biomedical control in a public health crisis. Lockdown policies during the emergency phase led to a marked increase in psychological problems among people living alone, adolescents and other vulnerable groups, with a particularly notable rise in emotional disorders among young people. In China, family members and community workers provided targeted psychosocial support, while in many high‑income countries, relatively mature counselling and public service systems-traditionally grounded in face-to-face, offline interventions-began to be complemented by emerging forms of online psychological assistance (Pfefferbaum and Van Horn, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). On the economic front, China advocated \u0026ldquo;coordinating epidemic prevention and control with economic and social development\u0026rdquo;, pursuing targeted containment to reduce the impact on everyday life and production. In Europe and North America, governments gradually eased restrictions and promoted the resumption of work and production, reflecting a widely shared humanistic understanding that \u0026ldquo;health is the foundation of people\u0026rsquo;s livelihoods, and the economy underpins health\u0026rdquo;. Policy agendas in this stage also paid increasing attention to vulnerable groups: for example, support measures for small and micro enterprises and older adults in China, and unemployment benefits and priority vaccination schemes in Europe and the United States, all aimed at mitigating health and social inequalities (Chi-Kin Kwan et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). From the perspective of health humanities, this phase highlights the comprehensiveness of physical and mental health: recovery is not limited to treating bodily illness, but also involves restoring psychological well‑being and rebuilding the social conditions that sustain a healthy life.\u003c/p\u003e \u003cp\u003eIn the long-term governance phase, COVID-19 gradually entered a stage of normalization, and policy goals shifted toward building a resilient public health system, establishing enduring health governance mechanisms, drawing lessons from the crisis and preventing future risks. This is reflected in the frequent appearance of keywords such as policy-making, longitudinal study, healthcare policy and government. Research priorities increasingly moved toward public health policy design, the strengthening of health system resilience, and the provision of long-term health security. Across the literature, resilience is widely regarded as a core capacity for responding to public health crises. Public health systems have undergone an upgrading in their humanistic orientation, combining a preventive focus with the livelihood-related nature of health, emphasizing early intervention and life‑course health management, and placing greater weight on care, dignity and respect in the design of policies and services so as to enhance people\u0026rsquo;s sense of health gain and overall quality of life (Moolla and Hiilamo, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). At the preventive level, the notion of \u0026ldquo;proactive health\u0026rdquo; has been promoted, with health education and science communication being used to foster autonomous health behaviours among individuals (Gizaw et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). At the livelihood level, attention has turned to the accessibility, equity and inclusiveness of services, with more human‑centred measures introduced for older adults, children, pregnant and postpartum women, persons with disabilities and other groups, signalling a humanistic shift from \u0026ldquo;disease response\u0026rdquo; to health promotion (Shete et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Governance models have also evolved from government‑dominated approaches to collaborative arrangements involving government, society and the public, echoing the idea that citizens themselves are key subjects of health governance (Sandhu et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Health equity has gradually become a central item on the policy agenda: the differentiated impacts of COVID-19 on various social groups have driven public health evaluation frameworks to incorporate an equity perspective, highlighting the importance of institutional factors. China\u0026rsquo;s revision of the Law on the Prevention and Treatment of Infectious Diseases as well as its public health emergency legislation, and the WHO\u0026rsquo;s launch of negotiations on a pandemic accord that explicitly incorporates \u0026ldquo;equity\u0026rdquo; into its draft text, both signal heightened domestic and international attention to fairness and cooperation (Shete et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Overall, this phase of research closely aligns with the health humanities ideal of sustainable health management, emphasizing the use of institutionalized, long-term governance mechanisms to enhance both population health and societal capacity to withstand future crises.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Limitations\u003c/h2\u003e \u003cp\u003eMethodologically, bibliometric analysis can objectively depict research trends, but it is limited in its capacity to elucidate the deeper logic of policy texts and to assess implementation outcomes. Subsequent research should integrate qualitative approaches\u0026mdash;such as case studies and policy effectiveness evaluations\u0026mdash;to deepen and validate the findings derived from bibliometric analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThe COVID-19 pandemic has attracted worldwide attention and generated an extensive body of research. As COVID-19 and other public health emergencies are inherently transnational in nature, they necessarily require global, coordinated responses. Future studies need to pay closer attention to the design of public health policies, the combined effects of different policy instruments, and the construction of long-term governance mechanisms. Emerging technologies such as artificial intelligence (AI) should be more fully integrated into the prediction and early warning of public health emergencies, the optimization of resource allocation, and the simulation and evaluation of intervention effects. At the same time, the pandemic has exposed significant shortcomings in global cooperation, underscoring the need to strengthen and operationalise collaborative mechanisms so as to enhance the fairness of health rights across countries. In addition, research should engage more systematically with the long-term and multidimensional impacts of the pandemic on population health, and incorporate the principles of health humanities\u0026mdash;emphasising health equity, social participation and life‑course care\u0026mdash;into the formulation and evaluation of public health policies. By doing so, scholars and policymakers can work together to develop a new paradigm of global public health governance that is more resilient, inclusive and human-centred.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch1\u003eData availability\u003c/h1\u003e\n\u003cp\u003eThe data used in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch1\u003eCompeting interests\u003c/h1\u003e\n\u003cp\u003eThe author(s) declare no competing interests.\u003c/p\u003e\n\u003ch1\u003eEthical statements\u003c/h1\u003e\n\u003cp\u003eThis article does not contain any studies with human participants performed by any of the authors.\u003c/p\u003e\n\u003ch1\u003eInformed consent\u003c/h1\u003e\n\u003cp\u003eThis article does not contain any studies with human participants performed by any of the authors.\u003c/p\u003e\n\u003ch1\u003eAdditional information\u003c/h1\u003e\n\u003cp\u003eCorrespondence and requests for materials should be addressed to Zhiguang Duan.\u003c/p\u003e\n\u003ch1\u003eFunding Declaration\u003c/h1\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eWJ Wu wrote the main manuscript text, RN Tian was responsible for bibliographic retrieval, HQ Guo was responsible for the data screening and analysis, and ZG Duan was responsible for reviewing and guiding the article. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAna I Bento, Thuy Nguyen, Coady Wing, Felipe Lozano-Rojas, Yong-Yeol Ahn, Kosali Simon, 2020. Evidence from internet search data shows information-seeking responses to news of local COVID-19 cases. Proc. Natl. Acad. Sci. U. S. A. 117, 11220\u0026ndash;11222. https://doi.org/10.1073/pnas.2005335117\u003c/li\u003e\n \u003cli\u003eArmocida, B., Formenti, B., Ussai, S., Palestra, F., Missoni, E., 2020. The italian health system and the COVID-19 challenge. Lancet Public Health 5, e253. https://doi.org/10.1016/S2468-2667(20)30074-8\u003c/li\u003e\n \u003cli\u003eBelasen, A.R., Belasen, A.T., Bass, M., 2024. Tracking the uneven outcomes of COVID-19 on racial and ethnic groups: implications for health policy. J. Racial Ethn. Health Disparities 11, 2247\u0026ndash;2255. https://doi.org/10.1007/s40615-023-01692-5\u003c/li\u003e\n \u003cli\u003eCDC, 2025. Clinical considerations for special populations [WWW Document]. Covid-19. URL https://www.cdc.gov/covid/hcp/clinical-care/considerations-special-groups.html (accessed 7.8.25).\u003c/li\u003e\n \u003cli\u003eChih-Cheng Lai, Tzu-Ping Shih, Wen-Chien Ko, Hung-Jen Tang, Po-Ren Hsueh, 2020. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int. J. Antimicrob. Agents 55, 105924. https://doi.org/10.1016/j.ijantimicag.2020.105924\u003c/li\u003e\n \u003cli\u003eChi-Kin Kwan, Henry Wai-Hang Ling, Johnson Chun-Sing Cheung, Ernest Wing-Tak Chui, 2021. Safeguarding health equality for the disadvantaged during the COVID-19 pandemic: lessons learned for the social work profession. Qual Soc Work 20, 463\u0026ndash;469. https://doi.org/10.1177/1473325020973337\u003c/li\u003e\n \u003cli\u003eCOVID-19 cases | WHO COVID-19 dashboard [WWW Document], n.d. . Datadot. URL https://data.who.int/dashboards/covid19/cases (accessed 7.8.25).\u003c/li\u003e\n \u003cli\u003eCrawford, P., Brown, B., Baker, C., Tischler, V., Abrams, B., 2015. Health humanities. Palgrave Macmillan.\u003c/li\u003e\n \u003cli\u003eDeiana G, Azara A, Dettori M, Delogu F, Vargiu G, Gessa I, Arghittu A, Tidore M, Steri G, Castiglia P, 2021. Characteristics of SARS-CoV-2 positive cases beyond health-care professionals or social and health-care facilities. BMC Public Health 21. https://doi.org/10.1186/s12889-020-10093-w\u003c/li\u003e\n \u003cli\u003eEccleston‐Turner, M., Upton, H., 2021. International collaboration to ensure equitable access to vaccines for COVID‐19: the ACT‐accelerator and the COVAX facility. Milbank Q 99, 426\u0026ndash;449. https://doi.org/10.1111/1468-0009.12503\u003c/li\u003e\n \u003cli\u003eFilip, R., Gheorghita Puscaselu, R., Anchidin-Norocel, L., Dimian, M., Savage, W.K., 2022. Global challenges to public health care systems during the COVID-19 pandemic: a review of pandemic measures and problems. J Pers Med 12, 1295. https://doi.org/10.3390/jpm12081295\u003c/li\u003e\n \u003cli\u003eGAVI, n.d. COVAX explained [WWW Document]. COVAX explained. URL https://www.gavi.org/vaccineswork/covax-explained (accessed 8.14.25).\u003c/li\u003e\n \u003cli\u003eGizaw, Z., Astale, T., Kassie, G.M., 2022. What improves access to primary healthcare services in rural communities? A systematic review. BMC Prim Care 23, 313. https://doi.org/10.1186/s12875-022-01919-0\u003c/li\u003e\n \u003cli\u003eLevin, J., Bradshaw, M., 2022. Determinants of COVID-19 skepticism and SARS-CoV-2 vaccine hesitancy: findings from a national population survey of U.S. adults. BMC Public Health 22, 1047. https://doi.org/10.1186/s12889-022-13477-2\u003c/li\u003e\n \u003cli\u003eLewis, B., 2020. Planetary health humanities\u0026mdash;responding to COVID times. The Journal of Medical Humanities 42, 3. https://doi.org/10.1007/s10912-020-09670-2\u003c/li\u003e\n \u003cli\u003eLu, Y., Liu, T., Wang, T., 2021. Dynamic analysis of emergency inter-organizational communication network under public health emergency: a case study of COVID-19 in hubei province of China. Nat. Hazards (dordr. Neth.) 109, 2003\u0026ndash;2026. https://doi.org/10.1007/s11069-021-04908-1\u003c/li\u003e\n \u003cli\u003eMacnaughton, J., 2023. Does medical humanities matter? The challenge of COVID-19. Med. Humanit. 49, 545\u0026ndash;552. https://doi.org/10.1136/medhum-2022-012602\u003c/li\u003e\n \u003cli\u003eMazinani M, Rude Bj, 2021. The novel zoonotic coronavirus disease 2019 (COVID-19) pandemic: health perspective on the outbreak. Journal of healthcare quality research 36. https://doi.org/10.1016/j.jhqr.2020.09.004\u003c/li\u003e\n \u003cli\u003eMoolla, I., Hiilamo, H., 2023. Health system characteristics and COVID-19 performance in high-income countries. BMC Health Serv. Res. 23, 244. https://doi.org/10.1186/s12913-023-09206-z\u003c/li\u003e\n \u003cli\u003ePearce, C., McLeod, A., Supple, J., Gardner, K., Proposch, A., Ferrigi, J., 2022. Responding to COVID-19 with real-time general practice data in Australia. Int. J. Med. Inf. 157, 104624. https://doi.org/10.1016/j.ijmedinf.2021.104624\u003c/li\u003e\n \u003cli\u003ePfefferbaum, B., Van Horn, R.L., 2022. Physical activity and sedentary behavior in children during the COVID-19 pandemic: implications for mental health. Curr. Psychiatry Rep. 24, 493\u0026ndash;501. https://doi.org/10.1007/s11920-022-01366-9\u003c/li\u003e\n \u003cli\u003eQuestion and answers hub [WWW Document], n.d. URL https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub (accessed 7.8.25).\u003c/li\u003e\n \u003cli\u003eSandhu, H.S., Otterman, V., Tjaden, L., Shephard, R., Apatu, E., Di Ruggiero, E., Musto, R., Pawa, J., Steinberg, M., Betker, C., 2023. The governance of core competencies for public health: a rapid review of the literature. Public Health Rev. 44, 1606110. https://doi.org/10.3389/phrs.2023.1606110\u003c/li\u003e\n \u003cli\u003eScharf Lg, Adeniyi K, Augustini E, Boyd D, Corvin L, Kalach Re, Fast H, Fath J, Harris L, Henderson D, Hicks-Thomson J, Jones-Jack N, Kellerman A, Khan An, McGarvey Ss, McGehee Je, E. Miner C, Moore Lb, Murthy Bp, Myerburg S, Neuhaus E, Nguyen K, Parker M, Pierce-Richards S, Samchok D, Shaw Lk, Spoto S, Srinivasan A, Stearle C, Thomas J, Winarsky M, Zell E, 2024. Monitoring and reporting the US COVID-19 vaccination effort. Vaccine 42 Suppl 3. https://doi.org/10.1016/j.vaccine.2023.12.005\u003c/li\u003e\n \u003cli\u003eShete, P.B., Santos, N., Spindler, H., Le\u0026oacute;n, T., Petersen, M., Kilpatrick, A.M., Jain, S., Watt, J., Radhakrishna, R., Pan, E., Arag\u0026oacute;n, T., 2025. Building an agile state-wide research infrastructure to address COVID-19 and emerging threats: insights from an equity-centered public health and academic collaboration in california. Front. Public Health 13, 1549326. https://doi.org/10.3389/fpubh.2025.1549326\u003c/li\u003e\n \u003cli\u003eTsampasian, V., Elghazaly, H., Chattopadhyay, R., Debski, M., Naing, T.K.P., Garg, P., Clark, A., Ntatsaki, E., Vassiliou, V.S., 2023. Risk factors associated with post\u0026minus;COVID-19 condition. JAMA Intern. Med. 183, 566\u0026ndash;580. https://doi.org/10.1001/jamainternmed.2023.0750\u003c/li\u003e\n \u003cli\u003eWang M, Wang J, 2024. Performance evaluation of urban emergency governance: conceptual connotations and empirical research based on the crisis life cycle theory. Eval. Rev. 48. https://doi.org/10.1177/0193841X231215208\u003c/li\u003e\n \u003cli\u003eWiersinga Wj, Rhodes A, Cheng Ac, Peacock Sj, Prescott Hc, 2020. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA 324. https://doi.org/10.1001/jama.2020.12839\u003c/li\u003e\n \u003cli\u003eXie, X., Lei, P., Liu, L., Hu, J., Liang, P., 2022. Research trends and hotspots of COVID-19 impact on sexual function: a bibliometric analysis based on web of science. Front. Public Health 10, 976582. https://doi.org/10.3389/fpubh.2022.976582\u003c/li\u003e\n \u003cli\u003eYang, F., Zhang, S., Wang, Q., Zhang, Q., Han, J., Wang, L., Wu, X., Xue, F., 2020. Analysis of the global situation of COVID-19 research based on bibliometrics. Health Inf. Sci. Syst. 8, 30. https://doi.org/10.1007/s13755-020-00120-w\u003c/li\u003e\n \u003cli\u003eYuxing Xie, Xianhua Sun, 2025. An overview of the integration and development trends between arts and psychotherapy. Front. Psychol. 16, 1617700. https://doi.org/10.3389/fpsyg.2025.1617700\u003c/li\u003e\n \u003cli\u003eZhang, X., Pang, H., Duan, Z., 2023. Educational efficacy of medical humanities in empathy of medical students and healthcare professionals: a systematic review and meta-analysis. BMC Med. Educ. 23. https://doi.org/10.1186/s12909-023-04932-8\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"COVID-19 pandemic, public health governance, public health policy, bibliometric analysis, health humanities","lastPublishedDoi":"10.21203/rs.3.rs-8926699/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8926699/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe global COVID-19 pandemic has exerted unprecedented pressure on public health governance systems, underscoring the need for robust evaluations of public health policy responses. This study examines domestic and international research on public health policy during the COVID-19 crisis, drawing on the Web of Science Core Collection and other major English-language databases, as well as CNKI and related Chinese databases. Using VOSviewer for bibliometric visualisation, and informed by health humanities and crisis life-cycle theory, we conduct a systematic analysis of the intellectual foundations, research hotspots, and evolutionary trajectories of this field. The findings reveal a shared developmental logic in the literature, moving from \u0026ldquo;upgrading governance systems\u0026rdquo; to \u0026ldquo;innovating policy instruments\u0026rdquo; and \u0026ldquo;strengthening grassroots capacity\u0026rdquo; alongside divergent explorations in domains such as digital governance and health equity. The study further identifies convergences and tensions in Chinese and international value orientations regarding pandemic control, illuminates how health humanities perspectives are articulated in responses to public health emergencies, and argues that public health serves as a key vehicle for realizing health humanities ideals. We conclude that future policy design must go beyond a narrow focus on technology and efficiency, embedding the three core dimensions of health humanities\u0026mdash;population-wide, whole-of-society, and globally oriented\u0026mdash;across all stages of emergency management. Such an approach can support the development of more inclusive and resilient public health systems.\u003c/p\u003e","manuscriptTitle":"Evidence for health humanities: A study from the COVID-19 pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-13 17:57:50","doi":"10.21203/rs.3.rs-8926699/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-10T09:18:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T15:32:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T12:09:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-14T21:23:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42915879216562211430976130452088524604","date":"2026-04-07T15:45:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268353301290197843474535823769107241276","date":"2026-04-07T10:43:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26504838190409483828270339350108435159","date":"2026-04-07T08:13:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T07:56:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-11T06:55:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-06T07:00:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-05T04:41:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Humanities and Social Sciences Communications","date":"2026-02-20T13:58:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1f438d63-1f10-4cf7-8337-e301ff18fdad","owner":[],"postedDate":"April 13th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-10T09:18:51+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":65999800,"name":"Humanities/Cultural and media studies"},{"id":65999801,"name":"Social science/Cultural and media studies"},{"id":65999802,"name":"Humanities/Health humanities"},{"id":65999803,"name":"Humanities/Medical humanities"},{"id":65999804,"name":"Social science/Social policy"},{"id":65999805,"name":"Social science/Sociology"}],"tags":[],"updatedAt":"2026-05-10T09:24:52+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-13 17:57:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8926699","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8926699","identity":"rs-8926699","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}