Health, environment and colonial legacies: Situating the science of pesticides, bananas and bodies in Ecuador

Are we there yet? Principles in advancing equity though global public health research

Canadian engagement in global and public health includes a long history of centering issues of equity in practice, policy, and research. In 2015, through a series of deliberative dialogues about what ethical standards should guide how people engage in global health research, the Canadian Coalition for Global Health Research (CCGHR) released a set of six equity-centred principles and critically reflective questions. These principles offered a platform for identifying equity implications and choices about theories, methods, approaches, partnerships, or practices in global and public health. In 2022, as questions of how to unsettle systems of power and move beyond rhetorical efforts to advance equity action continue to grow, Canada's global public health research community is turning a critically reflexive gaze at our own practices and ways of working, recognizing excellence as necessarily integrating equity in research pursuits, processes, and outcomes. In this commentary, we reflect on the contexts that led to the evolution of the CCGHR Principles for Global Health Research and highlight their current reach and impact, including their integration in the Canadian Institutes Framework for Action on Global Health Research. We invite others to embrace a lifelong commitment to equity work as an act of solidarity and investment in our collective futures.

Equity at a time of pandemic

Health promotion has long aspired for a world where all people can live to their full potential. Yet, COVID-19 illuminates dramatically different consequences for populations bearing heavy burdens of systemic disadvantage within countries and between the Global South and Global North. Many months of pandemic is entrenching inequities that reveal themselves in the vastly differential distribution of hospitalization and mortality, for example, among racialized groups in the USA. Amplified awareness of the intimate relationship between health, social structures, and economy opens a window of opportunity to act on decades of global commitments to prioritize health equity. Choices to act (or not act) are likely to accelerate already vast inequities within and between countries as rapidly as the COVID-19 pandemic itself. Recognizing the inherently global nature of this pandemic, this article explores how determinants of equity are embedded in global responses to it, arguing that these determinants will critically shape our global futures. This article aims to stimulate dialogue about equity-centered health promoting action during a pandemic, using the Canadian Coalition for Global Health Research (CCGHR) Principles for Global Health Research to examine equity considerations at a time of pandemic. Attentiveness to power and the relationship between political economy and health are argued as central to identifying and examining issues of equity. This article invites dialogue about how equity-centered planning, decision-making and action could leverage this massive disruption to society to spark a more hopeful, just, and humane collective future.

Assessing how global health partnerships function: an equity-informed critical interpretive synthesis

Background

Global health partnerships (GHPs) are situated in complex political and economic relationships and involve partners with different needs and interests (e.g., government agencies, non-governmental organizations, corporations, universities, professional associations, philanthropic organizations and communities). As part of a mixed methods study designed to develop an equity-sensitive tool to support more equity-centred North-South GHPs, this critical interpretive synthesis examined reported assessments of GHPs.

Results

We examined 30 peer-reviewed articles for power dynamics, equity and inequities, and contradictions or challenges encountered in North-South partnerships. Among articles reviewed, authors most often situated GHPs around a topical focus on research, capacity-building, clinical, or health services issues, with the ‘work’ of the partnership aiming to foster skills or respond to community needs.

The specific features of GHPs that were assessed varied widely, with consistently-reported elements including the early phases of partnering; governance issues; the day-to-day work of partnerships; the performance, impacts and benefits of GHPs; and issues of inclusion. Articles shared a general interest in partnering processes and often touched briefly on issues of equity; but they rarely accounted for the complexity of sociopolitical and historical contexts shaping issues of equity in GHPs. Further, assessments of GHPs were often reported without inclusion of voices from all partners or named beneficiaries.

GHPs were frequently portrayed as inherently beneficial for Southern partners, without attention to power dynamics and inequities (North-South, South-South). Though historical and political dynamics of the Global North and South were inconsistently examined as influential forces in GHPs, such dynamics were frequently portrayed as complex and characterized by asymmetries in power and resources. Generally, assessments of GHPs paid little attention to the macroeconomic forces in the power and resource dynamics of GHPs highlights the importance of considering the broader political. Our findings suggest that GHPs can serve to entrench both inequitable relationships and unfair distributions of power, resources, and wealth within and between countries (and partners) if inequitable power relationships are left unmitigated.

Conclusions

We argue that specific practices could enhance GHPs’ contributions to equity, both in their processes and outcomes. Enhancing partnering practices to focus on inclusion, responsiveness to North-South and South-South inequities, and recognition of GHPs as situated in a broader (and inequitable) political economy. A relational and equity-centred approach to assessing GHPs would place social justice, humility and mutual benefits as central practices—that is, regular, routine things that partners involved in partnering do intentionally to make GHPs function well. Practicing equity in GHPs requires continuous efforts to explicitly acknowledge and examine the equity implications of all aspects of partnering.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-021-00726-z.

Storylines of research on resource extraction and health in Canada: A modified metanarrative synthesis

Patterns of research on resource extraction's health effects display problematic gaps and underlying assumptions, indicating a need to situate health knowledge production in the context of disciplinary, corporate and neocolonial influences and structures. This paper reports on a modified metanarrative synthesis of 'storylines' of research on resource extraction and health in the Canadian context. Peer-reviewed articles on mining or petroleum extraction and health published between 2000 and 2018 and dealing with Canadian populations or policies (n = 87) were identified through a systematic literature search. Coding identified main disciplinary traditions, methodologies and approaches for judging high-quality research. Underlying assumptions were analyzed in terms of models of health and well-being; resource extraction's political economic drivers; and representations of Indigenous peoples, territories and concerns. Findings included a preponderance of occupational and environmental health studies; frequent presentation of resource extraction without political economic antecedents, and as a major contributor to Canadian society; sustainable development aspirations to mitigate health impacts through voluntary private-sector governance activities; representations of Indigenous peoples and concerns ranging from complete absence to engagement with legacies of historical trauma and environmental dispossession; and indictment of corporate (especially asbestos industry) and government malfeasance in a subset of studies. Canada's world-leading mining sector, petroleum reserves and population health traditions, coupled with colonial legacies in both domestic and overseas mining and petroleum development, make these insights relevant to broader efforts for health equity in relation to resource extraction. They suggest a need for strengthened application of the precautionary principle in relation to resource extraction; nuanced attention to corporate influences on the production of health science; more profound challenges to dominant economic development models; and extension of well-intentioned efforts of researchers and policymakers working within flawed institutions.

Mining, Colonial Legacies, and Neoliberalism: A Political Ecology of Health Knowledge : Minerıa, legados coloniales y neoliberalismo: una ecologıa polıtica del conocimiento en salud

Scholarship on the health impacts of resource extraction displays prominent gaps and apparent corporate and neocolonial footprints that raise questions about how science is produced. We analyze production of knowledge, on the health impacts of mining, carried out in relation to the Canadian International Resources and Development Institute (CIRDI), a university-based organization with substantial extractive industry involvement and links to Canada’s mining-dominated foreign policy. We use a “political ecology of knowledge” framework to situate CIRDI in the context of neoliberal capitalism, neocolonial sustainable development discourses, and mining industry corporate social responsibility techniques. We then document the interactions of specific health disciplinary conventions and knowledges within CIRDI-related research and advocacy efforts involving a major Canadian global health organization. This analysis illustrates both accommodation and resistance to large-scale political economic structures and the need to directly confront the global North governments and sectors pushing extractive-led neoliberal development globally.

Resumen

La investigación sobre los impactos en la salud de la extracción de recursos naturales delata brechas importantes y huellas corporativas y neocoloniales, que plantean dudas acerca de cómo se produce la ciencia. Analizamos la producción de conocimiento sobre los impactos en la salud de la minería en relación con el Instituto Canadiense de Desarrollo y Recursos Internacionales (CIRDI, siglas en inglés), una organización universitaria que cuenta con participación sustancial de la industria extractiva y tiene vínculos con la política exterior de Canadá, la cual es dominada por intereses mineros. Utilizamos un marco de "ecología política del conocimiento" para situar a CIRDI en el contexto del capitalismo neoliberal, los discursos neocoloniales de desarrollo sostenible y las técnicas de responsabilidad social corporativa de la industria minera. Luego, documentamos las interacciones entre los conocimientos y convenciones disciplinarias de salud dentro de los esfuerzos de investigación y promoción relacionados con CIRDI que involucran a una importante organización canadiense de salud global. Este análisis muestra tanto la complacencia como la resistencia a las estructuras políticas económicas a gran escala, y la necesidad de confrontar directamente a los gobiernos y sectores del Norte global que manejan el desarrollo neoliberal impulsado por la extracción a nivel mundial.

Pesticide risk perceptions among bystanders of aerial spraying on bananas in Costa Rica

Little is known about how bystanders perceive risks from pesticide use in areas with frequent aerial spraying of pesticides. This research aims to better understand how bystanders (school workers) from three counties of the Limón province in Costa Rica, who did not have a contractual relationship with agricultural production, perceive risks of pesticides in the areas where they work and live. A face-to-face survey was carried out among 475 school workers, of whom 455 completed all 33 questions on pesticide risk perception. An exploratory factor analysis characterized underlying perceptions of pesticide exposure. Nine factors explained 40% of total variance and concerned severity and magnitude of perceived risk, manageability, benefits and support of pesticide use, amongst others. We subsequently analyzed what variables explained the five factors with satisfactory internal consistency, using separate multivariable linear regression models. Older school workers, (male) elementary teachers, and women school workers (particularly from schools situated near agricultural fields with aerial spraying of pesticides), felt greater severity and/or magnitude of risk from pesticide use. This study shows that bystanders are concerned about health risks from pesticide use. Their risk perceptions are not only shaped by gender and age like previously reported in the literature, but also by job title and geographical context. Understanding of what hazards people care about and how they deal with them is essential for successful risk management, bystanders should therefore be considered as a relevant actor in debates around pesticide issues and for informing the development of regulations and risk reduction strategies.

A tool to assess alignment between knowledge and action for health equity

Advancing health equity is a central goal and ethical imperative in public and global health. Though the commitment to health equity in these fields and among the health professions is clear, alignment between good equity intentions and action remains a challenge. This work regularly encounters the same power structures that are known to cause health inequities. Despite consensus about causes, health inequities persist-illustrating an uncomfortable paradox: good intentions and good evidence do not necessarily lead to meaningful action. This article describes a theoretically informed, reflective tool for assessing alignment between knowledge and action for health equity. It is grounded in an assumption that progressively more productive action toward health inequities is justified and desired and an explicit acceptance of the evidence about the socioeconomic, political, and power-related root causes of health inequities. Intentionally simple, the tool presents six possible actions that describe ways in which health equity work could respond to causes of health inequities: discredit, distract, disregard, acknowledge, illuminate, or disrupt. The tool can be used to assess or inform any kind of health equity work, in different settings and at different levels of intervention. It is a practical resource against which practice, policy, or research can be held to account, encouraging steps toward equity- and evidence-informed action. It is meant to complement other tools and training resources to build capacity for allyship, de- colonization, and cultural safety in the field of health equity, ultimately contributing to growing awareness of how to advance meaningful health equity action.