Water, ecology and health: ecosystems as settings for promoting health and sustainability

Multiscale exploration of spatiotemporal dynamics in China's largest urban agglomeration: An interactive coupling perspective on human activity intensity and ecosystem health

Human economic construction increasingly impacts highly sensitive ecological zones, weakening ecosystem health in cross-regional urban agglomerations. Exploring the spatiotemporal dynamics of urban agglomerations from the interactive coupling perspective between human activity intensity (HAI) and ecosystem health index (EHI) is crucial for resolving human-land conflicts. This study developed a human-land coupling assessment framework integrating human footprint and ecosystem Maintain-Bearing-Service-Resilience models. Across multiple scales, from urban agglomerations and cities to grid cells, we initially employed exploratory spatiotemporal data analysis techniques to reveal HAI and EHI evolution patterns. Subsequently, we used the four-quadrant model, coupling coordination degree (CCD), and relative development model to explore their spatiotemporal interactions. Applied to China's largest urban agglomeration, the middle reaches of the Yangtze River urban agglomerations (MRYRUA), results revealed a significant spatiotemporal mismatch pattern between HAI and EHI. High HAI and low EHI areas were widely distributed in highly urbanized waterfront plains. At the urban agglomeration scale, HAI and EHI exhibited spatiotemporal differentiation patterns extending toward polarization along the Yangtze River Economic Belt, while their correlation intensity among cities indicated conflicting development patterns. At the grid scale, the spatiotemporal clustering pattern highlighted waterfront built-up areas as HAI hotspots and peripheral forest zones as EHI hotspots. The interactive relationship between HAI and EHI shifted increasingly towards Quadrant IV as HAI rose. The coupling levels between HAI and EHI will tend toward misalignment as urbanization advances, although current CCD shows positive trends. This study offers scientific guidance for achieving sustainable development in urban agglomerations across multiple scales.

If a fish comes out of the river and speaks, we should believe it: South African perspective on fish kills

In South Africa, fish kill events are increasing in frequency because of multiple stressors associated with managing natural resources. Despite the ecosystem services associated with fish, South Africa's progressive legislation towards environmental protection seems to negate the management of fish kills. In this study, we provide an overview of reports and regulations associated with acute pollution spills resulting in fish kill events in South Africa. In addition, we highlight the implication of these using a fish kill event from 2019 on the Msunduzi River, South Africa, as a case study. The fish kill on the Msunduzi River showed a decline in relative abundance by up to 41%, and its ecological condition was already impaired by poor management. The poor condition of the Msunduzi River has jeopardised the recovery of the fish populations, and intervention is needed to restore the fish population that includes species red-listed as vulnerable by the International Union for the Conservation of Nature. We found that despite the severity of fish kills and the detriment to the fish fauna, including near-threatened species, there is a general apathy, incapacity and lack of knowledge on managing fish kills in South Africa. In addition, although several legislated Acts have good intentions for protecting nature, they do not align and show that a fish kill is an afterthought rather than a need to prevent. Poor management practices have exacerbated this in an already stressed state from excessive use of environmental water. As a way forward, the alignment of the various Acts associated with various ministerial departments in South Africa is needed so that better protection of the environment may occur. Finally, we argue that the African proverb 'If the fish comes out of the river to tell you that the crocodile has one eye, you should believe it' is not considered when managing water resources and that with the present ecological state and water resource use there may be no fish to 'come out of the water' warning us that our water is unsafe even for human consumption and use.

Comparative risk assessment studies estimating the hazard posed by long-term consumption of PPCPs in river water

This study assesses the risk due to Emerging Contaminants (ECs), present in Indian rivers - Ganga (650 million inhabitants), Yamuna (57 million inhabitants), and Musi (7,500,000 inhabitants), 13 ECs in total, have been used for risk assessment studies. Their concentrations (e.g., Fluconazole: 236950 μg/l, Ciprofloxacin: 31000 μg/l, Caffeine: 21.57 μg/l, etc.) were higher than the threshold concentrations for safe consumption (e.g. Fluconazole allowable level is 3.8 μg/l, and Ciprofloxacin allowable level is 0.51 μg/l). Three different pathways of emerging contaminants (ECs) transfer (oral water ingestion, oral fish ingestion, and dermal water contact) have been considered and the study is carried out in 2 ways: (i) deterministic and (ii) probabilistic approaches (using Monte Carlo iterative methods with 10000 simulations) with the aid of a software - Risk (version 7.5). The risk value, quantified by Hazard Quotient (HQ) is higher than the allowable limit of 1 for several compounds in the three rivers like Fluconazole (HQ = 18276.713), Ciprofloxacin (HQ = 278.675), Voriconazole (HQ = 14.578), Cetirizine (HQ = 1006.917), Moxifloxacin (HQ = 8.076), Caffeine (HQ = 55.150), and Ibuprofen (HQ = 9.503). Results show that Fluconazole and Caffeine pose the maximum risk in the rivers via the "oral pathway" that allows maximum transfer of the ECs present in the river (93% and 82% contribution to total risk). The risk values vary from nearly 25 times to 19000 times the United States Environmental Protection Agency (USEPA) threshold limit of 1 (e.g., Caffeine Infant Risk = 25.990 and Fluconazole Adult Risk = 18276.713). The most susceptible age group, from this study, is "Adults" (19-70 years old), who stand the chance of experiencing the adverse health hazards associated with prolonged over-exposure to the ECs present in the river waters. Musi has the maximum concentration of pollutants and requires immediate remediation measures. Further, both methods indicate that nearly 60-70% of the population in all the three study areas are at risk of developing health hazards associated with over-exposure to ECs regularly, making the areas inhabitable.

River conversations: A confluence of lessons and emergence from the Taieri River and the Nechako River

Drawing on ongoing patterns of learning and relationship, this paper offers a reflection and acknowledgement on the notable influence of two rivers and their role as respected and highly valued "eco-social elders": The Taieri River in Otago, New Zealand, and the Nechako River in northern British Columbia, Canada. The paper is motivated by the question: "If a river has 'voice', what can be learned from the emergence arising from rivers 'in conversation'?". At the heart of the reflection are the themes of confluence and emergence-ways in which we grasp the coming together of things, especially when that combination is more than the sum of their parts. The paper aims to explore a "conversation" between the river teachings of the Taieri River and the Nechako River, identifying examples of patterns and connections between distinct river "voices," and how these may contribute to emergence and ongoing conversations among different rivers and their teachings. The paper commences with an introduction to both rivers, identifying points of direct comparison and contrast, then moving to explore themes of confluence, weaving and emergence, combining ecological, metaphorical, and personal perspectives. The conversation then progresses downstream to river-ocean relationships, reflecting on rivers as eco-social elders that inspire conversations, provide a sense of home, and offer a point of reference to consider the wider influence on rivers and waterways on the health of diverse species within catchments and across the planet.

An Integrated Analysis of Social, Economic, and Environmental Indicators' Effects on Public Health and Health Inequality Globally: From the Perspective of Vulnerability

Public health and health inequality have been widely researched as they are essential for human development and social justice. Although factors influencing public health and health inequality have been explored, an integrated and comprehensive analysis of social, economic, and environmental indicators' effects on public health and health inequality globally is yet to be conducted. The current study addresses this gap by using a theoretical framework that integrates these three dimensions, examining their effects on public health and health inequality from the perspective of vulnerability. Considering the spatial heterogeneity across countries, spatial econometric models and geographically weighted regressions were conducted for the examination of these effects. Our findings reveal the social indicators of urbanisation ratio, social education level, and social governance capacity had positive effects on public health promotion and health inequality elimination globally. Besides these, environmental risk and economic capacity had relatively low impacts on health inequality. Further, the geographically weighted regression results indicate that vulnerability's effects on public health and health inequality varied significantly across countries. This integrated analysis provides national policymakers with a new perspective of vulnerability for public health promotion and health inequality reduction.

Waiora: the importance of Indigenous worldviews and spirituality to inspire and inform Planetary Health Promotion in the Anthropocene

We now live in a new geological age, the Anthropocene – the age of humans – the start of which coincides with the founding of the International Union for Health Promotion and Education (IUHPE) 70 years ago. In this article, we address the fundamental challenge facing health promotion in its next 70 years, which takes us almost to 2100: how do we achieve planetary health? We begin with a brief overview of the massive and rapid global ecological changes we face, the social, economic and technological driving forces behind those changes, and their health implications. At the heart of these driving forces lie a set of core values that are incompatible with planetary health. Central to our argument is the need for a new set of values, which heed and privilege the wisdom of Indigenous worldviews, as well as a renewed sense of spirituality that can re-establish a reverence for nature. We propose an Indigenous-informed framing to inspire and inform what we call planetary health promotion so that, as the United Nations Secretary General wrote recently, we can make peace with nature.

The Human Ecological Perspective and Biopsychosocial Medicine

With regard to philosophical anthropology, a human ecological framework for the human-environment relationship as an "ecology of the person" is outlined, which focuses on the term "relationship" and aims to be scientifically sound. It also provides theoretical orientations for multiprofessional clinical work. For this purpose, a multi-dimensional basic grid for the characterization of the individual human being is proposed. The necessity and meaningfulness of a differentiation and systematization of the terms "environment", and above all "relationship", are demonstrated, and practical examples and links to similar framework models are given.

Attending to scalar ethical issues in emerging approaches to environmental health research and practice

Accelerated changes to the planet have created novel spaces to re-imagine the boundaries and foci of environmental health research. Climate change, mass species extinction, ocean acidification, biogeochemical disturbance, and other emergent environmental issues have precipitated new population health perspectives, including, but not limited to, one health, ecohealth, and planetary health. These perspectives, while nuanced, all attempt to reconcile broad global challenges with localized health impacts by attending to the reciprocal relationships between the health of ecosystems, animals, and humans. While such innovation is to be encouraged, we argue that a more comprehensive engagement with the ethics of these emerging fields of inquiry will add value in terms of the significance and impact of associated interventions. In this contribution, we highlight how the concept of spatial and temporal scale can be usefully deployed to shed light on a variety of ethical issues common to emerging environmental health perspectives, and that the potential of scalar analysis implicit to van Potter's conceptualization of bioethics has yet to be fully appreciated. Specifically, we identify how scale interacts with key ethical issues that require consideration and clarification by one health, ecohealth, and planetary health researchers and practitioners to enhance the effectiveness of research and practice, including justice and governance.

The Transition of EU Water Policy Towards the Water Framework Directive's Integrated River Basin Management Paradigm

Introduced in 2000 to reform and rationalise water policy and management across the European Union (EU) Member States (MS), the Water Framework Directive (WFD), the EU's flagship legislation on water protection, is widely acknowledged as the embodiment and vessel for the application of the Integrated River Basin Management (IRBM) paradigm. Its ecological objectives, perhaps even more challenging than the prospect of statutory catchment planning itself, were for all EU waters to achieve 'good status' by 2015 (except where exemptions applied) and the prevention of any further deterioration. In support of the upcoming WFD review in 2019, the paper reviews the transition of EU policies that led to the adoption of the WFD, to identify the reasons why the Directive was introduced and what it is trying to deliver, and to place progress with its implementation into context. It further investigates reasons that might have limited the effectiveness of the Directive and contributed to the limited delivery and delays in water quality improvements. Findings reveal that different interpretations on the Directive's objectives and exemptions left unresolved since its negotiation, ambiguity and compromises observed by its Common Implementation Strategy and lack of real support for the policy shift required have all been barriers to the harmonised transposition of the IRBM paradigm, the key to delivering good ecological status. The 2019 WFD review offers a unique opportunity to realign the implementation of the Directive to its initial aspirations and goals.

Voices from the landscape: Storytelling as emergent counter-narratives and collective action from northern BC watersheds

The 'Ecohealth and Watersheds in Northern BC'' project, situated in a resource rich, settler colonial context, generated three digital stories at the request of the project's Steering Committee members that sought to connect health, environment, and community. Three Steering Committee members championed these stories from their distinct watersheds, resulting in emergent counter-narratives that respond directly to their social-ecological contexts. Nested in literature on blue and green spaces, we present and examine the process of storytelling as emergent counter-narrative and how these narratives challenge us to think of blue and green spaces in interconnected and nuanced ways.

Mapping the Hidden Hazards: Community-Led Spatial Data Collection of Street-Level Environmental Stressors in a Degraded, Urban Watershed

We utilized a participatory mapping approach to collect point locations, photographs, and descriptive data about select built environment stressors identified and prioritized by community residents living in the Proctor Creek Watershed, a degraded, urban watershed in Northwest Atlanta, Georgia. Residents (watershed researchers) used an indicator identification framework to select three watershed stressors that influence urban livability: standing water, illegal dumping on land and in surface water, and faulty stormwater infrastructure. Through a community⁻university partnership and using Geographic Information Systems and digital mapping tools, watershed researchers and university students designed a mobile application (app) that enabled them to collect data associated with these stressors to create a spatial narrative, informed by local community knowledge, that offers visual documentation and representation of community conditions that negatively influence the environment, health, and quality of life in urban areas. By elevating the local knowledge and lived experience of community residents and codeveloping a relevant data collection tool, community residents generated fine-grained, street-level, actionable data. This process helped to fill gaps in publicly available datasets about environmental hazards in their watershed and helped residents initiate solution-oriented dialogue with government officials to address problem areas. We demonstrate that community-based knowledge can contribute to and extend scientific inquiry, as well as help communities to advance environmental justice and leverage opportunities for remediation and policy change.

Health promotion and sustainability programmes in Australia: barriers and enablers to evaluation

In an era characterised by the adverse impacts of climate change and environmental degradation, health promotion programmes are beginning to actively link human health with environmental sustainability imperatives. This paper draws on a study of health promotion and sustainability programmes in Australia, providing insights to evaluation approaches being used and barriers and enablers to these evaluations. The study was based on a multi-strategy research involving both quantitative and qualitative methods. Health promotion practitioners explained through surveys and semi-structured interviews that they focused on five overarching health and sustainability programme types (healthy and sustainable food, active transport, energy efficiency, contact with nature, and capacity building). Various evaluation methods and indicators (health, social, environmental, economic and demographic) were identified as being valuable for monitoring and evaluating health and sustainability programmes. Findings identified several evaluation enablers such as successful community engagement, knowledge of health and sustainability issues and programme champions, whereas barriers included resource constraints and competing interests. This paper highlights the need for ecological models and evaluation tools to support the design and monitoring of health promotion and sustainability programmes.

Empowerment and the ecological determinants of health: three critical capacities for practitioners

Human agency or the expression of intentionality towards some form of betterment has long occupied human imagination and creativity. The ways in which we express such aspirations are fundamentally informed by our beliefs about the nature of reality, meanings of human well-being and progress, and the ways in which our social locations shape our interests. Within Western health-promoting discourse and practice, such processes have largely been expressed through the construct of empowerment. To date, like health, much empowerment practice has been implicitly rooted in Cartesianism, has tended towards anthropocentrism and in cases where it has engaged with environmental issues, has mirrored environmentalism's focus on externalities and objectivity. These tendencies coupled with the increasing complexity of global, ecological, human well-being issues call empowerment practitioners to integrate new kinds of capacities more suited to addressing the ecological determinants of health. Drawing in part on the author's empowerment research over more than a decade, this article distinguishes between a range of epistemological perspectives underlying contemporary empowerment practices while fore-grounding the concepts of place-based agency and social-ecological resilience. These constructs in turn form the basis for three capacities considered critical for practitioners addressing human-ecological well-being.

Contracting infectious diseases in Sub-Saharan African wetlands: A question of use? A review

Worldwide the pressure on water is increasing. In parts of Sub-Saharan Africa (SSA), natural wetlands constitute the only accessible water resources, providing water free of charge, agricultural potential and livelihoods in otherwise uninhabitable landscapes, which is why they are being used extensively. The degradation and contamination of water which result from the use of wetlands has the potential to spread disease-causing microorganisms and provide increased breeding habitats for disease vectors, Despite this importance, case studies are lacking and knowledge gaps remain about whether and how different kinds of wetland use influence the exposure to health risks and transmission of infectious diseases. This descriptive literature review aimed at identifying publications from peer-reviewed journals and book chapters that (i) address water-related infectious diseases in SSA wetlands and (ii) link those diseases to use-related exposures. The resulting overview includes 27 publications and shows that depending on the type of use, people in wetlands are exposed to different risk factors and water-related infectious diseases. Exposure to infectious agents depends on occupational characteristics, and time spent in wetlands. Disease transmission is driven by users' contact to water, characteristics of pathogens and vectors of disease. The amount of available literature varies significantly. Whereas several publications have linked crop production and the domestic use of wetland water to contraction of diseases, fewer are available on health risks identified with pastoralism in wetlands and other uses. Some risk factors are well researched, such as irrigation schemes favouring schistosomiasis prevalence. For others, including proximity of pastoralists to their livestock and the associated trachoma risk, knowledge remains limited. This review establishes connections of selected diseases with different transmission pathways that are linked to specific risk factors, transmission pathways and resulting diseases. All of these have been integrated into a detailed conceptual framework which simplifies the complexity of the relationships, while at the same time identifying missing links which might provide stimulus for future research tackling the potential research gaps. It concludes that socio-cultural and behavioural considerations regarding the wetland users are not sufficiently evaluated and should receive increased attention in future investigations.

Health at the Sub-catchment Scale: Typhoid and Its Environmental Determinants in Central Division, Fiji

The impact of environmental change on transmission patterns of waterborne enteric diseases is a major public health concern. This study concerns the burden and spatial nature of enteric fever, attributable to Salmonella Typhi infection in the Central Division, Republic of Fiji at a sub-catchment scale over 30-months (2013-2015). Quantitative spatial analysis suggested relationships between environmental conditions of sub-catchments and incidence and recurrence of typhoid fever. Average incidence per inhabited sub-catchment for the Central Division was high at 205.9/100,000, with cases recurring in each calendar year in 26% of sub-catchments. Although the numbers of cases were highest within dense, urban coastal sub-catchments, the incidence was highest in low-density mountainous rural areas. Significant environmental determinants at this scale suggest increased risk of exposure where sediment yields increase following runoff. The study suggests that populations living on large systems that broaden into meandering mid-reaches and floodplains with alluvial deposition are at a greater risk compared to small populations living near small, erosional, high-energy headwaters and small streams unconnected to large hydrological networks. This study suggests that anthropogenic alteration of land cover and hydrology (particularly via fragmentation of riparian forest and connectivity between road and river networks) facilitates increased transmission of typhoid fever and that environmental transmission of typhoid fever is important in Fiji.

Pacific connections for health, ecosystems and society: new approaches to the land-water-health nexus

Renewed effort to understand the social-ecological context of health is drawing attention to the dynamics of land and water resources and their combined influence on the determinants of health. A new area of research, education and policy is emerging that focuses on the land-water-health nexus: this orientation is applicable from small wetlands through to large-scale watersheds or river basins, and draws attention to the benefits of combined land and water governance, as well as the interrelated implications for health, ecological and societal concerns. Informed by research precedents, imperatives and collaborations emerging in Canada and parts of Oceania, this review profiles three integrative, applied approaches that are bringing attention to the importance the land-water-health nexus within the Pacific Basin: wetlands and watersheds as intersectoral settings to address land-water-health dynamics; tools to integrate health, ecological and societal dynamics at the land-water-health nexus; and indigenous leadership that is linking health and well-being with land and water governance. Emphasis is given to key characteristics of a new generation of inquiry and action at the land-water-health nexus, as well as capacity-building, practice and policy opportunities to address converging environmental, social and health objectives linked to the management and governance of land and water resources.

Qualitative analysis of water quality deterioration and infection by Helicobacter pylori in a community with high risk of stomach cancer (Cauca, Colombia)

This study looks at aspects of the environmental health of the rural population in Timbío (Cauca, Columbia) in relation to the deterioration of water quality. The information was obtained through participatory research methods exploring the management and use of water, the sources of pollution and the perception of water quality and its relation to Helicobacter pylori infection. The results are part of the qualitative analysis of a first research phase characterizing water and sanitation problems and their relation to emerging infectious diseases as well as possible solutions, which was carried out between November 2013 and August 2014. The results of this research are discussed from an ecosystemic approach to human health, recognizing the complexity of environmental conflicts related to water resources and their impacts on the health of populations. Through the methodology used, it is possible to detect and visualize the most urgent problems as well as frequent causes of contamination of water resources so as to propose solutions within a joint agenda of multiple social actors.

Watershed management and public health: an exploration of the intersection of two fields as reported in the literature from 2000 to 2010

Watersheds are settings for health and well-being that have a great deal to offer the public health community due to the correspondence between the spatial form of the watershed unit and the importance to health and well-being of water. However, managing watersheds for human health and well-being requires the ability to move beyond typical reductionist approaches toward more holistic methods. Health and well-being are emergent properties of inter-related social and biophysical processes. This paper characterizes points of connection and integration between watershed management and public health and tests a new conceptual model, the Watershed Governance Prism, to determine the prevalence in peer-reviewed literature of different perspectives relating to watersheds and public health. We conducted an initial search of academic databases for papers that addressed the interface between watershed management (or governance) and public health themes. We then generated a sample of these papers and undertook a collaborative analysis informed by the Watershed Governance Prism. Our analysis found that although these manuscripts dealt with a range of biophysical and social determinants of health, there was a tendency for social factors and health outcomes to be framed as context only for these studies, rather than form the core of the relationships being investigated. At least one cluster of papers emerged from this analysis that represented a cohesive perspective on watershed governance and health; "Perspective B" on the Watershed Governance Prism, "water governance for ecosystems and well-being," was dominant. Overall, the integration of watershed management/governance and public health is in its infancy.

Ecosystem approaches to health for a global sustainability agenda

International research agendas are placing greater emphasis on the need for more sustainable development to achieve gains in global health. Research using ecosystem approaches to health, and the wider field of ecohealth, contribute to this goal, by addressing health in the context of inter-linked social and ecological systems. We review recent contributions to conceptual development of ecosystem approaches to health, with insights from their application in international development research. Various similar frameworks have emerged to apply the approach. Most predicate integration across disciplines and sectors, stakeholder participation, and an articulation of sustainability and equity to achieve relevant actions for change. Drawing on several frameworks and on case studies, a model process for application of ecosystem approaches is proposed, consisting of an iterative cycles of participatory study design, knowledge generation, intervention, and systematization of knowledge. The benefits of the research approach include innovations that improve health, evidence-based policies that reduce health risks; empowerment of marginalized groups through knowledge gained, and more effective engagement of decision makers. With improved tools to describe environmental and economic dimensions, and explicit strategies for scaling-up the use and application of research results, the field of ecohealth will help integrate both improved health and sustainability into the development agenda.

Global distribution of outbreaks of water-associated infectious diseases

BACKGROUND

Water plays an important role in the transmission of many infectious diseases, which pose a great burden on global public health. However, the global distribution of these water-associated infectious diseases and underlying factors remain largely unexplored.

METHODS AND FINDINGS

Based on the Global Infectious Disease and Epidemiology Network (GIDEON), a global database including water-associated pathogens and diseases was developed. In this study, reported outbreak events associated with corresponding water-associated infectious diseases from 1991 to 2008 were extracted from the database. The location of each reported outbreak event was identified and geocoded into a GIS database. Also collected in the GIS database included geo-referenced socio-environmental information including population density (2000), annual accumulated temperature, surface water area, and average annual precipitation. Poisson models with Bayesian inference were developed to explore the association between these socio-environmental factors and distribution of the reported outbreak events. Based on model predictions a global relative risk map was generated. A total of 1,428 reported outbreak events were retrieved from the database. The analysis suggested that outbreaks of water-associated diseases are significantly correlated with socio-environmental factors. Population density is a significant risk factor for all categories of reported outbreaks of water-associated diseases; water-related diseases (e.g., vector-borne diseases) are associated with accumulated temperature; water-washed diseases (e.g., conjunctivitis) are inversely related to surface water area; both water-borne and water-related diseases are inversely related to average annual rainfall. Based on the model predictions, "hotspots" of risks for all categories of water-associated diseases were explored.

CONCLUSIONS

At the global scale, water-associated infectious diseases are significantly correlated with socio-environmental factors, impacting all regions which are affected disproportionately by different categories of water-associated infectious diseases.

Community-based health research led by the Vuntut Gwitchin First Nation

OBJECTIVES

This paper documents an exceptional research partnership developed between the Vuntut Gwitchin Government (VGG) in Old Crow, Yukon, with a group of scientists to examine northern food security and health as part of a larger, multidisciplinary International Polar Year (IPY) research program. We focus on the elements that enabled a successful community-researcher relationship. Study design. The VGG led the development of the research and acted as Principal Investigator on the IPY grant. The multidisciplinary collaboration spanned the physical, biological and health sciences, including issues related to food security.

METHODS

The food security and health component of this research was carried out using a series of complementary methods, including focus groups, structured interviews, a household questionnaire, an interactive workshop, community meetings, transcript analysis and a caribou flesh exposure assessment.

RESULTS

Results from the food security component are informing local and regional adaptation planning. The legacy of the research collaboration includes a number of results-based outputs for a range of stakeholders, a community-based environmental monitoring program, long-term research relationships and improved community capacity.

CONCLUSIONS

The type of collaboration described here provides a useful model for new types of participatory health research with northern communities.

Peak oil and health in low- and middle-income countries: impacts and potential responses

Peak oil refers to the predicted peak and subsequent decline in global production of petroleum products over the coming decades. We describe how peak oil will affect health, nutrition, and health systems in low- and middle-income countries along 5 pathways. The negative effects of peak oil on health and nutrition will be felt most acutely in the 58 low-income countries experiencing minimal or negative economic growth because of their patterns of sociopolitical, geographic, and economic vulnerability. The global health community needs to take additional steps to build resilience among the residents of low- and middle-income countries and maintain access to maternal and other health services in the face of predicted changes in availability and price of fossil fuels.

Assessing the vulnerability of eco-environmental health to climate change

There is an urgent need to assess the vulnerability of eco-environmental health to climate change. This paper aims to provide an overview of current research, to identify knowledge gaps, and to propose future research needs in this challenging area. Evidence shows that climate change is affecting and will, in the future, have more (mostly adverse) impacts on ecosystems. Ecosystem degradation, particularly the decline of the life support systems, will undoubtedly affect human health and wellbeing. Therefore, it is important to develop a framework to assess the vulnerability of eco-environmental health to climate change, and to identify appropriate adaptation strategies to minimize the impact of climate change.