The political ecology of health: perceptions of environment, economy, health and well-being among ‘Namgis First Nation

Climate change, biodiversity loss, and Indigenous Peoples' health and wellbeing: A systematic umbrella review

Indigenous Peoples worldwide are experiencing a cascade of impacts on their health and wellbeing as a result of climate change and biodiversity loss. Existing literature at the interface of climate change, biodiversity loss, and Indigenous health tells us that Indigenous Peoples are among those most disproportionately and acutely affected by these impacts. Yet, a gap exists with respect to comprehensively and critically synthesizing the impacts reported across this literature and identifying Indigenous-led responses. Guided by an Indigenous advisory group, we employed a systematic umbrella review methodology, following PRISMA guidelines, to characterize the global secondary literature (PROSPERO registration #: CRD42023417060). In so doing, we identified the proximal, intermediate, distal, and gendered impacts of climate change and biodiversity loss on Indigenous health and wellbeing as well as Indigenous-led responses. Five databases were searched for published reviews, along with a grey literature search that focused on underrepresented geographic regions in the academic literature. Two independent reviewers conducted two-stage screening, data extraction, and quality assessment of retrieved records. Basic descriptive statistics were calculated. Qualitative data were analyzed thematically, using a constant comparative approach. A total of 38 review articles met the eligibility criteria and 37 grey literature records were retrieved and included in the review. Reviews were published between 2010-2023 and geographically clustered in the Circumpolar North. Intersecting proximal, intermediate, and distal impacts were characterized as place-based and specific, and linked to colonialism as an antecedent to and driver of these impacts. Gendered impacts were underexplored within reviews. Reviewed literature underscored the value of engaging diverse knowledge systems; platforming localized, community-led adaptation to climate change and biodiversity loss, while addressing sociopolitical constraints to these efforts; and applying a broader conceptualization of health that aligns with Indigenous frameworks. Going forward, we must foreground equity- and rights-based considerations within integrated responses to climate and biodiversity crises.

Climate change, biodiversity loss, and Indigenous Peoples' health and wellbeing: a systematic umbrella review protocol

BACKGROUND

Research that examines the intersections of Indigenous Peoples' health and wellbeing with climate change and biodiversity loss is abundant in the global scholarship. A synthesis of this evidence base is crucial in order to map current pathways of impact, as well as to identify responses across the global literature that advance Indigenous health and wellbeing, all while centering Indigenous voices and perspectives. This protocol details our proposed methodology to systematically conduct an umbrella review (or review of reviews) of the synthesized literature on climate change, biodiversity loss, and the health and wellbeing of Indigenous Peoples globally.

METHODS

A multidisciplinary team of Indigenous and non-Indigenous scholars will conduct the review, guided by an engagement process with an Indigenous Experts group. A search hedge will be used to search PubMed®, Scopus®, Web of Science™, CINAHL (via EBSCOHost®), and Campbell Collaboration databases and adapted for use in grey literature sources. Two independent reviewers will conduct level one (title/abstract) and level two (full-text) eligibility screening using inclusion/exclusion criteria. Data will be extracted from included records and analyzed using quantitative (e.g., basic descriptive statistics) and qualitative methods (e.g., thematic analysis, using a constant comparative method).

DISCUSSION

This protocol outlines our approach to systematically and transparently review synthesized literature that examines the intersections of climate change, biodiversity loss, and Indigenous Peoples' health and wellbeing globally.

SYSTEMATIC REVIEW REGISTRATION

This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on April 24, 2023 (registration number: CRD42023417060).

The Impact of Health Geography on Public Health Research, Policy, and Practice in Canada

The link between geography and health means that the places we occupy-where we are born, where we live, where we work, and where we play-have a direct impact on our health, including our experiences of health. A subdiscipline of human geography, health geography studies the relationships between our environments and the impact of factors that operate within those environments on human health. Researchers have focused on the social and physical environments, including spatial location, patterns, causes of disease and related outcomes, and health service delivery. The work of health geographers has adopted various theories and philosophies (i.e., positivism, social interactionism, structuralism) and methods to collect and analyze data (i.e., quantitative, qualitative, spatial analysis) to examine our environments and their relationship to health. The field of public health is an organized effort to promote the health of its population and prevent disease, injury, and premature death. Public health agencies and practitioners develop programs, services, and policies to promote healthy environments to support and enable health. This commentary provides an overview of the recent landscape of health geography and makes a case for how health geography is critically important to the field of public health, including examples from the field to highlight these links in practice.

Stepping into the Void: Lessons Learned from Civil Society Organizations during COVID-19 in Rio de Janeiro

Brazil experienced some of the highest rates of COVID-19 globally. This was complicated by the fact that 35 million of its citizens have limited access to water, a primary resource necessary to stem the spread of infectious diseases. In many cases, civil society organizations (CSOs) stepped into this void left by responsible authorities. This paper explores how CSOs in Rio de Janeiro helped populations struggling with access to water, sanitation, and hygiene (WASH) during the pandemic, and what coping strategies are transferable to similar contexts. In-depth interviews (n = 15) were conducted with CSO representatives in the metropolitan region of Rio de Janeiro. Thematic analysis of the interviews revealed that COVID-19 exacerbated pre-existing social inequities among vulnerable populations, undermining their ability to protect their health. CSOs provided emergency relief aid but faced the counterproductive actions of public authorities who promoted a narrative that diminished the risks of COVID-19 and the importance of non-pharmacological interventions. CSOs fought this narrative by promoting sensitization among vulnerable populations and partnering with other stakeholders in networks of solidarity, playing a vital role in the distribution of health-promoting services. These strategies are transferrable to other contexts where state narratives oppose public health understandings, particularly for extremely vulnerable populations.

Social-ecological considerations informing a universal screening strategy for sleep health in the community

"Poor sleep health" (PSH), defined as reduced amount of sleep and non-restorative sleep, affects cognitive, social and emotional development. Evidence suggests an association of sleep deprivation and mental health problems; however, there are no universal concepts allowing a first-tier screening of PSH at a community level. The focus of this narrative review is to highlight the cultural context of the current medicalized approach to PSH and to suggest social ecological strategies informing new and holistic community-based screening concepts. We present two conceptual screening frameworks; a "medical" and a merged "social emotional wellbeing framework" and combine them utilizing the concept of "ecologies." The first framework proposes the incorporation of "sleep" in the interpretation of "vigilance" and "inappropriate" labeled behaviors. In the first framework, we provide a logic model for screening the myriad of presentations and possible root causes of sleep disturbances as a tool to assess daytime behaviors in context with PSH. In the second framework, we provide evidence that informs screening for "social emotional wellbeing" in the context of predictive factors, perpetuating factors and predispositions through different cultural perspectives. The distinct goals of both frameworks are to overcome training-biased unidirectional thinking and a priori medicalization of challenging, disruptive and/or disobedient behaviors. The latter has been explicitly informed by the critical discourse on colonization and its consequences, spearheaded by First Nations. Our "transcultural, transdisciplinary and transdiagnostic screening framework" may serve as a starting point from which adaptations of medical models could be developed to suit the purposes of holistic screening, diagnosis, and treatment of complex childhood presentations in different cultural contexts.

Conceptualizing the Socio-Built Environment: An Expanded Theoretical Framework to Promote a Better Understanding of Risk for Nonmedical Opioid Overdose Outcomes in Urban and Non-Urban Settings

Nonmedical opioid (NMO) use has been linked to significant increases in rates of NMO morbidity and mortality in non-urban areas. While there has been a great deal of empirical evidence suggesting that physical features of built environments represent strong predictors of drug use and mental health outcomes in urban settings, there is a dearth of research assessing the physical, built environment features of non-urban settings in order to predict risk for NMO overdose outcomes. Likewise, there is strong extant literature suggesting that social characteristics of environments also predict NMO overdoses and other NMO use outcomes, but limited research that considers the combined effects of both physical and social characteristics of environments on NMO outcomes. As a result, important gaps in the scientific literature currently limit our understanding of how both physical and social features of environments shape risk for NMO overdose in rural and suburban settings and therefore limit our ability to intervene effectively. In order to foster a more holistic understanding of environmental features predicting the emerging epidemic of NMO overdose, this article presents a novel, expanded theoretical framework that conceptualizes "socio-built environments" as comprised of (a) environmental characteristics that are applicable to both non-urban and urban settings and (b) not only traditional features of environments as conceptualized by the extant built environment framework, but also social features of environments. This novel framework can help improve our ability to identify settings at highest risk for high rates of NMO overdose, in order to improve resource allocation, targeting, and implementation for interventions such as opioid treatment services, mental health services, and care and harm reduction services for people who use drugs.

Reclaiming Land, Identity and Mental Wellness in Biigtigong Nishnaabeg Territory

Indigenous peoples globally are pursuing diverse strategies to foster mental, emotional, and spiritual wellness by reclaiming and restoring their relationships to land. For Anishinaabe communities, the land is the source of local knowledge systems that sustain identities and foster mino-bimaadiziwin, that is, living in a good and healthy way. In July 2019, the community of Biigtigong Nishnaabeg in Ontario, Canada hosted a week-long land camp to reclaim Mountain Lake and reconnect Elders, youth and band staff to the land, history, and relationships of this place. Framed theoretically by environmental repossession, we explore the perceptions of 15 participating community members and examine local and intergenerational meanings of the camp for mental wellness. The findings show that the Mountain Lake camp strengthened social relationships, supported the sharing and practice of Anishinaabe knowledge, and fostered community pride in ways that reinforced the community’s Anishinaabe identity. By exploring the links between land reclamation, identity, and community empowerment, we suggest environmental repossession as a useful concept for understanding how land reconnection and self-determination can support Indigenous mental wellness.

“I see my culture starting to disappear”: Anishinaabe perspectives on the socioecological impacts of climate change and future research needs

Climate change disproportionately affects Indigenous Peoples because of strong connections between environmental, cultural, and spiritual well-being. While much of the global discourse surrounding climate change is founded in Western science, the holistic, place-based knowledge of Indigenous Peoples offers a complementary way of understanding and mitigating climate change impacts. The goal of this research was to elevate Anishinaabe concerns, observations, and perspectives about climate change impacts and future research needs. We organized a workshop called “Connecting Guardians in a Changing World” where participants shared concerns about animal and plant life cycles, water cycles and water quality, and impacts to ways of life, including reduced capacity to perform cultural practices and erosion of their knowledge. Participants highlighted the challenge of prioritizing a single impact of climate change, emphasizing that impacts to the environment and ways of life are interconnected. Participants also expressed the need for research and policy that move beyond interdisciplinarity to include intercultural philosophy and research that better reflects Indigenous worldviews and incorporates Indigenous methodologies. Moving forward, meaningful partnerships and opportunities for knowledge sharing should be prioritized in climate change discourse to ensure solutions are generated together, with all of the tools and knowledge available.

Families navigating community resources: understanding and supporting Nunavimmiut families

In a project aiming to develop community-led resources for families in northern Quebec, Canada, members (Inuit and non-Inuit) of the project decided to meet with Inuit parents to hear their experiences and needs, and to better understand how family dynamics might be related to ways of using resources within communities. In this article, we present secondary analyses of interviews conducted in 2015 with 14 parents living in a community of Nunavik, northern Quebec, accompanied by participatory analysis sessions. A dual data analysis strategy was adopted. Non-Inuit researchers and research assistants with significant lived experience in Nunavik explored what they learned from the stories that Inuit parents shared with them through the interviews and through informal exchanges. Inuit partners then discussed the large themes identified by the research team to guide non-Inuit researchers in their analysis. The aim was to better inform non-Inuit service providers and people whose mandate it is to support community mobilisation in relation to the heterogeneous realities of Inuit families, and the ways in which they can be of support to families based on their specific realities and needs.

Forging just dietary futures: bringing mainstream and critical nutrition into conversation

Despite decades of action to reduce global malnutrition, rates of undernutrition remain stubbornly high and rates of overweight, obesity and chronic disease are simultaneously on the rise. Moreover, while volumes of robust research on causes and solutions to malnutrition have been published, and calls for interdisciplinarity are on the rise, researchers taking different epistemological and methodological choices have largely remained disciplinarily siloed. This paper works to open a scholarly conversation between "mainstream" public health nutrition and "critical" nutrition studies. While critical nutrition scholars collectively question aspects of mainstream nutrition approaches, they also chart a different way to approach malnutrition research by focusing on politics, structural conditions, and the diverse ways people make sense of food and malnutrition. In this paper, we highlight the key research agendas and insights within both mainstream and critical nutrition in order to suggest spaces for their potential conversation. We ultimately argue that global public health nutrition interventions might achieve greater success in more equitable ways if they are informed by critical nutrition research. We aim for this intervention to facilitate more substantial crossing of disciplinary boundaries, critical to forging more socially and environmentally just dietary futures in the global South and beyond.

Towards an integrated theoretical framework for understanding water insecurity and gender-based violence in Low-and middle-income countries (LMICs)

Disparities in access to basic needs and resources such as water is largely borne out of power imbalance across scale. In examining these power dynamics in the context of health inequalities, scholars have deployed Feminist political ecology analytical framework to situate gender and other forms of vulnerability as emerging from unequal power relations, and political ecology of health to emphasise the health implications of inherent relational power in the distribution of resources. Although appealing, the two theoretical frameworks over time have proven to be limiting in the study of intersectional vulnerabilities such as gender-based violence and water insecurity which reflect multiple dimensions of unequal power structures. This study expands the theoretical space for the study of inequalities in health geography by demonstrating the utility of incorporating feminist political ecology with political ecology of health to form an integrated theoretical framework - Feminist Political Ecology of Health (FPEH). This proposed theoretical framework gives guidance for engaging with a suite of questions and methods related to multifaceted problems such as water insecurity and gender based-violence. The paper highlights these theoretical issues and then discusses how FPEH can enrich research on water security and gender-based violence in Low-and middle-income countries (LMICs).

Wellbeing of Indigenous Peoples in Canada, Aotearoa (New Zealand) and the United States: A Systematic Review

Despite the health improvements afforded to non-Indigenous peoples in Canada, Aotearoa (New Zealand) and the United States, the Indigenous peoples in these countries continue to endure disproportionately high rates of mortality and morbidity. Indigenous peoples' concepts and understanding of health and wellbeing are holistic; however, due to their diverse social, political, cultural, environmental and economic contexts within and across countries, wellbeing is not experienced uniformly across all Indigenous populations. We aim to identify aspects of wellbeing important to the Indigenous people in Canada, Aotearoa and the United States. We searched CINAHL, Embase, PsycINFO and PubMed databases for papers that included key Indigenous and wellbeing search terms from database inception to April 2020. Papers that included a focus on Indigenous adults residing in Canada, Aotearoa and the United States, and that included empirical qualitative data that described at least one aspect of wellbeing were eligible. Data were analysed using the stages of thematic development recommended by Thomas and Harden for thematic synthesis of qualitative research. Our search resulted in 2669 papers being screened for eligibility. Following full-text screening, 100 papers were deemed eligible for inclusion (Aotearoa (New Zealand) n = 16, Canada n = 43, United States n = 41). Themes varied across countries; however, identity, connection, balance and self-determination were common aspects of wellbeing. Having this broader understanding of wellbeing across these cultures can inform decisions made about public health actions and resources.

From social determinants to social epigenetics: Health geographies of chronic disease

Social epigenetics explores relationships between social factors and health inequities embodied at the molecular level. Through modulating gene expression, epigenetic changes resulting from human-environment interactions may play a role in shaping health trajectories. This paper applies a health geography lens to explore the potential and support for conducting social epigenetic studies of chronic diseases with complex and dynamic etiologies. In so doing, we argue that social epigenetics presents a novel space for investigations of health and disease that is transdisciplinary and builds upon new understandings of bodies and place-based experiences. Given gender disparities in chronic diseases, we adopt a feminist perspective that cogitates the transactive relationships between gender and health/ill-health as mediated by biosocial processes at a variety of scales. Looking forward to the practical undertaking of social epigenetic studies, we assess existing theoretical and methodological support as well as insights to be gained. Reflecting upon the central tenets of health geography, we propose a unique positionality for health geographers to drive this field forward.

Climate change, women's workload in smallholder agriculture, and embodied political ecologies of undernutrition in northern Ghana

The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women's workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers' time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana's Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women's productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature.

The impact of Neglected Tropical Diseases (NTDs) on health and wellbeing in sub-Saharan Africa (SSA): A case study of Kenya

Neglected Tropical Diseases (NTDs) remain endemic to many regions of sub-Saharan Africa (SSA) left behind by socioeconomic progress. As such, these diseases are markers of extreme poverty and inequity that are propagated by the political, economic, social, and cultural systems that affect health and wellbeing. As countries embrace and work towards achieving the Sustainable Development Goals (SDGs), the needs of such vulnerable populations need to be addressed in local and global arenas. The research uses primary qualitative data collected from five NTD endemic counties of Kenya: interviews key informants (n = 21) involved in NTD implementation programs and focus groups (n = 5) of affected individuals. Informed by theories of political ecology of health, the research focuses on post-devolution Kenya and identifies the political, economic, social, and cultural factors that propagate NTDs and their effects on health and wellbeing. Our findings indicate that structural factors such as competing political interests, health worker strikes, inadequate budgetary allocations, economic opportunity, marginalization, illiteracy, entrenched cultural norms and practices, poor access to water, sanitation and housing, all serve to propagate NTD transmission and subsequently affect the health and wellbeing of populations. As such, we recommend that post-devolution Kenya ensures local political, economic and socio-cultural structures are equitable, sensitive and responsive to the needs of all people. We also propose poverty alleviation through capacity building and empowerment as a means of tackling NTDs for sustained economic opportunity and productivity at the local and national level.

Wellbeing is currently seen as an avenue that shapes, happiness, productivity, environmental awareness, social inclusion, and justice; however, most countries presently adopting wellbeing measures are in the global north. Neglected Tropical Diseases (NTDs) significantly compromise populations’ health and well-being in the global south, causing undesirable effects on the personal, social, and economic capabilities of communities living in endemic regions. As countries work towards achieving the Sustainable Development Goals (SDGs), it is paramount that countries in the global south adopt wellbeing measures and, in doing so, capture the lived experiences of individuals experiencing inequities, particularly as these are shaped by NTDs. In sub-Saharan Africa (SSA), political and economic power manifests across different scales, determining human-environmental interaction, distribution of resources, and the transmission of infectious agents. This paper uses a political ecology of health approach to identify the political, economic, social and cultural factors that contribute to NTDs, which are among the world’s greatest global health problems. The vast majority of people bearing the burden of NTDs reside in low-income countries. Surprisingly, as the economies of the low-income countries improve to middle-income status, NTDs continue to thrive among sub-populations of low socioeconomic status because of the unequal distribution of economic gains. As a result, NTDs are found in environments characterized by poverty and income inequality, and other inequalities in access to health services, housing, safe water, and sanitation. This paper uses political ecology of health in the primarily biomedical field of NTDs to demonstrate that inequities are embedded within the broad political, socio-cultural, and economic systems that exacerbate NTD infection. The study recommends that NTD endemic countries in SSA formulate policies that enhance equity through capacity building and empowerment enhance population wellbeing.

Health inequalities, fundamental causes and power: towards the practice of good theory

Reducing health inequalities remains a challenge for policy makers across the world. Beginning from Lewin's famous dictum that "there is nothing as practical as a good theory", this paper begins from an appreciative discussion of 'fundamental cause theory', emphasizing the elegance of its theoretical encapsulation of the challenge, the relevance of its critical focus for action, and its potential to support the practical mobilisation of knowledge in generating change. Moreover, it is argued that recent developments in the theory, provide an opportunity for further theoretical development focused more clearly on the concept of power (Dickie et al. 2015). A critical focus on power as the essential element in maintaining, increasing or reducing social and economic inequalities - including health inequalities - can both enhance the coherence of the theory, and also enhance the capacity to challenge the roots of health inequalities at different levels and scales. This paper provides an initial contribution by proposing a framework to help to identify the most important sources, forms and positions of power, as well as the social spaces in which they operate. Subsequent work could usefully test, elaborate and adapt this framework, or indeed ultimately replace it with something better, to help focus actions to reduce inequalities.

A century of knowledge: Kwakwaka’wakw Elders and environmental change

This paper reviews a century of Kwakwaka’wakw knowledge on ecological, climate, and social change. We trace the era of Indigenous governance (about the precolonial period), especially from about 1910 to the devastation of the flood in Dzawada’enuxw First Nation territory in Kingcome, British Columbia, in 2010. This time period has been chosen as the assessment period as this is the lifetime of the 10 Elders that we collaborated with to understand and position change during this tumultuous era. We call the results of this process “a century of knowledge”. Ecological, social, and climate change are positioned with scientific literature for potential divergence/convergence. Almost all aspects of the Kwakwaka’wakw home area have undergone large-scale changes including clear-cut forestry, salmon farms, climate change affecting species ranges, cultural impositions, and colonial processes working to destroy Indigenous governance. Despite these imposed changes, the communities emerge as survivors on their own terms, including using the traditional feast system known as the Potlatch to come to terms with the devastation of the 2010 flood and beyond.

Harvest Programs in First Nations of Subarctic Canada: The Benefits Go Beyond Addressing Food Security and Environmental Sustainability Issues

By breaking down barriers that impacted the ability of subarctic First Nations people to harvest waterfowl, the Sharing-the-Harvest program provided a safe, nutritious, and culturally appropriate food (i.e., geese) to James Bay Cree communities while also helping to protect the environment by harvesting overabundant geese. However, the impacts extend beyond those described above. Thus, the objectives of the present paper are twofold: to document the food sharing networks of the Sharing-the-Harvest program; and to examine the benefits associated with the harvest program beyond food security and environmental sustainability issues, as revealed through semi-directed interviews. In the regional initiative, harvested geese were shared with all James Bay communities; sharing is an important part of Cree culture. Where detailed information was collected, the goose-sharing network reached 76% of the homes in one of the communities. Likewise, in the local initiative, the goose-sharing network had a 76% coverage rate of the homes in the community. Although decreasing food insecurity was an important focus of the harvest-sharing programs, there were other benefits, from an Indigenous perspective, of being on the land, as identified by the Cree harvesters through semi-directed interviews (e.g., the transmission of Indigenous knowledge, the strengthening of social networks, and the feeling of wellness while out on-the-land). Thus, by participating in the on-the-land harvest programs, the Cree gained benefits beyond those solely related to strengthening food security and contributing in part to environmental sustainability. The Sharing-the-Harvest protocol has the potential to be adapted and employed by other Indigenous (or marginalized) groups worldwide, to help improve health and wellness, while, also protecting the environment from overabundant and/or invasive species.

When It Is Not Measured, How Then Will It Be Planned for? WaSH a Critical Indicator for Universal Health Coverage in Kenya

The quality and safety of healthcare facility (HCF) services are critical to achieving universal health coverage (UHC) and yet the WHO/UNICEF joint monitoring program for water supply, sanitation and hygiene report indicates that only 51% and 23% of HCF in Sub-Saharan Africa have basic access to water and sanitation, respectively. Global commitments on improving access to water, sanitation, hygiene, waste management and environmental cleaning (WaSH) in HCF as part of implementing UHC have surged since 2015. Guided by political ecology of health theory, we explored the country level commitment to ensuring access to WaSH in HCFs as part of piloting UHC in Kisumu, Kenya. Through content analysis, 17 relevant policy documents were systematically reviewed using NVIVO. None of the national documents mentioned all the component of WaSH in healthcare facilities. Furthermore, these WaSH components are not measured as part of the universal health coverage pilot. Comprehensively incorporating WaSH measurement and monitoring in HCFs in the context of UHC policies creates a foundation for achieving SDG 6.

Impacts of Environmental Changes on Well-Being in Indigenous Communities in Eastern Canada

Climate change and natural resource exploitation can affect Indigenous people's well-being by reducing access to ecosystem services, in turn impeding transmission of traditional knowledge and causing mental health problems. We used a questionnaire based on the Environmental Distress Scale (EDS) and the Connor-Davidson Resilience Scale (CD-RISC-10) to examine the impacts of environmental changes on 251 members of four Indigenous communities in the eastern Canadian boreal forest. We also considered the potential mitigating effects of sociodemographic characteristics (i.e., age, gender, parenthood, and time spent on the land) and protective factors (i.e., health, quality of life, resilience, life on the land, life in the community, and support from family and friends). Using linear regression, model selection, and multi-model inference, we show that the felt impacts of environmental changes increased with age but were lower for participants with higher quality of life. The effect of resilience was opposite to expectations: more resilient participants felt more impacts. This could be because less resilient individuals ceased to go on the land when environmental changes exceeded a given threshold; thus, only the most resilient participants could testify to the impacts of acute changes. Further research will be needed to test this hypothesis.

The legacy of the Home Owners' Loan Corporation and the political ecology of urban trees and air pollution in the United States

This study examines the persistent impacts of historical racebased discriminatory housing policies on contemporary urban environments in the United States. Specifically, we examine the relationships between Home Owners' Loan Corporation (HOLC) grades assigned to neighborhoods in the 1930s and the current distribution of tree canopy and level of exposure to air pollution hazards. Our results indicate a clear gradient in tree canopy by HOLC grade, with better neighborhood grades associated with significantly higher percentage of tree canopy coverage. The pattern also exists for airborne carcinogens and respiratory hazards, with worse neighborhood grades associated with significantly higher hazards exposure. Our findings indicate that early 20th century discriminatory housing policies exert a contemporary influence on patterns of green space exposure in American cities, with implications for health and health inequities. Our findings suggest that, in order to achieve equitable access to the benefits of urban greenspace, we must acknowledge these historical influences and consider policies and practices that directly counter these influences, for example, through targeted greenspace development in areas historically identified as unfit for investment.

Link to the Land and Mino-Pimatisiwin (Comprehensive Health) of Indigenous People Living in Urban Areas in Eastern Canada

Mino-pimatisiwin is a comprehensive health philosophy shared by several Indigenous peoples in North America. As the link to the land is a key element of mino-pimatisiwin, our aim was to determine if Indigenous people living in urban areas can reach mino-pimatisiwin. We show that Indigenous people living in urban areas develop particular ways to maintain their link to the land, notably by embracing broader views of "land" (including urban areas) and "community" (including members of different Indigenous peoples). Access to the bush and relations with family and friends are necessary to fully experience mino-pimatisiwin. Culturally safe places are needed in urban areas, where knowledge and practices can be shared, contributing to identity safeguarding. There is a three-way equilibrium between bush, community, and city; and mobility between these places is key to maintaining the balance at the heart of mino-pimatisiwin.

Informal transit, socio-spatial exclusion, and changing geographies of HIV/AIDS in urban Malawi

The role played by the transport sector in the regional spread of HIV in sub-Saharan Africa is well known, yet attention has remained confined to entertainment hotspots and stopping places along long-distance highways and cross-border transport corridors. This paper draws attention to informal modes of transit prevalent in sub-Saharan African cities, by linking the rise of two-wheeled, manually operated bicycles, known as "Sacramento", to the potential spread of HIV and AIDS in Malawi. The findings of a qualitative study from Mzuzu city show that Sacramento operators are prone to demanding or accepting sexual favours from female commuters as payment for a ride. We draw on complementary theories of the political ecology of health (PEH) and feminist political ecology to show how a popular belief that Sacramento is an inferior mode of urban transit underpins risky sexual behaviour among men hired to operate this informal mode transport. The findings further show that operators' responses to this perceived inferiority are themselves also driven by gender discourses that seek to validate their identities as powerful go-getters. These scripts also create an environment that fosters multiple sexual partners and venerates unprotected sex. Because Sacramento is both a source of livelihood and an HIV risk milieu, it epitomises the contraction inherent in HIV and AIDS vulnerability in sub-Saharan Africa.

A comparative ethnography of nutrition interventions: Structural violence and the industrialisation of agrifood systems in the Caribbean and the Pacific

Public health interventions that involve strategies to re-localise food fail in part because they pay insufficient attention to the global history of industrial food and agriculture. In this paper we use the method of comparative ethnography and the concept of structural violence to illustrate how historical and geographical patterns related to colonialism and industrialisation (e.g. agrarian change, power relations and trade dependencies) hinder efforts to address diet-related non-communicable diseases on two small islands. We find comparative ethnography provides a useful framework for cross-country analysis of public health programmes that can complement quantitative analysis. At the same time, the concept of structural violence enables us to make sense of qualitative material and link the failure of such programmes to wider historical and geographical processes. We use ethnographic research carried out from April to August 2013 and from June to July 2014 in Trinidad (with follow-up online interviews in 2018) and in Nauru from February to May 2010 and August 2010 to February 2011. Our island case studies share commonalities that point to similar experiences of colonialism and industrialisation and comparable health-related challenges faced in everyday life.

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.

Towards an integrated framework for understanding the links between inequalities and wellbeing of places in low and middle income countries

As part of a larger research programme undertaking the development of a global index of wellbeing (GLOWING) through the exploration of population wellbeing in low to middle income countries (LMICs), this paper examines the role of inequality in shaping experiences of wellbeing. The paper explores various conceptualizations of wellbeing and inequality and outlines an integrated framework for understanding the importance of measuring the wellbeing of places. We conclude by urging geographers to explicitly engage with theory and cross-disciplinary research in order to adequately conceptualize the role of place in 'Beyond GDP' and progress measures.

"What the mind does not know, the eyes do not see". Placing food allergy risk in sub-Saharan Africa

Policy makers and health geographers are increasingly intrigued by the global rise of chronic disease. While current engagement coalesce around cardiovascular disease, cancers, chronic respiratory disease, and diabetes, very little attention has been given to other important chronic conditions: e.g., allergic disease. Concerns about how health is shaped by context and experienced in place can provide important insights to understand the trajectory of allergic disease and inform policy especially in developing countries experiencing an epidemiologic transition. Using Ghana as a case study. this paper draw on theories of political ecology of health to enhance our understanding of how individual (e.g. care seeking behaviours), sociocultural (e.g. lack of education and awareness), health system (e.g. absence of logistics) and policy environments (e.g. absence of policy) influence the ways in which food allergy is perceived, diagnosed and managed. These findings highlight the need for decision makers to target structural factors that impede access to and utilization of healthcare, diagnostic practices, as well as food allergy coping and management strategies. Moreover, the findings highlight the need for a global health agenda that pays critical attention to place-based factors in the construction of emerging health risks.

"Ne nnipadua mmpe" (the body hates it): Exploring the lived experience of food allergy in Sub-Saharan Africa

Allergic diseases have closely followed the rise of non-communicable diseases (NCDs) especially in western societies. As prevalence of NCD is increasing in sub-Saharan Africa (SSA), researchers are hinting that the same future may hold for (food) allergic disease in this world region. Already, researchers are beginning to record prevalence, though with little attention to the social experience of individuals and parents with food allergic children. This paper presents the first qualitative analysis of the daily realities of adults and parents of children with allergies in SSA using Ghana as a case study. Drawing on political ecology of health, this study contextualizes the psychological (e.g. anxiety and fear), social (e.g. stigmatization, social exclusion), and economic (e.g. impact on work & household expenditures) wellbeing of affected persons within the broader sociocultural environment. By exploring the sociocultural environment, the results provide insights into the likely structures (e.g. the lack of familiarity, absence of local discursive repertoire on food allergy, infrastructure deficit) which interact to shape anxiety, and social exclusion of people with allergy. The case study provides evidence suggesting food allergies do have a global reach, and policy makers must heed the message to integrate food allergy into the broader chronic disease prevention agenda.

Political Ecologies of Global Health: Pesticide Exposure in Southwestern Ecuador's Banana Industry

Pesticide exposure in Ecuador's banana industry reflects political economic and ecological processes that interact across scales to affect human health. We use this case study to illustrate opportunities for applying political ecology of health scholarship in the burgeoning field of global health. Drawing on an historical literature review and ethnographic data collected in Ecuador's El Oro province, we present three main areas where a political ecological approach can enrich global health scholarship: perceptive characterization of multi-scalar and ecologically entangled pathways to health outcomes; critical analysis of discursive dynamics such as competing scalar narratives; and appreciation of the environment-linked subjectivities and emotions of people experiencing globalized health impacts. Rapprochement between these fields may also provide political ecologists with access to valuable empirical data on health outcomes, venues for engaged scholarship, and opportunities to synthesize numerous insightful case studies and discern broader patterns.

A matter of perception: Perceived socio-economic status and cortisol on the island of Utila, Honduras

OBJECTIVES

Numerous studies link low objective and subjective socioeconomic status (SES) to chronic activation of the hypothalamic pituitary adrenal (HPA) axis. Here, we examine associations between objective and subjective SES and diurnal salivary cortisol, a primary HPA component, as well as demographic and ecological predictors associated with SES perceptions and changes in diurnal cortisol.

METHODS

Participants were residents (age 18-79, n = 61) of Utila, a Honduran island where economic disparities are overt and geographically contained. Objective SES was measured as a composite of income, education, and occupation. Subjective SES was measured with a MacArthur ladder and a perceived lifestyle discrepancy (PLD) scale. Salivary cortisol was collected three times per day for two days. Questions addressing demographic, social, and household characteristics were assessed as predictors of PLD.

RESULTS

Assessed independently, objective SES (P = .06) and PLD (P = .003) were associated with the steepness of diurnal cortisol changes, while PLD was also associated with higher cortisol area under the curve (AUC) (P = .036). Modeled together, only PLD predicted diurnal slope and AUC. PLD was associated with household sanitation, immigration status, food scarcity, objective SES, and owing money. Only access to sanitation and owing money had direct associations with cortisol that were not mediated by PLD.

CONCLUSIONS

For adults on Utila, perceptions of unmet need outweigh other social and economic status factors in predicting cortisol AUC and slope. In addition, the unmediated effects of access to sanitation and owing money on cortisol suggest that these distinct aspects of inequality are important to consider when seeking to understand how inequality can impact HPA function.

Agroecology and sustainable food systems: Participatory research to improve food security among HIV-affected households in northern Malawi

This article shares results from a long-term participatory agroecological research project in northern Malawi. Drawing upon a political ecology of health conceptual framework, the paper explores whether and how participatory agroecological farming can improve food security and nutrition among HIV-affected households. In-depth interviews were conducted with 27 farmers in HIV-affected households in the area near Ekwendeni Trading Centre in northern Malawi. The results show that participatory agroecological farming has a strong potential to meet the food, dietary, labour and income needs of HIV-affected households, whilst helping them to manage natural resources sustainably. As well, the findings reveal that place-based politics, especially gendered power imbalances, are imperative for understanding the human impacts of the HIV/AIDS epidemic. Overall, the study adds valuable insights into the literature on the human-environment dimensions of health. It demonstrates that the onset of disease can radically transform the social relations governing access to and control over resources (e.g., land, labour, and capital), and that these altered social relations in turn affect sustainable disease management. The conclusion highlights how the promotion of sustainable agroecology could help to partly address the socio-ecological challenges associated with HIV/AIDS.

Contextual Predictors of Injection Drug Use Among Black Adolescents and Adults in US Metropolitan Areas, 1993-2007

OBJECTIVES

We sought to determine whether contextual factors shape injection drug use among Black adolescents and adults.

METHODS

For this longitudinal study of 95 US metropolitan statistical areas (MSAs), we drew annual MSA-specific estimates of the prevalence of injection drug use (IDU) among Black adolescents and adults in 1993 through 2007 from 3 surveillance databases. We used existing administrative data to measure MSA-level socioeconomic status; criminal justice activities; expenditures on social welfare, health, and policing; and histories of Black uprisings (1960-1969) and urban renewal funding (1949-1974). We regressed Black IDU prevalence on these predictors by using hierarchical linear models.

RESULTS

Black IDU prevalence was lower in MSAs with declining Black high-school dropout rates, a history of Black uprisings, higher percentages of Black residents, and, in MSAs where 1992 White income was high, higher 1992 Black income. Incarceration rates were unrelated.

CONCLUSIONS

Contextual factors shape patterns of drug use among Black individuals. Structural interventions, especially those that improve Black socioeconomic security and political strength, may help reduce IDU among Black adolescents and adults.

A framework to promote collective action within the One Health community of practice: Using participatory modelling to enable interdisciplinary, cross-sectoral and multi-level integration

As Southeast Asia (SEA) is characterized by high human and domestic animal densities, growing intensification of trade, drastic land use changes and biodiversity erosion, this region appears to be a hotspot to study complex dynamics of zoonoses emergence and health issues at the Animal–Human–Environment interface. Zoonotic diseases and environmental health issues can have devastating socioeconomic and wellbeing impacts. Assessing and managing the related risks implies to take into account ecological and social dynamics at play, in link with epidemiological patterns.

The implementation of a One Health (OH) approach in this context calls for improved integration among disciplines and improved cross-sectoral collaboration, involving stakeholders at different levels. For sure, such integration is not achieved spontaneously, implies methodological guidelines and has transaction costs. We explore pathways for implementing such collaboration in SEA context, highlighting the main challenges to be faced by researchers and other target groups involved in OH actions. On this basis, we propose a conceptual framework of OH integration. Throughout 3 components (field-based data management, professional training workshops and higher education), we suggest to develop a new culture of networking involving actors from various disciplines, sectors and levels (from the municipality to the Ministries) through a participatory modelling process, fostering synergies and cooperation. This framework could stimulate long-term dialogue process, based on the combination of case studies implementation and capacity building. It aims for implementing both institutional OH dynamics (multi-stakeholders and cross-sectoral) and research approaches promoting systems thinking and involving social sciences to follow-up and strengthen collective action.

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One Health framework is both an institutional movement and a set of research topics.

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One Health calls for inter-disciplinary, cross-sectoral and multi-level integration.

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These integration processes call for strong methodological guidelines.

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Participatory modelling and social sciences enable this integration.

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Participatory modelling promotes One Health collective action.

Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana

BACKGROUND

The Ghana Community based Health Planning and Services (CHPS) strategy targets to bring health services to the doorsteps of clients in a manner that improves maternal and child health outcomes. In this strategy, referral is an important component but it is threatened in a rural context where transportation service is a problem. Few studies have examined perceptions of rural dwellers on transportation challenges in accessing maternal health care services within CHPS.

METHODS

Using the political ecology of health framework, this paper investigates transportation barriers in health access in a rural context based on perceived cause, coping mechanisms and strategies for a sustainable transportation system. Eight (8) focus group discussions involving males (n = 40) and females (n = 45) in rural communities in a CHPS zone in the Upper West Region of Ghana were conducted between September and December 2013.

RESULTS

Lack of vehicular transport is suppressing the potential positive impact of CHPS on maternal and child health. Consistent neglect of road infrastructural development and endemic poverty in the study area makes provision of alternative transport services for health care difficult. As a result, pregnant women use risky methods such as bicycle/tricycle/motorbikes to access obstetric health care services, and some turn to traditional medicines and traditional birth attendants for maternal health care services.

CONCLUSION

These findings underscore the need for policy to address rural transport problems in order to improve maternal health. Community based transport strategy with CHPS is proposed to improve adherence to referral and access to emergency obstetric services.

"That land means everything to us as Anishinaabe….": Environmental dispossession and resilience on the North Shore of Lake Superior

This article shares results of a community-based (CBR) study that qualitatively examined the perceived health impacts of environmental dispossession among Elders in two Anishinaabe communities in Ontario, Canada. Through in-depth interviews, Elders (n=46) recounted changes in health and well-being, specifically that related to reduced access to traditional foods and decreased capacity to participate in, and share knowledge of, land-based practices. Elders discussed the ways in which they have remained resilient to these changes in their ways of living. With a greater purpose of proposing solutions that will improve contemporary patterns of Indigenous health, this research underscores the importance of engaging theoretically in concepts of environmental dispossession and resilience.

Reconceptualizing determinants of health: barriers to improving the health status of First Nations peoples

Comparing the key determinants of health articulated by the Public Health Agency of Canada (the Agency) with the spiritual and cultural knowledge systems of First Nations peoples, as expressed by the Four Worlds International Institute for Human and Community Development (Four Worlds) and their 14 determinants of well-being and health, reveals differing philosophical perspectives. The key determinants of health can be interpreted as lacking a holistic and inclusive approach to public health services. As a result, many public health programs in Canada marginalize, ignore and suppress the needs of First Nations communities and people. Incorporating the Four Worlds guiding principles and its 14 health determinants model within the context of Canadian public health services geared towards First Nations populations provides the opportunity to develop a deeper understanding of social determinants of health. Therefore, when implementing public health initiatives to address the health status of First Nations people in Canada, it is important that the Agency incorporate the guiding principles of the Four Worlds: Development Comes from Within; No Vision, No Development; Individual and Community Transformations Must Go Hand in Hand; and Holistic Learning is the Key to Deep and Lasting Change. Reconceptualizing the key determinants of health to encompass the worldview expressed by the Four Worlds acknowledges the cultural wisdom of First Nations people and offers the potential to develop more inclusive public health services.

Landscape structure and diseases profile: associating land use type composition with disease distribution

Human health and well-being presuppose environmental quality. Several studies have documented the indicative role of land use types in environmental quality. However, the exact role of land use composition on disease distribution has remained scientifically vague. We assessed the congruence of diseases' distribution with land use composition, focusing on high environmental quality areas, defined as tranquil areas with view to indicating places offering well-being. Landscape composition is linked to the presence of diseases across 51 prefectures of Greece. Agricultural and natural land use types proved to be the main drivers of disease distribution. Tranquility demonstrated a strong negative correlation with population density, thus could be considered as a quantitative spatial index of life-quality. We concluded that the landscape context affects the dominance of diseases' patterns. Special emphasis should be put on the role of tranquil areas in human health and the relative environmental health policies.

Health and the built environment: exploring foundations for a new interdisciplinary profession

The supportive role of the built environment for human health is a growing area of interdisciplinary research, evidence-based policy development, and related practice. Nevertheless, despite closely linked origins, the contemporary professions of public health and urban planning largely operate within the neoliberal framework of academic, political, and policy silos. A reinvigorated relationship between the two is fundamental to building and sustaining an effective “healthy built environment profession.” A recent comprehensive review of the burgeoning literature on healthy built environments identified an emergent theme which we have termed “Professional Development.” This literature relates to the development of relationships between health and built environment professionals. It covers case studies illustrating good practice models for policy change, as well as ways professionals can work to translate research into policy. Intertwined with this empirical research is a dialogue on theoretical tensions emerging as health and built environment practitioners and researchers seek to establish mutual understanding and respect. The nature of evidence required to justify policy change, for example, has surfaced as an area of asynchrony between accepted disciplinary protocols. Our paper discusses this important body of research with a view to initiating and supporting the ongoing development of an interdisciplinary profession of healthy planning.