Coming together as a whole: lessons from connecting across sectors, cultures, and contexts to elevate efforts for planetary health.

BACKGROUND: Addressing complex and interconnected ecological, social, and health issues necessitates upstream, solutions-oriented, and whole-systems thinking. Specifically, exploring what it means to live in reciprocity with the planet and all living systems, now and for generations to come, can have a crucial role in advancing planetary health. METHODS: In this presentation, we show findings from four gatherings that we co-designed and co-hosted to connect communities, lands, waters, climate, and health. We draw lessons from two events in the Cowichan watershed (co-hosted by Cowichan Tribes) and the Stellako and Nechako watersheds (co-hosted by Stellat'en First Nation) that were co-designed with the ECHO Network. These gatherings brought together youth, Indigenous leaders, researchers, and health, community, and environmental decision-makers across British Columbia to learn how to address connected health, environmental, and community concerns. We supplement these findings with insights from two co-hosted conversations, that connected five continents and more than 40 countries, each enabling 24 h of continuous dialogue on the theme of working together for a healthy, just, and sustainable planet. FINDINGS: Gatherings took place between Oct 12, 2022, and Dec 1, 2023. These gatherings each provided lessons about how Indigenous-led, integrative approaches that connect the health of people to lands, waters, and ecosystems can elevate and enhance our work and scholarship to address ecological, social, and health issues. Specifically, initiatives co-designed in this way help overcome challenges that arise when addressing boundary-crossing, intersectional and intersectoral issues at the nexus of climate, public health, and planetary health. Our findings include insights into strengthening research and public health capacity for integrative approaches to complex issues that are relevant to place-based contexts and have implications and applications for planetary health. INTERPRETATION: Our presentation summarises how these gatherings-each of which were fuelled by a sense of love for the planet, each other, and future generations-have progressed intersectoral, intergenerational, boundary-crossing, and transformative approaches to planetary health. These insights help guide future directions for planetary health research, practice, and policy. FUNDING: The Canadian Institute of Health Research Environment (IP4150712), Michael Smith Health Research BC (RA-2022-2872), and Vancouver Foundation (FOI19-1781).

On the possibility of decolonising planetary health: exploring new geographies for collaboration.

Decolonial planetary health aspires to centre the diversity and importance of Indigenous thought and stewardship. In this Viewpoint, we explore research in planetary health across holistic worldviews and western scientific approaches. We base our examination of decolonising interventions in planetary health by exploring how global trajectories play out in British Columbia, Canada. A central part of this analysis is highlighting intercultural thinking to promote an anti-colonial, anti-racist, and reciprocal approach to climate change and global health inequities across geographical space and within planetary health discourse. Our perspective encompasses an asset-based examination, which focuses on the Indigenous scholarship in planetary health that is already underway and considers how rigorous engagement with epistemic and geographical diversity can strengthen and advance planetary health. This is a place-based response to planetary health, as British Columbia experiences climate catastrophes that are impacting whole communities, cutting through major transportation systems, disrupting supply chains, and creating a further burden on public health agencies and authorities that are spread thin by COVID-19 response. We argue for a progressive acknowledgment of decolonising work that is pushing research and practice in planetary health forward.

Towards an educational praxis for planetary health: a call for transformative, inclusive, and integrative approaches for learning and relearning in the Anthropocene.

Fuelled by the intersecting challenges of climate change, biodiversity loss, pollution, and profound social, economic, and environmental injustices, calls for new ways to work together for a healthy, just, and sustainable future are burgeoning. Consequently, there is a growing imperative and mandate across the higher education space for transformative, inclusive, integrative-and sometimes disruptive-approaches to learning that strengthen our capacity to work towards the goals and imperatives of planetary health. This educational transformation requires attention to pathways of societal, policy, and system change, prioritising different voices and perspectives across jurisdictions, cultures, and learning contexts. This Viewpoint seeks to explore the developing areas of education for planetary health, while additionally reflecting on a praxis for education in the Anthropocene that is rooted within the confluence of diverse knowledges and practice legacies that have paved the way to learning and relearning for planetary health.

Transformative learning for a sustainable and healthy future through ecosystem approaches to health: insights from 15 years of co-designed ecohealth teaching and learning experiences.

This paper presents insights from the work of the Canadian Community of Practice in Ecosystem Approaches to Health (CoPEH-Canada) and 15 years (2008-2022) of land-based, transdisciplinary, learner-centred, transformative learning and training. We have oriented our learning approaches to Head, Hands, and Heart, which symbolise cognitive, psychomotor, and affective learning, respectively. Psychomotor and affective learning are necessary to grapple with and enact far-reaching structural changes (eg, decolonisation) needed to rekindle healthier, reciprocal relationships with nature and each other. We acknowledge that these approaches have been long understood by Indigenous colleagues and communities. We have developed a suite of teaching techniques and resources through an iterative and evolving pedagogy based on participatory approaches and operating reciprocal, research-pedagogical cycles; integrated different approaches and ways of knowing into our pedagogy; and built a networked Community of Practice for continued learning. Planetary health has become a dominant framing for health-ecosystem interactions. This Viewpoint underscores the depth of existing scholarship, collaboration, and pedagogical expertise in ecohealth teaching and learning that can inform planetary health education approaches.

Cumulative Impacts of Diverse Land Uses in British Columbia, Canada: Application of the "EnviroScreen" Method.

(1) Objectives: Cumulative impacts refer to the legacies of land use decisions on environmental, community and health values. New integrative impact assessment tools are required to assess cumulative impacts on diverse values to meet sustainability goals in the 21st century. In this contribution, the CalEnviroScreen methodology-a screening tool capable of merging environmental, socioeconomic and health data-is applied to Local Health Areas in British Columbia, Canada. (2) Methods: The CalEnviroScreen is a method that standardizes environmental, socioeconomic and health data to depict an indicator's percentile rank in the distribution of all units of analysis. The method combines indicators to measure four dimensions of pressure: environmental exposures, environmental effects, socioeconomic conditions, and sensitive populations (i.e., health outcomes). We create two versions of EnviroScreen: one following the CalEnviroScreen suite of indicators, and another that uses nuanced indicators to approximate the realities of industrial land uses present in British Columbia. BCEnviroScreen scores are plotted by race/ethnicity to understand potential racial inequities in cumulative exposures. (3) Results: The BCEnviroScreen has a greater likelihood of quantifying the cumulative impacts of diverse industries and land uses present across resource-dependent parts of the province, relative to the more urban-centric CalEnviroScreen indicator suite. Analyzing the distribution of BCEnviroScreen scores by race/ethnicity suggests that visible minority populations may be inequitably exposed to cumulative impacts in BC. (4) Conclusion: EnviroScreen tools hold significant potential to influence Canadian environmental health policy. This research demonstrates the applicability of the tool to British Columbia and other jurisdictions, illustrates how indicators can be tailored to better represent regional context, and shows how the tool can be used to screen for potential environmental health injustices.

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.

Exploring Cross-Sectoral Implications of the Sustainable Development Goals: Towards a Framework for Integrating Health Equity Perspectives With the Land-Water-Energy Nexus.

Objectives: To assess existing evidence and identify gaps in the integrative framework of the Sustainable Development Goals (SDGs) for their potential to advance cross-sectoral perspectives and actions that connect health equity with the land-water-energy nexus in a watershed context. Methods: Five bibliographic databases were searched from 2016 to 2021. This yielded an initial 226 publications, which were screened for titles, abstracts, and full texts on DistillerSR; resulting in a final 30 publications that were studied. These keywords defined the search terms: "health equity," "SDGs," "watershed," "resource nexus," and "cross-sectoral." Results: Thematic syntheses of debates and gaps point to the relevance of the SDGs as a cross-sectoral, integrative platform for place-based programming of the land-water-energy nexus, and to account for negative externalities and cascaded impacts on human and environmental health. Conclusion: For the purpose of monitoring health equity in the contexts of interactions of land, water, and energy in rural, remote, and Indigenous contexts, and on the basis of the SDGs, this paper generates evidence to inform health equity-oriented policies, programs and practices, and to enhance health for equity-seeking populations.

Patient- and Community-Oriented Primary Care Approaches for Health in Rural, Remote and Resource-Dependent Places: Insights for Eco-Social Praxis.

Accelerating ecological and societal changes require re-imagining the role of primary care and public health to address eco-social concerns in rural and remote places. In this narrative review, we searched literatures on: community-oriented primary care, patient-oriented research engagement, public health and primary care synergies, and primary care addressing social determinants of health. Our analysis was guided by questions oriented to utility for addressing concerns of social-ecological systems in rural, remote contexts characterized by a high degree of reliance on resource extraction and development (e.g., forestry, mining, oil and gas, fisheries, agriculture, ranching and/or renewables). We describe a range of useful frameworks, processes and tools that are oriented toward bolstering the resilience and engagement of both primary care and public health, though few explicitly incorporated considerations of eco-social approaches to health or broader eco-social context(s). In synthesizing the existing evidence base for integration between primary care and public health, the results signal that for community-oriented primary care and related frameworks to be useful in rural and remote community settings, practitioners are required to grapple with complexity, durable relationships, sustainable resources, holistic approaches to clinician training, Indigenous perspectives, and governance.

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.

Mining sick: Creatively unsettling normative narratives about industry, environment, extraction, and the health geographies of rural, remote, northern, and Indigenous communities in British Columbia.

Rural, remote, northern, and Indigenous communities on Turtle Island are routinely-as Cree Elder Willie Ermine says-pathologized. Social science and health scholarship, including scholarship by geographers, often constructs Indigenous human and physical geographies as unhealthy, diseased, vulnerable, and undergoing extraction. These constructions are not inaccurate: peoples and places beyond urban metropoles on Turtle Island live with higher burdens of poor health; Indigenous peoples face systemic violence and racism in colonial landscapes; rural, remote, northern, and Indigenous geographies are sites of industrial incursions; and many rural and remote geographies remain challenging for diverse Indigenous peoples. What, however, are the consequences of imagining and constructing people and places as "sick"? Constructions of "sick" geographies fulfill and extend settler (often European white) colonial narratives about othered geographies. Rural, remote, northern, and Indigenous geographies are discursively "mined" for narratives of sickness. This mining upholds a sense of health and wellness in southern, urban, Euro-white-settler imaginations. Drawing from multi-year, relationship-based, cross-disciplinary qualitative community-informed experiences, and anchored in feminist, anti-colonial, and anti-racist methodologies that guided creative and humanities-informed stories, this paper concludes with different stories. It unsettles settler-colonial powers reliant on constructing narratives about sickness in others and consequently reframes conversations about Indigenous well-being and the environment.

Les communautés autochtones, nordiques et rurales de Turtle Island sont, comme le dit l'aîné cri Willie Ermine, couramment considérées comme pathogènes. Le discours professoral en sciences sociales et en santé, y compris chez les géographes, conçoit souvent les géographies autochtones, tant humaines que physiques, comme étant malsaines, malades, vulnérables et soumises à l'extraction. Ces conceptions ne sont pas erronées: les gens et les endroits en dehors des agglomérations urbaines sur Turtle Island sont davantage exposés à un état de santé précaire, les Autochtones font face à une violence et un racisme systémique dans les milieux coloniaux, les géographies autochtones, nordiques et rurales sont le siège d'incursions industrielles et de nombreux contextes territoriaux ruraux et éloignés continuent de présenter un défi pour diverses populations autochtones. Toutefois, quelles sont les conséquences d'imaginer et de concevoir les gens et les endroits comme étant « malades ¼? Le concept de territoires « malades ¼ favorise et consolide les récits coloniaux (souvent le blanc européen) sur l'état d'autres territoires, lesquels seraient dans une situation plus favorable. Les géographies autochtones, nordiques et rurales sont alors « minées ¼ de manière discursive par les récits sur leur caractère pathogène. Ce minage soutient une impression de santé et de bien­être dans l'imaginaire colonial, blanc européen et urbain des populations du sud. S'inspirant d'expériences communautaires qualitatives éclairées interdisciplinaires pluriannuelles axées sur les relations et ancrées dans les méthodologies féministes, anticoloniales et antiracistes qui ont guidé les discours créatifs inspirés par les sciences humaines, le présent texte se termine avec des récits différents. Ceux­ci déstabilisent les pouvoirs coloniaux qui se fondent sur le concept de territoire pathogène et, par conséquent, ré­interprètent les perceptions et les affirmations sur l'environnement et le bien­être des Autochtones.

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

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

Education for sustainable healthcare: Leadership to get from here to there.

The current global crises, including climate, COVID-19, and environmental change, requires global collective action at all scales. These broad socio-ecological challenges require the engagement of diverse perspectives and ways of knowing and the meaningful engagement of all generations and stages of personal and professional development. The combination of systems thinking, change management, quality improvement approaches and models, appreciative/strength-based approaches, narratives, storytelling and the strengths of Indigenous knowledges, offer synergies and potential that can set the stage for transformative, strengths-based education for sustainable healthcare (ESH). The need for strong leadership to enact a vision for ESH is outlined here with the intent to enable and nurture the conditions for change, ultimately improving health and well-being across generations.

Associations of five food- and water-borne diseases with ecological zone, land use and aquifer type in a changing climate.

BACKGROUND: Food- and water-borne pathogens exhibit spatial heterogeneity, but attribution to specific environmental processes is lacking while anthropogenic climate change alters these processes. The goal of this study was to investigate ecology, land-use and health associations of these pathogens and to make future disease projections. METHODS: The rates of five acute gastrointestinal illnesses (AGIs) (campylobacteriosis, Verotoxin- producing Escherichia coli, salmonellosis, giardiasis and cryptosporidiosis) from 2000 to 2013 in British Columbia, Canada, were calculated across three environmental variables: ecological zone, land use, and aquifer type. A correlation analysis investigated relationships between 19 climatic factors and AGI. Mean annual temperature at the ecological zone scale was used in a univariate regression model to calculate annual relative AGI risk per 1 °C increase. Future cases attributable to climate change were estimated into the 2080s. FINDINGS: Each of the bacterial AGI rates was correlated with several annual temperature-related factors while the protozoan AGIs were not. In the regression model, combined relative risk for the three bacterial AGIs was 1.1 [95% CI: 1.02-1.21] for every 1 °C in mean annual temperature. Campylobacteriosis, salmonellosis and giardiasis rates were significantly higher (p < 0.05) in the urban land use class than in the rural one. In rural areas, bacteria and protozoan AGIs had significantly higher rates in the unconsolidated aquifers. Verotoxin-producing Escherichia coli rates were significantly higher in watersheds with more agricultural land, while rates of campylobacteriosis, salmonellosis and giardiasis were significantly lower in agricultural watersheds. Ecological zones with higher bacterial AGI rates were generally projected to expand in range by the 2080s. INTERPRETATION: These findings suggest that risk of AGI can vary across ecosystem, land use and aquifer type, and that warming temperatures may be associated with an increased risk of food-borne AGI. In addition, spatial patterns of these diseases are projected to shift under climate change.

Preparing for the future of public health: ecological determinants of health and the call for an eco-social approach to public health education.

As a collective organized to address the education implications of calls for public health engagement on the ecological determinants of health, we, the Ecological Determinants Group on Education (cpha.ca/EDGE), urge the health community to properly understand and address the importance of the ecological determinants of the public's health, consistent with long-standing calls from many quarters-including Indigenous communities-and as part of an eco-social approach to public health education, research and practice. Educational approaches will determine how well we will be equipped to understand and respond to the rapid changes occurring for the living systems on which all life-including human life-depends. We revisit findings from the Canadian Public Health Association's discussion paper on 'Global Change and Public Health: Addressing the Ecological Determinants of Health', and argue that an intentionally eco-social approach to education is needed to better support the health sector's role in protecting and promoting health, preventing disease and injury, and reducing health inequities. We call for a proactive approach, ensuring that the ecological determinants of health become integral to public health education, practice, policy, and research, as a key part of wider societal shifts required to foster a healthy, just, and ecologically sustainable future.

Towards environmental health equity in health impact assessment: innovations and opportunities.

OBJECTIVES: As global environmental change drives inequitable health outcomes, novel health equity assessment methodologies are increasingly required. We review literatures on equity-focused HIA to clarify how equity is informing HIA practice, and to surface innovations for assessing health equity in relation to a range of exposures across geographic and temporal scales. METHODS: A narrative review of the health equity and HIA literatures analysed English articles published between 2003 and 2017 across PubMed, PubMed Central, Biomed Central and Ovid Medline. Title and abstract reviews of 849 search results yielded 89 articles receiving full text review. RESULTS: Considerations of equity in HIA increased over the last 5 years, but equity continues to be conflated with health disparities rather than their root causes (i.e. inequities). Lessons from six literatures to inform future HIA practice are described: HIA for healthy cities, climate change vulnerability assessment, cumulative health risk assessment, intersectionality-based policy analysis, corporate health impact assessment and global health impact assessment. CONCLUSIONS: Academic reporting on incorporating equity in HIA practice has been limited. Nonetheless, significant methodological advancements are being made to examine the health equity implications of multiple environmental exposures.

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.

Public health guide to field developments linking ecosystems, environments and health in the Anthropocene.

The impacts of global environmental change have precipitated numerous approaches that connect the health of ecosystems, non-human organisms and humans. However, the proliferation of approaches can lead to confusion due to overlaps in terminology, ideas and foci. Recognising the need for clarity, this paper provides a guide to seven field developments in environmental public health research and practice: occupational and environmental health; political ecology of health; environmental justice; ecohealth; One Health; ecological public health; and planetary health. Field developments are defined in terms of their uniqueness from one another, are historically situated, and core texts or journals are highlighted. The paper ends by discussing some of the intersecting features across field developments, and considers opportunities created through such convergence. This field guide will be useful for those seeking to build a next generation of integrative research, policy, education and action that is equipped to respond to current health and sustainability challenges.

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.