How to carry out participatory research that takes account of sex and gender issues: a scoping review of guidelines targeting health inequities.

OBJECTIVE: Conducting participatory research (PR) aimed at improving health implies considering inequitable power relations, including those related to sex/gender (S/G). This necessitates specific skills and methods and may be challenging especially since guidelines are scarce. Our objective was to perform a scoping review to provide a typology of existing guidelines for researchers on how to take account of S/G in the context of PR in public health, with a focus on occupational and environmental health. METHODS: All steps of the research were conducted with the collaboration of an advisory committee, following PR principles. Nineteen documents were retained from 513 references identified in nine scientific databases and grey literature between 2000 and 2020. Data on recommendations were extracted and coded qualitatively. Cluster analysis based on similarities in recommendations proposed in the documents identified four types: (1) empowerment-centered; (2) concrete action-centered; (3) macrosystem-centered; and (4) stakeholder-centered. SYNTHESIS: Many sources gave pointers on how to include S/G during data collection and analysis or during the dissemination of findings, but there was a dearth of suggestions for building partnerships with stakeholders and producing sustainable S/G sociopolitical transformations. Occupational health PR showed less similarities with other public health subfields including environmental health PR. Power relationships with workplace stakeholders generated specific obstacles related to S/G integration that require further attention. Intersectionality and reflexive practices emerged as overarching themes. CONCLUSION: This review provides helpful guidelines to researchers at different stages of planning PR, ranging from familiarizing themselves with S/G approaches to anticipating difficulties in their ongoing S/G-transformative PR.

RéSUMé: OBJECTIF: Les recherches participatives (RP) visant l'amélioration de la santé doivent tenir compte de rapports de pouvoir inéquitables, incluant ceux liés au sexe/genre (S/G). Cela peut s'avérer difficile vu les compétences requises et la rareté de recommandations. Notre objectif consistait à réaliser une revue de portée menant à une typologie des recommandations existantes pour les chercheurs.euses sur l'intégration du S/G en contexte de RP en santé publique, particulièrement en santé environnementale ou au travail. MéTHODOLOGIE: Un comité d'encadrement a participé à chaque étape de l'étude. Nous avons retenu 19 documents parmi 513 références identifiées dans neuf bases de données scientifiques et la littérature grise (2000­2020). L'extraction et le codage qualitatif des recommandations a mené à une analyse de clusters basée sur les similitudes identifiant quatre types centrés sur : 1) pouvoir d'agir; 2) actions concrètes; 3) macro-système; et 4) parties prenantes. SYNTHèSE: Plusieurs sources indiquaient comment intégrer le S/G pendant la collecte/analyse des données ou la diffusion des résultats. Peu de recommandations touchaient l'aspect S/G au niveau des partenariats avec des parties prenantes ou des transformations sociopolitiques durables. Les recommandations en santé au travail étaient moins similaires aux autres sous-domaines de santé publique. Les relations de pouvoir en milieu de travail engendrent des obstacles spécifiques liés à l'intégration du S/G et nécessitent une attention particulière. L'intersectionnalité et les pratiques réflexives sont apparues comme des thèmes primordiaux. CONCLUSION: Les recommandations repérées aideront des chercheurs.euses à différents stades de leur parcours d'intégration du S/G dans une RP en cours, allant de la familiarisation à l'anticipation de difficultés.

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.

Integration of sex and gender in interventions by students in ergonomics.

This article aims to analyse the integration of sex and gender (s/g) by ergonomics students during their internship at the master's degree level, following training sessions on s/g issues in the workplace. This exploratory research used a descriptive mixed-methods design, encompassing evaluation of students' intention to use the content from the training (n = 13 students), and a multiple case study (n = 5 ergonomics interventions). The results show that while students found the training relevant, they only minimally integrated s/g in their interventions and when they did, it was primarily from an anthropometric and physiological perspective. In addition to discussing the training format limitations, the article discusses barriers to this integration: combining learning about s/g issues with learning about activity analysis is challenging; employers' and workers' organisations may be reluctant to approach s/g issues; and it is difficult for an ergonomist to integrate these issues when the employer's request does not specify it.Practitioner summary: This article aims to analyse the integration of s/g by ergonomics students during their internships. Findings show that they only minimally considered s/g. The discussion examines s/g training, organisational obstacles to inclusion of s/g during interventions, and how ergonomists can consider s/g in their practice.

Impacts of considering sex and gender during intervention studies in occupational health: Researchers' perspectives.

The aim of this article is to examine the impacts of incorporating sex and gender (s/g) analysis in integrated knowledge translation (iKT) initiatives in the field of ergonomics and occupational health. The article presents findings based on a retrospective analysis of twelve intervention-research (IR) studies, including a thematic content analysis of in-depth interviews conducted with 15 researchers involved in these IRs. The findings offer an overview of various categories of impacts, such as changes in partners' views, in workplace settings and conditions, in practices and policies, and in economic outcomes. In these types of IR, health effects measurement is not the main objective, and direct health outcomes are difficult to assess. Explicitly talking about sex/gender led more often to system-level changes but less often to workplace-level changes, compared to interventions where sex/gender was not identified as a specific object of the intervention.

Levels of 1-hydroxypyrene in urine of people living in an oil producing region of the Andean Amazon (Ecuador and Peru).

PURPOSE: Polycyclic aromatic hydrocarbons (PAHs) are contaminants with carcinogenic effects but little is known about their presence in environments surrounding oil drilling operations and spills or exposure levels in nearby communities. The objective of this study was to characterize PAH levels in people living near oil drilling operations in relation to fish consumption, occupation, source of water and other socio-demographic characteristics. METHODS: This pilot study examined PAH exposure by measuring 1-hydroxypyrene (1-OHP) in urine samples using high-performance liquid chromatography and fluorescence detection from 75 women and men in the Ecuadorian and Peruvian Amazon living near oil drilling operations and who answered a questionnaire collecting socio-demographic, occupational and dietary information. Data were analyzed using multiple linear regression models. RESULTS: The mean value of 1-OHP was 0.40 µmol/mol creatinine, 95% CI 0.32-0.46 µmol/mol creatinine. Women who used water from a surface source (for washing clothes or bathing) had almost twice the amount of 1-OHP in their urine (mean 1-OHP = 0.41 µmol/mol creatinine, 95% CI 0.28-0.54 µmol/mol creatinine, n = 23) as women who used water from either a well, a spring or rain (mean 1-OHP = 0.22 µmol/mol creatinine, 95% CI 0.11-0.34 µmol/mol creatinine, n = 6). Men who reported eating a bottom-dwelling species as their most commonly consumed fish (mean 1-OHP = 0.50 µmol/mol creatinine, 95% CI 0.36-0.64 µmol/mol creatinine, n = 31) had twice as much 1-OHP in their urine as men who reported a pelagic fish (mean 1-OHP = 0.25 µmol/mol creatinine, 95% CI 0.15-0.35 µmol/mol creatinine, n = 15), signaling either oral (fish consumption) or dermal (while standing in water fishing benthic species) exposure. CONCLUSIONS: More contact with surface water and benthic fish may result in higher levels of 1-OHP in human urine among the study population. Reducing the amount of oil and wastes entering the waterways in Andean Amazonia would be one way to reduce exposure.

Mercury concentrations in urine of amerindian populations near oil fields in the peruvian and ecuadorian amazon.

BACKGROUND: Mercury is a global contaminant with toxic, persistent effects on human health. Petroleum extraction is an important source of elemental mercury; little is known about human exposure levels near oil fields in the Amazon basin. OBJECTIVES: To characterize mercury levels in people living near oil production sites in the Peruvian and Ecuadorian Amazon, controlling for fish consumption, occupation, source of water and socio-demographic characteristics. METHODS: Analyze mercury levels in urine samples using cold vapour atomic fluorescence spectrometry from 76 indigenous men and women in eight riverine communities situated near oil wells or pipelines. Subjects answered a questionnaire soliciting socio-demographic, occupational and dietary information. Data were analyzed using multiple linear regression modeling. RESULTS: The mean value of U-Hg was 2.61µg/g creatinine (95% CI: 2.14-3.08), with 7% of the sample recording values above the global background standard suggested by The World Health Organization (5µg/g creatinine). Women who used water from a surface source had two and a half times the amount of mercury in their urine (mean=3.70µg/g creatinine, 95% CI: 2.26-5.15) compared with women who used other water sources (mean =1.39µg/g creatinine, 95% CI: 0.51-2.25). Men who were involved in an oil clean-up operation had twice as much mercury in their urine (mean =3.07µg/g creatinine, 95% CI: 1.97-4.16) as did those who worked on other tasks (mean =1.56µg/g creatinine, 95% CI: 1.48-2.65). Mercury levels were not associated with the number of fish meals per week. CONCLUSIONS: Indigenous peoples of the Peruvian and Ecuadorian Amazon living near oil production sites generally had urine mercury levels within the global background standard suggested by the World Health Organization. Increased levels of mercury in urine were detected for men involved in oil spill remediation and for women who relied on surface water for household needs. These findings signal the need for strict safety measures to limit the amount of oil entering the waterways in Andean Amazonia so as to protect the health of indigenous people.

Mercury Contamination in an Indicator Fish Species from Andean Amazonian Rivers Affected by Petroleum Extraction.

Elevated mercury (Hg) concentrations in fish from Amazonia have been associated with gold-mining, hydroelectric dams and deforestation but few studies consider the role of petroleum extraction. Hg levels were determined in fish samples collected in three river basins in Ecuador and Peru with contrasting petroleum exploitation and land-use characteristics. The non-migratory, piscivorous species, Hoplias malabaricus, was used as a bioindicator. The rate of Hg increase with body weight for this species was significantly higher on the Corrientes River, near the site of a recent oil spill, than on the other two rivers. In the absence of substantial deforestation and other anthropogenic sources in the Corrientes River basin, this finding suggests that oil contamination in Andean Amazonia may have a significant impact on Hg levels in fish.

Ecohealth as a field: looking forward.

This forum paper proposes a reflection on the "field of ecohealth" and on how best to sustain a supportive environment that enables the evolution of diverse partnerships and forms of collaboration in the field. It is based on the results of a preconference workshop held in October 2012, in Kunming, China at the fourth biennial conference of the International Association for Ecology and Health. Attended by 105 persons from 38 countries, this workshop aimed to have a large-group and encompassing discussion about ecohealth as an emerging field, touching on subjects such as actors, processes, structures, standards, and resources. Notes taken were used to conduct a qualitative thematic analysis combined with a semantic network analysis. Commonalities highlighted by these discussions draw a portrait of a field in which human health, complex systems thinking, action, and ecosystem health are considered central issues. The need to reach outside of academia to government and the general public was identified as a shared goal. A disconnect between participants' main concerns and what they perceived as the main concerns of funding agencies emerged as a primary roadblock for the future.

Tools for thoughtful action: the role of ecosystem approaches to health in enhancing public health.

The intimate interdependence of human health and the ecosystems in which we are embedded is now a commonplace observation. For much of the history of public health, this was not so obvious. After over a century of focus on diseases, their biologic causes and the correction of exposures (clean water and air) and facilitation of responses (immunizations and nutrition), public health discourse shifted to embrace the concept of determinants of health as extending to social, economic and environmental realms. This moved the discourse and science of public health into an unprecedented level of complexity just as public concern about the environment heightened. To address multifactorial, dynamic impacts on health, a new paradigm was needed which would overcome the separation of humans and ecosystems. Ecosystem approaches to health arose in the 1990s from a rich background of intellectual ferment as Canada wrestled with diverse problems ranging from Great Lakes contamination to zoonotic diseases. Canada's International Development Research Centre (IDRC) played a lead role in supporting an international community of scientists and scholars who advanced ecosystem approaches to health. These collective efforts have enabled a shift to a research paradigm that embraces transdisciplinarity, social justice, gender equity, multi-stakeholder participation and sustainability.

Use of the ecosystem approach to population health: the case of mercury contamination in aquatic environments and riparian populations, Andean Amazon, Napo River Valley, Ecuador.

BACKGROUND: Driven by accelerating transformation of land use in the Amazon, studies addressing the impacts of deforestation and mercury (Hg) leaching on the geophysical, biological, social, health, economic and political systems of Amazonian countries are crucial to evaluate the population health risks of these rapid changes. METHODS: We used an ecosystem approach, integrating Hg measurements with socio-cultural and politico-economic elements, to provide an integral analysis and comprehensive solutions. RESULTS: Our interdisciplinary research in the Ecuadorian Andean Amazon has shown that comestible fish and riparian communities which rely on fish as a major protein source have mercury levels that could potentially cause subtle but deleterious population health alterations. A parallel study identified deforestation and soil erosion as a significant source of mercury to the aquatic ecosystem. INTERPRETATION: The analysis of these results in conjunction with the prevailing socio-cultural and politico-economic context allowed us to identify economic trends, and especially petroleum exploitation, as pivotal in the deforestation/mercury-exposure dynamic. In collaboration with public health authorities, we shared our results with local health stakeholders, including public health care staff, federal government agencies, researchers and local communities, in such a way as to promote sustainable land use practices and the nutritional benefits of fish eating while reducing toxic exposures.