Diarrheal disease and associations with water access and sanitation in Indigenous Shawi children along the Armanayacu River basin in Peru.

INTRODUCTION: Diarrheal disease, particularly in children under 5 years old, remains a global health challenge due to its high prevalence and chronic health consequences. Public health interventions that reduce diarrheal disease risk include improving access to water, sanitation, and hygiene. Although Peru achieved the 2015 Millennium Development Goal (MDG) indicators for water access, less progress was achieved on sanitation. Furthermore, many Indigenous Peoples were overlooked in the MDG indicators, resulting in a prioritization of Indigenous Peoples in the 2030 Sustainable Development Goals (SDGs). This study aimed to estimate the prevalence of childhood diarrhea, characterize access to water and sanitation, and determine the association of childhood diarrhea with water access and sanitation indicators in 10 Shawi Indigenous communities along the Armanayacu River in the Peruvian Amazon. METHODS: A cross-sectional survey (n=82) that captured data on diarrheal disease, sociodemographic variables, and water and sanitation exposures was conducted in 10 Shawi communities. Nutritional status of children under 5 was also assessed via physical examination. Descriptive and comparative statistics were conducted. RESULTS: A small proportion (n=7; 8.54%) of participating children reported an episode of diarrhea in the previous month. Almost half (46.30%) of participating children had stunting, wasting, or both. Although not statistically significant, children living in households that used latrines were 4.29 times (95% confidence interval (CI) 1.01-18.19) more likely to report an episode of diarrhea than children living in households that practiced open defecation. Although not statistically significant, children living in households that used water treatment methods were 4.25 times (95%CI 0.54-33.71) more likely to report an episode of diarrhea than children living in households that did not. CONCLUSION: The prevalence of childhood diarrhea was lower for Shawi than for other Amazon areas. The higher prevalence of childhood diarrhea in households that used latrines and water treatments warrants further investigation into local risk and protective factors. These Shawi communities scored low for the WHO/UNICEF Joint Monitoring Programme indicators for water and sanitation, indicating that they should be prioritized in future water, sanitation, and hygiene initiatives. Research will be required to understand and incorporate local Indigenous values and cultural practices into water, sanitation, and hygiene initiatives to maximize intervention uptake and effectiveness.

Policy responses to COVID-19 in Sri Lanka and the consideration of Indigenous Peoples.

COVID-19 has had uneven impacts on health and well-being, with Indigenous communities in the Global South facing some of the highest risks. Focusing on the experience of Sri Lanka, this study identifies key policy responses to COVID-19, documents how they evolved over two years of the pandemic, and examines if and how government responses have addressed issues pertaining to Indigenous Peoples. Drawing upon an analysis of policy documents (n = 110) and interviews with policymakers (n = 20), we characterize seven key policy responses implemented by the Sri Lankan government: i) testing for and identifying COVID-19; ii) quarantine procedures; iii) provisional clinical treatments; iv) handling other diseases during COVID-19; v) movement; vi) guidelines to be adhered to by the general public; and vii) health and vaccination. The nature of these responses changed as the pandemic progressed. There is no evidence that policy development or implementation incorporated the voices and needs of Indigenous Peoples.

Indigenous peoples and the COVID-19 pandemic: a systematic scoping review.

Past influenza pandemics including the Spanish flu and H1N1 have disproportionately affected Indigenous Peoples. We conducted a systematic scoping review to provide an overview of the state of understanding of the experience of Indigenous peoples during the first 18 months of the COVID-19 pandemic, in doing so we capture the state of knowledge available to governments and decision makers for addressing the needs of Indigenous peoples in these early months of the pandemic. We addressed three questions: (a) How is COVID-19 impacting the health and livelihoods of Indigenous peoples, (b) What system level challenges are Indigenous peoples experiencing, (c) How are Indigenous peoples responding? We searched Web of Science, Scopus, and PubMed databases and UN organization websites for publications about Indigenous peoples and COVID-19. Results were analyzed using descriptive statistics and content analysis. A total of 153 publications were included: 140 peer-reviewed articles and 13 from UN organizations. Editorial/commentaries were the most (43%) frequent type of publication. Analysis identified Indigenous peoples from 19 different countries, although 56% of publications were centered upon those in Brazil, United States, and Canada. The majority (90%) of articles focused upon the general adult population, few (<2%) used a gender lens. A small number of articles documented COVID-19 testing (0.04%), incidence (18%), or mortality (16%). Five themes of system level challenges affecting exposure and livelihoods evolved: ecological, poverty, communication, education and health care services. Responses were formal and informal strategies from governments, Indigenous organizations and communities. A lack of ethnically disaggregated health data and a gender lens are constraining our knowledge, which is clustered around a limited number of Indigenous peoples in mostly high-income countries. Many Indigenous peoples have autonomously implemented their own coping strategies while government responses have been largely reactive and inadequate. To 'build back better' we must address these knowledge gaps.

Interactions between climate and COVID-19.

In this Personal View, we explain the ways that climatic risks affect the transmission, perception, response, and lived experience of COVID-19. First, temperature, wind, and humidity influence the transmission of COVID-19 in ways not fully understood, although non-climatic factors appear more important than climatic factors in explaining disease transmission. Second, climatic extremes coinciding with COVID-19 have affected disease exposure, increased susceptibility of people to COVID-19, compromised emergency responses, and reduced health system resilience to multiple stresses. Third, long-term climate change and prepandemic vulnerabilities have increased COVID-19 risk for some populations (eg, marginalised communities). The ways climate and COVID-19 interact vary considerably between and within populations and regions, and are affected by dynamic and complex interactions with underlying socioeconomic, political, demographic, and cultural conditions. These conditions can lead to vulnerability, resilience, transformation, or collapse of health systems, communities, and livelihoods throughout varying timescales. It is important that COVID-19 response and recovery measures consider climatic risks, particularly in locations that are susceptible to climate extremes, through integrated planning that includes public health, disaster preparedness, emergency management, sustainable development, and humanitarian response.

Sea level rise risks and societal adaptation benefits in low-lying coastal areas.

Sea level rise (SLR) will increase adaptation needs along low-lying coasts worldwide. Despite centuries of experience with coastal risk, knowledge about the effectiveness and feasibility of societal adaptation on the scale required in a warmer world remains limited. This paper contrasts end-century SLR risks under two warming and two adaptation scenarios, for four coastal settlement archetypes (Urban Atoll Islands, Arctic Communities, Large Tropical Agricultural Deltas, Resource-Rich Cities). We show that adaptation will be substantially beneficial to the continued habitability of most low-lying settlements over this century, at least until the RCP8.5 median SLR level is reached. However, diverse locations worldwide will experience adaptation limits over the course of this century, indicating situations where even ambitious adaptation cannot sufficiently offset a failure to effectively mitigate greenhouse-gas emissions.

Monitoring the dynamic vulnerability of an Arctic subsistence food system to climate change: The case of Ulukhaktok, NT.

Vulnerability to climate change is highly dynamic, varying between and within communities over different timescales. This paper draws upon complex adaptive systems thinking to develop an approach for capturing, understanding, and monitoring climate vulnerability in a case study from northern Canada, focusing on Inuit food systems. In the community of Ulukhaktok, Northwest Territories, we followed 10 hunters over a 2-year period, asking them to document their harvesting activities and discuss their lived experience of harvesting under changing environmental and societal conditions. GPS monitoring and participatory mapping sessions were used to document 23,996km of trails (n = 409), with conversational bi-weekly semi-structured interviews and secondary instrumental weather data used to contextualise climate change within a nexus of other socioeconomic, cultural, and political stressors that also affect harvesting. Our results demonstrate that climate change has considerable potential to affect harvesting activities, particularly when its impacts manifest as anomalous/extreme events. However, climate change impacts are not necessarily the most salient issues affecting harvesting on a day-to-day basis. Instead, factors relating to economics (particularly financial capital and the wage-based economy), social networks, and institutions are found to have a greater influence, either as standalone factors with cascading effects or when acting synchronously to augment the impacts of environmental change.

The effects on public health of climate change adaptation responses: a systematic review of evidence from low- and middle-income countries.

Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the 'Global Adaptation Mapping Initiative' database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013-2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action.

Seasonality, climate change, and food security during pregnancy among indigenous and non-indigenous women in rural Uganda: Implications for maternal-infant health.

BACKGROUND: Climate change is expected to decrease food security globally. Many Indigenous communities have heightened sensitivity to climate change and food insecurity for multifactorial reasons including close relationships with the local environment and socioeconomic inequities which increase exposures and challenge adaptation to climate change. Pregnant women have additional sensitivity to food insecurity, as antenatal undernutrition is linked with poor maternal-infant health. This study examined pathways through which climate change influenced food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda. Specific objectives were to characterize: 1) sensitivities to climate-associated declines in food security for pregnant Indigenous women; 2) women's perceptions of climate impacts on food security during pregnancy; and 3) changes in food security and maternal-infant health over time, as observed by women. METHODS: Using a community-based research approach, we conducted eight focus group discussions-four in Indigenous Batwa communities and four in non-Indigenous communities-in Kanungu District, Uganda, on the subject of climate and food security during pregnancy. Thirty-six women with ≥1 pregnancy participated. Data were analysed using a constant comparative method and thematic analysis. RESULTS: Women indicated that food insecurity was common during pregnancy and had a bidirectional relationship with antenatal health issues. Food security was thought to be decreasing due to weather changes including extended droughts and unpredictable seasons harming agriculture. Women linked food insecurity with declines in maternal-infant health over time, despite improved antenatal healthcare. While all communities described food security struggles, the challenges Indigenous women identified and described were more severe. CONCLUSIONS: Programs promoting women's adaptive capacity to climate change are required to improve food security for pregnant women and maternal-infant health. These interventions are particularly needed in Indigenous communities, which often face underlying health inequities. However, resiliency among mothers was strong and, with supports, they can reduce food security challenges in a changing climate.

Participatory Modeling of Water Vulnerability in Remote Alaskan Households Using Causal Loop Diagrams.

Despite perceptions of high water availability, adequate access to sufficient water resources remains a major challenge in Alaska. This paper uses a participatory modeling approach to investigate household water vulnerability in remote Alaska and to examine factors that affect water availability and water access. Specifically, the work asks: how do water policy stakeholders conceptualize the key processes that affect household water vulnerability in the context of rural Alaska? Fourteen water policy stakeholders participated in the modeling process, which included defining the problem of household water vulnerability and constructing individual causal loop diagrams (CLDs) that represent their conceptualization of household water vulnerability. Individual CLDs were subsequently combined and five sub-models emerged: environmental, economic, infrastructure, social, and health. The environmental and economic sub-models of the CLD are explored in depth. In the environmental sub-model, climate change and environmental barriers due to geography influence household water vulnerability. In the economic sub-model, four processes and one feedback loop affect household water vulnerability, including operations and maintenance funding, the strength of the rural Alaskan economy, and the impact of regulations. To overcome household water vulnerability and make households more resilient, stakeholders highlighted policy solutions under five themes: economics, social, regulatory, technological, and environmental.

Sewing and Inuit women's health in the Canadian Arctic.

Traditional Inuit cultural values and practices are integral to an Inuit understanding of health. We examine the role of sewing in Inuit women's health in the Canadian Arctic in a case study of Ulukhaktok, Northwest Territories, Canada. An analysis of data collected using semi-structured interviews with 30 Inuit women reveals that sewing contributes to participant's health and the collective health of the community in several ways including: pride and sense of accomplishment; cultural identity; relaxation, decompression, and socialization; and spirituality and healing. As a cultural practice, sewing is about older generations teaching younger generations about their identity, who they are and where they come from. For some participants, sewing is a way through which they express their culture. Sewing brings people together at a time when social isolation is becoming more apparent, and gives women the chance to learn vital, tangible skills that continue to have social, economic, and cultural importance. Sewing is also a form of healing that helps women ease their minds and focus on a challenging and productive task that brings them satisfaction, self-worth, and value. We conclude that sewing is important for cultural continuity, enabling Inuit to both practice and carryon their culture, and contributing positively to individual and the collective health of the community.

Climate change and community fisheries in the arctic: A case study from Pangnirtung, Canada.

Coastal fishery systems in the Arctic are undergoing rapid change. This paper examines the ways in which Inuit fishers experience and respond to such change, using a case study from Pangnirtung, Canada. The work is based on over two years of fieldwork, during which semi-structured interviews (n = 62), focus group discussions (n = 6, 31 participants) and key informant interviews (n = 25) were conducted. The changes that most Inuit fishers experience are: changes in sea-ice conditions, Inuit people themselves, the landscape and the seascape, fish-related changes, and changes in weather conditions, markets and fish selling prices. Inuit fishers respond to change individually as well as collectively. Fishers' responses were examined using the characteristics of a resilience-based conceptual framework focusing on place, human agency, collective action and collaboration, institutions, indigenous and local knowledge systems, and learning. Based on results, this paper identified three community-level adaptive strategies, which are diversification, technology use and fisheries governance that employs a co-management approach. Further, this work recognised four place-specific attributes that can shape community adaptations, which are Inuit worldviews, Inuit-owned institutions, a culture of sharing and collaborating, and indigenous and local knowledge systems. An examination of the ways in which Inuit fishers experience and respond to change is essential to better understand adaptations to climate change. This study delivers new insights to communities, scientists, and policymakers to work together to foster community adaptation.

Evaluating the effectiveness of hazard mapping as climate change adaptation for community planning in degrading permafrost terrain.

Permafrost in northern Canada is susceptible to degradation due to rapid climate change, with hazard mapping promoted as an important activity to guide sustainable community adaptation and planning. This paper presents a framework for evaluating permafrost mapping exercises designed to inform climate change adaptation actions. We apply the framework using a case study of the Incorporating Climate Change into Land Development-Terrain Analysis project (ICCiLD). ICCiLD is a hazard mapping project utilizing interferometric synthetic aperture radar to monitor ground disturbance and categorize land development suitability in seven communities in the territory of Nunavut, Canada. We looked at one of the communities, Arviat, as our case study. We examined technical data and drew upon semi-structured interviews (n = 19) with map creators and users. We found ICCiLD added new and relevant information for community planning, increased awareness of the risks posed by permafrost thaw and built stakeholder relations. Strong coordination and high public consciousness of local climate impacts emerged as key factors underpinning project success. Nevertheless, in the case of Arviat, the effectiveness of the hazard maps in influencing land-use planning was constrained by communication challenges between project creators and end-users. These challenges included limited community access to the data and uncertainty surrounding how to operationalize the map suitability classifications. Broader climate change adaptation challenges included the presence of other more immediate community planning priorities and a limited ability to incorporate Indigenous ways of knowing into a technical mapping project. The lessons from this evaluation provide insight for the development of mapping-based adaptations across Arctic regions.

An integrative climate change vulnerability index for Arctic aviation and marine transportation.

Climate change vulnerability research methods are often divergent, drawing from siloed biophysical risk approaches or social-contextual frameworks, lacking methods for integrative approaches. This substantial gap has been noted by scientists, policymakers and communities, inhibiting decision-makers' capacity to implement adaptation policies responsive to both physical risks and social sensitivities. Aiming to contribute to the growing literature on integrated vulnerability approaches, we conceptualize and translate new integrative theoretical insights of vulnerability research to a scalable quantitative method. Piloted through a climate change vulnerability index for aviation and marine sectors in the Canadian Arctic, this study demonstrates an avenue of applying vulnerability concepts to assess both biophysical and social components analyzing future changes with linked RCP climate projections. The iterative process we outline is transferable and adaptable across the circumpolar north, as well as other global regions and shows that transportation vulnerability varies across Inuit regions depending on modeled hazards and transportation infrastructures.

Enabling local public health adaptation to climate change.

Local public health authorities often lack the capacity to adapt to climate change, despite being on the 'front lines' of climate impacts. Upper-level governments are well positioned to create an enabling environment for adaptation and build local public health authorities' capacity, yet adaptation literature has not specified how upper-level governments can build local-level adaptive capacity. In this paper we examine how federal and regional governments can contribute to enabling and supporting public health adaptation to climate change at the local level in federal systems. We outline the local level's self-assessed adaptive capacity for public health adaptation in Canadian and German comparative case studies, in terms of funding, knowledge and skills, organizations, and prioritization, drawing upon 30 semi-structured interviews. Based on interviewees' recommendations and complemented by scientific literature, we develop a set of practical measures that could enable or support local-level public health adaptation. We find that adaptive capacity varies widely between local public health authorities, but most report having insufficient funding and staff for adaptation activities. We propose 10 specific measures upper-level governments can take to build local public health authorities' capacity for adaptation, under the interrelated target areas of: building financial capital; developing and disseminating usable knowledge; collaborating and coordinating for shared knowledge; and claiming leadership. Federal and regional governments have an important role to play in enabling local-level public health adaptation, and have many instruments available to them to fulfill that role. Selecting and implementing measures to enable local public health authorities' adaptive capacity will require tailoring to, and consideration, of the local context and needs.

What role can unmanned aerial vehicles play in emergency response in the Arctic: A case study from Canada.

This paper examines search and rescue and backcountry medical response constraints in the Canadian Arctic and potential for unmanned aerial vehicles (UAV) to aid in response and preparedness. Semi-structured interviews (n = 18) were conducted with search and rescue responders, Elders, and emergency management officials to collect data on current emergency response and potential for UAV use. UAV test flights (n = 17) were undertaken with community members. We analyzed five years of weather data to examine UAV flight suitability. Numerous challenges face Arctic search and rescue and backcountry emergency response. Changing social and environmental conditions were described as increasing vulnerability to backcountry emergencies. Responders desired additional first aid and emergency training. Legal and weather restrictions were found to limit where, when and who could fly UAVs. UAVs were demonstrated to have potential benefits for hazard monitoring but not for SAR or medical response due to legal restrictions, weather margins, and local capacity. We find that communities are ill-prepared for ongoing SAR demands, let alone a larger disaster. There are numerous limitations to the use of consumer UAVs by Arctic communities. Prevention of backcountry medical emergencies, building resilience to disasters, and first responder training should be prioritized over introducing UAVs to the response system.

The Impacts of Climate and Social Changes on Cloudberry (Bakeapple) Picking: a Case Study from Southeastern Labrador.

The traditional subsistence activities of Indigenous communities in Canada's subarctic are being affected by the impacts of climate change, compounding the effects of social, economic and political changes. Most research has focused on hunting and fishing activities, overlooking berry picking as an important socio-cultural activity and contributor to the diversity of food systems. We examined the vulnerability of cloudberry (referred to as 'bakeapple' consistent with local terminology) picking to environmental changes in the community of Cartwright, Labrador using semi-structured interviews (n = 18), field surveys, and satellite imagery. We identified the components of vulnerability including: the environmental changes affecting the abundance, quality, and ripening time of bakeapples (i.e., exposure), the characteristics of the community that affect how these changes have local impacts (i.e., sensitivity), and the ways in which the community is responding to environmental changes (i.e., adaptive capacity). Our results confirm that environmental changes related to permafrost, vegetation, and water have occurred at the bakeapple picking grounds with observed impacts on bakeapples. It is becoming increasingly difficult for bakeapple pickers to respond to variable growth as in the past because of changes in summer settlement patterns that place families farther from their bakeapple patches. We conclude that harvesters in Cartwright have high adaptive capacity to respond to environmental changes due to their knowledge of their bakeapple patches, and at present, socioeconomic changes have had a greater impact than environmental changes on their harvesting capacity.

Water quality and health in northern Canada: stored drinking water and acute gastrointestinal illness in Labrador Inuit.

One of the highest self-reported incidence rates of acute gastrointestinal illness (AGI) in the global peer-reviewed literature occurs in Inuit communities in the Canadian Arctic. This high incidence of illness could be due, in part, to the consumption of contaminated water, as many northern communities face challenges related to the quality of municipal drinking water. Furthermore, many Inuit store drinking water in containers in the home, which could increase the risk of contamination between source and point-of-use (i.e., water recontamination during storage). To examine this risk, this research characterized drinking water collection and storage practices, identified potential risk factors for water contamination between source and point-of-use, and examined possible associations between drinking water contamination and self-reported AGI in the Inuit community of Rigolet, Canada. The study included a cross-sectional census survey that captured data on types of drinking water used, household practices related to drinking water (e.g., how it was collected and stored), physical characteristics of water storage containers, and self-reported AGI. Additionally, water samples were collected from all identified drinking water containers in homes and analyzed for presence of Escherichia coli and total coliforms. Despite municipally treated tap water being available in all homes, 77.6% of households had alternative sources of drinking water stored in containers, and of these containers, 25.2% tested positive for total coliforms. The use of transfer devices and water dippers (i.e., smaller bowls or measuring cups) for the collection and retrieval of water from containers were both significantly associated with increased odds of total coliform presence in stored water (ORtransfer device = 3.4, 95% CI 1.2-11.7; ORdipper = 13.4, 95% CI 3.8-47.1). Twenty-eight-day period prevalence of self-reported AGI during the month before the survey was 17.2% (95% CI 13.0-22.5), which yielded an annual incidence rate of 2.4 cases per person per year (95% CI 1.8-3.1); no water-related risk factors were significantly associated with AGI. Considering the high prevalence of, and risk factors associated with, indicator bacteria in drinking water stored in containers, potential exposure to waterborne pathogens may be minimized through interventions at the household level.