Climate change and inequality.

This review explores how climate change is manifesting along existing lines of inequality and thus further exacerbating current health disparities with a particular focus on children and future generations. Climate change risk and vulnerability are not equally distributed, nor is the adaptive capacity to respond to its adverse effects, which include health consequences, economic impacts, and displacement. Existing lines of inequality are already magnifying the adverse effects of climate change. Today's children and future generations will experience a disproportionate number of adverse climate events than prior generations, especially children in lower-income populations, communities of color, and Indigenous communities. In order to mitigate the crisis of inequity accompanying the climate crisis, systemic action must be taken on a global scale - with a focus on protecting children and future generations, and in empowering youth-led environmental activism and engagement in climate policy. IMPACT STATEMENT: Our review offers a current summary of the ways in which inequality is manifesting with respect to climate change in children and future generations. Rather than use a systematic review, we opted to use a theoretical framework to guide our review. We divided the effects of climate change into three effect pathways: via disruptions in (i) climate and weather, (ii) ecosystems, and (iii) society. By dividing our review in this theoretical framework, we can better suggest targeted public health interventions at each effect level. Furthermore, we are able to successfully identify literature gaps and areas of future research.

Mitigating childhood food insecurity during COVID-19: a qualitative study of how school districts in California's San Joaquin Valley responded to growing needs.

OBJECTIVES: To explore best practices and challenges in providing school meals during COVID-19 in a low-income, predominantly Latino, urban-rural region. DESIGN: Semi-structured interviews with school district stakeholders and focus groups with parents were conducted to explore school meal provision during COVID-19 from June to August 2020. Data were coded and themes were identified to guide analysis. Community organisations were involved in all aspects of study design, recruitment, data collection and analysis. SETTING: Six school districts in California's San Joaquin Valley. PARTICIPANTS: School district stakeholders (n 11) included food service directors, school superintendents and community partners (e.g. funders, food cooperative). Focus groups (n 6) were comprised of parents (n 29) of children participating in school meal programmes. RESULTS: COVID-19-related challenges for districts included developing safe meal distribution systems, boosting low participation, covering COVID-19-related costs and staying informed of policy changes. Barriers for families included transportation difficulties, safety concerns and a lack of fresh foods. Innovative strategies to address obstacles included pandemic-electronic benefits transfer (EBT), bus-stop delivery, community pick-up locations, batched meals and leveraging partner resources. CONCLUSIONS: A focus on fresher, more appealing meals and greater communication between school officials and parents could boost participation. Districts that leveraged external partnerships were better equipped to provide meals during pandemic conditions. In addition, policies increasing access to fresh foods and capitalising on United States Department of Agriculture waivers could boost school meal participation. Finally, partnering with community organisations and acting upon parent feedback could improve school meal systems, and in combination with pandemic-EBT, address childhood food insecurity.

Virtual Exchange in Global Health: an innovative educational approach to foster socially responsible overseas collaboration.

Educators who design and manage study abroad programs face a series of ethical responsibilities. Meeting these responsibilities is critical in the field of global health, where study abroad programs are often designed to provide healthcare services in under-resourced communities. Leaders in global health have thus formed working groups to study the ethical implications of overseas programming and have led the way in establishing socially responsible best practices for study abroad. Their recommendations include development of bidirectional programming that is designed for mutual and equitable benefits, focused on locally identified needs and priorities, attentive to local community costs, and structured to build local capacity to ensure sustainability. Implementation remains a key challenge, however. Sustainable, bidirectional programming is difficult and costly. In the present study, authors questioned how technology could be used to connect students of global health in distant countries to make socially responsible global health programming more accessible. Drawing on empirical research in the learning sciences and leveraging best practices in technology design, the authors developed a Virtual Exchange in Global Health to connect university students in the U.S. with counterparts in Lebanon, who worked in teams to address humanitarian problems in Syrian refugee camps. Early results demonstrate the value of this approach. At dramatically lower cost than traditional study abroad-and with essentially no carbon footprint-students recognized complementary strengths in each other through bidirectional programming, learned about local needs and priorities through Virtual Reality, and built sustaining relationships while addressing a difficult real-world problem. The authors learned that technology could effectively facilitate socially responsible global health programming and do so at low cost. The program has important implications for teaching and learning during the COVID-19 crisis and beyond.

Health interventions among mobile pastoralists: a systematic review to guide health service design.

OBJECTIVE: Mobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterised, we set out to fill this gap. METHODS: We conducted a systematic search in PubMed/MEDLINE, Scopus, Embase, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilisation among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesised through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records. RESULTS: Our search yielded 4884 non-duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub-Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilisation. Only two randomised controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n = 16), community engagement (n = 12) and service mobility (n = 11). CONCLUSION: Without adaptations to account for mobile pastoralists' unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist-specific delivery strategies, such as combinations of mobile and 'temporary fixed' services informed by transhumance patterns, culturally acceptable waiting homes, community-directed interventions and combined joint human-animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.

OBJECTIF: Les éleveurs nomades sont l'une des dernières populations à être touchées par les services de santé et sont souvent ratés par les campagnes de santé. Etant donné que les interventions de santé parmi ces éleveurs ont été programmées dans une gamme de disciplines mais n'ont pas encore été systématiquement caractérisées, nous avons entrepris de combler cette lacune. MÉTHODES: Nous avons effectué une recherche systématique dans les répertoires PubMed/MEDLINE, Scopus, EMBASE, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar et de la littérature grise pour identifier les reports décrivant les interventions de santé, les facilitateurs et les obstacles au succès de l'intervention ainsi que les facteurs influençant l'utilisation des soins de santé chez les éleveurs nomades. Aucune restriction de date n'a été appliquée. En raison de l'hétérogénéité des rapports capturés dans cette revue, les données ont été principalement synthétisées au moyen d'une analyse narrative. Une analyse statistique descriptive a été effectuée pour les éléments de données présentés par une majorité des reports. RÉSULTATS: Notre recherche a révélé 4.884 rapports non dupliqués, dont 140 éligibles ont été inclus dans l'analyse. 89,3% des rapports présentaient des données d'Afrique subsaharienne, principalement en Afrique de l'Est (ex: Ethiopie, 30,0%; Kenya, 17,1%). Seuls 24,3% des rapports décrivaient une étude interventionnelle, tandis que les 75,7% restants décrivaient des données d'intérêt secondaires sur l'utilisation des soins de santé. Seuls deux essais contrôlés randomisés étaient présents dans notre analyse, et seuls cinq rapports présentaient des données sur le coût. Les facilitateurs les plus courants du succès des interventions étaient la sensibilité culturelle (n=16), l'engagement communautaire (n=12) et la mobilité des services (n=11). CONCLUSION: Sans adaptations pour tenir compte des modèles de subsistance et du contexte culturel uniques des éleveurs nomades, les services de santé formels les laissent de côté. Les lacunes de la recherche, y compris la négligence de certaines régions géographiques, le manque d'études interventionnelles et la diversité de la conception des études, et les données limitées sur la faisabilité économique des interventions doivent être comblées pour éclairer la conception de services de santé capables d'atteindre les éleveurs nomades. Des stratégies de prestation spécifiques aux éleveurs nomades, telles que des combinaisons de services mobiles et «fixes temporaires¼ éclairés par des schémas de transhumance, des maisons d'attente culturellement acceptables, des interventions dirigées par la communauté et une conception conjointe d'une seule santé homme-animal ainsi que le regroupement d'autres services de santé, ont montré une promesse initiale sur laquelle les travaux futurs devraient s'appuyer.

COVID-19: A Matter of Planetary, not Only National Health.

The COVID-19 pandemic highlights the multidimensional and inseparable connection between human health and environmental systems. COVID-19, similar to other emerging zoonotic diseases, has had a devastating impact on our planet. In this perspective, we argue that as humans continue to globalize and encroach on our surrounding natural systems, societies must adopt a "planetary health lens" to prepare and adapt to these emerging infectious diseases. This piece further explores other critical components of a planetary health approach to societal response, such as the seasonality of disease patterns, the impact of climate change on infectious disease, and the built environment, which can increase population vulnerabilities to pandemics. To address planetary health threats that cross international borders, such as COVID-19, societies must practice interdependence sovereignty and direct resources to organizations that facilitate shared global governance, and thus can enable us to adapt and ultimately build a more resilient world.

Ethnic identity, resilience, and well-being: a study of female Maasai migrants.

OBJECTIVES: Migration is an increasingly prevalent worldwide phenomenon. In recent years, Maasai men and women have migrated from their traditional rural villages to cities in Tanzania in growing numbers. This study explores the experience of rural-to-urban migration among female Maasai migrants and how this experience affects ethnic identity, resilience, and well-being. METHODS: Thirty-one female Maasai migrants were interviewed in Swahili, Maa, or English. Researchers used a rigorous multi-pass, qualitative coding process to analyze interview transcripts. RESULTS: Migration-driving factors, specifically a desire for education (leading to permanent migrants) and a need to support one's family (resulting in circular migrants), influence how Maasai women adapt and respond to challenges in the city. Circular migrants hold closely to their traditional ethnic identity and remain isolated from city life, while permanent migrants modulate their ethnic identity and integrate into urban society. CONCLUSIONS: Increasing connections among female Maasai migrants might create a more resilient community leading to improved health. Pilot workshops with this aim are being implemented.