A health promotion perspective on One Health.

The One Health concept has acquired increasing attention due to the COVID-19 pandemic. We argue for a health promotion perspective that frames One Health in terms of positive health for people, animals, and ecosystems and includes a spiritual-cosmological dimension. This would enhance policy, research, and practice across disciplines and sectors for a more resilient and harmonious planet.

RéSUMé: Le concept « Une seule santé ¼ fait l'objet d'une attention accrue en raison de la pandémie de COVID-19. Nous plaidons en faveur d'une perspective de promotion de la santé qui définit Une seule santé en termes de santé positive pour les personnes, les animaux et les écosystèmes et qui inclut une dimension spirituelle et cosmologique. Cela permettrait d'améliorer les politiques, la recherche et la pratique dans toutes les disciplines et tous les secteurs afin d'assurer une planète plus résiliente et plus harmonieuse.

Why we struggle to make progress in obesity prevention and how we might overcome policy inertia: Lessons from the complexity and political sciences.

Despite evidence for the effectiveness of policies that target obesogenic environments, their adoption remains deficient. Using methods and concepts from complexity and political science (Stock-and-Flow analysis and Punctuated Equilibrium Theory) and a qualitative literature review, we developed system maps to identify feedback loops that hinder policymaking on mitigating obesogenic environments and feedback loops that could trigger and sustain policy change. We found numerous self-reinforcing feedback loops that buttress the assumption that obesity is an individual problem, strengthening the biomedical and commercial weight-loss sectors' claim to "ownership" over solutions. That is, improvements in therapies for individuals with obesity reinforces policymakers' reluctance to target obesogenic environments. Random events that focus attention on obesity (e.g., celebrities dismissing soda) could disrupt this cycle, when actors from outside the medical and weight-loss sector (e.g., anti-weight stigma activists) successfully reframe obesity as a societal problem, which requires robust and politically relevant engagement with affected communities prior to such events taking place. Sustained prioritization of policies targeting obesogenic environments requires shared problem ownership of affected communities and nonhealth government sectors, by emphasizing cobenefits of policies that target obesogenic environments (e.g., ultraprocessed food taxation for raising revenue) and solutions that are meaningful for affected communities.

Making cities mental health friendly for adolescents and young adults.

Urban life shapes the mental health of city dwellers, and although cities provide access to health, education and economic gain, urban environments are often detrimental to mental health1,2. Increasing urbanization over the next three decades will be accompanied by a growing population of children and adolescents living in cities3. Shaping the aspects of urban life that influence youth mental health could have an enormous impact on adolescent well-being and adult trajectories4. We invited a multidisciplinary, global group of researchers, practitioners, advocates and young people to complete sequential surveys to identify and prioritize the characteristics of a mental health-friendly city for young people. Here we show a set of ranked characteristic statements, grouped by personal, interpersonal, community, organizational, policy and environmental domains of intervention. Life skills for personal development, valuing and accepting young people's ideas and choices, providing safe public space for social connection, employment and job security, centring youth input in urban planning and design, and addressing adverse social determinants were priorities by domain. We report the adversities that COVID-19 generated and link relevant actions to these data. Our findings highlight the need for intersectoral, multilevel intervention and for inclusive, equitable, participatory design of cities that support youth mental health.

Australian and Canadian financial wellbeing policy landscape during COVID-19: An equity-informed policy scan.

Background: This targeted and comprehensive policy scan examined how different levels of governments in Australia and Canada responded to the financial crisis brought on by the COVID-19 pandemic. We mapped the types of early policy responses addressing financial strain and promoting financial wellbeing. We also examined their equity considerations. Methods: Through a systematic search, snowballing, and manual search, we identified Canadian and Australian policies at all government levels related to financial strain or financial wellbeing enacted or amended in 2019-2020. Using a deductive-inductive approach, policies were categorized by jurisdiction level, focal areas, and target population groups. Results: In total, 213 and 97 policies in Canada and Australia, respectively, were included. Comparisons between Canadian and Australian policies indicated a more diversified and equity-targeted policy landscape in Canada. In both countries, most policies focused on individual and family finances, followed by housing and employment areas. Conclusions: The policy scan identified gaps and missed opportunities in the early policies related to financial strain and financial wellbeing. While fast, temporary actions addressed individuals' immediate needs, we recommend governments develop a longer-term action plan to tackle the root causes of financial strain and poor financial wellbeing for better health and non-health crisis preparedness. Statement on Ethics and Informed Consent: This research reported in this paper did not require ethical clearance or patient informed consent as the data sources were published policy documents. This study did not involve data collection with humans (or animals), nor any secondary datasets involving data provided by humans (or from animal studies).

Urban policy, space and wellbeing: a move towards LGBTQIA+ inclusive planning.

Public spaces influence the health and safety of lesbian, gay, bisexual, trans, queer, intersex, asexual and other sexual and gender-diverse (LGBTQIA+) communities. However, there is minimal research to demonstrate the link between inclusive urban policy and planning and the wellbeing of LGBTQIA+ communities. Consequently, in this perspective, we reflect on our project, which offered foundational work for understanding LGBTQIA+ experiences of public spaces in Australia's three most populous urban centres - Sydney, Melbourne and Brisbane. Our desk-based research approach provides a five-point evaluative framework to assess how local government areas (LGAs) accommodate LGBTQIA+ communities. We then present a recommendations framework for creating more inclusive local areas and public spaces. We propose that 'usualising' queerness in public spaces can lead to increased health and wellbeing for LGBTQIA+ communities.

Therapeutic aspects of Connection to Country and cultural landscapes among Aboriginal peoples from the Stolen Generations living in urban NSW, Australia.

Objectives and importance of the study: Most older Aboriginal peoples live in urban locations. Many of these people were displaced by the policies and practices that produced the Stolen Generations. As a result, access to 'Country' and cultural landscapes that are minimally impacted by urbanisation can be limited for older Aboriginal peoples, restricting the health and wellbeing benefits these environments promote. STUDY TYPE: Qualitative study. METHODS: Our study worked collaboratively with Aboriginal traditional cultural knowledge holders to observe and analyse how participation in a 'cultural camp' on a Yuwaalaraay sacred site in New South Wales (NSW), Australia, impacted wellbeing and connection to place among older Aboriginal people who were survivors or descendants of the Stolen Generations. RESULTS: Eight participants (three women; five men) attended the cultural camp and took part in the yarning circle. Thematic analysis of a yarning circle uncovered memories of traumatic experiences of institutionalisation, including abuse and loss of Country, community, and culture. Experiences of the cultural camp generated a sense of reconnection, cultural pride, wellbeing and place attachment. The sensory experience of Country emphasised a sense of belonging and healing. CONCLUSIONS: Our findings reflect the importance of sensory-led experiences on Country for older urban Aboriginal peoples and reinforce previous evidence on the 'therapeutic' aspects of culture and natural landscapes minimally impacted by colonisation. Policies and resources supporting grassroots initiatives such as Aboriginal cultural camps are needed to ensure accessibility for older Aboriginal peoples living in urban places.

Gaawaadhi Gadudha: understanding how cultural camps impact health, well-being and resilience among Aboriginal adults in New South Wales, Australia-a collaborative study protocol.

INTRODUCTION: The health and well-being of Aboriginal Australians is inextricably linked to culture and Country. Our study challenges deficit approaches to health inequities by seeking to examine how cultural connection, practice and resilience among Aboriginal peoples through participation in 'cultural camps' held on sites of cultural significance promotes health and well-being. METHODS AND ANALYSIS: The study will be undertaken in close collaboration and under the governance of traditional cultural knowledge holders from Yuwaalaraay, Gamilaraay and Yuin nation groups in New South Wales, Australia. Three cultural camps will be facilitated, where participants (n=105) will engage in activities that foster a connection to culture and cultural landscapes. A survey assessing connection to culture, access to cultural resources, resilience, self-rated health and quality of life will be administered to participants pre-camp and post-camp participation, and to a comparative group of Aboriginal adults who do not attend the camp (n=105). Twenty participants at each camp (n=60) will be invited to participate in a yarning circle to explore cultural health, well-being and resilience. Quantitative analysis will use independent samples' t-tests or χ2 analyses to compare camp and non-camp groups, and linear regression models to determine the impact of camp attendance. Qualitative analysis will apply inductive coding to data, which will be used to identify connections between coded concepts across the whole data set, and explore phenomenological aspects. Results will be used to collaboratively develop a 'Model of Cultural Health' that will be refined through a Delphi process with experts, stakeholders and policymakers. ETHICS AND DISSEMINATION: The study has ethics approval from the Aboriginal Health and Medical Research Council (#1851/21). Findings will be disseminated through a combination of peer-reviewed articles, media communication, policy briefs, presentations and summary documents to stakeholders.

Five urban health research traditions: A meta-narrative review.

Urban health scholars explore the connection between the urban space and health through ontological perspectives that are shaped by their disciplinary traditions. Without explicit recognition of the different approaches, there are barriers to collaboration. This paper maps the terrain of the urban health scholarship to identify key urban health research traditions; and to articulate the main features distinguishing these different traditions. We apply a meta-narrative review guided by a bibliometric co-citation network analysis to the body of research on urban health retrieved from the Web of Science Core Collection. Five urban health research traditions were identified: (1) sustainable urban development, (2) urban ecosystem services, (3) urban resilience, (4) healthy urban planning, and (5) urban green spaces. Each research tradition has a different conceptual and thematic perspective to addressing urban health. These include perspectives on the scale of the urban health issue of interest, and on the conceptualisation of the urban context and health. Additionally, we developed a framework to allow for better differentiation between the differing research traditions based on (1) perspectives of the urban system as complicated or complex, (2) the preferred locus of change as a function of structure and agency and (3) the geographic scale of the urban health issue that is addressed. These dimensions have even deeper implications for transdisciplinary collaboration as they are underpinned by paradigmatic differences, rather than disciplinary differences. We conclude that it is essential for urban health researchers to reflect on the different urban health approaches and seek coherence by understanding their similarities and differences. Such endeavours are required to produce and interpret transdisciplinary knowledge for the goal of improving health by transforming urban systems.

The Generative Mechanisms of Financial Strain and Financial Well-Being: A Critical Realist Analysis of Ideology and Difference.

BACKGROUND: Rapid, strategic action is required to mitigate the negative and unequal impact of the coronavirus disease 2019 (COVID-19) pandemic on the financial well-being (FWB) of global populations. Personal financial strain (FS) worsened most significantly among systematically excluded groups. Targeted government- and community-led initiatives are needed to address these inequities. The purpose of this applied research was to identify what works for whom, under what conditions, and why in relation to community and government initiatives that promote personal and household FWB and/or address FS in high income economies. METHODS: We employed a critical realist analysis to literature that reported on FWB/FS initiatives in high income countries. This included initiatives introduced in response to the pandemic as well as those that began prior to the pandemic. We included sources based on a rapid review. We coded academic, published literature (n=39) and practice-based (n=36) reports abductively to uncover generative mechanisms - ie, underlying, foundational factors related to community or government initiatives that either constrained and/or enabled FWB and FS. RESULTS: We identified two generative mechanisms: (1) neoliberal ideology; and (2) social equity ideology. A third mechanism, social location (eg, characteristics of identity, location of residence), cut across the two ideologies and demonstrated for whom the initiatives worked (or did not) in what circumstances. Neoliberal ideology (ie, individual responsibility) dominated initiative designs, which limited the positive impact on FS. This was particularly true for people who occupied systematically excluded social locations (eg, low-income young mothers). Social equity-based initiatives were less common within the literature, yet mostly had a positive impact on FWB and produced equitable outcomes. CONCLUSION: Equity-centric initiatives are required to improve FWB and reduce FS among systemically excluded and marginalized groups. These findings are of relevance now as nations strive for financial recovery in the face of the ongoing global pandemic.

A rapid review of initiatives to address financial strain and wellbeing in high-income contexts.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has exacerbated financial strain among populations worldwide. This is concerning, given the link between financial strain and health. There is little evidence to guide action in this area, particularly from a public health perspective. To address this gap, we examined initiatives to address financial wellbeing and financial strain in high-income contexts. METHODS: We used rapid review methodology and applied an equity-focused lens in our analysis. We searched six databases (MEDLINE, PsycINFO, Web of Science, ProQuest, Informit, and Google Advanced) for peer-reviewed, academic and practice-based literature evaluating initiatives to address financial strain and wellbeing in high-income contexts published between 2015-2020. We conducted a relevancy and quality appraisal of included academic sources. We used EPPI-reviewer software to extract equity-related, descriptive data, and author-reported outcomes. RESULTS: We conducted primary screening on a total of 4779 titles/abstracts (academic n = 4385, practice-based n = 394); of these, we reviewed 182 full text articles (academic n = 87, practice-based n = 95) to assess their relevancy and fit with our research question. A total of 107 sources were excluded based on our selection criteria and relevance to the research question (Figure 1), leaving 75 sources that were extracted for this review (academic n = 39, practice-based n = 36). These sources focused on initiatives predominantly based in Australia, the US, and Canada, with a smaller number from the UK and Europe. Most sources primarily targeted financial literacy and personal/family finances, followed by employment, housing, and education. CONCLUSIONS: We found that holistic initiatives (i.e., complex, wrap-around) that ensured people's basic needs were met (for example, before building financial skills) were aligned with positive and equitable financial wellbeing and financial strain outcomes, as reported in the reviewed studies. We noted significant gaps in the literature related to equity, such as the impact of initiatives on socially excluded populations (e.g., Indigenous peoples, racialised peoples, and rural dwellers). More research using a public health lens is required to guide equitable and sustainable action in this area.

An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries.

BACKGROUND: Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. METHODS: The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. RESULTS: The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. CONCLUSIONS: The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.

A Policy-Ready Public Health Guidebook of Strategies and Indicators to Promote Financial Well-Being and Address Financial Strain in Response to COVID-19.

INTRODUCTION: The COVID-19 pandemic has adversely affected the financial well-being of populations globally, escalating concerns about links with health care and overall well-being. Governments and organizations need to act quickly to protect population health relative to exacerbated financial strain. However, limited practice- and policy-relevant resources are available to guide action, particularly from a public health perspective, that is, targeting equity, social determinants of health, and health-in-all policies. Our study aimed to create a public health guidebook of strategies and indicators for multisectoral action on financial well-being and financial strain by decision makers in high-income contexts. METHODS: We used a multimethod approach to create the guidebook. We conducted a targeted review of existing theoretical and conceptual work on financial well-being and strain. By using rapid review methodology informed by principles of realist review, we collected data from academic and practice-based sources evaluating financial well-being or financial strain initiatives. We performed a critical review of these sources. We engaged our research-practice team and government and nongovernment partners and participants in Canada and Australia for guidance to strengthen the tool for policy and practice. RESULTS: The guidebook presents 62 targets, 140 evidence-informed strategies, and a sample of process and outcome indicators. CONCLUSION: The guidebook supports action on the root causes of poor financial well-being and financial strain. It addresses a gap in the academic literature around relevant public health strategies to promote financial well-being and reduce financial strain. Community organizations, nonprofit organizations, and governments in high-income countries can use the guidebook to direct initiative design, implementation, and assessment.

Experiences of Older Aboriginal People in Navigating Transport Systems in an Urban Setting: An Indigenous Perspective on Transport Access, a Social Determinant of Health.

BACKGROUND: In Australia, Aboriginal people are underserved by the transport system and are less able to easily get to places they need to go than others. This is a part of a larger pattern of exclusion and inequity for Aboriginal people which affects their health, wellbeing, and social participation. Guided by a decolonising framework, this research explored how older Aboriginal people, whose pivotal roles in their families and communities require their mobility, experience the transportation system, providing an Indigenous-centred view of the accessibility of transportation options in society. METHODS: Interviews drawing from the yarning technique were conducted with ten older Aboriginal people living in Greater Western Sydney and analysed qualitatively. RESULTS: In addition to the cognitive labour required to decipher the rules of the transport system and organise commitments to match the scheduling of transport services, older Aboriginal people in this study experienced stigmatising attitudes and condescending treatment from service professionals and the public when traveling. CONCLUSIONS: This study suggests three potential ways that the current trajectory that underserves older Aboriginal people could be disrupted, relating to service design, the diversity and inclusion agenda, and the social determinants of Indigenous health.

A Systematic Review with Framework Synthesis of the Ways That Urban Environments Influence Opportunities for Healthy and Sustainable Mobility in Older Age.

Supporting older people's use of sustainable transport is important for both population health and sustainable development, especially in the context of global population ageing. This systematic review identifies individual and environmental factors that influence older people's sustainable transport use and synthesises findings using a framework approach. Factors influencing older people's walking (n = 10 studies), bus use (n = 11), community transport use (n = 1), bicycling (n = 1), and e-bicycling (n = 1) were found to be physical, geographical, facility-based, economic, time-based, fear-based, space-based, information-based, or interpersonal. Many factors were common across transport modes. One reason for this is that environmental features designed to facilitate the use of one particular transport mode also influenced the use of other modes (e.g., bus shelters influence not only bus use but also walking as they provide pedestrian seating). Thus, environments need to be considered from the perspective of multiple, different types of road users. Another reason is that many factors related to the ways individuals experienced their environment (e.g., finding information guiding behaviour in public spaces to be unclear), regardless of any specific transport mode. This review highlights the important need for greater cross-sectoral action and input from older people.