Fostering planetary health in polluted environments: lessons from the Xonacatlán Indigenous Council in Mexico.

BACKGROUND: The communities of El Salto and Juanacatlán face negative impacts on human and ecosystem health due to their proximity to the second-largest industrial area in Mexico. Despite living in a region negatively impacted by high levels of pollution, these communities have organised to foster planetary health by reforesting with native plants, campaigning to stop further industrial development, and founding the Xonacatlán Indigenous Council (XIC) to reclaim traditional ways of living. This research project seeks to advance insights on the implications of fostering planetary health from the perspective of communities facing adverse socioeconomic and environmental conditions. METHODS: This qualitative study draws from participatory action research, Indigenous storywork, and ethnography. The XIC acted as the community advisory board of this research project and two XIC members are part of the research team. We investigate whether the stories and practices of community members associated with XIC contribute to fostering planetary health. Research activities will include 40-60 participants in storytelling interviews, story-making workshops, and participant observation in XIC activities. Data collection started on Nov 20, 2023, and will be finalised in August, 2024. FINDINGS: Our ethnographic analysis investigates local understandings of the relationships between human and ecosystem health. Anticipated findings include stories about the rejection of narratives of industrial progress due to environmental damage, the reconnection with Coca identities and traditional ways of relating to the land, and the use of direct action to counteract the negligence of the state-sponsored public health system and assert local planetary health needs. INTERPRETATION: By assessing grassroots Coca Indigenous action as a site of collective expertise on planetary health, we expect that this research project will bring attention to how people living in polluted environments can inform the conceptual development of planetary health and expand the range of practical initiatives that are considered fundamental to sustaining human and ecosystem life. FUNDING: None.

'It doesn't happen any other way': relationship-building and reflexivity for equity-focused intersectoral practice (EquIP).

Intersectoral processes that bring together public institutions, civil society organizations and affected community members are essential to tackling complex health equity challenges. While conventional wisdom points to the importance of human relationships in fostering collaboration, there is a lack of practical guidance on how to do intersectoral work in ways that support authentic relationship-building and mitigate power differentials among people with diverse experiences and roles. This article presents the results of RentSafe EquIP, a community-based participatory research initiative conducted in Owen Sound, Canada, in the midst of a housing crisis. The research explored the potential utility of equity-focused intersectoral practice (EquIP), a novel approach that invests in human relationships and knowledge co-creation among professionals and affected members of the community. The three-phase EquIP methodology centred the grounded expertise of community members with lived/living experience of housing inadequacy to catalyze reflexive thinking by people in professional roles about the institutional gaps and barriers that prevent effective intersectoral response to housing-related inequities. The research demonstrated that EquIP can support agency professionals and community members to (i) engage in (re)problematization to redefine the problem statement to better include upstream drivers of inequity, (ii) support reflexivity among those in professional roles to identify institutional practices, policies and norms that perpetuate stigma and impede effective intersectoral response and (iii) spark individual and collective agency and commitment towards a more equity-focused intersectoral system. We conclude that the EquIP methodology is a promising approach for communities seeking to address persistent health equity and social justice challenges.

Implementing Indigenous Gender-Based Analysis in Research: Principles, Practices and Lessons Learned.

Numerous tools for addressing gender inequality in governmental policies, programs, and research have emerged across the globe. Unfortunately, such tools have largely failed to account for the impacts of colonialism on Indigenous Peoples' lives and lands. In Canada, Indigenous organizations have advanced gender-based analysis frameworks that are culturally-grounded and situate the understanding of gender identities, roles, and responsibilities within and across diverse Indigenous contexts. However, there is limited guidance on how to integrate Indigenous gender-based frameworks in the context of research. The authors of this paper are participants of a multi-site research program investigating intersectoral spaces of Indigenous-led renewable energy development within Canada. Through introspective methods, we reflected on the implementation of gender considerations into our research team's governance and research activities. We found three critical lessons: (1) embracing Two-Eyed Seeing or Etuaptmumk while making space for Indigenous leadership; (2) trusting the expertise that stems from the lived experiences and relationships of researchers and team members; and (3) shifting the emphasis from 'gender-based analysis' to 'gender-based relationality' in the implementation of gender-related research considerations. Our research findings provide a novel empirical example of the day-to-day principles and practices that may arise when implementing Indigenous gender-based analysis frameworks in the context of research.

From controlling to connecting: M'Wikwedong as a place of urban Indigenous health promotion in Canada.

In recent years, health promotion has come under critique for being framed according to the contexts and priorities of Western communities, with the notion of 'control' underpinning much of its theoretical and practical development. Ceding space to Indigenous voices and knowledge is one way forward to overcoming this limitation and decolonizing the field. This paper reports on insights gained from a participatory digital storytelling project focused on Indigenous health promotion that took place at M'Wikwedong Indigenous Friendship Centre in the city of Owen Sound, Canada. The research team was formed by M'Wikwedong's Executive Director, five Indigenous youth and two university researchers. We co-created data through an 8-month digital storytelling process that involved 13 weekly research meetings, the creation of 4 digital stories and video screenings. We analysed data from seven group interview transcriptions, field notes and video transcripts through qualitative coding and theme building. The four themes we identified speak to the ways M'Wikwedong reinforced connections to youth, their sense of self, place in the city and Indigenous cultures. From our findings, we theorize that egalitarianism of knowledge, restoring balance in relationships and Indigenous leadership are core components of an 'ethos of connection' that underlies Indigenous health promotion. The 'ethos of connection' challenges Western notions of 'control' and brings attention to the unique expertise and practices of urban Indigenous communities and organizations as a primary basis for health promotion.

Stop ringing the alarm; it is time to get out of the building!

The volume of calls for governments and public health officials to take concerted action on climate change has become almost deafening. Public health researchers and practitioners need to look beyond what we know about the health impacts of climate change, to what we are doing as our part in contributing to holding global temperature rise to under 1.5°C. This commentary reflects on the common threads across the articles of a special section in this issue of the Canadian Journal of Public Health, "Moving on IPCC 1.5°C", which sought examples of bold research and action advancing climate change mitigation and adaptation. Among the articles, there are signs that the public health community is gaining momentum in confronting the climate crisis. Three critical lessons emerged: the need for institutional change from the top of public health, the essential power of community in intersectoral action on climate change preparedness, and the importance of centring Indigenous wisdom to decolonize colonial legacy systems. We encourage readers to move public health research and practice from an instrumental relationship with nature to one of reverence and sacred reciprocity.

RéSUMé: Le volume des appels aux gouvernements et aux autorités de santé publique à agir de concert face aux changements climatiques devient assourdissant. Au-delà de ce que nous savons des effets des changements climatiques sur la santé, les chercheurs et les praticiens en santé publique doivent examiner ce que nous faisons pour maintenir la hausse de la température mondiale en deçà de 1,5 °C. Dans ce commentaire, nous réfléchissons à la trame commune des articles d'une rubrique spéciale dans ce numéro de la Revue canadienne de santé publique, « Réaction au cri d'alarme du GIEC ¼, qui sollicitait des exemples d'études et de mesures audacieuses pour faire progresser l'atténuation des changements climatiques et l'adaptation à ces changements. Dans les articles de la rubrique, il y a des signes que la communauté de la santé publique se mobilise pour faire face à la crise climatique. Trois leçons essentielles s'en dégagent : la nécessité d'un changement institutionnel au sommet de la santé publique, le pouvoir essentiel de la communauté dans l'action intersectorielle de préparation aux changements climatiques, et l'importance de miser sur la sagesse autochtone pour décoloniser les systèmes hérités du colonialisme. Nous encourageons nos lecteurs à faire passer la recherche et la pratique en santé publique d'une relation instrumentale avec la nature à une relation de révérence et de réciprocité sacrée.

[Social participation and health: a collaborative experience on chronic kidney disease.] / Participación social y salud: una experiencia colaborativa sobre la enfermedad renal crónica.

OBJECTIVE: To identify challenges derived from renal insufficiency, as well as potential solutions and an agenda for action. MATERIALS AND METHODS: y adopting a collaborative research approach, diverse stakeholders -sick people, family members, advocacy groups, health professionals, and academics- participated in two gatherings in the context of the World Kidney Day in Guadalajara, Mexico and created an agenda for action. Data was gathered through group discussions. RESULTS: Two main issues are faced by kidney sick people and their family members: the first one related with health services and, second, the lack of economic resources to pay for renal treatment. The agenda for action included rallying on public squares, installing day of the dead altars, video making, and publishing a book. CONCLUSIONS: Participation of diverse stakeholders is a valuable option to face challenges derived from renal insufficiency.

OBJETIVO: Identificar los obstáculos derivados de la insuficiencia renal, las alternativas de solución y el plan de acció. MATERIAL Y MÉTODOS: A partir de un modelo colaborativo, diversos actores sociales ­individuos enfermos, familiares, asociaciones civiles, profesionales de salud y académicos­participaron en dos encuentros en Guadalajara, México con motivo del Día Mundial del Riñón y elaboraron un plan de acción. La información se obtuvo mediante grupos de discusión. RESULTADOS: Los individuos enfermos y sus familias enfrentan dos problemas prioritarios: uno relacionado con los servicios de salud y el otro con la carencia de recursos para el pago de las terapias renales. El plan de acción incluyó marchas en plazas públicas, colocación de altares de muertos, elaboración de material audiovisual y publicación de un libro. CONCLUSIONES: La participación de diversos actores es una opción valiosa para enfrentar desafíos derivados de la insuficiencia renal.

Participación social y salud: una experiencia colaborativa sobre la enfermedad renal crónica / Social participation and health: a collaborative experience on chronic kidney disease

Resumen: Objetivo: Identificar los obstáculos derivados de la insuficiencia renal, las alternativas de solución y el plan de acción. Material y métodos: A partir de un modelo colaborativo, diversos actores sociales -individuos enfermos, familiares, asociaciones civiles, profesionales de salud y académicos- participaron en dos encuentros en Guadalajara, México con motivo del Día Mundial del Riñón y elaboraron un plan de acción. La información se obtuvo mediante grupos de discusión. Resultados: Los individuos enfermos y sus familias enfrentan dos problemas prioritarios: uno relacionado con los servicios de salud y el otro con la carencia de recursos para el pago de las terapias renales. El plan de acción incluyó marchas en plazas públicas, colocación de altares de muertos, elaboración de material audiovisual y publicación de un libro. Conclusión: La participación de diversos actores es una opción valiosa para enfrentar desafíos derivados de la insuficiencia renal.

Abstract: Objective: To identify challenges derived from renal insufficiency, as well as potential solutions and an agenda for action. Materials and methods: By adopting a collaborative research approach, diverse stakeholders -sick people, family members, advocacy groups, health professionals, and academics- participated in two gatherings in the context of the World Kidney Day in Guadalajara, Mexico and created an agenda for action. Data was gathered through group discussions. Results: Two main issues are faced by kidney sick people and their family members: the first one related with health services and, second, the lack of economic resources to pay for renal treatment. The agenda for action included rallying on public squares, installing day of the dead altars, video making, and publishing a book. Conclusion: Participation of diverse stakeholders is a valuable option to face challenges derived from renal insufficiency.