Climate change, biodiversity loss, and Indigenous Peoples' health and wellbeing: A systematic umbrella review.

Indigenous Peoples worldwide are experiencing a cascade of impacts on their health and wellbeing as a result of climate change and biodiversity loss. Existing literature at the interface of climate change, biodiversity loss, and Indigenous health tells us that Indigenous Peoples are among those most disproportionately and acutely affected by these impacts. Yet, a gap exists with respect to comprehensively and critically synthesizing the impacts reported across this literature and identifying Indigenous-led responses. Guided by an Indigenous advisory group, we employed a systematic umbrella review methodology, following PRISMA guidelines, to characterize the global secondary literature (PROSPERO registration #: CRD42023417060). In so doing, we identified the proximal, intermediate, distal, and gendered impacts of climate change and biodiversity loss on Indigenous health and wellbeing as well as Indigenous-led responses. Five databases were searched for published reviews, along with a grey literature search that focused on underrepresented geographic regions in the academic literature. Two independent reviewers conducted two-stage screening, data extraction, and quality assessment of retrieved records. Basic descriptive statistics were calculated. Qualitative data were analyzed thematically, using a constant comparative approach. A total of 38 review articles met the eligibility criteria and 37 grey literature records were retrieved and included in the review. Reviews were published between 2010-2023 and geographically clustered in the Circumpolar North. Intersecting proximal, intermediate, and distal impacts were characterized as place-based and specific, and linked to colonialism as an antecedent to and driver of these impacts. Gendered impacts were underexplored within reviews. Reviewed literature underscored the value of engaging diverse knowledge systems; platforming localized, community-led adaptation to climate change and biodiversity loss, while addressing sociopolitical constraints to these efforts; and applying a broader conceptualization of health that aligns with Indigenous frameworks. Going forward, we must foreground equity- and rights-based considerations within integrated responses to climate and biodiversity crises.

How Public Health Organizational Structure Affected the Response to the COVID-19 Pandemic: A Case Study in British Columbia, Canada.

Objectives: This study sought to examine how public health organizational structures affected decision-making and provides recommendations to strengthen future public health crisis preparedness. Methods: The Institutions-Politics-Organizations-Governance (IPOG) framework and an organizational lens was applied to the analysis of COVID-19 governance within British Columbia (BC). Organizational charts detailing the structure of public health systems were compiled using available data and supplemented with data collected through key informant interviews. Results: In response to the COVID-19 pandemic, BC initiated several changes in its public health organization. BC's COVID-19 response attempted to utilize a centralized command structure within a decentralized health system. Four key themes were identified pertaining to the 1) locus of decision-making and action; 2) role of emergency structures; 3) challenges in organizational structure; and 4) balance between authority and participation in decision-making. Conclusion: The organizational adaptations enabled a substantively effective response. However, our findings also illustrate deficiencies in organizational structure in the current public health system. Two recommendations for consideration are: 1) a more formal vertical organizational structure; and 2) developing new mechanisms to link health and general emergency response structures.

Climate change, biodiversity loss, and Indigenous Peoples' health and wellbeing: a systematic umbrella review protocol.

BACKGROUND: Research that examines the intersections of Indigenous Peoples' health and wellbeing with climate change and biodiversity loss is abundant in the global scholarship. A synthesis of this evidence base is crucial in order to map current pathways of impact, as well as to identify responses across the global literature that advance Indigenous health and wellbeing, all while centering Indigenous voices and perspectives. This protocol details our proposed methodology to systematically conduct an umbrella review (or review of reviews) of the synthesized literature on climate change, biodiversity loss, and the health and wellbeing of Indigenous Peoples globally. METHODS: A multidisciplinary team of Indigenous and non-Indigenous scholars will conduct the review, guided by an engagement process with an Indigenous Experts group. A search hedge will be used to search PubMed®, Scopus®, Web of Science™, CINAHL (via EBSCOHost®), and Campbell Collaboration databases and adapted for use in grey literature sources. Two independent reviewers will conduct level one (title/abstract) and level two (full-text) eligibility screening using inclusion/exclusion criteria. Data will be extracted from included records and analyzed using quantitative (e.g., basic descriptive statistics) and qualitative methods (e.g., thematic analysis, using a constant comparative method). DISCUSSION: This protocol outlines our approach to systematically and transparently review synthesized literature that examines the intersections of climate change, biodiversity loss, and Indigenous Peoples' health and wellbeing globally. SYSTEMATIC REVIEW REGISTRATION: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on April 24, 2023 (registration number: CRD42023417060).

Indigenous communities and the mental health impacts of land dispossession related to industrial resource development: a systematic review.

Globally, many resource extraction projects such as mines and hydroelectric dams are developed on the territories of Indigenous Peoples. Recognising land as a determinant of Indigenous Peoples' health, our objective is to synthesise evidence about the mental health impacts on Indigenous communities who experience land dispossession due to industrial resource development (mining, hydroelectric, petroleum, and agricultural). We systematically reviewed studies that focused on Indigenous land dispossession in Australia, Aotearoa (New Zealand), North and South America, and the Circumpolar North. We searched Scopus, Medline, Embase, PsycINFO, and Global Health on OVID for peer-reviewed articles published in English from database inception to Dec 31, 2020. We also searched for books, research reports, and scholarly journals specialising in Indigenous health or Indigenous research. We included documents that reported on primary research, focused on Indigenous Peoples in settler colonial states, and reported on mental health and industrial resource development. Of the 29 included studies, 13 were related to hydroelectric dams, 11 to petroleum developments, nine to mining, and two to agriculture. Land dispossession due to industrial resource development had predominantly negative mental health impacts on Indigenous communities. The impacts were consequences of colonial relations that threatened Indigenous identities, resources, languages, traditions, spirituality, and ways of life. Health impact assessment processes in industrial resource development must expressly consider risks and potential impacts on mental health and respect Indigenous rights by making knowledge about mental health risks a central component to decisions about free, prior, and informed consent.

Caring in crisis: The experiences of local religious leaders meeting community food needs in the Philippines during the COVID-19 pandemic.

To respond to the unintended consequences of prevention measures to reduce COVID-19 transmission, individuals and groups, including religious leaders, have collaborated to provide care to those negatively impacted by these measures. Amid these various efforts and interventions, there is a need to deepen our understanding of diverse expressions of care across various geographical and social contexts. To address this need, the objective of this study was to investigate how religious leaders in the Philippines practiced care for their communities by meeting emergency food needs amid the COVID-19 pandemic. Guided by an ethics of care theoretical orientation, we conducted 25 remote semi-structured interviews with Filipino religious leaders who partnered with a Philippines-based non-governmental organization (NGO) to mobilize essential food aid to their local communities. Through defining the efforts and activities of these religious leaders as care work, we found that religious leader experiences revolved around navigating care responsibilities, caring alongside others, and engaging holistically with the care work. Additionally, we observed how contextual factors such as the humanitarian settings where religious leaders worked, the partnership with an NGO, and the positionality of local religious leaders within their communities, fundamentally shaped the care work. This study expands our understanding of how care is practiced and experienced and also brings greater visibility to the experiences and efforts of local religious leaders in responding to humanitarian emergencies.

The contributions of religious leaders in addressing food insecurity during the COVID-19 pandemic in the Philippines: A realist evaluation of the Rapid Emergencies and Disasters Intervention (REDI).

To address the unintended consequences of public health measures during the COVID-19 pandemic (e.g., emergency food insecurity, income loss), non-governmental organizations (NGOs) have partnered with diverse actors, including religious leaders, to provide humanitarian relief in resource-constrained communities. One such example is the Rapid Emergencies and Disasters Intervention (REDI), which is an NGO-led program in the Philippines that leverages a network of volunteer religious leaders to identify and address emergency food insecurity among households experiencing poverty. Guided by a realist evaluation approach, the objectives of this study were to identify the facilitators and barriers to effective implementation of REDI by religious leaders during the COVID-19 pandemic and to explore the context and mechanisms that influenced REDI implementation. In total, we conducted 25 virtual semi-structured interviews with religious leaders actively engaged in REDI implementation across 17 communities in Negros Occidental, Philippines. Interviews were audio recorded, transcribed, and thematically analyzed. Three main context-mechanism configurations were identified in shaping effective food aid distribution by religious leaders, including program infrastructure (e.g., technical and relational support from partner NGO), social infrastructure (e.g., social networks), and community infrastructure (e.g., community assets as well as a broader enabling environment). Overall, this study contributes insight into how the unique positionality of religious leaders in combination with organizational structures and guidance from a partner NGO shapes the implementation of a disaster response initiative across resource-constrained communities. Further, this study describes how intersectoral collaboration (involving religious leaders, NGOs, and local governments) can be facilitated through an NGO-led disaster response network.

How have researchers defined institutions, politics, organizations and governance in research related to epidemic and pandemic response? A scoping review to map current concepts.

In recent years, the literature on public health interventions and health outcomes in the context of epidemic and pandemic response has grown immensely. However, relatively few of these studies have situated their findings within the institutional, political, organizational and governmental (IPOG) context in which interventions and outcomes exist. This conceptual mapping scoping study synthesized the published literature on the impact of IPOG factors on epidemic and pandemic response and critically examined definitions and uses of the terms IPOG in this literature. This research involved a comprehensive search of four databases across the social, health and biomedical sciences as well as multi-level eligibility screening conducted by two independent reviewers. Data on the temporal, geographic and topical range of studies were extracted, then descriptive statistics were calculated to summarize these data. Hybrid inductive and deductive qualitative analysis of the full-text articles was conducted to critically analyse the definitions and uses of these terms in the literature. The searches retrieved 4918 distinct articles; 65 met the inclusion criteria and were thus reviewed. These articles were published from 2004 to 2022, were mostly written about COVID-19 (61.5%) and most frequently engaged with the concept of governance (36.9%) in relation to epidemic and pandemic response. Emergent themes related to the variable use of the investigated terms, the significant increase in relevant literature published amidst the COVID-19 pandemic, as well as a lack of consistent definitions used across all four terms: institutions, politics, organizations and governance. This study revealed opportunities for health systems researchers to further engage in interdisciplinary work with fields such as law and political science, to become more forthright in defining factors that shape responses to epidemics and pandemics and to develop greater consistency in using these IPOG terms in order to lessen confusion among a rapidly growing body of literature.

Navigating Paths to Wellness: A Strengths-Based Photovoice Study Conducted with One First Nation in Southern Ontario, Canada.

Research on substance use challenges in First Nations communities is often deficit-focused and can reinforce paternalistic stereotypes that lead to further discrimination. In this article, we report on findings of a strengths-based Photovoice project done in collaboration with a First Nations' community in southern Ontario, Canada to better understand experiences with substance use challenges in the community. We analyzed interview data collected with seventeen individuals who have lived experience or are supporting a loved one with lived experience with a substance use challenge. Participants described sources of strength that characterized their path to wellness, including strong family and social connections, cultural practices, identity, spirituality, day-to-day activities, and helpful supports and services. Furthermore, participants made several suggestions for improving services, including the need for integrated and flexible systems of care and trustful client-provider relationships. At its core, nurturing wellness involved a transformative process involving social and/or cultural connections. The stories shared by participants demonstrate the unique and varied strengths drawn from by individuals dealing with a substance use challenge.

Anishinabek sources of strength: Learning from First Nations people who have experienced mental health and substance use challenges.

We report on the system of care and sources of strength and resilience for mental health among First Nations People experiencing the impacts of historical and contemporary colonization. Aamjiwnaang First Nation, a vibrant community of approximately 2400 members in southwestern Ontario, Canada, partnered in research to reveal sources of strength and resilience among community members with lived experiences (PWLE) with mental health and/or substance use challenges. A thematic content analysis was done using qualitative data collected as part of two complementary studies. In the first study called the "Five Views on a Journey" study, interviews with PWLE and family members of PWLE were conducted to better understand strengths and deficits in the system of care for mental health and substance use. In the second study entitled "A Strengths-Based Approach to Understanding How First Nations People Cope with Stress and Trauma," Photovoice was used to examine sources of strength and resilience among PWLE. Combined, these studies revealed that mental health supports and services that are trustworthy, open, and confidential are foundational to healing, helping PWLE find pathways to wellness by engendering feelings of hope, self-worth and pride. The integral roles of Anishinaabe culture and cultural identity as well as strong connections with family and community were key sources of strength and resilience. Our findings are discussed in the context of Aamjiwnaang's informal and formal systems of care, culture as wellness, inner strength, and the Truth and Reconciliation Commission of Canada's Calls to Action.

Navigating fear and care: The lived experiences of community-based health actors in the Philippines during the COVID-19 pandemic.

The activities of community-based health actors are widely recognized as critical to pandemic response; yet, there exists a lack of clarity concerning who is included in this ecosystem of actors and how these actors experience the complexity of delivering community-level care in the context of a public health emergency. The objectives of this study were (1) to characterize the lived experiences of community-based health actors during the COVID-19 pandemic in the Philippines; and (2) to identify opportunities for further supporting these critical actors in the health workforce. Virtual semi-structured interviews were conducted (January-February 2021) with 28 workers employed by a Philippines-based non-governmental organization (NGO) to explore their lived experiences during the COVID-19 pandemic. Data were analyzed thematically using a hybrid inductive-deductive coding process, informed by Tronto's conceptualization of an ethic of care. Lived experiences among study participants were shaped by discourses of fear and care, and the interaction between these two affects. Participants reported everyday experiences of fear: NGO workers' fears of contracting and transmitting COVID-19 to others; perceived fear among community members where they worked; and fears around COVID-19 testing, recognizing the personal and social implications (e.g. stigma) of a positive test. Amid fear, participants had everyday experiences of care: care was a powerful motivator to continue their work; they felt supported by a caring organization that implemented safety protocols and provided material supports to those in quarantine; and they engaged in self-care practices. These findings contribute to understanding the ecosystem of actors involved in community-based health care and engagement efforts and the challenges they encounter in their work, particularly in a pandemic context. We highlight implications for civil society organizations charged with protecting the mental and physical well-being of their workers and describe how these actions can contribute to local health systems strengthening.

Impact on mental health and wellbeing in Indigenous communities due to land loss resulting from industrial resource development: protocol for a systematic review.

BACKGROUND: Indigenous Peoples are impacted by industrial resource development that takes place on, or near, their communities. Existing literature on impacts of industrial resource development on Indigenous Peoples primarily focus on physical health outcomes and rarely focus on the mental health impacts. To understand the full range of long-term and anticipated health impacts of industrial resource development on Indigenous communities, mental health impacts must be examined. It is well-established that there is a connection between the environment and Indigenous wellbeing, across interrelated dimensions of mental, physical, emotional, and spiritual health. METHODS: This paper identifies how the Community Advisory Team and a team of Indigenous and settler scholars will conduct the review. The literature search will use the OVID interface to search Medline, Embase, PsycINFO, and Global Health databases. Non-indexed peer-reviewed journals related to Indigenous health or research will be scanned. Books and book chapters will be identified in the Scopus and PsycINFO databases. The grey literature search will also include Google and be limited to reports published by government, academic, and non-profit organizations. Reference lists of key publications will be checked for additional relevant publications, including theses, dissertations, reports, and other articles not retrieved in the online searches. Additional sources may be recommended by team members. Included documents will focus on Indigenous Peoples in North America, South America, Australia, Aotearoa New Zealand, and Circumpolar regions, research that reports on mental health, and research that is based on land loss connected to dams, mines, agriculture, or petroleum development. Literature that meets the inclusion criteria will be screened at the title/abstract and full-text stages by two team members in Covidence. The included literature will be rated with a quality appraisal tool and information will be extracted by two team members; a consensus of information will be reached and be submitted for analysis. DISCUSSION: The synthesized evidence from this review is relevant for land use policy, health impact assessments, economic development, mental health service planning, and communities engaging in development projects. SYSTEMATIC REVIEW REGISTRATION: Registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration number CRD42021253720 ).

Investigating the influence of institutions, politics, organizations, and governance on the COVID-19 response in British Columbia, Canada: a jurisdictional case study protocol.

BACKGROUND: Research on public health responses to COVID-19 globally has largely focused on understanding the virus' epidemiology, identifying interventions to curb transmission, and assessing the impact of interventions on outcomes. Only recently have studies begun to situate their findings within the institutional, political, or organizational contexts of jurisdictions. Within British Columbia (BC), Canada, the COVID-19 response in early 2020 was deemed highly coordinated and effective overall; however, little is understood as to how these upstream factors influenced policy decisions. METHODS: Using a conceptual framework we developed, we are conducting a multidisciplinary jurisdictional case study to explore the influence of institutional (I), political (P), organizational (O), and governance (G) factors on BC's COVID-19 public health response in 2020-2021. A document review (e.g. policy documents, media reports) is being used to (1) characterize relevant institutional and political factors in BC, (2) identify key policy decisions in BC's epidemic progression, (3) create an organizational map of BC's public health system structure, and (4) identify key informants for interviews. Quantitative data (e.g. COVID-19 case, hospitalization, death counts) from publicly accessible sources will be used to construct BC's epidemic curve. Key informant interviews (n = 15-20) will explore governance processes in the COVID-19 response and triangulate data from prior procedures. Qualitative data will be analysed using a hybrid deductive-inductive coding approach and framework analysis. By integrating all of the data streams, our aim is to explore decision-making processes, identify how IPOG factors influenced policy decisions, and underscore implications for decision-making in public health crises in the BC context and elsewhere. Knowledge users within the jurisdiction will be consulted to construct recommendations for future planning and preparedness. DISCUSSION: As the COVID-19 pandemic evolves, governments have initiated retrospective examinations of their policies to identify lessons learned. Our conceptual framework articulates how interrelations between IPOG contextual factors might be applied to such analysis. Through this jurisdictional case study, we aim to contribute findings to strengthen governmental responses and improve preparedness for future health crises. This protocol can be adapted to and applied in other jurisdictions, across subnational jurisdictions, and internationally.

Exploring the Role of Social Networks in Facilitating Health Service Access Among Low-Income Women in the Philippines: A Qualitative Study.

Despite efforts to implement universal health care coverage (UHC) in the Philippines, income poor households continue to face barriers to health care access and use. In light of recent UHC legislation, the aim of this study was to explore how gender and social networks shape health care access and use among women experiencing poverty in Negros Occidental, Philippines. Semi-structured interviews were conducted with women (n = 35) and health care providers (n = 15). Descriptive statistical analyses were performed to report demographic information. Interview data were analyzed thematically using a hybrid deductive-inductive approach and guided by the Patient-Centred Access to Health Care framework. Women's decisions regarding health care access were influenced by their perceptions of illness severity, their trust in health care facilities, and their available financial resources. Experiences of health care use were shaped by interactions with health professionals, resource availability at facilities, health care costs, and health insurance acquisition. Women drew upon social networks throughout their lifespan for social and financial support to facilitate healthcare access and use. These findings indicate that social networks may be an important complement to formal supports (eg, UHC) in improving access to health care for women experiencing poverty in the Philippines.

'We don't use the same ways to treat the illness:' A qualitative study of heterogeneity in health-seeking behaviour for acute gastrointestinal illness among the Ugandan Batwa.

The Batwa (Twa), an Indigenous People of southwest Uganda, were evicted from their ancestral forest lands in 1991 due to establishment of the Bwindi Impenetrable Forest. This land dispossession forced Batwa to transition from a semi-nomadic, hunting-gathering livelihood to an agricultural livelihood; eliminated access to Indigenous food, medicines, and shelter; and shifted their healthcare options. Therefore, this exploratory study investigated why Batwa choose Indigenous or biomedical treatment, or no treatment, when experiencing acute gastrointestinal illness. Ten gender-stratified focus groups were conducted in five Batwa settlements in Kanungu District, Uganda (n = 63 participants), alongside eleven semi-structured interviews (2014). Qualitative data were analysed thematically, using a constant comparative method. Batwa emphasised that health-seeking behaviour for acute gastrointestinal illness was diverse: some Batwa used only Indigenous or biomedical healthcare, while others preferred a combination, or no healthcare. Physical and economic access to care, and also perceived efficacy and quality of care, influenced their healthcare decisions. This study provides insight into the Kanungu District Batwa's perceptions of biomedical and Indigenous healthcare, and barriers they experience to accessing either. This study is intended to inform public health interventions to reduce their burden of acute gastrointestinal illness and ensure adequate healthcare, biomedical or Indigenous, for Batwa.

"Sewing Is Part of Our Tradition": A Case Study of Sewing as a Strategy for Arts-Based Inquiry in Health Research With Inuit Women.

In this article, we present a case study of sewing as a strategy for arts-based inquiry in health research, situated within a broader project that highlighted Nunavut Inuit women's childbirth experiences. Five focus groups were hosted as sewing sessions with pregnant women (N = 19) in Iqaluit, Nunavut (2017-2018). Women's reflections on the sessions, and the significance of sewing to Inuit, were integrated with researchers' critical reflections to examine the value of sewing as a strategy for arts-based inquiry within a focus group method: results related to the flexibility of the sessions; how collective sewing created space for voicing, sharing, and relating; sewing as a tactile and place-specific practice tied to Inuit knowledge and tradition; and lessons learned. Our results underscore the possibilities of arts-based approaches, such as sewing, to enhance data gathering within a focus group method and to contribute to more locally appropriate, place-based methods for Indigenous health research.

Mapping the maternal health research landscape in Nunavut: A systematic search & critical review of methodology.

Nunavut's maternal healthcare system is characterized by rapid transition from community-based birth to a practice of obstetric evacuation and institutionalized birth. Given calls for Inuit self-determination in research, maternal health research - which informs healthcare practices and policies - may need to be conducted differently, using different research methodologies, to include Inuit women's voices and lived experiences. In light of these calls, this article systematically synthesized the published maternal health literature in Nunavut and critically examined reported research methods. This systematic search and critical review involved a comprehensive database search and multi-level eligibility screening conducted by two independent reviewers. Data on the temporal, geographic, methodological, and topical range of studies were extracted, then descriptive statistics were calculated to summarize these data. A hybrid inductive and deductive qualitative analysis of the full-text articles was conducted to critically analyze research methodology. The initial search yielded 2656 distinct articles and twenty-eight articles met the inclusion criteria. These articles were published from 1975 to 2016, mostly used quantitative research methodology (71.4%), were written from clinical perspectives (57.1%), and focused on maternity care (53.6%). Emergent themes related to both the contributions and areas for growth of research methodology in the conceptualization, initiation, implementation, reporting, and knowledge mobilization stages of the research process. This review revealed opportunities for maternal health researchers to: redress the ongoing impacts of colonization; further include Inuit definitions of health and perspectives on birth in study designs; explore new methodologies that resonate with Inuit ways of knowing; continue (re)aligning research with community priorities; and move from consultation and collaborative partnership in research to Inuit leadership and data ownership. Indeed, this review illustrates that at each step of the research process, opportunity exists for Inuit perspectives and active involvement to shape and define maternal health research in Nunavut.