Complex adaptive systems-based framework for modeling the health impacts of climate change.

Introduction: Climate change is a global phenomenon with far-reaching consequences, and its impact on human health is a growing concern. The intricate interplay of various factors makes it challenging to accurately predict and understand the implications of climate change on human well-being. Conventional methodologies have limitations in comprehensively addressing the complexity and nonlinearity inherent in the relationships between climate change and health outcomes. Objectives: The primary objective of this paper is to develop a robust theoretical framework that can effectively analyze and interpret the intricate web of variables influencing the human health impacts of climate change. By doing so, we aim to overcome the limitations of conventional approaches and provide a more nuanced understanding of the complex relationships involved. Furthermore, we seek to explore practical applications of this theoretical framework to enhance our ability to predict, mitigate, and adapt to the diverse health challenges posed by a changing climate. Methods: Addressing the challenges outlined in the objectives, this study introduces the Complex Adaptive Systems (CAS) framework, acknowledging its significance in capturing the nuanced dynamics of health effects linked to climate change. The research utilizes a blend of field observations, expert interviews, key informant interviews, and an extensive literature review to shape the development of the CAS framework. Results and discussion: The proposed CAS framework categorizes findings into six key sub-systems: ecological services, extreme weather, infectious diseases, food security, disaster risk management, and clinical public health. The study employs agent-based modeling, using causal loop diagrams (CLDs) tailored for each CAS sub-system. A set of identified variables is incorporated into predictive modeling to enhance the understanding of health outcomes within the CAS framework. Through a combination of theoretical development and practical application, this paper aspires to contribute valuable insights to the interdisciplinary field of climate change and health. Integrating agent-based modeling and CLDs enhances the predictive capabilities required for effective health outcome analysis in the context of climate change. Conclusion: This paper serves as a valuable resource for policymakers, researchers, and public health professionals by employing a CAS framework to understand and assess the complex network of health impacts associated with climate change. It offers insights into effective strategies for safeguarding human health amidst current and future climate challenges.

Transformative learning for a sustainable and healthy future through ecosystem approaches to health: insights from 15 years of co-designed ecohealth teaching and learning experiences.

This paper presents insights from the work of the Canadian Community of Practice in Ecosystem Approaches to Health (CoPEH-Canada) and 15 years (2008-2022) of land-based, transdisciplinary, learner-centred, transformative learning and training. We have oriented our learning approaches to Head, Hands, and Heart, which symbolise cognitive, psychomotor, and affective learning, respectively. Psychomotor and affective learning are necessary to grapple with and enact far-reaching structural changes (eg, decolonisation) needed to rekindle healthier, reciprocal relationships with nature and each other. We acknowledge that these approaches have been long understood by Indigenous colleagues and communities. We have developed a suite of teaching techniques and resources through an iterative and evolving pedagogy based on participatory approaches and operating reciprocal, research-pedagogical cycles; integrated different approaches and ways of knowing into our pedagogy; and built a networked Community of Practice for continued learning. Planetary health has become a dominant framing for health-ecosystem interactions. This Viewpoint underscores the depth of existing scholarship, collaboration, and pedagogical expertise in ecohealth teaching and learning that can inform planetary health education approaches.

Exploring spatial patterns of sudden cardiac arrests in the city of Toronto using Poisson kriging and Hot Spot analyses.

INTRODUCTION: Our study looked at out-of-hospital sudden cardiac arrest events in the City of Toronto. These are relatively rare events, yet present a serious global clinical and public health problem. We report on the application of spatial methods and tools that, although relatively well known to geographers and natural resource scientists, need to become better known and used more frequently by health care researchers. MATERIALS AND METHODS: Our data came from the population-based Rescu Epistry cardiac arrest database. We limited it to the residents of the City of Toronto who experienced sudden arrest in 2010. The data was aggregated at the Dissemination Area level, and population rates were calculated. Poisson kriging was carried out on one year of data using three different spatial weights. Kriging estimates were then compared in Hot Spot analyses. RESULTS: Spatial analysis revealed that Poisson kriging can yield reliable rates using limited data of high quality. We observed the highest rates of sudden arrests in the north and central parts of Etobicoke, western parts of North York as well as the central and southwestern parts of Scarborough while the lowest rates were found in north and eastern parts of Scarborough, downtown Toronto, and East York as well as east central parts of North York. Influence of spatial neighbours on the results did not extend past two rings of adjacent units. CONCLUSIONS: Poisson kriging has the potential to be applied to a wide range of healthcare research, particularly on rare events. This approach can be successfully combined with other spatial methods. More applied research, is needed to establish a wider acceptance for this method, especially among healthcare researchers and epidemiologists.

Watershed management and public health: an exploration of the intersection of two fields as reported in the literature from 2000 to 2010.

Watersheds are settings for health and well-being that have a great deal to offer the public health community due to the correspondence between the spatial form of the watershed unit and the importance to health and well-being of water. However, managing watersheds for human health and well-being requires the ability to move beyond typical reductionist approaches toward more holistic methods. Health and well-being are emergent properties of inter-related social and biophysical processes. This paper characterizes points of connection and integration between watershed management and public health and tests a new conceptual model, the Watershed Governance Prism, to determine the prevalence in peer-reviewed literature of different perspectives relating to watersheds and public health. We conducted an initial search of academic databases for papers that addressed the interface between watershed management (or governance) and public health themes. We then generated a sample of these papers and undertook a collaborative analysis informed by the Watershed Governance Prism. Our analysis found that although these manuscripts dealt with a range of biophysical and social determinants of health, there was a tendency for social factors and health outcomes to be framed as context only for these studies, rather than form the core of the relationships being investigated. At least one cluster of papers emerged from this analysis that represented a cohesive perspective on watershed governance and health; "Perspective B" on the Watershed Governance Prism, "water governance for ecosystems and well-being," was dominant. Overall, the integration of watershed management/governance and public health is in its infancy.

Canadian ENGOs in governance of water resources: information needs and monitoring practices.

Water quality monitoring involves a complex set of steps and a variety of approaches. Its goals include understanding of aquatic habitats, informing management and facilitating decision making, and educating citizens. Environmental nongovernmental organizations (ENGOs) are increasingly engaged in water quality monitoring and act as environmental watchdogs and stewards of water resources. These organizations exhibit different monitoring mandates. As government involvement in water quality monitoring continues to decline, it becomes essential that we understand their modi operandi. By doing so, we can enhance efficacy and encourage data sharing and communication. This research examined Canadian ENGOs that collect their own data on water quality with respect to water quality monitoring activities and information needs. This work had a twofold purpose: (1) to enhance knowledge about the Canadian ENGOs operating in the realm of water quality monitoring and (2) to guide and inform development of web-based geographic information systems (GIS) to support water quality monitoring, particularly using benthic macroinvertebrate protocols. A structured telephone survey was administered across 10 Canadian provinces to 21 ENGOs that undertake water quality monitoring. This generated information about barriers and challenges of data sharing, commonly collected metrics, human resources, and perceptions of volunteer-collected data. Results are presented on an aggregate level and among different groups of respondents. Use of geomatics technology was not consistent among respondents, and we found no noteworthy differences between organizations that did and did not use GIS tools. About one third of respondents did not employ computerized systems (including databases and spreadsheets) to support data management, analysis, and sharing. Despite their advantage as a holistic water quality indicator, benthic macroinvertebrates (BMIs) were not widely employed in stream monitoring. Although BMIs are particularly suitable for the purpose of citizen education, few organizations collected this metric, despite having public education and awareness as part of their mandate.

Mapping health on the internet: a new tool for environmental justice and public health research.

This paper examines the prospects for integrating Internet platform GIS or 'web-GIS' into environmental justice and related public health research. Specifically, we document the development of a web-GIS created for investigating relationships between health, air quality and socioeconomic factors in Hamilton, Canada. After development of the web-GIS site, we assembled a focus group of public health professionals to test functionality and render opinions about the potential of the site and geographic information in their program implementation. Results show overwhelming support for the further integration of GIS into public health practice. The results also underscore the potential of web-GIS to alleviate concerns of cost and data availability that often limit the use of GIS in community debates centred on environmental justice issues.

Soft systems methodology and the ecosystem approach: a system study of the Cooum River and environs in Chennai, India.

This paper discusses the integration of soft systems methodology (SSM) within an ecosystem approach in research to support rehabilitation and management of the Cooum River and environs in Chennai, India. The Cooum is an extremely polluted urban stream. Its management is complicated by high rates of population growth, poverty, uncontrolled urban development, jurisdictional conflicts, institutional culture, flat topography, tidal action, blockage of the river mouth, and monsoon flooding. The situation is characterized by basic uncertainty about main processes and activities, and the nature of relationships among actors and elements in the system.SSM is an approach for dealing with messy or ill-structured problematic situations involving human activity. In this work SSM contributed techniques (such as "rich picture" and "CATWOE" tools) to description of the Cooum situation as a socioecological system and informed the approach itself at a theoretical level. Application of three general phases in SSM is discussed in the context of the Cooum River research: (1) problem definition and exploration of the problem situation, (2) development of conceptual models of relevant systems, and (3) the use of these to generate insight and stimulate debate about desirable and feasible change. Its use here gives weight to the statement by others that SSM would be a particularly appropriate methodology to operate the ecosystem approach. As well as informing efforts at management of the Cooum system, this work led the way to explore an adaptive ecosystem approach more broadly to management of the urban environment for human health in Chennai.