Physical Health

Model Simulation of Margalla Forest to Mitigate Heatwaves and Improve Air Quality Index

Authors: Adnan Arshad1, Lizhen Zhang1, Kamran Yousfi1, Waying Wang1
Author Affiliations: 1China Agricultural University

This research article illustrates the application of SILVA and SWAT growth model in forestry practices to improve air quality index (AQI) and simulate the possible opportunities to mitigate extreme climatic changes to build resilience of forest. Pakistan is a developing country and contributes minimum to global warming, its CO2 emissions being less than 0.41% of the total global emission. Current urbanization, industrialization and motorization leads to air pollution, as countries around the sphere continue to emit millions of tons of carbon, the impacts of increasing temperature will keep deteriorating major cities (Islamabad & Rawalpindi). It was labeled as the most climate vulnerable nation according to the Climate Change Vulnerability Index (CCVI-12-2013). Extreme climatic events i.e. heatwaves, rising temperature and hail storming effecting all aspects of life of these cities and ranging from economic, social, food, energy, water, forest and politics. Both major cities are located on the front line of forest areas and current environmental and anthropogenic activities leads to deforestation and degradation. Urban ecosystems, particularly Margalla forests has the capacity to absorb and store maximum amount of urban CO2 and that recognized its significance in confronting further air pollution and heatwaves. Margalla forests are rich in carbon sequestrating and importantly prioritize in the field of adaptation and mitigation of extreme climate change events at globally. SILVA model simulations resulted that 2/3 of the urban CO2 stock can be deposited by Margalla forest which contributes 19% of the Margalla ecosystem. Model projected that forest areas of both cities has ability to absorb CO2 emissions up to 55.4 million tons. Models validation skill scores showed that forest has huge potential to contribute to global efforts to reduce carbon footprints through climate smart practices of restoration, afforestation, conservation, reforestation and sustainable management of Margalla forests. SILVA estimated that forest population has excellent sink capacity to absorb maximum atmospheric carbon to combat global climate change impacts and efficiently manage REDD+ so it contributes to improve the AQI and HW.

Residential surrounding greenness is associated with slower cognitive decline in the ageing Whitehall II cohort: a longitudinal study

Authors: Carmen de Keijzer1,2,3, Cathryn Tonne1,2,3, Xavier Basagaña1,2,3, Antònia Valentín1,2,3, Archana Singh-Manoux4,5, Jordi Alonso2,3,6, Josep Maria Antó1,2,3, Mark J Nieuwenhuijsen1,2,3, Jordi Sunyer1,2,3, Payam Dadvand1,2,3
Author Affiliations: 1ISGlobal, Centre for Research in Environmental Epidemiology; 2Universitat Pompeu Fabra; 3CIBER Epidemiologia y Salu Pública; 4INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay; 5Department of Epidemiology and Public Health, University College of London; 6Health Services Research Unit, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques

Background – Cognitive functioning is one of the most important indicators of healthy ageing. The evidence on beneficial associations of green space with cognitive function in older adults is very scarce and mainly limited to cross-sectional studies. This study aimed to investigate the association between long-term residential surrounding greenness and cognitive decline.

Methods – This longitudinal study was based on three follow-ups of 6506 participants (45-68 years old) from the Whitehall II cohort from the United Kingdom, covering a 10-year period (1997-1999 to 2007-2009). The exposure assessment was based on the characterization of outdoor residential surrounding greenness at each follow-up. We obtained the greenness across buffers of 500 and 1000 meter around the participants’ residential address using satellite images on greenness (Normalized Difference Vegetation Index, NVDI) from a summer month in every follow-up period. A battery of four cognitive tests was repeated three times over the study period, assessing reasoning, short-term memory, and verbal fluency. The cognitive scores were converted to z-scores and summarized in a “global cognition” z-score. To quantify the impact of greenness on the repeated measurements of cognition, we used linear mixed effect models that included an interaction between age and the indicator of greenness. The models were adjusted for time-varying covariates including individual and neighborhood indicators of socioeconomic status.

Findings – An interquartile range increase in NDVI was associated with a difference in the global cognition z-score of 0.020 (95% confidence interval (CI): 0.003 to 0.037, p=0.02) over 10 years. Comparing study participants of 55.7 years old, this difference was equivalent to a 4.6% slower decline over 10 years. Similar positive associations were also observed for reasoning (0.022, 95% CI: 0.007 to 0.038) and verbal fluency (0.021, 95% CI: 0.002 to 0.040). We observed some suggestions for stronger associations among women and participants with higher secondary education.

Interpretation – The findings suggest that higher residential surrounding greenness is associated with slower cognitive decline. Further research is needed to confirm our findings and provide information on the specific characteristics of green spaces that can maximize healthy cognitive ageing, especially for older adults residing in urban areas.

Integrating ecological and equity dynamics into the development of an Environment, Community, Health Observatory Network: Lessons for complexity-oriented research in the Anthropocene

Authors: Maya Gislason1, Margot W. Parkes1
Author Affiliations: 1School of Health Sciences, University of Northern British Columbia

Background:
Natural resource extraction is one way that humans profoundly impact the geologic record as well as the health and resilience of communities already contending with complex social and ecological changes. The impacts of intensive resource development have created an “integration imperative” as their environmental, community and health impacts need to be understood in terms of their cumulative influences on the health of people, places and animals across their life course. The urgency of the “integration imperative” is especially felt in rural, remote, northern and Indigenous communities where most intensive resource extraction occurs, and the need for more sustainable approaches to the management of the cumulative impacts of multiple resource development projects is evident.

Methods:
In this presentation, we will examine ways combined equity and ecosystem dynamics have been addressed during the foundational phase of a five-year international project, titled: “Environment, Community, Health Observatory (ECHO) Network: Strengthening intersectoral capacity to understand and respond to health impacts of resource development”. The ECHO project is based in Canada and is developing partnerships in Australia and New Zealand. By bringing together a diverse range of disciplines, sectors and stakeholder groups this project is refining methods for building integrative understanding and responses to the cumulative determinants of health, in relation to social and ecosystem change. The project has responded to the combined equity and ecosystem dynamics of cumulative impacts by prioritising equity-informed research across all four regional case studies in Canada, drawing on critical social theory and social inequities and health frameworks that incorporate both intersectoral and intersectional considerations.

Findings:
The foundational phase of research has highlighted the need to attend to pathways of influence that extend beyond the typical purview of health research, where ‘upstream’ includes places, waterways, landscapes and drivers of change, that are well outside the traditional ‘spheres of influence’ of the health sector, and which have combined implications for health equity and the ecological determinants of health. Our initial phase of research has also highlighted challenges and opportunities arising when equity considerations are incorporated into learning about a new generation of tools and processes that local, regional and international partners are using to “take notice for action”.

Interpretation:
Discussion will focus on the importance of both equity and ecological considerations when designing research that responds to the “integration imperative”, furthers evidence of cumulative determinants of health impacts and incorporates attention to the complex challenges facing health and sustainability agendas in the Anthropocene.

Climate Change and Urban Health: Combined Burden of Heat and Ultrafine Particles (UFP)

Author: Oskar Masztalera
Author Affiliation: 1Charité Berlin

BACKGROUND: Heat stress can be defined as the impact of meteorological variables leading to an excessive strain on the thermoregulatory capacity of the organism. Ultrafine Particles (UFP) include all particles with a thermodynamic diameter less than 100 nanometers and is ubiquitous in urban atmospheres. Traffic emissions, especially from diesel engines, are a major UFP source. It might be primarily responsible for the adverse health effects of overall particulate matter. It is not appropriately captured by current measurements and regulatory limits. There is evidence for adverse synergetic effects of air pollution and heat stress. Though studies dedicated to the combined burden of UFP and heat stress are missing.

OBJECTIVES AND METHODS: To generate possible approaches for the further scientific examination and the development of targeted preventive measures, this paper identifies overlaps between the impacts of UFP and those of heat stress. Within a systematic review, 63 epidemiological studies and review papers are examined. Additional literature is included in the analysis. Relevant scientific issues are elaborated from an interdisciplinary perspective. A possible index for the combined burden is developed (UTCI*UFP).

RESULTS: Overlaps between UFP and heat stress are given, concerning the functional systems, on which both stressors act in the organism, the cardiorespiratory diseases they favour, vulnerable subpopulations, and vulnerable spaces on a global, regional and local scale. Temporal coincidences throughout day and year are imaginable. Interactions and synergetic effects are plausible in all of the named dimensions. Exposure to one stressor could render a subject more sensitive to the effects of the other. Synergetic threshold crossing through a summation of subclinical effects could favour disease outbreaks. An increasing exposure has to be expected especially in low and middle income countries with limited adaptive capacities.

DISCUSSION AND CONCLUSIONS. It is plausible, that UFP and heat stress are hazards for urban health, both as single stressors, as well as in combination. The single and combined burden could increase through ongoing urbanization, global ageing and climate change. Several preventive measures could deliver multiple health benefits through combined protection from UFP, heat stress and climate change in general. Further scientific examination of both single stressors and the combined burden is reasonable to facilitate a rapid implementation of targeted preventive measures. Planetary Health could provide an innovative framework for interdisciplinary cooperation.

Disentangling determinants of insecticide use to manage production, food security, and health risks: Evidence from household survey and risk assessment experiments in Cambodia and Vietnam

Authors: Wei Zhang1, Yanyan Liu1, Andrew Bell2
Author Affiliations: 1International Food Policy Research Institute; 2New York University

Insect pest problems are among the main causes of crop yield losses in global agriculture. Insecticides are a risk-mitigating input that shields households from food security and income shocks, but they induce well-documented human health and environmental risks. Using field data collected from household survey and risk assessment experiments in 2014 in Cambodia and Vietnam, we disentangle the determinants of insecticide use by semi-subsistence farm households (SSFHs) and identify whether health consideration has had any influence on insecticide use. Farming for both consumption and sale, SSFHs make crop management and output allocation decisions to maximize utility that consists of food consumption, income, and health, given risk preferences and other household and community characteristics. Improved understanding of these issues is essential to inform policies that tackle multiple sustainable development objectives cutting across poverty reduction, food security, health, and the environment. Prior studies that address the health effects of insecticide use have focused on poisoning experienced by farmers. We extend the scope of previous studies by considering all possible impact channels in the private health risk domain: 1) exposure to contaminated products by family members, 2) exposure to chemicals by farmers, and 3) exposure to ambient drifting chemicals by family members and people in proximity.

Our econometric analysis identifies both push and deterring factors at household, plot, and crop levels in dictating insecticide use decisions. A more challenging question is which of those deterring factors are motivated by health consideration. Our initial findings are: 1) Crops (except for rice) whose outputs are used to a greater degree for consumption are less likely to be sprayed or sprayed fewer times. While it is possible that health consideration may have a role discouraging spray given the confounding factors controlled for, we cannot be certain about a direct causal linkage because of the complexity in SSFH decision-making. 2) Health-conscious households (as indicated by the adoption of modern-fuel cooking stove and reported concern over food safety) consistently refrain from spraying, but this tendency diminishes as outputs shifting toward commercial use, suggesting a possible moral hazard phenomenon. 3) Farmers are more likely to apply insecticides on crops of high food security or diet importance, such as rice, although the difference between fresh produce and grain produce in insecticide residue exposure risk might also play a role. 4) The two samples from Cambodia and Vietnam reveal similarities and differences, suggesting the importance of addressing specific contexts.

Air Quality Measures in Morelia City, Michoacan, Mexico in 2016 and Risk Communication

Authors: Alejandro Molina-Garcia1, Arturo Reyes-Hernandez1, Andrea Rodriguez-Gomez
Author Affiliations: 1Ministry of Health at Michoacan State

Background: The World Health Organization mentions that bad air quality causes 7 million premature deaths in the world associated to lung and heart diseases. Air pollution also affects ecosystems. The sources of air pollution is related with local economy, overloaded motor vehicle traffic, bad planning in urban zones and fuel consumption. Local geographic conditions and climate contributes to maintain good air quality breathing and with dispersion and accumulation of air pollutants. Here, this is the first records to know air quality in Morelia City, Mexico. To show if the air quality is affording with local regulations. Finally, to establish control and risk communication assessment. Citizens do not considerate that bad air pollution is a threat. Methods: Air quality measures during 365 days was done in around 2 kilometers with TELEDYNE trade mark sensor tools for several pollutants and meteorological conditions, mainly, O3, NO2, SO2, CO, PM10µ, PM2.5µ. The data was revising with national law regulations on air quality. Results: Particulate matter <2.5µ were 62.4 µg/m³ and 86.7 µg/m³ in 24 hours in april and may of 2016 (threshold levels is 45µ/m3); particulate matter 10µ was above 75 µg/m³ with highest values 160.7 µg/m³ since march through august, november and december, respectively. Ozone measures were above 0.095 ppm/hour with 0.920 ppm/hour in march, may and december in 2016. NO2 and SO2 were below threshold levels. Conclusions: The highest air polluted months were march, april and may with particulate matter 10µ, 2.5µ; and ozone in this zone of Morelia and their sources are by overloaded car traffic and forest fires on the land side mountains near from Morelia. April and may were the hottest months than ever registered before from NASA, NOAA reports and our air quality station. Local authorities must send early warnings on air quality in media access.

Unintended consequences of pharmaceutical pollutants: insights from population-level surveys and point-of-care interviews to identify points of intervention

Author: Christine Vatovec1,2,3
Author Affiliation: 1Gund Institute for Environment; 2Larner College of Medicine; 3Rubenstein School of Environment and Natural Resources, University of Vermont

BACKGROUND: Pharmaceuticals are classified as chemicals of emerging concern because of the unintended consequences they pose to the health of aquatic ecosystems. The biological activity that makes many medications valuable to human health can persist in natural environments after human excretion and disposal. These persistent chemicals can lead to behavioral and physiological changes in several aquatic species. After observing the disposal of unused medications down-the-drain in a variety of healthcare settings, we sampled wastewater entering Lake Champlain in Vermont, USA, and detected 51 pharmaceuticals directly entering the lake via effluent. The aims of the on-going studies reported here are 1) to examine the social governance of pharmaceutical pollution, and 2) identify key points of intervention to minimize the effects of these chemicals on aquatic environments.

METHODS: This research employs mixed social science methods including surveys to examine consumer purchasing, use, and disposal behaviors as sources of pharmaceutical pollution, and interviews to provide insight on clinical prescribing and dispensing practices.

FINDINGS: We share results from four interrelated studies that each provide insight on pharmaceutical pollutants resulting from different populations and various social governance factors. 1) A survey of university students (n = 358) indicates that leftover drugs pose disposal concerns among this young adult population, and that this demographic is unaware of appropriate disposal options for unwanted medications. 2) A survey of Burlington, Vermont residents (n = 161) indicates that flushing is not a major source of pharmaceutical pollution in wastewater effluent. 3) A survey of Vermont residents (n = 421) indicates that both human and veterinary medications are sources of pollution. 4) Interviews with clinicians and pharmacists suggest that the political economy of pharmaceutical prescribing and dispensing is a key point of intervention for minimizing pollution.

INTERPRETATION: The social governance of pharmaceutical contaminants in the aquatic environment is a complex system that involves both a lack of awareness at the consumer level and complex, contradicting directives at the institutional level. The surveys reported here indicate that large volumes of both prescription and over-the-counter drugs go unused and require appropriate disposal (currently high-heat incineration at a licensed facility), but that access to and awareness of disposal options is limited across all populations surveyed. Interviews with healthcare providers indicate several prescribing and dispensing practices that lead to leftover medications that require disposal. Key points of intervention include promoting appropriate disposal through existing policies, and decreasing the volume of drugs prescribed and dispensed.

Oil extraction in the Peruvian Amazon basin and exposure to metals in indigenous populations

Author: Cristina O’Callaghan-Gordo1, Juan A. Flores2Pilar Lizárraga2Tami Okamoto3, Diana M. Papoulias4, Federica Barclay5Martí Orta-Martínez6, Manolis Kogevinas1, John Astete2
Author Affiliations: 1ISGlobal; 2National Institute of Health-Centro Nacional de Salud ocupacional y Protección del Ambiente para la Salud; 3Pontificia Unviersidad Católica del Perú; 4E-Tech International; 5Centro de políticas Públicas y Derechos Humanos; 6International Institute of Social Studies, Erasmus University Rotterdam

Background:
Poor environmental practices by the oil industry and recurrent oil spills have contaminated the Corrientes, Pastaza, Tigre and Marañon river basins (Peru). Recent data have shown that wildlife species that play an important role in the diet of rural Amazonian human populations consume oil-contaminated soils and water. Indigenous population living in this area are exposed to metals and other contaminants related to oil extraction activities by diverse routes of exposure. We are currently measuring levels of exposure to metals and hydrocarbons in the population of these four basins and evaluating potential sources and routes of exposure. Data presented here correspond to a study conducted in the Marañón basin where we measured levels of exposure to metals in two Kukama communities. A wider study of the whole region is ongoing.

Methods:
In January 2016 we visited two Kukama communities to assess blood and urine levels of heavy metals. Participation was offered to all inhabitants that had been living in these communities during at least the previous six months. Demographic data and information on involvement in oil clean-up activities were collected through questionnaires. Venous blood and urine were collected. Concentrations of lead in blood, and arsenic, cadmium, and mercury in urine were determined using atomic absorption spectrophotometry (AAS) (AAS in graphite chamber for lead and cadmium, flow injection –hydride generation AAS for arsenic, and cold vapour AAS for mercury).

Findings:
Nine percent of the population (132/1400) participated in the survey. 19% of children ≤ 10 years had blood lead levels above 5 µg/dL. No participant exceeded arsenic benchmarks recommended by the Peruvian Ministry of Health (MINSA, i.e. 20 µg arsenic/g creatinine). 17% and 50% of the study population exceeded levels recommended by the MINSA for cadmium (2 µg cadmium/g creatinine) and mercury (5 µg mercury/g creatinine), respectively. These percentages were higher among children ≤ 10 years: 18% and 64% of them had cadmium and mercury levels higher than those recommended, respectively. Participants involved in clean-up activities had higher blood lead than those not involved in clean-up.

Interpretation:
Individuals in these two communities have levels of mercury, cadmium and lead that can be detrimental to health. Recurrent oil spills, may be a source of exposure to these metals, although we cannot exclude the existence of other sources of exposure, especially for mercury. Results of the larger ongoing project will help in the identification of sources and routes of exposure.

Overcoming the global environmental health burden of our own development

Authors: Gabriel Filippelli1, M. Taylor2
Author Affiliations: 1Center for Urban Health, Indiana University; 2Macquarie University

New analyses are revealing a tremendous consequences of pollution on global health, with a disproportionate share of the impact borne by lower income nations, and minority and marginalized individuals. Common themes emerge on the drivers of this pollution impact, including lack of regulations, research, expertise, and funding for mitigation. Creative approaches need to be developed and applied to address and overcome these obstacles, as “business as usual” continues externalize the human health costs related to pollution and exerts its negative influence on global environmental health.

Collectively, the solutions to pollution elimination cannot be developed with technology alone, but rather alongside those very people and communities that need solutions—these are the real drivers for sustained change. They are too often left out of the conversation, even when ample evidence exists that the human burden of environmental exposures can be reduced both by limiting the exposure source and by modifying the behavior of the exposed individual.

Imagine a planet 20 years in the future where resource extraction and utilization continues to follow a reckless trajectory where “business as usual” reigns, an approach that intrinsically leaves people and their health out of “business.” Like global warming and resulting sea level rise, we might all find ourselves standing ankle deep in the refuse of centuries of ignorant exploitation, suffering the health effects of our, in hindsight, poor choices.

Causal effect of stress on cardio-metabolic health: Glycated hemoglobin ten years after the Indian Ocean tsunami

Authors: Duncan Thomas1Elizabeth Frankenberg2,3Teresa Seeman4, Cecep Sumantri5
Author Affiliations: 1Duke University; 2University of North Carolina, Chapel Hil; 3Carolina Population Center; 4UCLA; 5SurveyMeter, Indonesia

Background. Increased stress is associated with elevated cardio-metabolic health risks but establishing a causal mechanism is challenging and evidence on the longer-term consequences of large-scale stressors on health is limited. To fill these gaps, we investigate the impact of elevated stress from direct exposure to the 2004 Indian Ocean tsunami on health ten years later. The tsunami destroyed the built and natural environment along coastal Aceh, Indonesia, killed 5% of the population and caused very high levels of post-traumatic stress among those exposed.

Methods. The health of those who were living in heavily damaged communities at the time of the tsunami is compared with those in other communities drawing on population-representative longitudinal survey data collected before and after the tsunami, the Study of the Tsunami Aftermath and Recovery. Ten years after the tsunami, levels of glycated hemoglobin (HbA1c) were measured for all survivors age 20y and older including post-tsunami movers. HbA1c, a biomarker for diabetes risks, is measured using carefully-validated point-of-care tests in mobile laboratories at respondents’ homes.

Comparing the pre-tsunami characteristics of populations living at the time of the tsunami in communities that were heavily damaged with those living in other, coastal communities indicates no systematic differences between the populations. This is because the extent of damage in each community depended on land topography, elevation, wave direction and the physical structure of the off-shore sea bed: some coastal communities were heavily damaged while other, nearby communities, were largely untouched. Drawing comparisons of HbA1c of those who were living in communities that were heavily damaged by the tsunami with those from other communities, controlling age and gender, this quasi-experimental design provides an estimate of the causal impact of elevated stress on diabetes risks over the longer-term.

Findings and interpretation. Overall, 12% of males age 40 to 64y are diabetic (HbA1c>=6.5%). The rate is 7.6 percentage points higher (p-value=0.02) among those who were living in heavily damaged communities relative to communities that were not damaged. In contrast, HbA1c does not vary with exposure to damage among males age 20-39 or among females age 20 to 64y. Tsunami damage exposures were essentially the same for males and females in both age groups so differential stress exposures cannot explain these patterns. It is likely that the loss of livelihoods took a greater toll on the cardio-metabolic health of older males who faced greater difficulty rebuilding their wealth late in the life course.

Disentangling determinants of insecticide use to manage production, food security, and health risks: Evidence from household survey and risk assessment experiments in Cambodia and Vietnam

Author: Wei Zhang1Yanyan Liu1, Andrew Bell2
Author Affiliations: 1International Food Policy Research Institute2New York University 

Insect pest problems are among the main causes of crop yield losses in global agriculture. Insecticides are a risk-mitigating input that shields households from food security and income shocks, but they induce well-documented human health and environmental risks. Using field data collected from household survey and risk assessment experiments in 2014 in Cambodia and Vietnam, we disentangle the determinants of insecticide use by semi-subsistence farm households (SSFHs) and identify whether health consideration has had any influence on insecticide use. Farming for both consumption and sale, SSFHs make crop management and output allocation decisions to maximize utility that consists of food consumption, income, and health, given risk preferences and other household and community characteristics. Improved understanding of these issues is essential to inform policies that tackle multiple sustainable development objectives cutting across poverty reduction, food security, health, and the environment. Prior studies that address the health effects of insecticide use have focused on poisoning experienced by farmers. We extend the scope of previous studies by considering all possible impact channels in the private health risk domain: 1) exposure to contaminated products by family members, 2) exposure to chemicals by farmers, and 3) exposure to ambient drifting chemicals by family members and people in proximity.

Our econometric analysis identifies both push and deterring factors at household, plot, and crop levels in dictating insecticide use decisions. A more challenging question is which of those deterring factors are motivated by health consideration. Our initial findings are: 1) Crops (except for rice) whose outputs are used to a greater degree for consumption are less likely to be sprayed or sprayed fewer times. While it is possible that health consideration may have a role discouraging spray given the confounding factors controlled for, we cannot be certain about a direct causal linkage because of the complexity in SSFH decision-making. 2) Health-conscious households (as indicated by the adoption of modern-fuel cooking stove and reported concern over food safety) consistently refrain from spraying, but this tendency diminishes as outputs shifting toward commercial use, suggesting a possible moral hazard phenomenon. 3) Farmers are more likely to apply insecticides on crops of high food security or diet importance, such as rice, although the difference between fresh produce and grain produce in insecticide residue exposure risk might also play a role. 4) The two samples from Cambodia and Vietnam reveal similarities and differences, suggesting the importance of addressing specific contexts.

Climate Shocks Constrain Human Fertility in Indonesia

Authors: Samuel Sellers1Clark Gray2
Author Affiliations: 1Center for Health and the Global Environment, University of Washington; 2Department of Geography, University of North Carolina at Chapel Hill

Background: Climate change is likely to induce a large range of household-level responses, including changes in human fertility behaviors and outcomes. These responses may have important implications for human and economic development, women’s empowerment, and environmental sustainability. However, to date, few studies have explored the linkages between climate change and fertility behaviors and outcomes.

Methods: Drawing on the literature linking climate variability to rice production in Indonesia, we use large-scale longitudinal household survey and high-resolution climate data to explore changes in childbearing preferences, family planning use, and births following community-level climate anomalies (timing of monsoon onset and temperature) from 1993 to 2015 using a series of fixed effects logistic regression models.

Findings: We find that, over the short-term (1-12 months prior to survey), fertility desires increase and family planning use declines in response to delays in monsoon onset, particularly for wealthier populations. Over the medium-term (1-60 months prior to survey), however, fertility desires decline in response to high temperatures, particularly for poorer populations who also increase use of family planning. We also measure parallel shifts in household well-being as measured by rice, food, and non-food consumption expenditures, with substantial reductions in food and non-food expenditures measured among households without farm businesses and high levels of education.

Interpretation: Collectively, these results document human fertility responses to climate change in a country vulnerable to its effects, and suggest that some populations will want to reduce their fertility in a future with climate change. Ensuring access to high-quality family planning services may help provide an important adaptation mechanism to households seeking to adapt to climate change.

A Qualitative Analysis of Water Security at Local Government Level in South Africa

Authors: Richard Meissner1, Nikki Funke1, Karen Nortje1, Inga Jacobs-Mata1, Elliot Moyo1, Maronel Steyn1, Justinus Shadung1, Winile Masangane1, Ngowenani Nohayi1
Author Affiliations: 1Council for Scientific and Industrial Research

As one of the 40 driest countries in the world with an annual average rainfall of 500 millimetres, South Africa is a water-scarce country. In addition, South Africa’s rate of economic development is closely linked to its level of water security, as rising water stress and increasing supply variability, flooding, inadequate access to safe drinking water and sanitation, and higher levels of water pollution are creating a drag on economic growth. Despite the high premium placed on our water resources, there is no commonly shared understanding of water security. The aim of this project was to research, using qualitative social scientific methodologies, how people in two South African local governments understand water security. We investigated how people, from different lifestyles, perceive water security in the Greater Sekhukhune District and the eThekwini Metropolitan Municipalities. The inland-situated Sekhukhune has a drier climate and a rural socio-economic profile as opposed to the coastal, urbanised eThekwini with its complex economy and diverse socio-economic structure. We conducted face-to-face structured interviews with a diverse stakeholder group in the municipalities and focus groups in two communities of each municipality: Leeuwfontein and Motetema (Sekhukhune) and Inanda and Ntshongweni (eThekwini). Following a qualitative analysis, we found that water security is a state of mind based on context-specific (i.e. localised and individualised) perception(s) held by an individual of water-related threats and how it influences individuals and their natural surroundings. How people perceive water security has policy implications at local government level in South Africa and further afield in other developing contexts. We established that people from diverse lifestyles hold various understandings and interpretations of water security relating mainly to the availability, access, and quality of water resources. Understanding how people perceive water security in specific localities could aid policy makers and (health) practitioners to develop more nuanced responses to ameliorate water insecurity and its negative impact on human wellbeing. We discovered that perceptions depend to a large extent on the changing state of the natural environment the person lives in; socio-economic status; experiences relating to various interactions with local governments, members of the community, and stakeholder further afield; as well as diverse practices to enhance individual or communal water security. That said, a changing natural environment is not the independent variable that influence water security perceptions; such conceptualisations also depend on varying degrees of inter-personal relationships and practices directly or indirectly related to water security enhancement.

Planetary Health in a Rapidly Changing Geopolitical Order- Role of Multi-Stakeholder Engagement & Dialogic Praxis in Resource-Constrained LMIC context

Author: Maheswar Satpathy1
Author Affiliations: 1Utkal University, Bhubaneswar, India

Background: Life in Low-and-Middle Income Countries is very different i.e. lived realities of humans and animals alike vary exceedingly from countries having adequate ratio of resources. Consistently, analysis formed on phenomenological and engaged ethnographic- narrative moorings, and health system focused social determinants based research indicate an unequal distribution of resources, persistent inequity coupled with inequality lasting over generations. Developing countries also experience highest degree of unplanned urbanization due to high population, causing a skewed demand-supply ratio. In addition, large-scale industrialization in order to meet the needs of its population (as in case of India, China or Nigeria) has led to deforestation, erosion of fertile landmass, resulting in alarming climate change, further affecting the health and wellbeing of the population.

Method: It is a Pan-Indian study in conception phase (SDG outcomes were piloted already), aiming to assess the Health and Wellbeing related concerns, and how do Youths (N= 566) at a University set-up in Eastern India (Odisha State) conceptualize the inter-relationships. Odisha has remained historically prone to experience the highest number of natural calamities in India. Data on 3 major parameters were collected using a mixed methods research (Qual-Quant-Qual): i) Knowledge and Attitude on Health-related SDGs; ii) Inter-relationships between different SDGs, and how do they play a role in India’s Development; iii) Perceived Need, Relevance and Utility of Multi-stakeholder engagement in order to achieve optimal health and wellbeing.

Findings: Qual-phase-1 (FGDs) suggested inadequate knowledge, and poor practice of SDG agenda among students. The findings were complemented by the Quantitative Data, preliminary analysis of which suggests that majority (82%) of them are unaware of all SDGs, Health-Related SDGs (HRSDGs), and their inter-relationship. Similarly, in-depth interviews with 18 respondents further brought in nuanced thematic focus on the linkage between inadequate knowledge-indifferent attitude often lashing onto apathy and resultant poor practices related to SDGs e.g. Environmental Protection, Sustainable Production & Consumption, Water Sanitation and Hygiene. Although they loosely conceive of these as important, are unable to see how they are all achievable. Another striking thing is about a pragmatic attitude regarding inequity, inequalities and resource limitations in the local context, which was identified as a core area to be addressed. Youths also saw their role (enhanced engagement, dialogue, and discourses-praxis) to some degree, although expressed helplessness attributing it to lack of political will, and systemic lapses.

Impact/Implications: Youth-focused programs oriented towards enhanced SDG programming will enable a better Planetary Health, and has implications for the world in general, and LMICs in particular.

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