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Capacity development as a structural intervention for sustainable health

By Ngozi Joe-Ikechebelu

As a public health specialist from the global south (Nigeria) and eager to start my much-anticipated Canadian PhD study, I never envisaged being involved with such a dynamic, trans-disciplinary health group as the BCCI. The on-site event at the Interior Health office in Kelowna, a city surrounded by hills, brought a serene environment suitable for capacity development in global health.

The theme was “Equity-Centered Practices for Connecting knowledge with Action,” one that the facilitators expounded on practical approaches that are aiding my academic and research inclines especially for health disparities seen with social related actions and its possible untoward health outcomes for certain groups. The associated networking and mentorship revealed the humble nature of this group in its quest for health equity. I was eager to be part of it, and it has been an eventful one year filled with academic and social processes.

I had been faced with certain capacity challenges necessary for global health practices; a contextual institutional restriction of my background. Following the Kelowna exposure, there has been a series of monthly activities at UVic (a part of BCCI) for me. The monthly networking of situated learning processes from ally researchers from different disciplines; the continuing nudges from mentors; the town and gown activity of January 2018 that featured engineering and medical researchers; the continuing webinar meetings and trainings on topical global health issues; the Social Sciences and Humanities Council (SSHRC) and Natural Sciences and Engineering Research Council (NSERC) connection grant writings; and the Nigerian working group on the impacts of climate change on health.

All of these activities are changing my approaches to global health practices and applications of varying theoretical frameworks. The diversity of members reveals an obvious partnership that humbles one from a global south context and the dual shared benefits show a sustainable interventional health approach that can help alleviate health disparities.

29d4b3bad9d644c08b0668e9119fdb7bNgozi is a Public Health specialist with an MBBS from Nnamdi Azikiwe University, an MPH from the University of Nigeria, Nsukka, an MSc in International Health Development and Management from the University of Birmingham, UK, and is currently a PhD student in the Social Dimensions of Health Program at the University of Victoria. Ngozi is an active member of the  BCCI Community of Practice and following the event in Kelowna, she and fellow participant Paivi Abernathy reported on the BCCI in a Discussion Group on Global Health Research session with the Centre for Global Studies (CFGS).

Solutions to pollution

Two students from the University of Fraser Valley describe how they took initiative in raising awareness about planetary health through the effective use of social media. Read on to explore how you can adapt this project in your own community.

By Julie Rhodes & Julia Chalmers

What are your names and research areas?

My name is Julia Chalmers, I am a third-year undergraduate nursing student at the University of the Fraser Valley (UFV). My current area of interest in global health and the connections between planetary health and human health.

My name is Julie Rhodes, I am a third-year undergraduate nursing student at the University of the Fraser Valley. My current area of interest is health promotion and primary health care as it relates to public and global health.

We both attended the study tour to Sierra Leone offered by UFV in Spring of 2019 which is where our passion for global health emerged. As undergraduate students we are not researchers however we hope to explore opportunities as we continue our education and careers. We are also cofounders of the “Student Nurses for Global Citizens” group at UFV.

Please briefly describe the project and its goals. 

This project was inspired by the momentum of the movement “Friday’s for Future”. As students we wanted to contribute and engage our student population in making a difference in climate change action. We wanted to hear the ideas of the student body and to display them on campus. So we hosted a giveaway on our Instagram page asking students to comment their ideas or “solutions to pollution” as we were calling them. Every comment was an entry and we drew a winner for a sustainability starter package after the contest was over. We then compiled the comments into themes and created a visual poster to display at our home campus in Chilliwack BC. We hoped that by spreading the word, we inspired some students to take some accountability towards how our actions impact the health of our local and global communities.

In your opinion, what are some of the most critical planetary health issues?

Beautiful mountains, lush forests, and pristine oceans and rivers are just a few of the things British Columbia is known for. However, in recent years these fundamental ecosystems have been under the threat of climate change. The WHO (2019), recognizes climate change as a significant global health threat. It is evident that planetary health has a profound effect on the health of humans. In British Columbia alone we have seen an influx of drastic weather events such as flash flooding, extreme heat and drought, and ramped wildfire activity. Flooding can displace people from their homes, lead to food and water contamination and result in property damage. Moreover, smoke from wildfires reduces air quality which can exacerbate cardiovascular and respiratory conditions such as asthma and COPD (Government of British Columbia, n.d.a). Additionally, the effects of climate change will impact vulnerable populations most such as those living in rural communities and Indigenous populations. As health care providers we must be prepared to respond to climate change related health issues. Development of emergency protocols, incorporating climate change education in patient teaching and lobbying for sustainable policy are just a few examples of how health care providers can respond to the climate crisis (Government of British Columbia, n.d.b). Globally, low income countries with weak health infrastructure will require significant support to cope with the effects of the climate crisis on human health (WHO, 2019).

What did you find successful about this project?

We had a lot of student engagement which was amazing to see. We had 143 different comments from students presenting their solutions to pollution. Ideas ranged from using reusable coffee cups to advocating and lobbying for more sustainable policies to local government and institutional bodies. It was very encouraging and inspiring to see the ideas of our peers on how individuals can make a practical difference for the health of our local and global communities. One thing that facilitated the success of this project was the timing: the contest took place during the Federal Election as well on the coat tails of Greta Thunberg’s appearance in Vancouver. We approached the community at a time when the discussion around climate change was at an all-time high and therefore received a significant amount of engagement.

What did you find challenging and/or surprising about the roll-out of this project?

We were unsure of the level of engagement we would receive from the UFV community as we had never done a project like this before. Moreover, we had to educate ourselves to ensure we were disseminating accurate information to our peers.

What advice would you give other students or young professionals if they wanted to pursue a similar project?

Know your audience. You can go into a project with as much motivation and initiative as you want but if you don’t know how to engage your audience then you won’t be as successful. An important factor when using social media to promote an initiative is to know what will stand out and how to spark an interest. For example, we kept our contest rules very simple: you just had to 1. Comment an original idea and 2. Be a student at UFV. We knew that a lot of Instagram contests often have multiple rules to gain an entry which can be a deterrent to people, so we wanted to keep ours simple and content focused. We weren’t fixated on gaining followers or likes, rather we wanted to hear the voices of our community and give them a platform to share their ideas.

In what ways was social media an advantage?

It’s very easily accessible for people and relevant to our population of interest: other students. Likewise, Instagram is a visual tool which has been helpful for us in our projects. Social media has the ability to grab people’s attention and expose them to the realities of our world. After this project we reflected back and realized how it really was a form of community brainstorming. In today’s day and age social media can be something that is very negative, and we can often become bogged down by marketing and consumerism. However, this project was a way of using social media to our advantage to spark an interest in our community and raise awareness about the action needed during the climate crisis.  

References

Government of British Columbia. (n.d.a). Addressing climate and health risks in BC: Climate change health risks. Retrieved from: https://www2.gov.bc.ca/assets/gov/environment/climate- change/adaptation/health/final_climate_change_and_health_backgrounder_overview.pdf

Government of British Columbia. (n.d.b) Addressing climate and health risks in BC: Frontline healthcare. Retrieved from: https://www2.gov.bc.ca/assets/gov/environment/climate- change/adaptation/health/final_climate_and_health_backgrounder_frontline_health_care.pdf

World Health Organisation [WHO]. (2018). Climate change and health. Retrieved from:https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health

Nursing in the realm of planetary health

By Raluca Radu

Planetary health is an attitude towards life and a philosophy for living.

Horton et al., 2014, p. 847

As the largest body of healthcare workers worldwide, nurses have been traditionally known to provide care for patients within a myriad of settings, whether they are hospitals, community health clinics, long-term facilities, to name a few.  However, it did not occur to me how essential nurses’ presence is within the realm of planetary health until I had the opportunity to attend the BC Coalition Institute-2 (BCCI-2) at the University of Victoria this past August.  Although I spent the last few months of my graduate degree at the University of BC looking at how climate change impacts human health and where nursing practice fits within this spectrum, it was only when I physically interacted with the topic of planetary health and listened to presentations delivered at this institute that more connections were being made for me as a registered nurse.  These ‘connections’ tie into what our moral obligation as a caregiving profession is towards the public and equally important towards our environment. 

In preparation to attend the BCCI-2 I wanted to equip myself with knowledge regarding what the concept of planetary health entailed. I looked no further than to the report of the Rockefeller Foundation-Lancet Commission on Planetary Health launched in 2015 to gain a better understanding of this intricate concept.  The authors assert that “planetary health is based on the understanding that human health and human civilization depend on flourishing natural systems” (Whitmee et al., 2015, p. 1974).  This statement was evident throughout the entire institute whereby everything was centered around the symbiotic interconnectedness between our planet and human health.  As I read through the report and grew furthermore fascinated by the lens with which the environment and health were being looked at, I was and continue to remain determined to act upon the authors’ call to health professionals who they strongly affirm “have an essential role in the achievement of planetary health: [by] working across sectors to integrate policies that advance health and environmental sustainability, tackling health inequities, reducing the environmental impacts of health systems, and increasing the resilience of health systems and populations to environmental change” (Whitmee et al., 2015, p.1974).

With this in mind, I realized that there is no better time than now for all healthcare professionals to enact principles of planetary health into all levels of practice.  I think it is essential that the delivery of care is made through a sustainable lens while accounting for how environmental changes and natural events directly impact the livelihood of individuals.  If we are to meet the 2030 Sustainable Development Goals then we as healthcare professionals need to place aside our differences and act in unity with the common goal of ensuring the continuation of our species and the ecological preservation of our planet.  Though we may face several challenges ahead that are out of our control such as increasing natural disasters, we must learn to integrate elements such as climate adaptation and mitigation into our practice and more so in educational settings, with the overall goal of building resilience in our communities to better cope when adversities occur. 

This institute instilled in me a level of inspiration and motivation I had not felt in a while.  I am truthfully forever grateful for being given the chance to meet a community of like-minded individuals who have a tremendous passion for planetary health and who through their work gear much of their energy toward raising awareness about the environment and its link to human health. 

On my way back to the mainland, as I stood on the platform of the ferry while it serenely made its way through the Gulf Islands, I took a deep breath and absorbed the beauty that surrounded me with an entirely renewed set of senses.  I thought about how many advancements we made in science, technology, and other fields, oftentimes at the expense of our planet.  I thought about the injustice that happens all around the world particularly in low- and middle-income countries where the effects of a changing climate are having proportionate impacts on the health of millions of people – increasing conflict, displacement, scarce resources, fight for survival, and the cost of all things living.  I also thought about how much more we could be doing to ensure this one and only Earth’s conservation. 

I left the BCCI-2 pondering on a few questions that even today continue to guide me as I pursue my scholarly research: How did we get here and why do we keep letting it get worse?  How do we shift our values to live equitably in harmony with each other and in good health on this small planet we call home?  These questions keep me grounded in my work and serve as motivators for why I am pursuing research on climate change, human health, and nursing.  They serve as reminders that this work is instrumental in helping shape actions that I personally hope are adopted with more urgency as we have no time left for inaction. 

Raluca is a registered nurse from Vancouver, BC. Raluca has worked as an acute care nurse in surgical, medical, ambulatory, rural, and emergency areas in both public and private settings.  She also enjoyed teaching LPN & BScN students within theory, laboratory, and clinical practice-based environments.

Raluca is currently pursuing a Master of Science in Nursing (MSN) at the University of British Columbia with a focus on integrating Climate Change topics into Nursing Education.  Throughout her MSN program Raluca has held numerous roles with the UBC Graduate Students in Nursing Association such as Events Director (2017/18) and President (2018/19).  

Various activities culminated her passion for Climate Change, such as attending the Canadian Association of Schools of Nursing National Forum on Vector-Borne Infectious Diseases in Ottawa and by being introduced to Planetary Health through participating at the BC Coalition Institute in Victoria (Aug, 2019).  Recently, Raluca was appointed as Secretary of the Canadian Association of Nurses for the Environment and looks forward to collaborating with other nurses across the country on driving change at the national level. In addition, this past summer, Raluca became a member of the Nursing Now BC Steering Committee and is excited to participate in organizing activities that lead up to the Year of Nurse & Midwife (2020).  

Raluca is excited to complete her MSN and looks forward to pursuing work in local and global health policy contexts.  Raluca believes the only way forward is for nurses to come together in unity as their expertise is not only highly valued and trusted by the public, but also an imperative component of attaining the Sustainable Development Goals by 2030.

References:

Horton, R., Beaglehole, R., Bonita, R., Raeburn, J., McKee, M., Wall, S.  (2014).  From public to planetary health: A manifesto.  The Lancet 383(9920), p. 847.  doi:  10.1016/S0140-6736(14)60409-8

Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A. G., Ferreira de Souza Dias, B., Ezeh, A., Frumkin, H., Gong, P., Head, P., Horton, R., Mace, G. M., Marten, R., Myers, S. S., Nishtar, S., Osofsky, S. A., Pattanayak, S. K., Pongsiri, M. J., Romanelli, C., Soucat, A., Vega, J., Yach, D.  (2015).  Safeguarding human health in the Anthropocene epoch:  Report of the Rockefeller Foundation-Lancet Commission on planetary health .  The Lancet 386, p.1973-2028.  doi:  doi.org/10.1016/S0140-6736(14)60409-8S0140-6736(15)60901-1

Podcast: How climate change affects nursing with Raluca Radu

The podcast for nurse leaders who are ready to shift their thinking from “just a nurse” to claim their position as a powerful agent for change. Join host, Amy Deagle, the Founder and CEO of the International Network of Nurse Leaders, as she interviews nurse leaders from across the country to talk about their personal journeys in leadership, and their advice for nurses wishing to be proactive in their careers.

Raluca Radu speaks about the current and future impacts of climate change on nursing. 

Nurse or not, listen on to hear about Raluca’s story:

  • Why she chose to leap into a Masters degree early in her career
  • Why she shifted her focus to climate change and nursing
  • Environmental factors that will increase health risks
  • What to do when you’re facing challenges in nursing
  • Recharging after burnout
  • Horizontal violence and bullying in the sector
  • Simple ways to get involved in policy change

Connections between planetary health, indigenous sovereignty, and sports

Reflections from the 2019 British Columbia Coalition Institute

By Claire Remington

A recent UN report celebrated the insight that “Indigenous sovereignty could save the planet.” At the British Columbia Coalition Institute workshop at the University of Victoria, Dr. Shannon Waters, a member of Stz’uminus First Nation and a Medical Health Officer with the Vancouver Island Health Authority, expounded on this insight with her observations of the state of planetary health in her home territory of Cowichan Valley. Planetary health is a field of research that illuminates the relationship between human health and the health of the environment. Dr. Waters plays a key leadership role on the Cowichan Watershed Board. The Cowichan Watershed Board is co-chaired by indigenous leadership and was instituted in response to a myriad of issues with water quality and availability in the Cowichan Valley.

The Cowichan Valley Regional District describes how summer drought is the “new normal” in the Cowichan Valley. Drought has immediate impacts on key ecosystem functioning like the availability of water in rivers for salmon migration as well as more indirect impacts on mental heath. Ecological grief, or solastalgia, is the experience of grief produced in response to the dramatic scale of ecological loss that we are experiencing, or anticipating, on both local and global scales. For indigenous communities, the sentiment of eco-grief can be magnified by the degree of connectedness of people with their land produced through historical relationships that continue to this day. These relationships are being tested by dramatic changes in environmental conditions that make it difficult, if not dangerous, to continue with traditional practices.

Dr. Waters shared how there was an outbreak of Vibrio cholera in Cowichan last year caused by the consumption of herring eggs. Eating raw herring eggs are a traditional food practice for many First Nations communities, but the health authorities’ response on the issue was to cook the herring eggs prior to consumption. It was conjectured that the prevalence of V. cholera was caused by an increased availability of nutrients and an increase in ocean temperatures and pH. This is one example among countless of the challenges, tension, and grief that we are experiencing – and anticipating – as a result of climate change.

I have been coaching Ultimate Frisbee to youth in indigenous communities with Victoria-based Ultimate Spirit. Ultimate Spirit was created in collaboration with the Indigenous Sport, Activity, and Recreation Council (ISPARC); Ultimate Canada; and BC Ultimate. Central to Ultimate Spirit is the principle of Spirit of the Game. Spirit of the Game has several tenets to guide players towards a greater sense of community even in times of competition, but fundamentally Spirit of the Game refers to the fostering of connection – between you and your spirit, between you and fellow players, and between you and your surrounding environment. Guided by the principles of Spirit of the Game, Ultimate Spirit seeks to use sport as a mechanism for social change, a fostering of wellbeing, and creating opportunities for healing.

As a coach with Ultimate Spirit, I have been grateful to share my enthusiasm for Ultimate Frisbee and what I’ve learned about connectivity through sport and Spirit of the Game. After listening to Dr. Waters and her clear expression that “we are the stories we tell ourselves,” I am grateful to learn more about how to foster confidence and positivity in indigenous youth around managing eco-grief and stewarding our planetary systems.

Claire is a master’s student in the Public Health & Environmental Engineering (PH2E) Lab at the University of Victoria. Her research explores the design of sustainable sanitation systems from three different but complementary perspectives: lab-based environmental engineering work to characterize fresh faeces, big-picture desk-based research looking at the flow of nitrogen through global agriculture and sanitation systems, and the installation of a composting toilet on the UVic campus. She communicates through these varied perspectives that sanitation is a global issue; the design of sanitation systems that 1) protects public health and 2) stewards sustainable water and biogeochemical cycles is an urgent priority for both developing and developed country contexts.

Previously, she was engaged in economic, geographic, and public health analyses of SOIL’s household sanitation service in Cap Haitien, Haiti.

(For more information: http://claireremington.com/)

Wildfires in BC: Health effects and system implications in a global perspective

March 27, 2019 at 12:00pm PT

Wildfires are becoming more severe in British Columbia (BC) and most areas of Canada. In 2017, over 1,300 fires displaced 65,000 residents, including 880 patients and 700 health system staff, costing over $560 million. In 2018, the largest area burned on record, disproportionately impacting remote and Indigenous communities. During both seasons, severe smoke pollution affected the province for weeks, with several communities experiencing some of the worst air quality conditions in the world. 

This webinar explores implications of climate-related severe events from an emergency management perspective, focusing on health care system impacts in BC and lessons learned from consecutive years of a provincial state of emergency. Using an environmental health lens, evidence from BC is placed in a global context to highlight critical gaps that researchers are racing to fill.

Suggested readings

Paul Kovacs, Alice Cullingford, Mike Flannigan, and Lilia Yumagulova. (2018). Canada’s Burning Question : An in-deph feature on the progress made and the callenges remaining for fire management in Canada. HazNet.

Tara K. McGee, Amy Christianson, Kyla Mottershead, and Henok Asfaw. (2018). Advice for emergency managers from the First Nations Wildfire Evacuation Partnership. HazNet.

Report and findings of the BC Flood and Wildfire. (2018). Addressing the New Normal: 21st Century Disaster Management in British Columbia

John Lavery is the Executive Director of Health Emergency Management British Columbia (HEMBC). John is an active member of the WHO’s Emergency Operations Centre Network, co-chairs multiple Canadian federal/provincial/territorial committees, and is a Canadian co-chair of the Pacific Northwest Border Alliance.

Sarah Henderson, Associate Professor, University of British Columbia and Senior Scientist, Environmental Health Services, BC Centre for Disease Control. Sarah is an international expert on the health effects of wildfire smoke and has been studying this topic in BC and around the world for more than 15 years. At the BCCDC she leads a program of applied research and surveillance to support evidence-based policy for the province.

Pre-workshop prep: Planetary health

These resource guides provide an introduction to planetary health.

Main sessions

Session 1

What (on earth) is planetary health: Planetary health through Western and Indigenous lenses

Session 2

Mobilizing our commitment to the future through equity- and evidence-informed health equity action

Session 3

Planetary health at the local level: The health co-benefits of a one planet region

Session 4

BC and beyond: An exploration of future research engagement

Special session guides

Session 1

A dialogue with Elizabeth May, Leader, Green Party of Canada

Dinner: 10 Acres Farm and Restaurant Group

Food systems: Local and global