HIV IS NOT A VERDICT

PEAH is pleased to cross-post an article by AFEW partner organization. AFEW is dedicated to improving the health of key populations in society. With a focus on Eastern Europe and Central Asia, AFEW strives to promote health and increase access to prevention, treatment and care for major public health concerns such as HIV, TB, viral hepatitis, and sexual and reproductive health

First published January 22, 2020 

By Olga Shelevakho

Communications officer, AFEW International

HIV IS NOT A VERDICT

I Love Every Minute of My Life

 

HIV is not a verdict. It is a reason to look at your life from a different angle and get to love every moment of it

That is exactly what Amina, the protagonist of this story who lives with HIV, did. She went through the dark side of self-tortures, reflections, and suicidal attempts to realize that every minute is precious and HIV is what helped her to become strong, independent and happy.

Amina works in the Tajikistan Network of Women Living with HIV. She found herself in this field and nowadays she is actively involved in the Antistigma project implemented within the Bridging the Gaps programme.

How I learned about my status

“In 2012, I got pregnant for the fourth time. Seven months into my pregnancy, I got tested for HIV within the routine health monitoring. Four weeks after, I was asked to come to the clinic and was told that they detected haemolysis in my blood. I got tested again. My doctor told me the result of this second test after my baby was already born.

HIV. The diagnosis sounded like a verdict. What should I do? How should I live? Where can I get accurate information? My conversations with health workers were not very informative. Nobody told me that one can live an absolutely normal life with the virus. I felt that I was alone, left somewhere in the middle of an ocean. I had my baby in my arms, my husband who injected drugs was in prison. Back then, I hoped that I could tell at least my mother about the diagnosis to make it easier for me. However, the virus drove us apart. My mother, who took care of me for all my life, turned her back on me. At the same time, my three-month-old daughter, who also had HIV, died of pneumocystis pneumonia. I hated myself so much that I even had suicidal thoughts. I took some gas oil, matches… If not for my brother, who saw me, I would have burned myself. Then I remember a handful of pills, an ambulance and another failed attempt to kill myself. I felt that I was completely alone on this dark road of life. I started losing weight and falling into depression”.

Through suicidal attempts to the new life

“Two years passed, and my suicidal thoughts started to gradually go away. I had to go on living. Throughout all this time, I kept ignoring my status, but I was searching for the information on HIV in the internet. I was not even thinking about ARVs, I was not ready for the therapy. Sometimes I did not believe that I had HIV as doctors kept telling me that HIV was a disease of sex workers.

After a while, I came to the AIDS centre with a clear intention to start ART. I passed all the required examinations and told the infectious disease doctor that I wanted to start the treatment. Six months after, I already had an undetectable viral load! I believed in myself, in my results, so I wanted to share this knowledge with all the people who found themselves in similar situations. That’s how I started working at the AIDS centre as a volunteer and later as a peer consultant”.

I am happy!

“HIV helped me to start a new life. I am happy – I help people, I am doing something good for the society working at the Tajikistan Network of Women Living with HIV. Recently, I was the coordinator of the Photo Voice project.

I want to keep people who find themselves in similar situations from repeating my mistakes. I want to protect them from unfair attitude, stigma and discrimination against PLWH as well as different conflicts, in particular based on gender.

In 2019, I gave birth to a baby. My boy is healthy. Just recently, with the help of the Photovoices project I disclosed my HIV status to my older sons.  Before that, I wanted to keep that as a secret, but after training and meetings with women within the framework of this project, I decided that I need to open my status. For me it was the scariest thing to do as I thought that they might not accept me as my mother did. However, I did not have to worry. My children hugged me and said that I am the best mother in the world. Now I’m a happy wife of my husband, whom I convinced to start opioid substitution treatment.

HIV helped me to be happy and independent! I am not afraid to say that I have HIV and I love every minute of my life!”

 

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The University in the early Decades of the Third Millennium: Saving the World from itself?

Recognising the need to change our worldview (belief systems) from human-centrism to eco-centrism – and re-building of trust in our institutions, in this chapter, the Author argues  for the re-conceptualization of  the university / higher education  purpose  and scope   focusing   on achieving the UN-2030 Transformative Vision –  “ending poverty, hunger, inequality and protecting the Earth’s  natural  resources.” 

Announcing a Forthcoming Chapter

The University in the early Decades of  the Third  Millennium

Saving the World from  itself?

 

By George Lueddeke, PhD, MEd, Dipl. AVES (Hon.)

 

Chapter Overview

Environmental degradation, economic and political threats along with ideological extremism necessitate a global redirection towards well-being and sustainability. Since the survival of all species (humans, animals, plants) is wholly dependent on a healthy planet, urgent action at the highest levels to address large-scale interconnected problems is  needed to counter the thinking that perpetuates the “folly of a limitless world.”1

Paralleling critical societal roles played by universities – ancient, medieval and modern – throughout the  millennia, and  prompted by  my current book, Survival: One Health, One Planet, One Future , 1  and  contributing chapter to a forthcoming publication,2  I call  for all universities and  higher education institutions generally – estimated  at over 28,000 with close to 300 million students – to take a lead  together  with the United Nations  Youth Forum and other major partners – to tackle  the pressing complex and intractable challenges that face  us.

Recognising the need to change our worldview (belief systems) from human-centrism to eco-centrism – and re-building of trust in our institutions, in this chapter, 2,1  I argue   for the re-conceptualization of  the university / higher education  purpose  and scope   focusing   on achieving the UN-2030 Transformative Vision –  “ending poverty, hunger, inequality and protecting the Earth’s  natural  resources.” 4

Time is not on our side. While much of the groundwork has been done by the UN and civil society, concerns remain over the variable support given to the UN-2030 Sustainable Development Goals (SDGs), especially in light of the negative impact of global biodiversity loss3 on achieving the UN-2030 Sustainable Development Goals (SDGs).4

Ten Propositions for Global Sustainability,1  ranging from adopting the SDGs4 at national and local levels to ensuring peaceful uses of technology  and UN reforms in line with global socioeconomic shifts,  are  highlighted.1  As one example, Proposition #7 calls for the unifying One Health and  Well-Being (OHWB) concept to become the cornerstone of our educational systems as well as societal institutions and  to underpin the UN-2030 SDGs.

A step in this direction is the evolving international One Health for One Planet Education  initiative (1 HOPE),  led by the One Health Commission and  the  One Health Initiative.5  With working groups from education and societal sectors presently being established across six global regions,  its main aim  is  to ‘Build global capacity for promoting and valuing the OHWB concept and approach as the foundation for achieving the UN-2030 Sustainable Development Goals (SDGs).’

In a post-chapter reflection the evidence that our planet’s biosphere  continues to be at  risk (e.g., Australian bushfires) is increasing. As a consequence, it appears that some who see their role as having to satisfy different  interest groups  (e.g., electorate, shareholders)  are having  second  thoughts. The  efforts of Sir David Attenborough,6, Greta Thunberg,7 Xiuhtezcatl Martinez,8 and   pro-environment Youth campaigners  around the globe are  having  at least some  impact on reversing irresponsible decisions. A few   government and corporate leaders are even re-setting their priorities – not because of external pressures but because they personally realise what is at stake for their families and future generations.

Indeed, global support for those who continue to ‘subscribe  to the follies that Earth  resources are limitless, that climate change is a hoax, that autocracy is preferable to democracy,  that compassion is a sign of weakness, that profit  comes before  principle, that division is preferable to unity,’ 2  is gradually  weakening at least in a few corners of the world.

Martin Wolfe, chief economics commentator at the Financial Times, London, concludes that tackling climate change ‘policy has to be global, with all the bigger economies involved’ and  with solutions  ‘found in generous assistance from high-income countries to emerging and developing countries.’ 9 He doubts the probability of success  ‘in an era of populism and nationalism’ cautioning  his readers, ‘But the young are surely right to expect better.’

It is noteworthy that for the first time since 2006 the World Economic Forum ‘Global Risks Report 2020 is dominated by the environment’.10  In the light of projected global impacts (e.g., extreme weather, biodiversity loss),  it seems unimaginable and totally unacceptable “that in the face of  this development, when the challenges before us demand immediate collective action, fractures within the global community appear to only be widening.”

 

References

1Lueddeke, G. (2019). Survival: One Health, One Planet, One Future. London: Routledge.

2Lueddeke, G.R. (2020, summer). The University in the early Decades of  the Third  Millennium    (Saving the World from  itself?).  In  E. Sengupta, P. Blessinger, & C. Mahoney (Eds.), Civil society and social responsibility in higher education  (vol.21, Innovations in Higher  Education Teaching and Learning).

3IPBES (2019, May 6). Global assessment report on biodiversity and ecosystem services. Retrieved from https://ipbes.net/global-assessment-report-biodiversity-ecosystem-services

4 United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development. Division for Sustainable Development Goals. (Department of Economic and Social Affairs). Retrieved from https://sustainabledevelopment.un.org/post2015/transformingourworld

5One Health Commission & One Health Initiative. (2020, December 12). The One Health education task force: Preparing society for the world we need. Retrieved from  https://www.onehealthcommission.org/en/programs/one_health_education_task_force/

6Davies, H.J. (2020, January 15 ). David Attenborough warns that humans have ‘overrun the world.’ The Guardian. Retrieved from https://www.theguardian.com/tv-and-radio/2020/jan/15/david-attenborough-warns-that-humans-have-overrun-the-world

7Berghof, E. (2019,  August 23). Economics can  no longer ignore the earth’s natural boundaries. World Economic Forum. Retrieved from https://www.weforum.org/agenda/2019/08/building-a-truly-sustainable-global-economy-heres-how/

8Tang, M.C. (2019, August 28). Xiuhtezcatl Martinez: “This crisis is one of the most unifying moments of human history.” Landscape News. Retrieved from https://news.globallandscapesforum.org/38449/xiuhtezcatl-martinez-this-crisis-is-one-of-the-most-unifying-moments-of-human-history/

9Wolf, M. (2019, |November 5). There is one way forward on climate change. Financial Times. Retrieved from https://www.ft.com/content/27c9a6e8-ffb7-11e9-b7bc-f3fa4e77dd47

10World Economic Forum. (2020, January 17). Retrieved from https://www.weforum.org/agenda/2020/01/global-risks-climate-change-cyberattacks-economic-political/?utm_source=sfmc&utm_medium=email&utm_campaign=2710051_Agenda_weekly-17January2020-20200115_083452&utm_term=&emailType=Newsletter

(Image- https://www.freepik.com/free-vector/ecosystem-concept-with-city_2739756.htm#page=1&query=environment&position=3)

 


ADDENDUM

On the same topic recently on PEAH

INTERVIEW – ‘Survival: One Health, One Planet, One Future’ – Routledge, 1st edition, 2019

Also of interest

USA Senate (bi-partisan) declares January 2020  National One Health Awareness Month! 

https://www.onehealthcommission.org/index.cfm/38050/47205/one_health_awareness_month_campaign)

WEBINAR INVITATIONS

 (1) January 30, 20209:30 AM – 10:30 AM Eastern Standard Time (EST)

*ONE HEALTH AND WELL-BEING: TOWARD HUMAN-NATURE SUSTAINABILITY*

Hosted by the CORE Group. Presentation by Dr. George Lueddeke

https://www.eventbrite.com/e/one-health-well-being-toward-human-nature-sustainability-tickets-89635132093


(2) 9 February, 20201PM-2:30 PM EST

*ONE HEALTH ADVOCACY: EDUCATION AND POLICY IN ACTION*

Hosted by the  International Student One Health Alliance (ISOHA)

Presentations by Dr Deborah Thomson and Dr George Lueddeke 

https://attendee.gotowebinar.com/register/6070814218892000269

 

 

 

 

 

 

 

 

 

 

PEAH News Flash 365

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Mitigating and Adapting to the Effects of Climate Change on Health in the Suburbs Through Adaptations in the Built Environment by Debbie Brace, Vanessa Kishimoto, Michelle A. Quaye, Mike Benusic, Louise Aubin, Lawrence C. Loh

Mitigating and Adapting to the Effects of Climate Change on Health in the Suburbs

This literature review aims to identify evidence-based built environment interventions that may be deployed in North American contexts to mitigate and adapt to the health effects of climate change. Identified mitigation and adaptation strategies are then analyzed for potential application within a suburban context

image credit: WHO

Debbie Brace1, Vanessa Kishimoto2, Michelle A. Quaye3, Mike Benusic4, Louise Aubin5, Lawrence C. Loh, MD, MPH, FCFP, FRCPC, FACPM4,5

 1 – Degroote School of Medicine, McMaster University

2 – Faculty of Arts & Science, University of Toronto

3 – Schulich School of Medicine and Dentistry, Western University

4 – Dalla Lana School of Public Health, University of Toronto

5 – Region of Peel—Public Health

Mitigating and Adapting to the Effects of Climate Change on Health in the Suburbs Through Adaptations in the Built Environment

A Literature Review

 

Background

Climate change has been heralded as the “biggest global health threat of the 21st century” (Watts 2018). The World Health Organization (WHO) has estimated that between 2030 and 2050, climate change will cause 250 000 deaths per year: 38 000 due to heat exposure in elderly people, 48 000 due to diarrheal diseases, 60 000 due to malaria, and 95 000 due to childhood under-nutrition (World Health Organization 2018).

One way of categorizing the health impacts of climate change is classifying those impacts as direct or indirect. Examples of direct health impacts include worsening air pollution that can contribute to cardiovascular diseases or heat stress and injuries due to more extreme weather, while indirect effects include food insecurity due to extreme weather and droughts, or changes in vector patterns that contribute to higher rates of vector-borne diseases (Watts 2018).

Another categorization from the Centers for Disease Control (CDC) categorizes health effects as they relate to environmental changes such as rising temperature, extreme weather, rising sea levels, and increasing carbon dioxide levels (Centers for Disease Control and Prevention 2014).

There is also a recognition that different communities and populations will be impacted by these health effects. Well known are the anticipated impacts on vulnerable populations of concern including the elderly, young children, individuals living with chronic diseases, and individuals of lower socioeconomic status or social marginalization. (Buse 2012, Intergovernmental Panel of Climate Change 2018) However, there will also be differential impacts anticipated by community context and form, with suburban settings being of particular importance given that they are home to a large proportion of the Canadian population.

Suburbs face the highest growth in the coming years (Ibbitson 2018) while simultaneously presenting challenges to climate change intervention owing to their automobile centric design and lower population density (Williams et al. 2010, 2012). Given this, our literature review aims to identify evidence-based built environment interventions that may be deployed to mitigate and adapt to the health effects of climate change. Identified mitigation and adaptation strategies are then analyzed for potential application within a suburban context.

Context

Suburbs represented the predominant planning paradigm following World War II, driving increasing sprawl and automobile-dependence in metropolitan areas across Canada. (David and Janzen 2013). Suburbs have become the predominant neighbourhood type for metropolitan dwellers, with the Canadian suburban population surpassing the city centre population in the 1970s (Bourne 1996). By 2006, 80% of Canadians in metropolitan areas lived in suburbs (David and Janzen 2013). It has been estimated that two thirds of the total Canadian population live in suburbs. Gordon and Shirokoff (2014) found that the overwhelming majority of population growth in a study of census metropolitan areas was found to be in automobile-dependent suburbs and “exurbs”, defined as rural areas with commuting access to metropolitan centres. Suburbs are currently growing 160% faster than city centres in Canada (Thompson 2013).

The typical North American suburban community has a built form that encompasses low density housing, dispersed amenities and services, and reliance on personal vehicles (Leichenko and Solecki 2013).  Despite these common elements, various suburbs exhibit demographic differences with regards to age, income, and visible minorities, with consequent impacts on health status. As an example, while suburbs have traditionally resulted in housing that is more affordable compared to the city, low socioeconomic status individuals living in suburbs often find themselves isolated from easy geographic access to work and important services because of unaffordability of automobiles and poor public transit infrastructure (Bourne 1996).

Community reliance on automobile transport also affects environmental health and drives climate change through air pollution and greenhouse gas emissions (Gordon and Shirokoff 2014). Greenhouse gas emissions come largely from road-based vehicles, and these emissions increased 33% from 1990 to 2010. Motor vehicles are also sources of air contaminants that lead to smog, with smog estimated to be responsible for 9500 deaths in Ontario per year.

Finally, other climate change effects experienced differently by suburban settings are extreme weather events, which can cause community and economic disruption (Thompson 2013), and also extreme temperature events, particularly extreme heat, which amplify the urban heat island effect. The latter is the result of infrastructure supporting suburban reliance on motorized vehicles (i.e. wide roadways and highways, industrial surfaces, a lack of vegetation, and parking lots) which results in surface temperatures that magnify the urban heat island effect in suburban areas (Taylor et al. 2018).

An example of a suburban community is the Region of Peel, a diverse and large upper-tier municipality in the Greater Toronto Area that is home to nearly 1.3 million people (Region of Peel 2016). Peel encompasses three municipalities, the Town of Caledon, and the cities of Mississauga and Brampton, and has a predominantly suburban form that envelopes dense urban, urbanizing, and rural forms. Approximately 14.7% of the population of Mississauga, 11.3% of Brampton and 5.7% of Caledon are considered low income (Region of Peel 2017a). According to the 2016 census, 62.3% of the Peel population are a visible minority, of whom 50.8% are South Asian, 15.3% are African American and 7.5% are Chinese (Region of Peel 2017b).

Concerning the urban heat island effect, meteorological data has demonstrated that Peel has seen an average increase in daily temperature of 1.2°C between 1938 and 2017 (Region of Peel 2019), though the range of surface temperatures varies, particularly with distance from the lake. Data on vegetation shows that 11% of Brampton, 15% of Mississauga, and 29% of Caledon East has tree cover (Buse 2012), with no recorded data for tree cover in Caledon West.

This context and community example shows the importance of intervening to address the impacts of climate change for all who live in suburban settings, while also prioritizing vulnerable populations that already experience disadvantage and are at increased risk of adverse health outcomes.

Methods

A literature review was performed to identify current built environment interventions being used to mitigate and adapt the health effects of climate change that may apply to a suburban context. The following databases were searched: Environment Complete, Web of Science, PsychINFO, Emcare, PubMed, MEDLINE, MEDLINE In-Process, Global Health, Health Star, and Cochrane Database of Systematic Reviews. Search terms used were: climate change, global warming, environmental pollution and/or greenhouse effect, and health, and measuring, mitigating, strategies, interventions, policy or prevention, and/or city planning or environmental design or built environment. The search was limited to papers published in English, between 2009-2019, and available online.

The initial search provided 577 results. A single reviewer scanned titles and abstracts to determine inclusion or exclusion based on their relevance to climate change and health, and interventions specifically relating to the built environment. Papers were included if they cited climate change as the exposure of interest, analyzed the effect of an intervention in the built environment, reported human health-related outcomes, and were published in English. Papers were excluded if they could not be applied to North American contexts (i.e., if the papers were based in a low-income or developing nation), if they were published before 2009, and if they were not related to suburban environments. A total of 23 articles were identified as possible for inclusion. One was excluded as it was not available in online archives. A further 9 were excluded as they did not report health outcomes related to climate change, or were related exclusively to urban contexts. Two reviewers then retrieved these articles and appraised these full texts for final inclusion. In total, 13 articles met the criteria.

From these included articles, promising built environment interventions were then extracted and summarized in key themes, which underwent critical analysis. These themes were then critically analyzed against suburban context and considerations to identify interventions that might support adaptation and mitigation efforts in such settings.

For the purposes of this review, we defined mitigation interventions as those designed to abate contributing factors to climate change, with related health co-benefits, and defined adaptation measures as adjusting and resourcing a community to manage health-related climate change impacts (Prior et al. 2018).

Results

Thirteen papers were identified in our review. Six articles were literature reviews and five articles reported simulation or predictive modeling. The final two papers were primary research articles, one of which was an online survey of Australian’s heat stress resilience, while the other reported on water quality monitoring and interventions.

Identified common themes for suburban interventions included urban vegetation and green infrastructure to cool temperatures, reducing heat stress, improving infrastructure resiliency, retrofitting buildings, and reducing greenhouse gases by promoting healthy and active living.

Mitigation

Two articles found that active transport was linked with better health outcomes and decreased greenhouse gas emissions (Ulmer et al. 2014, Frank et al. 2010).

Ulmer et al. (2014) used predictive modeling to characterize the health impacts of policies and laws regarding urban planning, land use and transportation. They found that walkability, sidewalks, bike facilities, and recreational activities was correlated with more physical activity and better health, as well as decreased greenhouse gas emissions.

Frank et al. (2010) used simulations to investigate how active transport can improve health and reduce greenhouse gas emissions. They found that increasing transit and density improves health indicators and decreases emissions from motorized transport and concluded that funding for transit should be increased to improve health and climate sustainability.

Adaptation

Five of the papers investigated the impact of green infrastructure, such as urban vegetation, green roofs, and suspended pavements to protect vegetation. Taken together, these papers found that green infrastructure reduces the risks of climate-related exposures. Stone et al. (2013) demonstrated that increased vegetation in urban centres and the surrounding areas was linked with mitigation of the “urban heat island effect” through decreased land surface temperature. Several other papers also linked vegetation to improved air quality and reduced pollutant concentrations, which was predicted to help mitigate anticipated poorer air quality owing to hotter ambient community temperatures (Abhijith et al. 2017, Page et al. 2015, Demuzere et al. 2014, Houghton and Castillo-Salgado 2017).

Four articles demonstrated that various building retrofits could reduce heat related mortality; three of these were specific to residential buildings (Taylor et al. 2018, Hatvani-Kovacs et al. 2016, Williams et al 2013) while one was a general review of cooling technologies (Pisello 2017). Of note, Taylor et al. (2018) found that shutters on windows were linked with lower summer time heat-related mortality, while complete energy-efficient retrofitting was associated with an increase in heat-related mortality.  This finding was at odds with the other three papers that linked energy efficient retrofitting and cool coatings with decreased risk of heat-related illness and better health outcomes (Hatvani-Kovacs et al. 2016, Williams et al. 2013, Pisello 2017).

Two of the papers were literature reviews investigating the various strategies and characteristics being used to mitigate urban heat islands (Santamouris et al. 2017, Hintz et al. 2017). Both of these papers identified benefits from a multifactorial approach including the use of urban vegetation and green infrastructure, the use of cooling techniques like increased albedo on surfaces, and individual behaviors, such as remaining in air conditioned spaces and avoiding strenuous exercise during extreme heat events (Santamouris et al. 2017, Hintz et al. 2017).

Discussion

Our review found evidence-based interventions that, if implemented, could have promise in addressing climate change contributions and impacts in suburban settings. Both mitigation and health-protective adaptation efforts would be supported by suburban investments in green infrastructure, the former through improved carbon capture by increased foliage and shade, and the latter through increased soil and root systems that increase resilience to seasonal flooding and improved air and water quality. Other interventions that could be deployed in suburbs to protect health relate more to adaptation, specifically building retrofits that might reduce heat-related mortality and morbidity, and health promotion messaging that encourages remaining indoors and avoiding strenuous physical activity during extreme heat events.

Broadly applying these interventions to the suburban context, one notes that active transportation (e.g., walking, cycling, taking public transit) would not only contribute to climate change mitigation efforts but also provide important health co-benefits through increased physical activity and improved air quality. In the absence of built environments that encourage physical activity, it has been shown that there is risk of obesity (Papas et al. 2007). In addition, increased driving time has been associated with higher prevalence of self-reported smoking, physical activity, insufficient sleep and psychological distress (Ding et al 2014). In other parts of the world, childhood asthma has emerged, likely as a consequence of industrial and car-related pollution (Loh and Brieger 2014)

People who live in suburbs spend more time in cars, owing to long distances, low density, and limited public transport. (Sugiyama et al. 2012). Active transportation use in adults is further associated with subjective density, mixed land use, walkability, and safety for cycling (Van Dyck et al. 2013). However, our findings are clear that a suburban transformation toward active transportation is not optional; in addition to mitigating climate change, greater intensification to promote active transportation will provide health benefits to a growing population and reduce congestion and air pollution. Compared to traditional urban settings, suburban contexts will require significant investment and effort in determining how to transform automobile-focused transportation infrastructure towards making active transportation safer, more desirable, and more feasible in thinking of where and how people move around.

This review also found that green infrastructure and urban vegetation has important mitigation and adaptation benefits. In the Region of Peel, substantial natural cover is present largely in the northern rural areas, with more built up areas in the south left vulnerable to urban heat island effect. Research suggests that areas vulnerable to urban heat island effect would benefit from increased urban vegetation and green infrastructure, which is linked to lower land surface temperatures, better air quality, and flood mitigation. This poses considerable challenges given the spread and scale of various developments that rely on wide arterial roads and low-density buildings with extensive parking lot facilities.

The final theme that emerged from the literature is that of building retrofitting, though evidence in this review is mixed. Increasing the energy efficiency of buildings through retrofitting would help reduce energy use and mitigate greenhouse gas emissions, while helping residents adapt to extreme shifts in temperature. Specific data from Natural Resources Canada indicate that residential and commercial activities account for about 14% of total Canadian energy use and greenhouse gas emissions; in residential settings, data suggests that 81% of the energy consumption is used for space and water heating (Natural Resources Canada 2019). As most retrofits are cost-effective when borne out in more dense settings, suburban settings will need to consider how best to encourage changes, particularly in residential settings.

Limitations

A direct comparison of results and conclusions from the included papers was not possible given their variability in topics, contexts, and research methods. While some of the papers identified potential interventions, none of them presented specific data that would permit a quantification of the impact of their interventions on health outcomes. Specific to context, the evidence reviewed largely focused on urban environments, with only one of the included papers specifically focused on a suburban context. Finally, none of the papers examined the effects of interventions on specific sub-populations or comparatively across different areas.

Conclusion

The results of this literature review point to some promising practices around climate change mitigation and adaptation through the built environment that might be health-supportive and may be of some application to suburban settings. Key themes identified include opportunities presented by green infrastructure, building retrofit, and active transportation interventions. Cross-referencing these to the built form found in a traditional suburban context identifies certain barriers to implementation.

Further research and evaluation will help to determine, in suburban settings, how feasible such interventions might be, how they might be deployed, and how they might impact efforts to mitigate climate change and also adapt to protect general and vulnerable community populations from the direct and indirect health impacts of this phenomenon.

 

References

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More Equitable Nutrition and Health within Inequitable Societies

You can -as individuals- come to the will and intent to change underlying structural inequalities in society either from a primarily ethical or political process. In terms of equity, the bottom-up political process (in which commitments are needed beyond ethics)  looks preferable in that it better accommodates and represents the perceptions of needed development actions as seen from the perspective of development’s beneficiaries. In this approach, beneficiaries are clearly the protagonists of the process; the process is mostly politically motivated and assigns a key role to ‘social activists and political advocates’ who are to advance the cascading process 

By Claudio Schuftan*

Ho Chi Minh City, schuftan@gmail.com

Making Nutrition and Health More Equitable within Inequitable Societies 

 

I would like to think that you -as me- often ask yourself what we could all do better to achieve greater equity in what we do given that we most often work in countries with appalling social inequities. Allow me to share with you some of my thoughts on this.

I see our role in helping put in place the needed social processes and mechanisms that will drive sustainable policies in health and nutrition as being inseparable from us helping to re-establish a will and intent to change underlying structural inequalities in society. To achieve the latter, you can -as individuals- come to this will from either of 2 backgrounds: you can either come to it from a primarily ethical or from a political motivation.

These two motivational approaches that can drive us to become more involved in lessening social inequities represent, not packages of universal solutions, but rather paths to follow to get things that need to be done done, and the latter by whom and with whom (and against whom).

Living as we do in a mean, unfair and selfish world, I see the challenge we face as being one to graduate from the first into the second approach. Let me explain why.

THE PRIMARILY ETHICS-LED PROCESS TO SUSTAINABLE DEVELOPMENT IN HEALTH AND NUTRITION

As is true for slavery, there are ethical limits to tolerating extreme poverty

The growing new development ethics that calls for working with the poor as protagonists and not merely as recipients has, so far, itself unfortunately remained mostly a top-down approach. It represents mostly the view of academicians, of intellectuals, of church leaders, of international bureaucrats and of a few politicians (mostly in the opposition). Beneficiaries have remained mostly passive in this approach, merely being counted as the ‘object’ of the process. This ethics-led process is mostly ethically motivated and assigns a key role to ‘moral advocates’ who are to advance the following cascading process:

– NEEDS (Entails assessing needs requiring fulfillment using
 “objective”(?) field research techniques)
 |
 – ENTITLEMENTS (Entails granting selected identified needs the status of
 entitlements to be honored by society)
 |
 – RIGHTS (Entails translating accepted entitlements into actual rights)*
 |
 – LAWS (Entails delegating to members of Parliament the
 legitimization of selected rights by promulgating them
 into laws)
 |
 – LAW ENFORCEMENT (Entails assuring/securing that the laws get
 enforced by government institutions)**
 _________________________________________________________
 * : Promoting these rights is not, by itself, a progressive political
 act.
 **: Often very weak or non-existent and without the people getting involved
 directly in it.

The inherent weakness of this process is that to have rights ultimately respected, someone other than the poor takes the responsibility at each step to steer the process from entitlement to enforcement.

THE PRIMARILY POLITICALLY-LED PROCESS TO SUSTAINABLE DEVELOPMENT IN HEALTH AND NUTRITION

This more bottom-up political approach (in which commitments are needed beyond ethics) better accommodates and represents the perceptions of needed development actions as seen from the perspective of development’s beneficiaries. In this approach, beneficiaries are clearly the protagonists of the process; the process is mostly politically motivated and assigns a key role to ‘social activists and political advocates’ who are to advance the following cascading process:

– FELT NEEDS (As freely and spontaneously expressed by organized
 communities)
 |
 [Consciousness raising]
 |
 – CONCRETE DEMANDS (Felt needs are articulated into concrete
 demands each tackling perceived causes)
 |
 [Social learning]
 |
 – CLAIMS/EFFECTIVE DEMANDS (Based on concrete demands, people
 make claims* and exert an effective
 demand**)
 |
 [Social Mobilization/Empowerment]
 |
 [Acquisition of Social Power]
 |
 – ORGANIZED PEOPLE’S ACTIONS (Initial mobilization of own and
 other available resources)
 |
 [Gains in self-confidence]
 |
DE-FACTO EXERCISE OF POWER (Within or challenging the law;

bringing in, using and progressively
 controlling needed external resources)
 |
 [Networking]
 |
 [Acquisition of Political Power]
 |
 – CONSOLIDATION OF NEW POWER (Coalition building)
 |
 [Leads to new felt needs and the cycle restarts]
 ________________________________________________________
 * : Claims correspond to entitlements in the previous diagram.
 **: When people are willing to invest their own resources to fulfill
 their felt needs.

Although the ethically and politically led approaches, as simplified in these two diagrams, represent different paths, both can contribute -through their own merits- to sustainable changes in the health and nutrition of the poor. The two approaches complement each other, but would be even more synergistic if the ethically led process gets more proactive civil society inputs and gets more politically savvy.

It is in the realm of the second diagram that I see us ever getting a chance to influence the choice of needed investments in health and nutrition, as well as influencing the redistributive and social protection measures/priorities that will concomitantly address the poverty underlying the ill-health and malnutrition we (as professionals) are left to deal with.

It is in the realm of the second diagram as well -with the added strength coming from an organized community- that I see us ever  effectively influencing how the public sector allocates its resources and chooses geographic/socioeconomic/ethnic targets, and how, in the process, the government favors programs that are under strong community control.

Finally, it is also in the realm of the second diagram that I see us succeeding in re-establishing a will and an intent to change structural inequalities underlying ill-health and malnutrition; our strength will come from building the new constituencies that do have a vested interest in pushing for the
unpostponable changes in the system that basically reproduces the existing structural inequalities and determines the parameters within which we (as professionals) are “allowed” to intervene.

———————————-

*Short Bio

Claudio Schuftan has worked extensively at global level (especially in Africa and Asia) in fields such as Public Health including, Strengthening Management of Health Systems and Health Policy Formulation, Public Health Nutrition, Primary Health Care; Maternal and Child Health Care, Health Management Information Systems, Human Resources for Health, Health Project Design, Health in SWAPs, District Health Management, Health and Human Rights Capacity Building, Community Health, Health Promotion, Health governance, Health Sector Reform and Gender Issues. Dr Schuftan has significant monitoring and evaluation experience in these fields. Apart from sector and joint evaluations for various donors,he has monitored EU projects mainly in the fields of health and nutrition especially since the establishment of the ROM initiative in 2001. 

Dr. Schuftan has worked on the drafting of national plans of action in Cameroon, Kenya and Vietnam and has carried out in-depth situation analyses including access to health and right to health issues. He has prepared health investment plans and facilitated numerous training workshops. He has also written numerous training manuals. As senior adviser in the MOHs in Nairobi and in Hanoi he was in charge of operational planning at both central and local levels and contributed to SWAP-related work in one province in Vietnam. The same was done in Bangladesh. He has closely worked with concerned government agencies including public finance institutions and human rights committees.

By training, Dr Schuftan is a Medical Doctor and Pediatrician with a degree of the Universidad de Chile in Santiago and holds a post-graduate diploma in Food and Nutrition Planning from the Massachusetts Institute of Technology (MIT) in the US. He is a US, Chilean and German national and resides in Vietnam since 1995 (first Hanoi and then in Ho Chi Min City since 2003). He is the author of over 85 scholarly papers published in refereed journals.

 

 

PEAH News Flash 364

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 364

 

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PEAH News Flash 363

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 363

 

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Convenience store visitors recall cigarette advertisements even if they do not purchase cigarettes 

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Industry and farmers expect ‘science-based’ solutions to deliver New Green Deal 

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