Challenges, Volume 9, Issue 2 (December 2018) – 18 articles

Childbearing and infant care practices have dramatically evolved since the 15th century. Shifting away from traditional home-based experiences, with the emergence of the microbial aware era and the hospital as a quintessential sanitizing machine, early life has now long been characterized as a condition to be medically managed. Paradoxically, this ‘germ-free’ march towards a healthier early life environment has opened the door to greater microbial susceptibility and dysbiosis. Many studies have now established that infant exposure to excessive sanitation and hygiene regimens are associated with an increased risk for and onset of childhood immune system diseases. In this paper, we explore the ways in which biomedical-centered efforts to enhance early life have come at a cost to planetary health, in relation to infant microbial succession. We examine three major areas of early life that have been subject to the ‘ripple effect’ of hygiene and sanitation concerns—childbirth, home environment, and breastfeeding. Full article

Intrauterine and early life has been accepted as important susceptibility windows for environmental exposure and disease later in life. Emerging evidence suggests that exposure before conception may also influence health in future generations. There has been little research on human data to support this until now. This review gives evidence from epigenetic as well as immunologic research, and from animal as well as human models, supporting the hypothesis that there may be important susceptibility windows before conception in relation to exposure such as obesity, diet, smoking and infections. It is likely that we can identify vulnerability windows in men and women in which interventions may have an impact on several generations in addition to individual health. Establishing vulnerability windows affecting health over future generations, and not only in the now or the near future of the individual, may provide tremendous opportunities for health policy and practice. Full article

All awareness, thoughts, emotions, perceptions, memories, actions—everything that encompasses our human capacity and reality—are mediated through the biological interface of our brains. While the source of consciousness remains a fundamental and elusive question, it is also inescapable that threats to biological health can compromise any and all aspects of psychological and neurological functioning, from the first moments of life. The effects of environmental threats to specific aspects of individual brain health are well recognized, yet precious little attention is given to the collective effects of planetary-scale environmental damage, and the erosion of numerous planetary systems, on the biology of the human brain. Although, these are likely to vary widely with individual circumstances, it is also inevitable that the ‘dysbiotic drift’ (increasing life in distress) at the planetary scale is reflected at the personal scale, with a collective shift towards increased biological stress of all kinds. Here, we make the case that ‘planetary distress’ is directly implicated in a collective increase in ‘personal distress’, and that multifaceted biological pressures, as well as psychological pressures, are implicated in the mental health crisis and predisposition to numerous disorders in brain development, functioning and aging. In turn, this has implications for every aspect of health, capacity, and the very essence of human experience for generations to come. Viewed on this scale, we call for a quantum shift in efforts to address the many factors affecting brain health, ranging from air pollution to disappearing greenspace. These all stem from ecological imbalance and point to a unifying need to restore planetary health. Ultimately, the future of human capacity depends on this. Full article

Principles of ecology apply at myriad scales, including within the human body and the intertwined macro and microscopic ecosystems that we depend upon for survival. The conceptual principles of dysbiosis (‘life in distress’) also apply to different realms of life—our microbiome, the macro environment and the socioeconomic domain. Viewing the human body as a holobiont—a host plus billions of microbial organisms working symbiotically to form a functioning ecological unit—has the potential to enhance personal and planetary health. We discuss this ecological perspective in our paper. We also discuss the proposals to rewild the microbiome, innovative microbiome-inspired green infrastructure (MIGI) and the basis of prescribing ‘doses of nature’. Particular emphasis is given to MIGI—a collective term for the design and management of innovative living urban features that could potentially enhance public health via health-inducing microbial interactions. This concept builds upon the microbiome rewilding hypothesis. Mounting evidence points to the importance of microbial diversity in maintaining favorable health. Moreover, connecting with nature—both physically and psychologically–has been shown to enhance our health and wellbeing. However, we still need to understand the underlying mechanisms, and optimal types and levels of exposure. This paper adds to other recent calls for the inclusion of the environment-microbiome-health axis in nature–human health research. Recognizing that all forms of life—both the seen and the unseen—are in some way connected (ecologically, socially, evolutionarily), paves the way to valuing reciprocity in the nature–human relationship. It is with a holistic and symbiotic perspective that we can begin to integrate strategies and address connected issues of human and environmental health. The prospective strategies discussed in our paper focus on enhancing our connections with the natural world, and ultimately aim to help address the global challenge of halting and reversing dysbiosis in all its manifestations. Full article

Moral suasion offers a versatile and low-cost approach to influence social norms and risky health behaviours, but is often neglected in health promotion in favour of using educational approaches. The purpose of this paper is to discuss the challenges and the benefits of using moral suasion in health promotion. Past and present experiences of using moral suasion to promote health are discussed in conjunction with other approaches, such as harm reduction. The challenge of using moral suasion as an approach is that it focuses on individual behaviour change, rather than addressing the broader structural causes of poor health. However, the paper concludes that the versatility of the moral suasion approach and the success of using “pledges” means that it can be an important intervention, alongside other educational and motivational techniques, to help to change behaviours at the individual and collective levels. Full article

Planetary health, formally defined as the interdependent vitality of all natural and anthropogenic ecosystems—social, political, and otherwise—is a vast concept that has now entered the scientific lexicon. The problems associated with planetary ill-health—biodiversity losses, climate change, environmental degradation, and other problems of so-called “anthropocene syndrome”—are considered so enormous that they can immobilize us; we may feel environmental guilt, but that alone cannot save us or the planet. What is missing is environmental empathy, the nurturance of our capacity to recognize the planet and its many life forms as more than elusive entities to be objectified. Although experts in planetary health have called for a more sophisticated understanding of the psychological connections between humans and the natural world, these appeals are almost exclusively cordoned off from the taboos of science; applying concepts of “self” to non-human animals, and especially non-mammals, are generally proscribed. Here, I will personalize the planetary health concept by describing my research-based endeavors on the Great Barrier Reef—experiences that would change my scientific career and personal life forever. The small damselfish, Pomacentrus amboinensis, became the teacher; the student-in-me departed the reef with an education in environmental empathy, and a greater understanding of the urgency with which we must alter our teaching in ecology and other branches of science. Planetary health as a unifying, multidisciplinary effort generally lacks a narrative perspective in academia; I am hopeful that others will share their narrative perspectives and, in doing so, foster the growth of environmental empathy. Full article

The aim of this paper is to discuss the relevance of tailored interventions to ensure that vulnerable groups, such as migrants, are covered by public health programs. Most migrants do not have access to universal health care, including preventive and protective services. Tailored interventions can play an important role in helping to promote better migrant health through improved access to health care, increased awareness, better community-based structures and positive behaviour changes. The paper identifies some of the most effective strategies for the application of tailored public health interventions for migrants. In particular, migrants are especially vulnerable during a health emergency or disease outbreak and tailored approaches can be more effective than mainstream approaches. The paper advocates for the use of tailored interventions alongside the strengthening of universal health care to improve the health of migrants. Full article

inVIVO Planetary Health is a progressive, humanist scientific movement promoting both evidence and advocacy around concepts of planetary health which denote the interdependence between human health and place at all scales. Our seventh annual conference was held in Canmore, Alberta 4-6th April 2018, themed “Transforming Life: Unify Personal, Public, and Planetary Health” included diverse topics and perspectives to emphasise the interdependent vitality of all natural and anthropogenic ecosystems—social, political and otherwise. A key outcome of this meeting was the The Canmore Declaration: Statement of Principles for Planetary Health (published separately) which underscores that improving the health of all systems depends on: mutualistic values; planetary consciousness; advocacy; unity of purpose; recognition of biopsychosocial interdependence; emotional bonds between people and the land; efforts to counter elitism, social dominance and marginalization; meaningful cross-sectoral and cross-cultural narrative; self-awareness; and a personal commitment to shaping new normative attitudes and behaviors. Here we present the collection of abstracts of invited lectures and oral communications presented during the meeting. These formed the foundations and direction for discussions that became the basis of The Canmore Declaration. Full article

Nearly one-third of the U.S. population provides unpaid, informal caregiving to a loved one or friend. Caregiver health literacy involves a complex set of actions and decisions, all shaped by communication. Existing definitions depict health literacy as individuals’ skills in obtaining, understanding, communicating, and applying health information to successfully navigate the health management process. One of the major problems with existing definitions of health literacy is that it disproportionately places responsibilities of health literacy on patients and caregivers. In this conceptual piece, we define and introduce a new model of Relational Health Literacy (RHL) that emphasizes the communicative aspects of health literacy among all stakeholders (patients, caregivers, providers, systems, and communities) and how communication functions as a pathway or barrier in co-creating health care and health management processes. Future directions and recommendations for model development are described. Full article

Obesity is preventable but there is still no single model for prevention and no country has managed to convincingly reverse the growing trend, estimated in 2016 to be 650 million adults. Globally, the increase in obesity will have catastrophic consequences for the economy and for population health. ‘Desperate times breed desperate measures’ and this paper outlines the shift that many governments are being forced to make to halt the growth of obesity. Moving to the extremes means that the planning and coordination of strategies places an equal emphasis on top-down (policy, regulation, and taxation) and bottom-up (local actions, self-help groups, volunteerism) interventions. There is still an important role for communication, the middle-ground between the extremes of bottom-up and top-down, but governments must use ‘power-over’ measures to take control of the causes of obesity. Bringing the public with them will be crucial to success and can be achieved through a sharing of resources, a ‘power-with’, to combine top-down and bottom-up interventions in the future. Full article

This paper provides a rapid review of the literature on the current knowledge on health promotion for improved refugee and migrant health in the European region. The aim of the paper is to identify implications for future policy and practice. The literature review used standard systematic methodologies to search databases followed by data extraction and synthesis. General sources of grey literature were also included in the review as well as consultations with people working in the field. The paper identifies the lack of knowledge on how to engage with refugees and migrants in a culturally competent way, to address fear and violence and the application of health literacy. The review of the literature also identifies evidence to support peer education, working with community-based organisations and the tailoring of interventions to the needs of refugees and migrants. The paper concludes with a discussion of the technical content and future implications for the implementation of health promotion programs. Full article

The term planetary health—denoting the interdependence between human health and place at all scales—emerged from the environmental and preventive health movements of the 1970–80s; in 1980, Friends of the Earth expanded the World Health Organization definition of health, stating: “health is a state of complete physical, mental, social and ecological well-being and not merely the absence of disease—personal health involvesplanetary health”. Planetary health is not a new discipline; it is an extension of a concept understood by our ancestors, and remains the vocation of multiple disciplines. Planetary health, inseparably bonded to human health, is formally defined by the inVIVO Planetary Health network as the interdependent vitality of all natural and anthropogenic ecosystems (social, political and otherwise). Here, we provide the historical background and philosophies that have guided the network, and summarize the major themes that emerged at the 7th inVIVO meeting in Canmore, Alberta, Canada. We also provide the Canmore Declaration, a Statement of Principles for Planetary Health. This consensus statement, framed by representative participants, expands upon the 1986 Ottawa Charter for Health Promotion and affirms the urgent need to consider the health of people, places and the planet as indistinguishable. Full article

In order to fulfill a broader vision of health and wellness, the World Health Organization (WHO) 2014–2023 strategy for global health has outlined a culturally sensitive blending of conventional biomedicine with traditional forms of healing. At the same time, scientists working in various fields—from anthropology and ecology to biology and climatology—are validating and demonstrating the utility of Indigenous knowledge. There is a misperception that Indigenous peoples are in need of Westernized science in order to “legitimize” our knowledge systems. The Lancet Planetary Health Commission report calls for the “training of indigenous and other local community members” in order to “help protect health and biodiversity” (p. 2007). Such calls have merit but appear authoritarian when they sit (unbalanced) without equally loud calls for the training of (socially dominant) westernized in-groups by Indigenous groups “in order to help protect health and biodiversity.” The problems of planetary health are both profound and complex; solutions can be found in a greater understanding of the self and the universe and the land as a medicine place. The following message was delivered as part of a keynote at the inVIVO Planetary Health Conference in Canmore, Alberta, Canada—20 points of consideration for a planetary health science in its pure, raw form, on behalf of the Indigenous elders. Full article

Congenital heart disease (CHD) is a serious anomaly for which the etiology remains elusive. We explored temporal trend associations between industrial developmental toxicant (DT) air emissions and CHD in Alberta. Patients born between 2004–2011 with a diagnosis of CHD and 18 DTs from the National Pollutant Release Inventory (2003–2010) were identified. We applied principal component analysis (PCA) to DT amounts and toxicity risk scores (RS) and defined yearly crude CHD and septal defects rates for urban and rural regions. Correlations between DT groups and CHD rates were examined with Spearman test and Bonferroni correction was conducted for multiple comparisons. PCA identified three DT groups: Group 1 (volatile organic compounds (VOCs) and other gases,) Group 2 (other VOCs), and Group 3 (mainly heavy metals). Province-wide, we found associations between Group 1 DTs and CHD and septal defect rates, when using amounts (r = 0.86, CI 0.39, 0.97 and r = 0.89, CI 0.48, 0.98, respectively) and RS (r = 0.88, CI 0.47, 0.98 and r = 0.85, CI 0.36, 0.97, respectively). Rural Group 2 DTs were positively associated with septal defect rates in both amounts released and RS (r = 0.91, CI 0.55, 0.98 and r = 0.91, CI 0.55, 0.98, respectively). In this exploratory study, we found a temporal decrease in emissions and CHD rates in rural regions and a potential positive association between CHD and septal defect rates and mixtures of organic compounds with or without gases. Full article

Poly(ADP-ribose) (PAR) formation is catalyzed by poly(ADP-ribose) polymerase (PARP) family proteins in nuclei as well as in cytosols. The anti-PAR antibodies that specifically detect PAR are useful for the quantitative measurement of PAR in cells, in tissue, and in the body. In clinical trials of PARP inhibitors, a pharmacodynamic (PD) assay for the measurement of PARP activity inhibition in peripheral blood mononuclear cells (PBMCs) with dot-blot assay or an ELISA assay using anti-PAR antibodies have been used. In these assays, ex vivo PARP activity and its inhibition assay have been used. For a PD assay to assess the efficacy of the treatment, the measurement of PARP activity inhibition in tumor tissues/cells has been recommended. A dot or slot blot assay may also be suitable for the measurement of such crude tissue samples. Here, we investigate the optimum conditions for a dot/slot blot assay of an ex vivo PARP activity assay by utilizing physical and chemical crosslinking methods. Using 10H monoclonal antibody to PAR, we show that use of a nylon membrane and UV crosslink at 254 nm can stably enhance the detection level of PAR. However, the limitation of this assay is that the size of PAR detectable using the 10H antibody must be around 20 ADP-ribose residues, since the antibody cannot bind PAR of lower size. Full article

The etiology of congenital heart defects (CHD) is not known for many affected patients. In the present study, we examined the association between industrial emissions and CHD in urban and rural Alberta. We acquired the emissions data reported in the Canadian National Pollutant Release Inventory (n = 18) and identified CHD patients born in Alberta from 2003–2010 (n = 2413). We identified three groups of emissions after principal component analysis: Groups 1, 2, and 3. The distribution of exposure to the postal codes with births was determined using an inverse distance weighted approach. Poisson or negative binomial regression models helped estimate associations (relative risk (RR), 95% Confidence Intervals (CI)) adjusted for socioeconomic status and two criteria pollutants: nitrogen dioxide and particulate matter with a mean aerodynamic diameter of ≤2.5 micrometers. The adjusted RR in urban settings was 1.8 (95% CI: 1.5, 2.3) for Group 1 and 1.4 (95% CI: 1.3, 1.6) for both Groups 2 and 3. In rural postal codes, Groups 1 and 3 emissions had a RR of 2.6 (95% CI: 1.03, 7). Associations were only observed in postal codes with the highest levels of emissions and maps demonstrated that regions with very high exposures were sparse. Full article