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Background: Addressing complex and interconnected ecological, social, and health issues necessitates upstream, solutions-oriented, and whole-systems thinking. Specifically, exploring what it means to live in reciprocity with the planet and all living systems, now and for generations to come, can have a crucial role in advancing planetary health. Methods: In this presentation, we show findings from four gatherings that we co-designed and co-hosted to connect communities, lands, waters, climate, and health. We draw lessons from two events in the Cowichan watershed (co-hosted by Cowichan Tribes) and the Stellako and Nechako watersheds (co-hosted by Stellat'en First Nation) that were co-designed with the ECHO Network. These gatherings brought together youth, Indigenous leaders, researchers, and health, community, and environmental decision-makers across British Columbia to learn how to address connected health, environmental, and community concerns. We supplement these findings with insights from two co-hosted conversations, that connected five continents and more than 40 countries, each enabling 24 h of continuous dialogue on the theme of working together for a healthy, just, and sustainable planet. Findings: Gatherings took place between Oct 12, 2022, and Dec 1, 2023. These gatherings each provided lessons about how Indigenous-led, integrative approaches that connect the health of people to lands, waters, and ecosystems can elevate and enhance our work and scholarship to address ecological, social, and health issues. Specifically, initiatives co-designed in this way help overcome challenges that arise when addressing boundary-crossing, intersectional and intersectoral issues at the nexus of climate, public health, and planetary health. Our findings include insights into strengthening research and public health capacity for integrative approaches to complex issues that are relevant to place-based contexts and have implications and applications for planetary health. Interpretation: Our presentation summarises how these gatherings—each of which were fuelled by a sense of love for the planet, each other, and future generations—have progressed intersectoral, intergenerational, boundary-crossing, and transformative approaches to planetary health. These insights help guide future directions for planetary health research, practice, and policy. Funding: The Canadian Institute of Health Research Environment (IP4150712), Michael Smith Health Research BC (RA-2022-2872), and Vancouver Foundation (FOI19-1781).

Abstract Background ‘Syndemic’ refers to socially produced, intertwined, and co-occurring epidemics. Syndemic theory is increasingly used to understand the population-level relationships between sexual health (including HIV) and mental health (including problematic substance use) epidemics. Syndemic-informed clinical interventions are rare. Methods We therefore asked 22 sexual health practitioners from six sexual health clinics in British Columbia, Canada to define the word ‘syndemic’ and then asked how the theory related to their clinical practice. Results Responses to syndemic theory ranged widely, with some practitioners providing nuanced and clinically informed definitions, others expressing a vague familiarity with the term, and others still having no prior knowledge of it. Where practitioners acknowledged the relevance of syndemic theory to their practice, they articulated specific ways in which syndemics create moral distress, that is, feeling that the most ethical course of action is different from what they are mandated to do. While some practitioners routinely used open-ended questions to understand the social and economic contexts of patients’ sexual health needs, they described an uneasiness at potentially having surfaced concerns that could not be addressed in the sexual health clinic. Many observed persistent social, mental health, and substance use-related needs among their patients, but were unable to find feasible solutions to these issues. Conclusions We therefore propose that interventions are needed to support sexual health practitioners in addressing psychosocial health needs that extend beyond their scope of practice, thereby reducing ‘syndemic moral distress’.

In Canada, community and policy leaders have issued urgent calls to collect, analyze, and mobilize disaggregated data to inform equity-oriented initiatives aimed at addressing systemic racism and gender inequity, as well as other social inequities. This essay presents critical reflections from a national Roundtable discussion regarding how meaningful community engagement within academia–community–government research collaborations offers the opportunity to harness disaggregated data and advanced analytics to centre and address the priorities of equity-deserving and sovereignty-seeking groups. Participants emphasized four key priorities: (1) Building equitable and engaged partnerships that centre community-driven priorities and address structural barriers to community engagement; (2) Co-creating ethical data governance policies and infrastructure to support community data ownership and access; (3) Stimulating innovation and pursuing community involvement to create contextualized, advanced analyses and effective visualizations of disaggregated data; and (4) Building the capacity of all partners to effectively contribute to partnership goals. Capacity building was viewed as a bridge across a diversity of lived and professional expertise, enabling intersectoral research teams to collaborate in culturally safe and respectful ways. Beyond identifying key structural barriers impeding the promise of disaggregated data, we present practical opportunities for innovation in community-engaged scholarship to address social justice challenges in Canada.