Search

Adaptation to impacts of climate change is a key pillar of climate change policy, and local governments have historically played a major role in the design and implementation of these policies. An array of political, economic, institutional, social, and individual factors influence adaptation policy instrument choice. At the local government level, these choices also reflect inter-governmental dynamics that can constrain or support local efforts. We analyze eight hypothesized drivers of local adaptation policy instrument choice using fractional regression analysis and multilevel modelling. Local governments are pursuing diverse adaptation policy implementation styles that are associated with different levels of internal capacity, local political economies and problem perception. Dependence on national governments, the presence or absence of national adaptation mandates, national decision-making traditions, and national adaptation policy approaches may also influence local policy instrument choices. [ABSTRACT FROM AUTHOR]

Objective: To develop an online food composition database of locally consumed foods among an Indigenous population in south-western Uganda.Design: Using a community-based approach and collaboration with local nutritionists, we collected a list of foods for inclusion in the database through focus group discussions, an individual dietary survey and markets and shops assessment. The food database was then created using seven steps: identification of foods for inclusion in the database; initial data cleaning and removal of duplicate items; linkage of foods to existing generic food composition tables; mapping and calculation of the nutrient content of recipes and foods; allocating portion sizes and accompanying foods; quality checks with local and international nutritionists; and translation into relevant local languages.Setting: Kanungu District, south-western Uganda.Participants: Seventy-four participants, 36 Indigenous Batwa and 38 Bakiga, were randomly selected and interviewed to inform the development of a food list prior the construction of the food database.Results: We developed an online food database for south-western Uganda including 148 commonly consumed foods complete with values for 120 micronutrients and macronutrients. This was for use with the online dietary assessment tool myfood24. Of the locally reported foods included, 56 % (n 82 items) of the items were already available in the myfood24 database, while 25 % (n 37 items) were found in existing Ugandan and Tanzanian food databases, 18 % (n 27 items) came from generated recipes and 1 % (n 2 items) from food packaging labels.Conclusion: Locally relevant food databases are sparse for African Indigenous communities. Here, we created a tool that can be used for assessing food intake and for tracking undernutrition among the communities living in Kanungu District. This will help to develop locally relevant food and nutrition policies. [ABSTRACT FROM AUTHOR]

Background: Climate change is expected to decrease food security globally. Many Indigenous communities have heightened sensitivity to climate change and food insecurity for multifactorial reasons including close relationships with the local environment and socioeconomic inequities which increase exposures and challenge adaptation to climate change. Pregnant women have additional sensitivity to food insecurity, as antenatal undernutrition is linked with poor maternal-infant health. This study examined pathways through which climate change influenced food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda. Specific objectives were to characterize: 1) sensitivities to climate-associated declines in food security for pregnant Indigenous women; 2) women's perceptions of climate impacts on food security during pregnancy; and 3) changes in food security and maternal-infant health over time, as observed by women. Methods: Using a community-based research approach, we conducted eight focus group discussions—four in Indigenous Batwa communities and four in non-Indigenous communities—in Kanungu District, Uganda, on the subject of climate and food security during pregnancy. Thirty-six women with ≥1 pregnancy participated. Data were analysed using a constant comparative method and thematic analysis. Results: Women indicated that food insecurity was common during pregnancy and had a bidirectional relationship with antenatal health issues. Food security was thought to be decreasing due to weather changes including extended droughts and unpredictable seasons harming agriculture. Women linked food insecurity with declines in maternal-infant health over time, despite improved antenatal healthcare. While all communities described food security struggles, the challenges Indigenous women identified and described were more severe. Conclusions: Programs promoting women's adaptive capacity to climate change are required to improve food security for pregnant women and maternal-infant health. These interventions are particularly needed in Indigenous communities, which often face underlying health inequities. However, resiliency among mothers was strong and, with supports, they can reduce food security challenges in a changing climate. [ABSTRACT FROM AUTHOR]

Abstract Conflict and war have long been recognized as determinants of infectious disease risk. Re-emergence of epidemic sleeping sickness in sub-Saharan Africa since the 1970s has coincided with extensive civil conflict in affected regions. Sleeping sickness incidence has placed increasing pressure on the health resources of countries already burdened by malaria, HIV/AIDS, and tuberculosis. In areas of Sudan, the Democratic Republic of the Congo, and Angola, sleeping sickness occurs in epidemic proportions, and is the first or second greatest cause of mortality in some areas, ahead of HIV/AIDS. In Uganda, there is evidence of increasing spread and establishment of new foci in central districts. Conflict is an important determinant of sleeping sickness outbreaks, and has contributed to disease resurgence. This paper presents a review and characterization of the processes by which conflict has contributed to the occurrence of sleeping sickness in Africa. Conflict contributes to disease risk by affecting the transmission potential of sleeping sickness via economic impacts, degradation of health systems and services, internal displacement of populations, regional insecurity, and reduced access for humanitarian support. Particular focus is given to the case of sleeping sickness in south-eastern Uganda, where incidence increase is expected to continue. Disease intervention is constrained in regions with high insecurity; in these areas, political stabilization, localized deployment of health resources, increased administrative integration and national capacity are required to mitigate incidence. Conflict-related variables should be explicitly integrated into risk mapping and prioritization of targeted sleeping sickness research and mitigation initiatives.

Access to safe drinking water is limited in many isolated areas, such as the Amazon where Indigenous peoples frequently reside. Identifying safe forms of drinking water accepted by the communities could have positive health benefits for Indigenous peoples. Many Amazon Indigenous peoples traditionally prepare and consume a fermented beverage called masato, which is frequently the only form of water consumption. Despite its widespread consumption and evidence of the health benefits of fermentation, masato remains poorly investigated. We partnered with a Shawi Indigenous community in the Peruvian Amazon to conduct participatory photography to research masato preparation, and to characterize key cultural features and to assess the presence of total and fecal coliform bacteria by using a membrane filter technique. Pictures show that masato preparation is a key part of cultural practices and that there are clear gender roles in the preparation process. We found that 100% of communal water sources (26/26) were contaminated with coliform bacteria; by contrast, fewer, 18% of masato samples (2/11), were positive for coliform. This exploratory study suggests that fermented beverages like masato merit further investigation as they represent an Indigenous method to improve water quality in Amazonian communities where water safety cannot be assured. [ABSTRACT FROM AUTHOR]

Acute gastrointestinal illness (AGI) is a global public health priority that often disproportionately effects Indigenous populations. While previous research examines the association between meteorological conditions and AGI, little is known about how socio-cultural factors may modify this relationship. This present study seeks to address this research gap by comparing AGI prevalence and determinants between an Indigenous and non-Indigenous population in Uganda. We estimate the 14-day self-reported prevalence of AGI among adults in an Indigenous Batwa population and their non-Indigenous neighbours using cross-sectional panel data collected over four periods spanning typically rainy and dry seasons (January 2013 to April 2014). The independent associations between Indigenous status, precipitation, and AGI are examined with multivariable multi-level logistic regression models, controlling for relative wealth status and clustering at the community level. Estimated prevalence of AGI among the Indigenous Batwa was greater than among the non-Indigenous Bakiga. Our models indicate that both Indigenous identity and decreased levels of precipitation in the weeks preceding the survey period were significantly associated with increased AGI, after adjusting for confounders. Multivariable models stratified by Indigenous identity suggest that Indigenous identity may not modify the association between precipitation and AGI in this context. Our results suggest that short-term changes in precipitation affect both Indigenous and non-Indigenous populations similarly, though from different baseline AGI prevalences, maintaining rather than exacerbating this socially patterned health disparity. In the context of climate change, these results may challenge the assumption that changing weather patterns will necessarily exacerbate existing socially patterned health disparities. [ABSTRACT FROM AUTHOR]

To the Editor: The past 2 decades have heralded notable success in efforts to control sleeping sickness (human African trypanosomiasis [HAT]) in Africa. HAT is a neglected tropical disease with [...]

Highlights • Canadian and German intergovernmental relations for health adaptation are studied. • Federal-regional relationships for adaptation follow federalism patterns. • Regional-local relationships for adaptation deviate from federalism patterns. • Examining other countries' approaches to health adaptation can promote learning. Abstract Climate change is a significant threat to public health, and governments at all scales will need to adapt to protect the health of their populations. The impacts of climate change are highly localized and thus federal systems theoretically have the inherent advantage of allowing for regional diversity and policy experimentation in adaptation. However, there are also higher levels of conflict and stalemates in federal systems than in unitary systems, complicating intergovernmental relations and coordination necessary for public health adaptation. We examine how intergovernmental dynamics are patterned across national, regional and local levels of government for public health adaptation to climate change, drawing upon semi-structured interviews (n = 28) in comparative embedded case studies of Canada and Germany. We find that coordination between levels of government specifically for climate change and health is rare, but climate change issues are occasionally discussed through working groups or through existing methods of public health coordination. These findings have implications for national and regional governments in federal systems seeking to enable sub-national public health adaptation to climate change and create synergies between levels of government. [ABSTRACT FROM AUTHOR]

Climate change presents substantial risks to the health of Indigenous peoples. Research is needed to inform health policy and practice for managing risks, with community based adaptation (CBA) emerging as one approach to conducting research to support such efforts. Few, if any, studies however, have critically examined the application of CBA in a health or Indigenous peoples context. We examine the strengths, challenges, and opportunities of health-related CBA research in Indigenous community settings, drawing on the experiences of the multi-nation interdisciplinary Indigenous Health Adaptation to Climate Change (IHACC) project. Data collection was guided by a framework developed to evaluate CBA projects. Semi-structured interviews (n = 114) and focus groups (n = 23, 177 participants) were conducted with faculty-based researchers, institutional partners, community members, students, and trainees involved in the IHACC project in Canada, Uganda, and Peru. Results illustrate the importance of CBA in co-generating knowledge on climate-health vulnerability and adaptation options, capacity building, and informing decision choices. There are also significant challenges of conducting CBA which can have unintended negative consequences, with results emphasizing the importance of managing the tension between health research and tangible and immediate benefits; developing a working architecture for collective impact, including team building, identification of common goals, and meaningful engagement of knowledge users; and the need to continuously monitor and evaluate progress. CBA holds significant promise in a health adaptation context, but only in the ‘right’ circumstances, where considerable time is spent developing the work with partners. [ABSTRACT FROM AUTHOR]

Equity and efficiency should be considered when allocating resources for climate change adaptation. More than a decade after the Least Developed Countries Fund approved adaptation funds for 18 countries in 2003, it is possible to take the stock of investment data and to test empirically whether equity and efficiency have been factored into adaptation investment decision-making. To evaluate equity, one must determine if resources were distributed to areas of greatest need. Vulnerability assessments provide information on the global distribution of the need for adaptation. To evaluate efficiency, one must compare cost and benefit of an investment. Although it is difficult to assess ex-ante the cost and benefit of investment strategies, it is possible to measure efficient use of expenditures with readiness assessment, as a metric of capacity to deploy adaptation resources. We used vulnerability and readiness measures of the Notre Dame Global Adaptation Initiative (ND-GAIN) Country Index as proxies of equity and efficiency. This article quantitatively interrogates-through the lens of public fund allocation-the roles of vulnerability and readiness in shaping adaptation investment decisions. Our findings suggest that countries facing increasing impacts from climate change have received more adaptation investments from international sources than countries with less vulnerability. Further, international investments also preferentially flow to countries that are more ready to deploy adaptation resources. Since the most vulnerable countries are likely to be less ready for investment, our findings support the efforts to improve the investment potential of the most vulnerable countries by investing first to enhance their readiness, in order to unlock adaptation solutions. [ABSTRACT FROM AUTHOR]

Food insecurity is a major challenge facing Peru’s Indigenous Shawi communities, who receive food support through national level programs. There is limited research, however, on how national food and social programming support is perceived, received and used among Indigenous communities. We address this research gap by characterizing the preferred diet and coping mechanisms among Shawi Indigenous households, and investigating community perspectives on the national food program and national social supports. We used a mixed methods approach, including a quantitative survey among eleven Shawi communities in the Peruvian Amazon (n = 177 households), and semi-structured interviews with key informants (n = 24). We found that national food programs in Peru rarely provide foods that are desired and preferred among the Shawi, particularly familiar and locally-sourced protein sources such as bushmeat and fish. Food and social programming requirements do not integrate consideration of the remoteness of many vulnerable households, and are considered culturally or linguistically inaccessible to many families. In some cases, foods supplied by national programs are not consumed as they are perceived as unfamiliar. Key opportunities to improve food and social programing include: monitoring and revising eligibility requirements for remote and highly vulnerable households; increasing provision of locally-preferred protein food and familiar food types; avoiding use of written Spanish as a sole source of information to support programming; extending food provision outside of school months; developing contingency plans during education sector strikes; considering hiring of staff with working knowledge of local languages for community distributions; using visual or oral communication rather than written communication to increase accessibility of programs; increasing knowledge on the use and nutritional value of external food; and considering exemptions to school and health eligibility requirements during the rainy season and during sector strikes. Nationally-developed programming that does not consider Indigenous and cultural contexts risks inefficiency, limited improvement of health outcomes, and the potential to increase inequities in Indigenous health. [ABSTRACT FROM AUTHOR]