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Introduction: The understanding of the role of climate change in worsening health outcomes and social disparities is growing, highlighting poverty as a key factor amplifying exposure to environmental hazards and as a result of such exposure. However, there has been insufficient focus on the unique risks encountered in Canada, highlighting the necessity for targeted understanding to inform and evaluate effective responses. The question guiding the present scoping review is: In the Canadian context, what are the impacts and implications of climate change and weather extremes on the physical and mental health of those experiencing poverty, as evidenced in the peer-reviewed academic literature? Methods: A systematic search was conducted within the following four databases: Scopus, PubMed, PsycINFO, and Google Scholar, using key terms related to poverty, climate change, and health and well-being in the Canadian context. Primary research and review articles published in English were included (n = 28). Results: The articles included 23 reports of primary research and five reviews, spanning 2000 to 2022. Six theme areas emerged at the climate change, poverty, and health intersection in Canada: heat, air pollution, food security, pollen, wildfire evacuation, and health systems. Discussion: Addressing poverty reduction is identified as a critical lever for reducing environmental risks and enhancing resilience, although challenges remain in implementing evidence-based interventions due to significant gaps in knowledge. Future research should consider exploring outcomes disaggregated by sociodemographic factors, interconnections between heat and air pollution, and interventions targeting vulnerable groups.

Background: Climate change poses a substantial threat to the mental wellbeing of young people. Population-level research is urgently needed to help inform policies and interventions to ensure that young people are not burdened by long-term mental health impacts from climate change. We sought to identify the prevalence, distribution, and factors associated with climate change-related mental and emotional health outcomes among young people (aged 13–34 years) in Canada. Methods: This study is part of a larger cross-sectional survey, which examined mental and emotional health responses to climate change among individuals aged 13 years or older from across Canada. We used a multi-stage, multi-stratified random probability sampling procedure. Participants were randomly recruited through either an addressed letter or a telephone call. Online and telephone questionnaires were used to interview individuals in English, French, or Inuktitut between April 1, 2022, and March 31, 2023. Data were weighted by age and province using population estimates from Statistics Canada and analysed using descriptive statistics, factor analyses, and multivariable regression analyses. Findings: The full survey included 2476 participants, with a subgroup of 409 young people. Of the 401 respondents who provided their gender identity, 215 (54%) identified as cisgender women, 167 (42%) identified as cisgender men, and 19 (5%) identified as non-binary. Preliminary results suggest that young people in Canada experience a wide range of climate-related emotional and mental health outcomes. More than 70% of respondents in the young people subgroup reported having at least mild levels of sadness, anger, worry, anxiety, concern, helplessness, hopelessness, or powerlessness related to climate change. The severity of climate-related emotional responses differed by gender, with non-binary respondents and cisgender women reporting higher average levels of distress than cisgender men. Regional differences were also observed, with northern regions and urban locations reporting more severe reactions. Interpretation: This study builds on the understanding of the burden of climate change on the mental health of young people. If unaddressed, the impact of this burden could have long-standing and wide-reaching public health and related socioeconomic effects. Funding: Canadian Institutes of Health Research, ArcticNet, Social Sciences and Humanities Research Council Doctoral Fellowship, Izaak Walton Killam Memorial Scholarship, and Alberta Innovates Graduate Student Scholarship.

Introduction: Diarrheal disease, particularly in children under 5 years old, remains a global health challenge due to its high prevalence and chronic health consequences. Public health interventions that reduce diarrheal disease risk include improving access to water, sanitation, and hygiene. Although Peru achieved the 2015 Millennium Development Goal (MDG) indicators for water access, less progress was achieved on sanitation. Furthermore, many Indigenous Peoples were overlooked in the MDG indicators, resulting in a prioritization of Indigenous Peoples in the 2030 Sustainable Development Goals (SDGs). This study aimed to estimate the prevalence of childhood diarrhea, characterize access to water and sanitation, and determine the association of childhood diarrhea with water access and sanitation indicators in 10 Shawi Indigenous communities along the Armanayacu River in the Peruvian Amazon. Methods: A cross-sectional survey (n=82) that captured data on diarrheal disease, sociodemographic variables, and water and sanitation exposures was conducted in 10 Shawi communities. Nutritional status of children under 5 was also assessed via physical examination. Descriptive and comparative statistics were conducted. Results: A small proportion (n=7; 8.54%) of participating children reported an episode of diarrhea in the previous month. Almost half (46.30%) of participating children had stunting, wasting, or both. Although not statistically significant, children living in households that used latrines were 4.29 times (95% confidence interval (CI) 1.01-18.19) more likely to report an episode of diarrhea than children living in households that practiced open defecation. Although not statistically significant, children living in households that used water treatment methods were 4.25 times (95%CI 0.54-33.71) more likely to report an episode of diarrhea than children living in households that did not. Conclusion: The prevalence of childhood diarrhea was lower for Shawi than for other Amazon areas. The higher prevalence of childhood diarrhea in households that used latrines and water treatments warrants further investigation into local risk and protective factors. These Shawi communities scored low for the WHO/UNICEF Joint Monitoring Programme indicators for water and sanitation, indicating that they should be prioritized in future water, sanitation, and hygiene initiatives. Research will be required to understand and incorporate local Indigenous values and cultural practices into water, sanitation, and hygiene initiatives to maximize intervention uptake and effectiveness.

Climate change exerts a profound and far-reaching toll on mental health, resulting in mental illness, diminished wellbeing, and strained social relations, with the severity of these impacts anticipated to intensify under future climate change. News coverage of climate-mental health issues can shape public perceptions and responses, and therefore understanding this coverage is vital for creating and implementing strategies to lessen climate-mental health risks. We systematically examined the extent, nature, and range of news articles from Canada and the United States that covered climate-mental health impacts. Five electronic databases were searched. Articles were included if they were print or online news stories that covered climate-mental health impacts and were published in English or French by sources in Canada or the United States between 2016 and 2020. A total of 1085 articles (642 unique stories) met the inclusion criteria and underwent data extraction and analysis using descriptive statistics and thematic analysis. Coverage of climate-mental health outcomes increased in both Canada and the United States from 2016 to 2019. There was, however, a substantial decrease in coverage by Canadian news outlets from 2019 to 2020. Further, although 468 different news outlets published at least one story on the topic, repeat coverage by any one news outlet was infrequent. Most opinion pieces presented climate-mental health impacts as legitimate or expressed support for people experiencing these issues. Roughly half of the included stories identified populations that are vulnerable to climate-mental health impacts, particularly children and young people. Additionally, approximately half of the included stories identified potential interventions or coping strategies to protect mental health, most often involving changes to individual lifestyles or behavior. More sustained coverage that focuses on protective factors, interventions, and coping strategies is needed, as this could help foster public understanding and drive action to reduce climate-mental health risks.

Introduction: The number of maternal deaths remains high in sub-Saharan Africa. Effective antenatal care (ANC) reduces maternal morbidity and mortality; therefore, provision of improved antenatal care services has been prioritised across sub-Saharan Africa. Yet, research is limited on the ANC experiences of Indigenous women in sub-Saharan Africa. This study characterised ANC attendance patterns at a hospital, and characterised factors influencing attendance among Bakiga and Indigenous Batwa women in Kanungu District, Uganda. Methods: A community-based, mixed-methods approach was used. Quantitative data were collected from a local hospital (records for 2299 ANC visits) and analysed by using descriptive statistics and multivariable regression analysis. Qualitative data from eight key informant interviews (n=9 healthcare providers) and 16 focus group discussions (n=120 Batwa and Bakiga women) were analysed by thematic analysis. Results: Most ANC patients attended between one and three ANC visits per pregnancy (n=1259; 92.57%), and few attended the recommended four or more visits (n=101; 7.43%). Distance from a woman's home to the hospital was significantly associated with lower ANC attendance (p

Introduction: Indigenous populations in low-income regions are often the most acutely affected by social gradients that impact health, including high burdens of infectious disease. Using a mixed methods approach, this study characterized the lived experience of acute gastrointestinal illness (AGI) in an Indigenous Batwa population in south-western Uganda. Methods: Quantitative data analyses were conducted on data from three cross-sectional census surveys of Batwa conducted in January 2013 (n=583), January 2014 (n=569) and April 2014 (n=540). Using a 14-day recall period, cases of AGI were defined as three or more loose stools or any vomiting in a 24-hour period. These analyses were supplemented by qualitative data from key informant interviews (n=11 interviews) and Batwa focus group discussions (n=61 participants). Results: From the surveys, episodes of diarrhea and episodes of vomiting lasted on average 3.6 (95%CI 2.3-4.3) and 3.0 (95%CI 2.1-3.9) days, and individuals experienced an average of 4.3 (95%CI 3.9-4.8) and 2.6 (95%CI 2.1-3.1) loose stools and vomiting episodes in 24 hours. Focus group participants and key informants indicated that episodes of AGI for Batwa were not limited to symptom-based consequences for the individual, but also had economic, social and nutritional impacts. Conclusion: Despite efforts to increase health literacy in disease transmission dynamics, risks and prevention measures, the perceived barriers and a lack of benefits still largely underscored adopting positive AGI prevention behaviors. This study moved beyond surveillance and provided information on the broader community-level burden of AGI and highlighted the current challenges and opportunities for improved uptake of AGI prevention measures for the Batwa.

The normative concepts of equity and justice are rising narratives within global climate change discourse. Despite growing considerations of climate equity and justice within the adaptation literature, the extent to which adaptation research has worked to empirically assess and operationalize concepts of equity and justice in practice remains unclear. We employ a systematic mapping approach to examine how equity and justice are defined and understood within empirical climate change adaptation research, and how extensively they are being assessed within adaptation literature. Structuring our work using a conceptual approach focusing on distributional, recognition, procedural, and capability approaches to justice, we document and review articles that included empirical assessments from searches performed in Web of Science™, Scopus®, and Google Scholar™ databases. Our results highlight that greater attention in the literature is given to certain aspects of justice (e.g. distributive and procedural justice concerns) on certain topics such as climate policy and adaptation finance. Most of the included papers scored highly according to our criteria on their empirical assessment of equity and justice. The lowest scores were found for the methodological rigor of assessments. We find limited research on empirical equity and justice assessment and call for a multiscale and holistic approach to justice to address this research gap.

Acute gastrointestinal illness (AGI) incidence and per-capita healthcare expenditures are higher in some Inuit communities as compared to elsewhere in Canada. Consequently, there is a demand for strategies that will reduce the individual-level costs of AGI; this will require a comprehensive understanding of the economic costs of AGI. However, given Inuit communities' unique cultural, economic, and geographic contexts, there is a knowledge gap regarding the context-specific indirect costs of AGI borne by Inuit community members. This study aimed to identify the major indirect costs of AGI, and explore factors associated with these indirect costs, in the Inuit community of Rigolet, Canada, in order to develop a case-based context-specific study framework that can be used to evaluate these costs.A mixed methods study design and community-based methods were used. Qualitative in-depth, group, and case interviews were analyzed using thematic analysis to identify and describe indirect costs of AGI specific to Rigolet. Data from two quantitative cross-sectional retrospective surveys were analyzed using univariable regression models to examine potential associations between predictor variables and the indirect costs.The most notable indirect costs of AGI that should be incorporated into cost-of-illness evaluations were the tangible costs related to missing paid employment and subsistence activities, as well as the intangible costs associated with missing community and cultural events. Seasonal cost variations should also be considered. This study was intended to inform cost-of-illness studies conducted in Rigolet and other similar research settings. These results contribute to a better understanding of the economic impacts of AGI on Rigolet residents, which could be used to help identify priority areas and resource allocation for public health policies and programs.

Despite innovative technological "solutions" to address ongoing water crises in Indigenous communities, significant disparities persist in Canada. Financial investment in infrastructure is necessary, but it is hardly sufficient to address the real problem: entrenched colonialism. One of the greatest challenges in decolonizing research is to prevent that research from reproducing the very categories it is seeking to critique and dismantle. We share findings from thematically-analyzed interviews with academic and community-based researchers who conducted water research with a stated intent to implement Western and Indigenous knowledge systems. Findings revealed that while there is co-learning, ontological and epistemological assumptions carried into these relationships often impede truly integrative practice. Respondents shared how they worked through these persistent barriers of a colonial system.

Indigenous (First Nations, Inuit, and Métis/Metis) peoples in Canada experience persistent and disproportionate water-related challenges compared to non-Indigenous Canadians. These circumstances are largely attributable to enduring colonial policies and practices. Attempts for redress have been unsuccessful, and Western science and technology have been largely unsuccessful in remedying Canada’s water-related challenges. A systematic review of the academic and grey literature on integrative Indigenous and Western approaches to water research and management identified 279 items of which 63 were relevant inclusions; these were then analyzed using a realist review tool. We found an emerging trend of literature in this area, much of which called for the rejection of tokenism and the development of respectful nation-to-nation relationships in water research, management, and policy.

Pregnancy and birth outcomes have been found to be sensitive to meteorological variation, yet few studies explore this relationship in sub-Saharan Africa where infant mortality rates are the highest in the world. We address this research gap by examining the association between meteorological factors and birth weight in a rural population in southwestern Uganda. Our study included hospital birth records (n = 3197) from 2012 to 2015, for which we extracted meteorological exposure data for the three trimesters preceding each birth. We used linear regression, controlling for key covariates, to estimate the timing, strength, and direction of meteorological effects on birth weight. Our results indicated that precipitation during the third trimester had a positive association with birth weight, with more frequent days of precipitation associated with higher birth weight: we observed a 3.1g (95% CI: 1.0-5.3g) increase in birth weight per additional day of exposure to rainfall over 5mm. Increases in average daily temperature during the third trimester were also associated with birth weight, with an increase of 41.8g (95% CI: 0.6-82.9g) per additional degree Celsius. When the sample was stratified by season of birth, only infants born between June and November experienced a significant associated between meteorological exposures and birth weight. The association of meteorological variation with foetal growth seemed to differ by ethnicity; effect sizes of meteorological were greater among an Indigenous subset of the population, in particular for variation in temperature. Effects in all populations in this study are higher than estimates of the African continental average, highlighting the heterogeneity in the vulnerability of infant health to meteorological variation in different contexts. Our results indicate that while there is an association between meteorological variation and birth weight, the magnitude of these associations may vary across ethnic groups with differential socioeconomic resources, with implications for interventions to reduce these gradients and offset the health impacts predicted under climate change.

Introduction: Indigenous populations in low-income regions are often the most acutely affected by social gradients that impact health, including high burdens of infectious disease. Using a mixed methods approach, this study characterized the lived experience of acute gastrointestinal illness (AGI) in an Indigenous Batwa population in south-western Uganda., Methods: Quantitative data analyses were conducted on data from three cross-sectional census surveys of Batwa conducted in January 2013 (n=583), January 2014 (n=569) and April 2014 (n=540). Using a 14-day recall period, cases of AGI were defined as three or more loose stools or any vomiting in a 24-hour period. These analyses were supplemented by qualitative data from key informant interviews (n=11 interviews) and Batwa focus group discussions (n=61 participants)., Results: From the surveys, episodes of diarrhea and episodes of vomiting lasted on average 3.6 (95%CI 2.3-4.3) and 3.0 (95%CI 2.1-3.9) days, and individuals experienced an average of 4.3 (95%CI 3.9-4.8) and 2.6 (95%CI 2.1-3.1) loose stools and vomiting episodes in 24 hours. Focus group participants and key informants indicated that episodes of AGI for Batwa were not limited to symptom-based consequences for the individual, but also had economic, social and nutritional impacts., Conclusion: Despite efforts to increase health literacy in disease transmission dynamics, risks and prevention measures, the perceived barriers and a lack of benefits still largely underscored adopting positive AGI prevention behaviors. This study moved beyond surveillance and provided information on the broader community-level burden of AGI and highlighted the current challenges and opportunities for improved uptake of AGI prevention measures for the Batwa.

Climate change will have far-reaching implications for Inuit health. Focusing on adaptation offers a proactive approach for managing climate-related health risks-one that views Inuit populations as active agents in planning and responding at household, community, and regional levels. Adaptation can direct attention to the root causes of climate vulnerability and emphasize the importance of traditional knowledge regarding environmental change and adaptive strategies. An evidence base on adaptation options and processes for Inuit regions is currently lacking, however, thus constraining climate policy development. In this article, we tackled this deficit, drawing upon our understanding of the determinants of health vulnerability to climate change in Canada to propose key considerations for adaptation decision-making in an Inuit context.