Global health and climate change: moving from denial and catastrophic fatalism to positive action

Impact of climate change on human health: evidence from riverine island dwellers of Bangladesh

This study aims to explore the impact of climate change on health, including local adaptation strategies. A mixed-method approach has been used in this study. The results reveal that increasing the frequency of flooding, severity of riverbank erosion and drought, and rising disease outbreak are the highest indicators of climate change perceived by riverine island (char) dwellers, which is similar to the observed data. It also uncovers, approximately all respondents encounter several health-related issues during different seasons where prevailing cold and cough with fever, skin diseases, and diarrhoea are the leading ailments. Several adaptation strategies are accommodated by char inhabitants in order to enhance resilience against the climate change health impacts, but the paucity of money, disrupted communication, lack of formal health-care centre are the most obstacles to the sustainability of adaptation. This research recommends that healthcare-associated project should be performed through proper monitoring for exterminating char dwellers' health issues.

Climate change impacts and adaptations on health of Internally Displaced People (IDP): An exploratory study on coastal areas of Bangladesh

Every year thousands of people are being displaced in coastal areas of Bangladesh due to natural calamities associated with climate change, known as Internally Displaced Peoples (IDPs). Climate change adaptation measures play a significant role in coping with the alteration of climatic components, while various forms of barriers hinder the sustainability of adaptation. This research was conducted to understand the perception of IDPs on climate change impact on health in the coastal areas of Bangladesh, including the adaptation practices and barriers to the coping strategies. To fulfill the objective, 420 individual surveys were conducted randomly in two Sub-districts of Khulna district in Bangladesh. The findings reveal that the riverbank erosion and cyclones were the primary reasons for displacement, and the social relationships were hampered in the new places of living. Also, the temperature in summer and winter, and the rainfall intensity increased, whereas rainfall slightly decreased over the last ten years. Differences of opinion were identified about the effects of the changing climatic variables on the respondents' health between the previous and present locations. Despite practicing different adaptive strategies, the weak financial condition and a lack of access to health care information are mostly hindering the sustainability of adaptation. This research may help policymakers in taking proper initiatives to ensure sustainable adaptation practices in the coastal areas.

Patient experience studies in the circumpolar region: a scoping review

OBJECTIVES

Patient experiences with health systems constitute a crucial pillar of quality care. Across the Arctic, patients' interactions with the healthcare system are influenced by challenges of access, historical inequities and social determinants. This scoping review sought to describe the range and nature of peer-reviewed literature on patient experience studies conducted within the circumpolar region.

DESIGN

In a partnership between Danish/Greenlandic, Canadian and American research teams, a scoping review of published research exploring patient experiences in circumpolar regions was undertaken.

DATA SOURCES

Seven electronic databases were queried: MEDLINE, Embase, Scopus, 'Global Health 1910 to 2019 Week 11', CINAHL, PsycINFO and SveMed+.

ELIGIBILITY CRITERIA

Articles were eligible for inclusion if they (a) took place in the circumpolar region, (b) reported patients' perspective and (c) were focussed primarily on patient experiences with care, rather than satisfaction with treatment outcome.

DATA EXTRACTION AND SYNTHESIS

Title and abstract screening, full-text review and data extraction was conducted by four researchers. Bibliometric information such as publication date and country of origin was extracted, as was information regarding study design and whether or not the article contained results relevant to the themes of Indigenous values, rural and remote context, telehealth and climate change. Two researchers then synthesised and characterised results relevant to these themes.

RESULTS

Of the 2824 articles initially found through systematic searches in seven databases, 96 articles were included for data extraction. Findings from the review included unique features related to Indigenous values, rural and remote health, telehealth and climate change.

CONCLUSIONS

The review findings provide an overview of patient experiences measures used in circumpolar nations. These findings can be used to inform health system improvement based on patient needs in the circumpolar context, as well as in other regions that share common features. This work can be further contextualized through Indigenous methodologies such as sharing circles and community based participatory methods.

Communicating with the Public about Emerald Ash Borer: Militaristic and Fatalistic Framings in the News Media

Invasive species can spread to new landscapes through various anthropogenic factors and negatively impact urban ecosystems, societies, and economies. Public awareness is considered central to mitigating the spread of invasive species. News media contributes to awareness although it is unclear what messages are being communicated. We incorporated Frame Theory to investigate newspapers’ coverage of the emerald ash borer (EAB; Agrilus planipennis Fairmaire (Coleoptera: Buprestidae)), which has killed millions of ash trees in the continental United States. We conducted a content analysis of 924 news articles published between 2002 and 2017 to examine language framing (how a phenomenon like invasive species is constructed and communicated), information sources, management methods, recommended actions for the public and whether this communication changed overtime. Seventy-seven percent of articles used language evocative of distinctive risk framings, with the majority of these using negative attribute frames like invasion-militaristic and/or fatalistic language to describe EAB management. Few discussed positive impacts like galvanizing public support. Most articles used expert sources, primarily government agents. We recommend that public communications regarding invasive species be cautious about language evoking militarism and fatalism. Furthermore, invasive species communication requires a broader diversity and representation of voices because invasive species management requires community effort.

Joint external evaluation of the International Health Regulation (2005) capacities: current status and lessons learnt in the WHO African region

The International Health Regulations (IHR, 2005) are an essential vehicle for addressing global health security. Here, we report the IHR capacities in the WHO African from independent joint external evaluation (JEE). The JEE is a voluntary component of the IHR monitoring and evaluation framework. It evaluates IHR capacities in 19 technical areas in four broad themes: ‘Prevent’ (7 technical areas, 15 indicators); ‘Detect’ (4 technical areas, 13 indicators); ‘Respond’ (5 technical areas, 14 indicators), points of entry (PoE) and other IHR hazards (chemical and radiation) (3 technical areas, 6 indicators). The IHR capacity scores are graded from level 1 (no capacity) to level 5 (sustainable capacity). From February 2016 to March 2019, 40 of 47 WHO African region countries (81% coverage) evaluated their IHR capacities using the JEE tool. No country had the required IHR capacities. Under the theme ‘Prevent’, no country scored level 5 for 12 of 15 indicators. Over 80% of them scored level 1 or 2 for most indicators. For ‘Detect’, none scored level 5 for 12 of 13 indicators. However, many scored level 3 or 4 for several indicators. For ‘Respond’, none scored level 5 for 13 of 14 indicators, and less than 10% had a national multihazard public health emergency preparedness and response plan. For PoE and other IHR hazards, most countries scored level 1 or 2 and none scored level 5. Countries in the WHO African region are commended for embracing the JEE to assess their IHR capacities. However, major gaps have been identified. Urgent collective action is needed now to protect the WHO African region from health security threats.

Harnessing instability as an opportunity for health system strengthening: A review of health system resilience

In recent years, resilience has emerged as a prominent topic in global health systems discourse as a result of the increasing variety and volume of sources of instability inflicting strain on systems. In line with this study's intent to bring together existing literature on health system resilience as a means to understand the process through which systems achieve resilience, a review of academic literature related to health system resilience was conducted. Emerging from this review is an operational model of resilience that builds on existing health systems frameworks. The model highlights health system resilience as a process through which leaders in all sectors need to be mobilized in order to harness instability as an opportunity for health system strengthening rather than a threat to the system's sustainability and integrity.

Regional organisations supporting health sector responses to climate change in Southeast Asia

BACKGROUND

The role played by regional organisations in climate change adaptation and health is growing in Southeast Asia, with the Asian Development Bank and the Asia-Pacific Regional Forum on Health and Environment both supporting health and adaptation initiatives. There is, however, a lack of empirical research on the value that regional organisations add to national health-related adaptation. This qualitative research compares regional project and governance-based models of adaptation and health support in Southeast Asia, providing an analysis of strengths and weaknesses of each, as well as possibilities for improvement.

METHODS

An existing adaptation assessment framework was modified for this research, and used as a guide to gather and analyse data from academic and grey literature, policy documents and interviews in order to qualitatively assess two organisations and their different models of adaptation and health support.

RESULTS

This research found differing strengths in the approaches to climate change and health used by the Asian Development Bank and by the Asia-Pacific Regional Forum on Health and Environment. The regional forum has vision, high levels of perceived legitimacy, and access to 'in-house' expertise in public health and climate change. Conversely, the Asian Development Bank has strengths in project management and access to significant financial resources to support work in climate change and health.

CONCLUSION

When regional organisations, such as the Asian Development Bank and the Asia-Pacific Regional Forum on Health and Environment, have membership and mandate overlaps, their work will likely benefit from well designed, institutionalised and incentivised coordination mechanisms. Coordination can reduce redundancies as well as the administrative workload on partner government agencies. In the case-study examined, the Asian Development Bank's project management expertise complements the vision and high levels of perceived legitimacy of the Asia-Pacific Regional Forum on Health and Environment, thus a coordinated approach could deliver improved adaptation and health outcomes.

Mind the gap: The role of mindfulness in adapting to increasing risk and climate change

It is becoming clear that increasingly complex global challenges cannot simply be solved by new technology or governments alone. We also need to develop new social practices and encourage a broader cultural shift towards sustainability. Against this background, this paper explores the role of mindfulness in adapting to increasing risk and climate change. Based on a literature review, it assesses current research on 'mindful climate adaptation', and explores how individual mindfulness is linked to climate adaptation. While in practice mindfulness-based approaches to climate adaptation have gained widespread recognition (e.g., by the United Nations), the results show that related research is scarce and fragmented. There is almost no research into the role of mindfulness in climate adaptation. At the same time, new scientific domains are opening up in cognate fields that illuminate the mindfulness-adaptation nexus from certain perspectives. These fields include: (1) disaster management; (2) individual well-being; (3) organisational management; (4) environmental behaviour; (5) social justice; and (6) knowledge production. As new concepts and approaches emerge, they require critical construct validation and empirical testing. The importance of further investigation is supported by a complementary empirical study, which shows that individual mindfulness disposition coincides with increased motivation to take (or support) climate adaptation actions. The paper concludes that mindfulness has the potential to facilitate adaptation at all scales (through cognitive, managerial, structural, ontological, and epistemological change processes) and should, therefore, become a core element in climate and associated sustainability research. Finally, it sketches the conceptual trajectories of the mindfulness-adaptation nexus and presents a pioneering, comprehensive framework for 'mindful climate adaptation'.

Indigenous Values and Health Systems Stewardship in Circumpolar Countries

Circumpolar regions, and the nations within which they reside, have recently gained international attention because of shared and pressing public policy issues such as climate change, resource development, endangered wildlife and sovereignty disputes. In a call for national and circumpolar action on shared areas of concern, the Arctic states health ministers recently met and signed a declaration that identified shared priorities for international cooperation. Among the areas for collaboration raised, the declaration highlighted the importance of enhancing intercultural understanding, promoting culturally appropriate health care delivery and strengthening circumpolar collaboration in culturally appropriate health care delivery. This paper responds to the opportunity for further study to fully understand indigenous values and contexts, and presents these as they may apply to a framework that will support international comparisons and systems improvements within circumpolar regions. We explored the value base of indigenous peoples and provide considerations on how these values might interface with national values, health systems values and value bases between indigenous nations particularly in the context of health system policy-making that is inevitably shared between indigenous communities and jurisdictional or federal governments. Through a mixed methods nominal consensus process, nine values were identified and described: humanity, cultural responsiveness, teaching, nourishment, community voice, kinship, respect, holism and empowerment.

How Economic Analysis Can Contribute to Understanding the Links between Housing and Health

An economic analysis of housing's linkages to health can assist policy makers and researchers to make better decisions about which housing interventions and policies are the most cost-beneficial. The challenge is to include cobenefits. The adoption in 2015 of the UN Sustainable Development Goals underscores the importance of understanding how policies interact, and the merit of comprehensively evaluating cobenefits. We explain our approach to the empirical assessment of such cobenefits in the housing and health context, and consider lessons from empirical economic appraisals of the impact of housing on health outcomes. Critical assumptions relating to cobenefits are explicitly examined. A key finding is that when wider policy outcome measures are included, such as mental health impacts and carbon emission reductions, it is important that effects of assumptions on outcomes are considered. Another is that differing values underlie appraisal, for example, the weight given to future generations through the discount rate. Cost-benefit analyses (CBAs) can better facilitate meaningful debate when they are based on explicit assumptions about values. In short, the insights drawn from an economic framework for housing-and-health studies are valuable, but nonetheless contingent. Given that housing interventions typically have both health and other cobenefits, and incorporate social value judgements, it is important to take a broad view but be explicit about how such interventions are assessed.

Mindful Climate Action: Health and Environmental Co-Benefits from Mindfulness-Based Behavioral Training

Greenhouse gases from human activities are causing climate change, creating risks for people around the globe. Behaviors involving transportation, diet, energy use, and purchasing drive greenhouse gas emissions, but are also related to health and well-being, providing opportunity for co-benefits. Replacing shorter automobile trips with walking or cycling, or eating plants rather than animals, for example, may increase personal health, while also reducing environmental impact. Mindfulness-based practices have been shown to enhance a variety of health outcomes, but have not been adapted towards environmental purposes. We designed the Mindful Climate Action (MCA) curriculum to help people improve their health while simultaneously lowering their carbon footprints. Combining mindfulness-based practices with the Stages of Change theory, the MCA program aims to: (1) improve personal health and well-being; (2) decrease energy use; (3) reduce automobile use; (4) increase active transport; (5) shift diet towards plant-based foods; and (6) reduce unnecessary purchasing. Mindfulness practices will foster attentional awareness, openness, and response flexibility, supporting positive behavior change. We plan to test MCA in a randomized controlled trial, with rigorous assessment of targeted outcomes. Our long-term goal is to refine and adapt the MCA program to a variety of audiences, in order to enhance public health and environmental sustainability.

Understanding the systemic nature of cities to improve health and climate change mitigation

Understanding cities comprehensively as systems is a costly challenge and is typically not feasible for policy makers. Nevertheless, focusing on some key systemic characteristics of cities can give useful insights for policy to advance health and well-being outcomes. Moreover, if we take a coevolutionary systems view of cities, some conventional assumptions about the nature of urban development (e.g. the growth in private vehicle use with income) may not stand up. We illustrate this by examining the coevolution of urban transport and land use systems, and institutional change, giving examples of policy implications. At a high level, our concern derives from the need to better understand the dynamics of urban change, and its implications for health and well-being. At a practical level, we see opportunities to use stylised findings about urban systems to underpin policy experiments. While it is now not uncommon to view cities as systems, policy makers appear to have made little use so far of a systems approach to inform choice of policies with consequences for health and well-being. System insights can be applied to intelligently anticipate change - for example, as cities are subjected to increasing natural system reactions to climate change, they must find ways to mitigate and adapt to it. Secondly, systems insights around policy cobenefits are vital for better informing horizontal policy integration. Lastly, an implication of system complexity is that rather than seeking detailed, 'full' knowledge about urban issues and policies, cities would be well advised to engage in policy experimentation to address increasingly urgent health and climate change issues.

Public health adaptation to climate change in Canadian jurisdictions

Climate change poses numerous risks to the health of Canadians. Extreme weather events, poor air quality, and food insecurity in northern regions are likely to increase along with the increasing incidence and range of infectious diseases. In this study we identify and characterize Canadian federal, provincial, territorial and municipal adaptation to these health risks based on publically available information. Federal health adaptation initiatives emphasize capacity building and gathering information to address general health, infectious disease and heat-related risks. Provincial and territorial adaptation is varied. Quebec is a leader in climate change adaptation, having a notably higher number of adaptation initiatives reported, addressing almost all risks posed by climate change in the province, and having implemented various adaptation types. Meanwhile, all other Canadian provinces and territories are in the early stages of health adaptation. Based on publically available information, reported adaptation also varies greatly by municipality. The six sampled Canadian regional health authorities (or equivalent) are not reporting any adaptation initiatives. We also find little relationship between the number of initiatives reported in the six sampled municipalities and their provinces, suggesting that municipalities are adapting (or not adapting) autonomously.

Climate change, human health, and epidemiological transition

The health of populations depends on the availability of clean air, water, food, and sanitation, exposure to pathogens, toxins and environmental hazards, and numerous genetic, behavioral and social factors. For many thousands of years, human life expectancy was low, and population growth was slow. The development of technology-based civilizations facilitated what Abdel Omran called "epidemiological transition," with increasing life expectancy and rapid population growth. To a large extent, the spectacular growth of human populations during the past two centuries was made possible by the energy extracted from fossil fuels. We have now learned, however, that greenhouse gases from fossil fuel combustion are warming the planet's surface, causing changes in oceanic and atmospheric systems, and disrupting weather and hydrological patterns. Climate change poses unprecedented threats to human health by impacts on food and water security, heat waves and droughts, violent storms, infectious disease, and rising sea levels. Whether or not humanity can reduce greenhouse gas emissions quickly enough to slow climate change to a rate that will allow societies to successfully adapt is not yet known. This essay reviews the current state of relevant knowledge, and points in a few directions that those interested in human health may wish to consider.

Old health risks in new places? An ecological niche model for I. ricinus tick distribution in Europe under a changing climate

Climate change will likely have impacts on disease vector distribution. Posing a significant health threat in the 21st century, risk of tick-borne diseases may increase with higher annual mean temperatures and changes in precipitation. We modeled the current and future potential distribution of the Ixodes ricinus tick species in Europe. The Genetic Algorithm for Rule-set Prediction (GARP) was utilized to predict potential distributions of I. ricinus based on current (1990-2010 averages) and future (2040-2060 averages) environmental variables. A ten model best subset was created out of a possible 200 models based on omission and commission criteria. Our results show that under the A2 climate change scenario the potential habitat range for the I. ricinus tick in Europe will expand into higher elevations and latitudes (e.g., Scandinavia, the Baltics, and Belarus), while contracting in other areas (e.g., Alps, Pyrenees, interior Italy, and northwestern Poland). Overall, a potential habitat expansion of 3.8% in all of Europe is possible. Our results may be used to inform climate change adaptation efforts in Europe.

Adapting to the effects of climate change on Inuit health

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.

Health coping strategies of the people vulnerable to climate change in a resource-poor rural setting in Bangladesh

BACKGROUND

Among the many challenges faced by the people of Bangladesh, the effects of climate change are discernibly threatening, impacting on human settlement, agricultural production, economic development, and human health. Bangladesh is a low-income country with limited resources; its vulnerability to climate change has influenced individuals to seek out health coping strategies. The objectives of the study were to explore the different strategies/measures people employ to cope with climate sensitive diseases and sickness.

METHODS

A cross-sectional study was conducted among 450 households from Rajshahi and Khulna districts of Bangladesh selected through multi-stage sampling techniques, using a semi-structured questionnaire supplemented by 12 focus group discussions and 15 key informant interviews.

RESULTS

Respondents applied 22 types of primary health coping strategies to prevent climate related diseases and sickness. To cope with health problems, 80.8% used personal treatment experiences and 99.3% sought any treatments available at village level. The percentage of respondents that visited unqualified health providers to cope with climate induced health problems was quite high, namely 92.7% visited village doctors, 75.9% drug stores, and 67.3% self-medicated. Ninety per cent of the respondents took treatment from unqualified providers as their first choice. Public health facilities were the first choice of treatment for only 11.0% of respondents. On average, every household spent Bangladesh Currency Taka 9,323 per year for the treatment of climate sensitive diseases and sickness. Only 46% of health expenditure was managed from their savings. The rest, 54% expenditure, was supported by using 24 different sources, such as social capital and the selling of family assets. The rate of out-of-pocket payment was almost 100%.

CONCLUSION

People are concerned about climate induced diseases and sickness and sought preventive as well as curative measures to cope with health problems. The most common and widely used climate health coping strategies among the respondents included self-medicating and seeking the health service of unqualified private health care providers. Per family spending to cope with such health problems is expensive and completely based on out of pocket payment. There is no fund pooling, community funding or health insurance program in rural areas to support the health coping of the people. Policies are needed to reduce out-of-pocket payment, to improve the quality of the unqualified providers and to extend public health services at rural areas and support climate related health coping. Collection of such knowledge on climate related health coping strategies can allow researchers to study any specific issue on health coping, and policy makers to initiate effective climate related health coping strategies for climate vulnerable people.

Potential changes in disease patterns and pharmaceutical use in response to climate change

As climate change alters environmental conditions, the incidence and global patterns of human diseases are changing. These modifications to disease profiles and the effects upon human pharmaceutical usage are discussed. Climate-related environmental changes are associated with a rise in the incidence of chronic diseases already prevalent in the Northern Hemisphere, for example, cardiovascular disease and mental illness, leading to greater use of associated heavily used Western medications. Sufferers of respiratory diseases may exhibit exacerbated symptoms due to altered environmental conditions (e.g., pollen). Respiratory, water-borne, and food-borne toxicants and infections, including those that are vector borne, may become more common in Western countries, central and eastern Asia, and across North America. As new disease threats emerge, substantially higher pharmaceutical use appears inevitable, especially of pharmaceuticals not commonly employed at present (e.g., antiprotozoals). The use of medications for the treatment of general symptoms (e.g., analgesics) will also rise. These developments need to be viewed in the context of other major environmental changes (e.g., industrial chemical pollution, biodiversity loss, reduced water and food security) as well as marked shifts in human demographics, including aging of the population. To identify, prevent, mitigate, and adapt to potential threats, one needs to be aware of the major factors underlying changes in the use of pharmaceuticals and their subsequent release, deliberately or unintentionally, into the environment. This review explores the likely consequences of climate change upon the use of medical pharmaceuticals in the Northern Hemisphere.

The resilience and adaptive capacity of social-environmental systems in colonial Mexico

Civilization collapse scenarios highlight what for some are worrying parallels between past case studies and societies under threat from apparently unprecedented global environmental and climate change today. Archive-based studies of socio-economic responses to climate variability in colonial Mexico suggest that the complex interactions between environment and society influence the degree to which regional livelihoods may be vulnerable or resilient to disruption and also illustrate that vulnerability to change can lead to improved understanding of risk and increased adaptive capacity. In this paper, I draw on examples to argue that experience of climate variability, extreme weather events, or weather-related events and crises can challenge societal resilience, but can also increase opportunities for learning and innovation, extending the repertoire of adaptive responses. The historical examples selected might help inform the degree to which societies can develop strategies to deal with environmental perturbations at different scales and highlight that social breakdown and collapse are not an inevitable result of transformation.

Multiple crises and global health: new and necessary frontiers of health politics

The world economy is entering an era of multiple crises, involving finance, food security and global environmental change. This article assesses the implications for global public health, describes the contours of post-2007 crises in food security and finance, and then briefly indicates the probable health impacts. There follows a discussion of the crisis of climate change, one that will unfold over a longer time frame but with manifestations that may already be upon us. The article then discusses the political economy of responses to these crises, noting the formidable obstacles that exist to equitable resolution. The article concludes by noting the threat that such crises present to recent progress in global health, arguing that global health researchers and practitioners must become more familiar with the relevant social processes, and that proposed solutions that neglect the continuing importance of the nation-state are misdirected.

Reducing the silent burden of impaired mental health

Mental and behavioral disorders account for about one third of the world's disability caused by all ill health among adults, with unipolar depressive disorders set to be the world's number one cause of illhealth and premature death in 2030, affecting high- and low-income countries. There is a range of evidence-based cost-effective interventions that can be implemented in parenting, at schools, at the workplace, and in older age that can promote health and well-being, reduce mental disorders, lead to improved productivity, and increase resilience to cope with many of the stressors in the world. These facts need to be better communicated to policymakers to ensure that the silent burden of impaired mental health is adequately heard and reduced.

Incentives for health

This article discusses incentives to help make healthy choices the easy choices for individuals, operating at the levels of the individual, producers and service providers, and governments. Whereas paying individuals directly to be healthier seems to have a limited effect, offering financial incentives through health insurance improves health. Changing the environment to make healthier choices more accessible acts as an incentive to improve health. Employers can provide incentives to improve the health of their employees. Producers and service providers can take voluntary action to make their products less harmful, and they can be nudged into marketing healthier products within a regulatory environment. International agreements and monitoring systems can incentivize governments to do more for health. Lessons from climate change adaptation suggest that multilevel governance and policy integration are greater obstacles to policy change and implementation than knowing what has to be done. Policy change and implementation are triggered by many drivers, many of which are side effects of other policy pressures rather than of the direct policy goal itself. Effective action to reduce noncommunicable diseases will require leveraging social networks into a new ways of thinking about health; making better health prestigious and aspirational, and giving health and wellness a brand that encourages positive behavior change.