Understanding Wicked Problems: A Key to Advancing Environmental Health Promotion

Public perceptions of air pollution and associated health risks in Nevada, USA: applications for health communication

BACKGROUND

We examine the extent to which acute and chronic health conditions motivate individuals to seek air quality information. We apply the theoretical elements of the Health Belief Model (HBM) to improve risk communication about ambient air pollution. We discuss the practical applications of HBM, in tandem with the principles of health communication, within an environmental health context.

METHODS

We test the predictive power of selected components related to the HBM (perceived susceptibility, perceived severity, and cues to action) for intentions to seek information about ambient air quality. We surveyed 325 individuals throughout Nevada where poor air quality poses a risk for vulnerable populations.

RESULTS

Ordinal logistic regression analyses showed that experiencing mucous membrane symptoms (eye itching, nose irritation, and dry throat/cough), perceived severity to future health threats, and having an at-risk member in the household positively and significantly predicted intentions to seek air quality information. Experiencing neuropsychological symptoms (fatigue, feeling heavy-headed, and nausea/dizziness), and having a cardiovascular or a respiratory condition did not have significant effects on reported intentions.

CONCLUSIONS

We discuss how the results of this study can be integrated into health communication practices to increase public engagement with air quality information as a personal intervention measure.

Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.

Promoting community health and climate justice co-benefits: insights from a rural and remote island climate planning process

Climate change is an environmental crisis, a health crisis, a socio-political and an economic crisis that illuminates the ways in which our human-environment relationships are arriving at crucial tipping points. Through these relational axes, social structures, and institutional practices, patterns of inequity are produced, wherein climate change disproportionately impacts several priority populations, including rural and remote communities. To make evidence-based change, it is important that engagements with climate change are informed by data that convey the nuance of various living realities and forms of knowledge; decisions are rooted in the social, structural, and ecological determinants of health; and an intersectional lens informs the research to action cycle. Our team applied theory- and equity-driven conceptualizations of data to our work with the community on Cortes Island-a remote island in the northern end of the Salish Sea in British Columbia, Canada-to aid their climate change adaptation and mitigation planning. This work was completed in five iterative stages which were informed by community-identified needs and preferences, including: An environmental scan, informal scoping interviews, attending a community forum, a scoping review, and co-development of questions for a community survey to guide the development of the Island's climate change adaptation and mitigation plan. Through this community-led collaboration we learned about the importance of ground truthing data inaccuracies and quantitative data gaps through community consultation; shifting planning focus from deficit to strengths- and asset-based engagement; responding to the needs of the community when working collaboratively across academic and community contexts; and, foregrounding the importance of, and relationship to, place when doing community engagement work. This suite of practices illuminates the integrative solution-oriented thinking needed to address complex and intersecting issues of climate change and community health.

The Limitations and Potentials of Evaluating Economic Aspects of Community-Based Health Promotion: A Critical Review

Community-based health promotion (CBHP) interventions are promising approaches to address public health problems; however, their economic evaluation presents unique challenges. This review aims to explore the opportunities and limitations of evaluating economic aspects of CBHP, focusing on the assessment of intervention costs and outcomes, and the consideration of political-level changes and health equity. A systematic search of the PubMed, Web of Science and PsycInfo databases identified 24 CBHP interventions, the majority of which targeted disadvantaged communities. Only five interventions included a detailed cost/resource assessment. Outcomes at the operational level were mainly quantitative, related to sociodemographics and environment or health status, while outcomes at the political level were often qualitative, related to public policy, capacity building or networks/collaboration. The study highlights the limitations of traditional health economic evaluation methods in capturing the complexity of CBHP interventions. It proposes the use of cost-consequence analysis (CCA) as a more comprehensive approach, offering a flexible and multifaceted assessment of costs and outcomes. However, challenges remain in the measurement and valuation of outcomes, equity considerations, intersectoral costs and attribution of effects. While CCA is a promising starting point, further research and methodological advancements are needed to refine its application and improve decision making in CBHP.

Reflective structured dialogue as a tool for addressing wicked public health problems

Introduction

Attempts to address wicked public health problems can benefit from collaborative approaches to problem-solving, such as dialogue through structured conversations, that engage a wide range of stakeholders in deliberate inquiry to build trust and mutual understanding. This study seeks to assess the effects of participation in Reflective Structured Dialogue (RSD) on university students' polarization-related attitudes.

Methods

The BYU Campus Conversations project held 27 structured conversations with 139 participants on three divisive public health topics: COVID-19, mental health, and racism. The conversation structure encouraged students to share their personal experiences and learn from others in an environment that promoted vulnerability and confidentiality.

Results

Pre- and post-conversation surveys measured participant outcomes and found that participation in conversations was strongly associated with improved attitudes related to openness, tribal identity, and moral disdain. Over 95% of participants reported that they enjoyed taking part in the conversations and that it helped them better understand the experiences of others.

Discussion

The results of this project indicate similar conversations could be an effective tool in helping build understanding around divisive public health issues in university and community settings.

Strengthening Mental Health and Resilience Through Schools: Protocol for a Participatory Design Project

BACKGROUND

Mental health problems are a main contributor to the global burden of disease in children and young people within urban environments. In response, the potential of both school- and sport-based mental health promotion interventions has been advocated. However, there exists limited insights into how sport-based interventions can be integrated within school environment. Moreover, there is a need to consider children and young people's specific needs, challenges, and motivations when designing novel mental health promotion interventions.

OBJECTIVE

The Strengthening Mental Health and Resilience Through Schools (SMARTS) project aims to co-design an evidence-informed school-sport-based mental health promotion program. Specific objectives include (1) co-designing a multicomponent program, integrating sport sessions with class-based sessions, and complementing with educational modules for teachers and parents; (2) exploring how the mental health program can be implemented most effectively within the Brussels school system; and (3) conducting preliminary process and outcome testing of the program.

METHODS

A participatory design framework will be adopted to develop the program. This framework involves end users throughout the entire study process, from problem identification to intervention delivery and evaluation, while at the same time ensuring program development remains directly informed by the available scientific evidence.

RESULTS

Participant recruitment will commence in September 2023. The full project will be completed by March 2027.

CONCLUSIONS

With this intervention, we aim to provide a direct contribution to the promotion of children and young people's mental health within the Brussels school context. At a broader level, conducting and documenting this large participatory design project can, hopefully, inspire other researchers to tailor their mental health programs to specific populations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/49670.

A psycho-social-environmental lens on radon air pollutant: authorities', mitigation contractors', and residents' perceptions of barriers and facilitators to domestic radon mitigation

Introduction

Radon is a major indoor air pollutant that poses a significant risk of lung cancer to those exposed in their homes. While mitigation of high radon levels in homes has been shown to be effective, home mitigation rates remain low. This study examines the barriers and facilitators to radon mitigation in homes from the perspectives of authorities responsible for radon risk management, the mitigation industry (contractors), and residents in four European countries (Belgium, Ireland, Slovenia, and the UK) with high radon risks and low mitigation rates.

Methods

A multi-method approach was used to gather data from various stakeholders, including online surveys, content analysis of legal documents, group interviews, workshops, and focus groups.

Results

Authorities, contractors, and residents identified various facilitators to radon mitigation, including legal requirements for mitigation, awareness campaigns, low mitigation costs, availability of financial support, accreditation of mitigation contractors, and a perception of radon as a health threat. However, barriers to mitigation were also identified, such as a lack of awareness, fragmented mitigation processes, and inadequate communication between stakeholders.

Discussion

The study highlights the complexity of the radon mitigation process and suggests that interventions aimed at increasing mitigation rates should target stakeholders beyond just residents, such as constructors, health professionals, and policy makers. An integrated approach to radon mitigation, from policy to provision, is necessary to effectively lower levels of this indoor air pollutant.

The Need for Systems Approaches for Precision Communications in Public Health

A major challenge in communicating health-related information is the involvement of multiple complex systems from the creation of the information to the sources and channels of dispersion to the information users themselves. To date, public health communications approaches have often not adequately accounted for the complexities of these systems to the degree necessary to have maximum impact. The virality of COVID-19 misinformation and disinformation has brought to light the need to consider these system complexities more extensively. Unaided, it is difficult for humans to see and fully understand complex systems. Luckily, there are a range of systems approaches and methods, such as systems mapping and systems modeling, that can help better elucidate complex systems. Using these methods to better characterize the various systems involved in communicating public health-related information can lead to the development of more tailored, precise, and proactive communications. Proceeding in an iterative manner to help design, implement, and adjust such communications strategies can increase impact and leave less opportunity for misinformation and disinformation to spread.

'Why would they spend all this money and give us these items for free?': Exploring precarity and power in a cleaner cookstove intervention in rural Malawi

We carried out a qualitative study to gain a deeper understanding of the social context of the Cooking and Pneumonia Study (CAPS) and implications for implementation of clean cooking and similar interventions. Such initiatives are recognised as complex, power-laden processes, which has consequences for outcomes and uptake. However, understanding of how precarious livelihoods and unequal power differentials impact on trials of technology is limited and potentially hampers the achievement of the SDGs including SDG 7, Affordable and Clean Energy. An in-depth exploration of experiences and perceptions of cooking and cookstove use within CAPS was completed using qualitative methods and the participatory methodology Photovoice. Ten CAPS participants from each of five villages participated in Photovoice activities and five village representatives were interviewed. Twelve fieldworkers participated in gender specific focus groups and four were interviewed. A thematic content approach was used for data analysis. The analysis showed that economic and power inequity underpinned the complex social relationships within CAPS impacting on trial participation, perceptions of the cookstoves, and on the potential of the intervention to affect health and other benefits. Power can be understood as relational and productive within the research environment. This is illustrated by an analysis of the role of fieldworkers and community representatives who needed to negotiate resistance to trial compliance decisions, including 'satanic' rumours about cookstoves and blood-taking. Transformative approaches that challenge existing power inequities are needed to maximise the success and beneficence of cookstove and other health promoting interventions, and achievement of the SDGs.

System dynamics modeling to understand mental model of public humiliation in medical education

BACKGROUND

Mistreatment in medical school is a wicked or complex problem demonstrating inter-relatedness and dynamicity of factors that affect students. Many studies have outlined the causes, perceptions, and negative consequences of mistreatment; however, a comprehensive mental model of public humiliation, the most common type of mistreatment, is still incomplete. This study aims to provide insight into the reasons why public humiliation in medical school continues to be a problem despite existing for decades, and to propose a shift in paradigm that potentially improve these incidents.

METHOD

A systems thinking approach is used to conceptualize related components of public humiliation and student behavior. System dynamics modeling was conducted through narrative review, developing a causal loop diagram (CLD), and validation of results with 60 medical students and 40 medical educators.

RESULTS

Findings from the narrative review outlined key variables, interconnections and five emerging themes: etiology, eustress, motivation, distress, and self-esteem. The themes were conceptualized and constructed into feedback loops as a basis for the CLD. Finally, the mental model proposes three major systems underlying the consequences. The "No Pain, No Gain" illustrates the perception that stress positively drives learning, while "Stress Overload" displays the negative consequences of public humiliation. Lastly, "The Delayed Side Effect" refers to long-term side-effects on self-esteem.

CONCLUSION

The mental model illustrates how public humiliation has both immediate and delayed side-effects, simultaneously succeeding and failing at motivating student growth. Therefore, public humiliation requires continuous changes in perspective along with multiple interventions to overcome the vicious cycle.

Chemical risk governance: Exploring stakeholder participation in Canada, the USA, and the EU

Hazardous chemicals are one of the greatest environmental challenges facing our planet, testing governments in the face of economic and social development. Chemical risks are often complex systemic risks, which require particular governance processes, stakeholder participation mechanisms, and communication procedures to manage. In this article we explore how such processes, mechanisms, and procedures could offer more effective pathways for international chemical risk assessment and management. Combining document analysis with 69 key informant interviews and four focus groups with experts from across government, non-governmental organizations (NGOs) and industry in Canada, the USA and Europe (n = 24), the results highlight the importance of increasing stakeholder participation and risk communication in existing chemical risk assessment and management frameworks. Similarities and differences between the three jurisdictions are discussed with a view to inform future risk governance strategies. The contemporary insights are of relevance to decision-makers seeking to improve the effectiveness of chemical risk governance in practice.

Enhancing Title V Workforce Capacity to Address Complex Challenges: Impact of the National Maternal and Child Health Workforce Development Center

Introduction

The National Maternal and Child Health Workforce Development Center provides training, coaching, and consultation to Title V programs. The flagship experience is the Cohort program, a 6-8-month leadership development program where Title V programs convene a multisector team to address a pre-selected state/jurisdictional challenge related to health systems transformation. The overall objective of this paper is to demonstrate the impact of skills developed via the Cohort program on state/jurisdictional capacities to address complex challenges.

Methods

Qualitative, post-Cohort evaluation data were analyzed using inductive and deductive coding and the “Sort and Sift, Think and Shift” method. Themes and supporting text were summarized using episode profiles for each team and subsequently organized using the EvaluLEAD methodology for identifying and documenting impact.

Results

Teams brought an array of challenges related to health systems transformation and 94% of teams reported achieving progress on their challenge six-months after the Cohort program. Teams described how the Cohort program improved workforce skills in strategic thinking, systems thinking, adaptive leadership, and communication. Teams also reported the Cohort program contributed to stronger partnerships, improved sustainability of their project, produced mindset shifts, and increased confidence. The Cohort program has also led to improved population health outcomes.

Discussion

Through working with the Center, Title V leaders and their teams achieved episodic, developmental, and transformative results through application of Center tools and skills to complex challenges. Investment in the MCH workforce through skill development is critical for achieving transformative results and solving “wicked” public health problems.

Critical collaboration model: an enhanced model to support public health collaboration

Public health problems are often complex and 'wicked' in nature. Wicked problems have multi-factorial causation, are dynamic and often understood and acted upon differently by different actors. Multi-sectoral collaboration is increasingly emphasized for tackling wicked problems through developing a strategic multi-sectoral plan and then taking collective action. Critical systems thinking can support the development of a shared perspective of the problem, strengthen participation in collective action and foster reflective practices to continuously improve both problem understanding and action. In this paper, we present a critical collaboration model, drawing together two complementary theoretical frameworks, as well as insights from three case studies from New Zealand, to offer a systematic approach to adopting a critical systems perspective in public health collaboration. The model provides six questions to make explicit individuals' understandings or assumptions about how others perceive an issue, problem or evidence, and the process of identifying answers strengthens the dialogical and reflective aspects of the collaboration. We indicate some potential areas for the application of the model to integrate critical systems thinking in collaborative practices.

Tradeoffs of chemicals regulation - The science and tacit knowledge of decisions

In this paper, we want to shed light on the tradeoffs of chemicals regulation. We will discuss two types of tradeoffs: the social-economic impacts of regulation such as cost-induced fatalities and the tradeoffs between 'old' and 'new' chemicals, that is the established chemicals in industry and society deemed in need of replacement with 'new' chemicals. We will show that the progression from the science of chemicals risk assessment to regulation requires the science of regulatory (economic) analyses, with added insight from the philosophy of science. Indeed, risk assessment as such, which is significantly driven but is not limited to the broad toxicological context, does not unescapably dictate regulatory choices. The science of regulatory and economic analyses, we believe, could add considerably to the science of toxicology in a combined effort to improve upon the protection of public health and the environment.

Perspective: Unpacking the Wicked Challenges for Alternative Proteins in the United States: Can Highly Processed Plant-Based and Cell-Cultured Food and Beverage Products Support Healthy and Sustainable Diets and Food Systems?

Over the past decade, a plethora of alternative protein (AP) products has entered the US food system as plant-based food and beverage products. These AP products, which include plant-based meat and dairy alternatives and cell-cultured meat and seafood products, are being developed for the marketplace to simulate the appearance, texture, taste, and flavor and nutritional profiles of animal products. The new generation of AP plant-based and cell-cultured food and beverage products are part of a market-driven narrative that has embraced technology to address future human health, environmental, ethical, and planetary health challenges. This perspective article synthesizes evidence about the benefits of adopting minimally processed plant-based diets that support sustainable food systems and human and planetary health. Thereafter, it examines 4 wicked challenges related to AP products in the US context that include 1) a confusing marketing landscape for the public; 2) diverse views and varying acceptance among consumers about the health and environmental benefits of these products; 3) inadequate education and labeling provided by federal agencies to enable consumers to understand how these may support healthy sustainable diets; and 4) slow federal policy and regulatory actions to address the range of AP products and provide industry guidance. The article concludes with suggested policies and actions for government agencies and food system actors to address these challenges. Future research and actions are needed to balance the human health, equity, animal welfare, and economic viability goals and to clarify how AP products may support safe, healthy, sustainable diets and food systems.

The Application of Systems Science in Nutrition-Related Behaviors and Outcomes Implementation Research: A Scoping Review

Use of systems science can improve the dissemination and implementation (D&I) process. However, little is known about use of systems science in nutrition D&I research. The purpose of this article is to synthesize the ways in which systems science methodology is applied in nutrition D&I research. Scoping review methodology involved searching 6 academic databases for full-text, peer-reviewed, English articles published between 1970 and 2020 that employed systems science within nutrition D&I research. Data extraction included intervention type, population, study aim, methods, theoretical approach, outcomes, and results. Descriptive statistics and qualitative thematic analysis followed. Thirty-four retained articles qualitatively identified benefits (successful planning and organization of complex interventions) and challenges (limited resources, trainings, and lack of knowledge) to utilizing systems science in nutrition D&I research. Future research should work toward building knowledge capacity among nutrition practitioners by increasing available trainings and resources to enhance the utilization of systems science in nutrition D&I research.

The Crossfire Rhetoric. Success in Danger vs. Unsustainable Growth. Analysis of Tourism Stakeholders’ Narratives in the Spanish Press (2008–2019)

Tourism has always stood out in terms of economic opportunities and personal enjoyment. However, the problem of overtourism has emerged in recent years in urban contexts of cities with diversified economies. Overtourism has become—to a much greater extent than any other variable challenging the sustainability of the tourism model—an object of public debate and the media reflect this debate, which, in the case of Spain, is concentrated in the term “tourismphobia.” This paper aims to analyse the two main opposing narratives reflected in the Spanish media on the emergence of the problem of tourismphobia and that defined what was happening to influence both public opinion and public policymakers themselves. The methodological approach used is the narrative policy framework (NPF), which considers public policies as a social construct, shaped by particular ideologies, values, and worldviews that are structured in narratives. The conclusions point to the fact that even though the “success in danger” narrative was the winner, for the first time the sustainability of the country’s tourism model is being broadly questioned and by very diverse actors. It is also clear that in order to change the trajectory of consolidated tourism policies, it is necessary to build tangible public policy alternatives that can be articulated and implemented by public actors. Based on the findings of the paper, future lines of research could use the “Narrative Policy Framework” for the analysis of sustainable tourism policies or for the study of overtourism in different countries from a comparative perspective.

Transference of Citizen Science Program Impacts: A Theory Grounded in Public Participation in Scientific Research

Citizen science is known for increasing the geographic, spatial, and temporal scale from which scientists can gather data. It is championed for its potential to provide experiential learning opportunities to the public. Documentation of educational outcomes and benefits for citizen scientists continues to grow. This study proposes an added benefit of these collaborations: the transference of program impacts to individuals outside of the program. The experiences of fifteen citizen scientists in entomology citizen science programs were analyzed using a constructivist grounded theory methodology. We propose the substantive-level theory of transference to describe the social process by which the educational and attitudinal impacts intended by program leaders for the program participants are filtered by citizen scientists and transferred to others. This process involves individual and external phases, each with associated actions. Transference occurred in participants who had maintained a long-term interest in nature, joined a citizen science program, shared science knowledge and experiences, acquired an expert role to others, and influenced change in others. Transference has implications for how citizen scientists are perceived by professional communities, understanding of the broader impacts and contributions of citizen science to wicked problems, program evaluation, and the design of these programs as informal science education opportunities.

Complex Human-Shark Conflicts Confound Conservation Action

Human-wildlife conflicts are a growing phenomenon globally as human populations expand and wildlife interactions become more commonplace. While these conflicts have been well-defined in terrestrial systems, marine forms are less well-understood. As concerns grow for the future of many shark species it is becoming clear that a key to conservation success lies in changing human behaviors in relation to sharks. However, human-shark conflicts are multidimensional, each with different ecological, social and economic implications. Sharks have functional roles as occasional predators of humans and competitors with humans for fish stocks. In addition, and unlike most terrestrial predators, sharks are also important prey species for humans, being a source of animal protein and other products taken in fisheries. These functional roles are complex and often inter-dependent which can lead to multiple kinds of conflict. Shark management for conservation and human safety is also leading to conflict between different groups of people with different values and beliefs, demonstrating that human wildlife conflict can be a proxy for human-human conflict in the marine domain. Sharks are iconic species in society, being both feared and revered. As such human beliefs, attitudes and perceptions play key roles that underpin much human-shark conflict and future work to understanding these will contribute significantly to solutions that reduce conflict and hence improve conservation outcomes.

Health promotion and harm reduction attributes in One Health literature: A scoping review

One Health faces enormous pressure and challenges as it attempts to mitigate dynamic, surprising and complex global events that threaten the health and sustainability of human and animal populations and the biosphere. One Health practitioners and researchers need every advantage to developing working solutions to the world's imminent complex issues. Heath promotion and harm reduction, interrelated approaches that have seen much success over decades of use in global public health, may be important models to consider. Both use an upstream socioecological determinant of health approach to reach beyond the health sector in all health efforts, and encourage active community participation and empowerment to attain and sustain human and ecological health. This scoping review of 411 documents, believed to be the first to relate health promotion and harm reduction to One Health, searched self-declared One Health research literature for evidence of health promotion and harm reduction policies, principles and methodologies. It sought to answer the questions: "What is the scope of practice of One Health in self-declared One Health publications?" and "Are attributes of health promotion and harm reduction found in self-declared One Health-reviewed research literature?" Over half of the papers revealed no health promotion or harm reduction attributes while 7% were well-endowed with these attributes. These 7% of papers focused on deep-seated, complex health issues with systemic knowledge gaps and decision-making issues revolving around specific population vulnerabilities, social inequities and competing stakeholders. Implementing 'on the ground change' was a common theme in the strongest health promotion/harm reduction papers we identified. Alternatively, papers lacking health promotion or harm reduction attributes focused on managing proximate risks, primarily for infectious diseases. The addition of health promotion and harm reduction to One Health practices may help the field rise to the growing expectations for its involvement in complex global issues like pandemics and climate change.

Advancing Behavioural Theories in Sustainable Mobility: A Research Agenda

Ensuring that the growing mobility demand is met in a sustainable manner is important for our climate goals, and this would require changes to our current mobility behaviours. Behaviour and behaviour change theories have an important role in informing the mobility behaviour research and practices that seek to achieve these changes, and this paper discusses the application of these theories in both research and practice. Newer and more comprehensive theories have been developed in this area in the last decade, improving the quality of theories available. However, two key challenges of using theories are identified. The great number of theories today makes it challenging when deciding what and when to use them, and the appropriateness of many theories are either too simplistic or too complex. Thus, there is a need to critically review the state of theories in this area and identify ways to advance our application and development of behavioural theories. Here, two suggestions are put forward on how we can address these challenges while advancing the use of theories in mobility behaviour research and practice. First, integrate and summarise multiple, individual theories into a comprehensive and accessible framework for researchers and practitioners. Second, expand this framework beyond behaviour and behaviour-change theories by mapping out their interconnections with theories from other paradigms and disciplines using a systems approach to facilitate a more holistic theorisation.

Inside-out: normalising practice-based IPE

Practice-based interprofessional education (IPE), a key feature in developing a collaboration-ready workforce, is poorly integrated in healthcare curriculums. This study aimed to synthesise educator perspectives on implementing practice-based IPE and develop recommendations to inform sustainable practice-based IPE. An ethnographic case study was carried out at a school of allied health. Data collection involved six observations, 11 interviews and a review of eight documents. Reflexive thematic analysis, informed by Normalisation Process Theory, established two key themes. First, we found that strategic planning is needed, with a coherent implementation agenda and planned reflection on activities. Second, building partnerships with placement partners was identified as essential. This can be achieved by supporting and championing practice-based IPE activities developed by placement sites and establishing how university and clinical educators can work collaboratively to deliver sustainable practice-based IPE. These conditions create a favourable environment for normalising practice-based IPE in healthcare curriculums, benefitting students, patients, and the overall healthcare service.

Views of American animal and dairy science students on the future of dairy farms and public expectations for dairy cattle care: A focus group study

Students completing advanced degrees in dairy or animal science may go on to have a major impact on the food animal agriculture industries. The aim of this study was to better understand student views of the future of dairying, including changes in practices affecting animal care on farms as well as perceived public perceptions. We conducted 6 focus group sessions with undergraduate students enrolled in the 2019 US Dairy Education and Training Consortium held in Clovis, New Mexico, and used explorative key word analysis of written notes and thematic analysis of the semi-structured discussions. Some "must-haves" of future animal care on dairy farms included increased use of technology, group housing of calves, and adequate facilities, including enrichment. Students also discussed their views of public expectations regarding animal care on dairy farms, and measures that they felt must be put into place to address these expectations in the coming years. Although the influence of the public was highlighted by the students, they were not always certain what specific values the public holds and doubted the feasibility and practicality of some expectations, such as providing pasture access or keeping the calf and cow together. They further demonstrated uncertainty about how best to align the directions of the industry with public expectations. Although they felt that public education could be used to demonstrate the legitimacy of dairy practices, they also believed that the industry should strive to find compromises and work toward meeting public expectations. Deciding what animal welfare considerations (e.g., naturalness, affective states, or animal health) were most relevant was a challenge for the students, perhaps reflecting diverging messages received during their own education.

Applications of Systems Science to Understand and Manage Multiple Influences within Children's Environmental Health in Least Developed Countries: A Causal Loop Diagram Approach

Least developed countries (LDCs) are home to over a billion people throughout Africa, Asia-Pacific, and the Caribbean. The people who live in LDCs represent just 13% of the global population but 40% of its growth rate. Characterised by low incomes and low education levels, high proportions of the population practising subsistence living, inadequate infrastructure, and lack of economic diversity and resilience, LDCs face serious health, environmental, social, and economic challenges. Many communities in LDCs have very limited access to adequate sanitation, safe water, and clean cooking fuel. LDCs are environmentally vulnerable; facing depletion of natural resources, the effects of unsustainable urbanization, and the impacts of climate change, leaving them unable to safeguard their children’s lifetime health and wellbeing. This paper reviews and describes the complexity of the causal relationships between children’s health and its environmental, social, and economic influences in LDCs using a causal loop diagram (CLD). The results identify some critical feedbacks between poverty, family size, population growth, children’s and adults’ health, inadequate water, sanitation and hygiene (WASH), air pollution, and education levels in LDCs and suggest leverage points for potential interventions. A CLD can also be a starting point for quantitative systems science approaches in the field, which can predict and compare the effects of interventions.

Pragmatic and (or) Constitutive? On the Foundations of Contemporary Risk Communication Research

A diffuse and interdisciplinary field, risk communication research, is founded on how we understand the process and purpose of communication more generally. To that end, this article outlines two fundamental functions of risk communication: (1) a pragmatic function, in which senders direct messages at audiences (and vice versa), with various intended (and sometimes unintended) effects; and (2) a constitutive function, in which messages re(create) what we mean by "risk" in a given social context, including how we can, and/or should relate to it. Although representing distinct epistemological and theoretical social scientific traditions, these functions necessarily coexist in a broader understanding of risk communication, including its so-called "effectiveness." The article concludes by considering how we might enact this fuller understanding of risk communication's dual functions through engagement in collaborative, sustainability science-oriented research.

Picture perfect? Gazing into girls' health, physical activity, and nutrition through photovoice

Background: Women face contradictions regarding their health: Pressure to be feminine, but also athletic; Criticism for being too sporty or muscular, but equally so for being perceived as lazy or overweight. These complexities are perpetuated through media and discourse.

Purpose: Using a feminist post-structural approach and photovoice, this study explored health, physical activity, and nutrition in adolescent girls and young women.

Methods: Photovoice enables reflection, promotes dialogue, and sparks change. The process involved conducting a workshop, collecting photos, and participatory analysis sessions, which engaged the participants (n = 7, ages 13–26) in photo selection, contextualization, and codifying.

Results: This resulted in three themes: First, (Breaking) Stereotypes, in which participants identified gender norms, conflicts, and contradictions; Second, Emotional Safety, or the contexts in which girls and young women feel confident and comfortable; Finally, Being Outside in Nature emerged as significant. Each theme is supported by quotations and photographs. This work suggests being outside in nature provides important context for girls and young women to feel emotionally safe, such that they may engage in the complex navigation of competing discourses surrounding health.

Exploring anti-corruption, transparency, and accountability in the World Health Organization, the United Nations Development Programme, the World Bank Group, and the Global Fund to Fight AIDS, Tuberculosis and Malaria

Corruption is recognized by the global community as a threat to development generally and to achieving health goals, such as the United Nations Sustainable Development Goal # 3: ensuring healthy lives and promoting well-being for all. As such, international organizations such as the World Health Organizations and the United Nations Development Program are creating an evidence base on how best to address corruption in health systems. At present, the risk of corruption is even more apparent, given the need for quick and nimble responses to the COVID-19 pandemic, which may include a relaxation of standards and the rapid mobilization of large funds. As international organizations and governments attempt to respond to the ever-changing demands of this pandemic, there is a need to acknowledge and address the increased opportunity for corruption.In order to explore how such risks of corruption are addressed in international organizations, this paper focuses on the question: How are international organizations implementing measures to promote accountability and transparency, and anti-corruption, in their own operations? The following international organizations were selected as the focus of this paper given their current involvement in anti-corruption, transparency, and accountability in the health sector: the World Health Organization, the United Nations Development Program, the World Bank Group, and the Global Fund to Fight Aids, Tuberculosis and Malaria. Our findings demonstrate that there has been a clear increase in the volume and scope of anti-corruption, accountability, and transparency measures implemented by these international organizations in recent years. However, the efficacy of these measures remains unclear. Further research is needed to determine how these measures are achieving their transparency, accountability, and anti-corruption goals.

Institutional Engagement Practices as Barriers to Public Health Capacity in Climate Change Policy Discourse: Lessons from the Canadian Province of Ontario

Public health engagement in the communication, discussion, and development of climate change policies is essential for climate change policy decisions and discourse. This study examines how the existing governance approaches impact, enable, or constrain the inclusion, participation, and deliberation of public health stakeholders in the climate change policy discourse. Using the case study of the Canadian Province of Ontario, we conducted semi-structured, key informant interviews of public health (11) and non-public health (13) participants engaged in climate change policies in the province. The study results reveal that engagement and partnerships on climate change policies occurred within and across public health and non-public health organizations in Ontario. These engagements impacted public health's roles, decisions, mandate, and capacities beyond the climate change discourse; enabled access to funds, expertise, and new stakeholders; built relationships for future engagements; supported knowledge sharing, generation, and creation; and advanced public health interests in political platforms and decision making. However, public health's participation and deliberation were constrained by a fragmented sectoral approach, a lack of holistic inter-organizational structures and process, political and bureaucratic influences, irregular and unestablished communication channels for public health integration, and identities and culture focused on functions, mandates, biased ideologies, and a lack of clear commitment to engage public health. We conclude by providing practical approaches for integrating public health into climate change discourse and policymaking processes and advancing public health partnerships and collaborative opportunities.

The public health emergency of climate change: how/are Canadian post-secondary public health sciences programs responding?

OBJECTIVE

The Intergovernmental Panel on Climate Change recently issued a statement that the fate of human society and human health is at serious risk of catastrophic impacts unless we take bold action to keep global warming under 1.5 °C. In 2015, the Canadian Public Health Association noted emerging efforts to embrace intersectoral approaches to global change in public health research and practice. In this study, we question the extent to which Canadian Graduate Public Health Sciences Programs have kept pace with these efforts to see climate change surface as a new frontier for training the next generation of researchers and practitioners.

METHODS

Semi-structured interviews (19) were conducted with Department Heads (or equivalents) of graduate-level Public Health Sciences Programs at 15 Canadian universities concerning the place of climate change in their respective curricula. Interviews were designed to elicit participants' institutional perspectives on the importance of climate change in the Public Health Sciences and identify perceived challenges and opportunities.

RESULTS

Despite wide recognition among participants that climate change is a public health "crisis", very few reported having substantive curricular engagement on the topic. Key challenges identified were lack of resources, organizational issues, and political barriers. Key opportunities to adapt curricula to address this new frontier in Public Health were faculty interest and expertise, cross-disciplinary collaboration, and pressure from the institution.

CONCLUSION

Our findings provide evidence for post-secondary Public Health Sciences Programs to understand the need to address their own sluggishness when what is needed are bold, even radical, shifts to existing curricula.

Transformability as a Wicked Problem: A Cautionary Tale?

Transformability is increasingly promoted as a way of moving societies toward more sustainable futures in the era of the Anthropocene, mostly because the concept of resilience has fallen short in many instances where impacts on social-ecological systems are continuous, varied, and usually unknown. While such transformations can play a crucial role in improving the sustainability of social-ecological systems, they may lead to unexpected and undesirable outcomes. This literature review on social-ecological transformability and wicked problems seeks to shed light on and acknowledge some of the limitations of transformability regarding unforeseen conditions. We argue that wicked problems arise in transformation initiatives in the presence of high complexity, deep uncertainty, deep conflicts, and divergence among stakeholders, as well as scale mismatches concerning spatial, temporal, and institutional processes. Our findings may explain why some transformation initiatives fail to generate expected changes on the ground, mainly in two cases: (a) a polarized configuration that maintains the status quo of the system to be transformed and (b) an unforeseen transformation that causes the system to lurch from crisis to crisis. To conclude, we recommend using diagnostic questions to prevent wicked problems in social-ecological transformations.

Systems Thinking: A Review and Bibliometric Analysis

Systems thinking (ST) is an interdisciplinary domain that offers different ways to better understand the behavior and structure of a complex system. Over the past decades, several publications can be identified in academic literature, focusing on different aspects of systems thinking. However, two critical questions are not properly addressed in the extant body of ST literature: (i) How to conduct the content analysis exclusively to derive the prominent statistics (i.e., influential journals, authors, affiliated organizations and countries) pertaining to the domain of ST? (ii) How to get better insights regarding the current and emerging trends that may evolve over time based on the existing body of ST literature? To address these gaps, the aim of this research study is to provide a comprehensive insight into the domain of systems thinking through bibliometric and network analysis. Beginning with over 6000 accumulated publications, the analysis narrowed down to 626 prominent articles with proven influence published over the past three decades. Leveraging rigorous bibliometric tools analysis, this research unveils the influential authors, leading journals and top contributing organizations and countries germane to the domain of systems thinking. In addition, citation, co-citation and page rank analysis used to rank top influential articles in the area of systems thinking. Finally, with the aid of the network analysis, key clusters in the existing literature are identified based on the research areas of systems thinking. The findings of this research will serve as a bluebook for practitioners and scholars to conduct future research within systems thinking context.

International management of underwater noise: Transforming conflict into effective action

Underwater noise and its effects on the environment now sit squarely on the international stage and are being addressed by high-level international bodies, such as the European Union and United Nations. This is in addition to the many governments of coastal nations also working to address concerns under their own national laws and requirements. At the same time, the issue's intractability in reaching solutions continues to grow. Initial concerns in the 1990s over impacts of certain naval sonars on marine mammals have now expanded to a broader range of species, geographies, sound sources, stakeholder groups, and political and regulatory interests. In addition, there are now concerns over impacts to fishery catch rates and, for some, how reduced catch rates may affect available food for people. This paper examines how the international community can work to find solutions to this seemingly intractable problem. It reviews ten major international agreements and identifies "what" major topical areas are ripe for collaboration and then ties these findings to "how" collaborative processes should be designed to reach effective and lasting solutions.

Examining peer networking as a capacity-building strategy for Housing First implementation

AIMS

This study examines peer networking as a capacity-building strategy for the implementation of Housing First (HF), a complex community intervention targeting chronic homelessness.

METHODS

A qualitative, multiple case study was conducted to examine the capacity-building activities of two, multicommunity peer networks established by community leaders in the Canadian Homelessness sector. Data collection activities included document analysis, key informant interviews (n = 10), and a follow-up focus group with interview participants in each network. Thematic analyses were conducted for each network, followed by a cross-case analysis.

RESULTS

Engaging in a multicommunity peer network enhances leaders' capacity to advance HF by creating opportunities to foster trust and communication, inform continuous improvement, and navigate ambiguity. A number of contextual factors influence connections between peer networking and capacity building.

CONCLUSION

Peer networks are a valuable source of support and timely, contextually relevant knowledge for community leaders advancing local adaptation and implementation of HF.

The Politics of Health Care: Health Disparities, the Affordable Care Act, and Solutions for Success

This article explores why racial and income health disparities continue to exist in the United States. Poverty and racism are the primary drivers of the social problem which impact social determinants of health for vulnerable populations. The theoretical frameworks of conflict theory and critical race theory contextualize the causes and provide direction for overhauling public health policy in general and the Patient Protection and Affordable Care Act (Affordable Care Act) in particular. Although the Affordable Care Act was implemented to increase health coverage, economic and racial health inequities still exist in the United States. Policy recommendations for improving the health and welfare of low-income minorities include: 1) impacting poverty itself by desegregating urban areas of concentrated poverty, and 2) impacting racial discrimination in health care by putting the voices of African-American patients in the forefront to inform culturally relevant policy and practice.

Building Interdisciplinary Partnerships for Community-Engaged Environmental Health Research in Appalachian Virginia

This article describes a collaboration among a group of university faculty, undergraduate students, local governments, local residents, and U.S. Army staff to address long-standing concerns about the environmental health effects of an Army ammunition plant. The authors describe community-responsive scientific pilot studies that examined potential environmental contamination and a related undergraduate research course that documented residents' concerns, contextualized those concerns, and developed recommendations. We make a case for the value of resource-intensive university-community partnerships that promote the production of knowledge through collaborations across disciplinary paradigms (natural/physical sciences, social sciences, health sciences, and humanities) in response to questions raised by local residents. Our experience also suggests that enacting this type of research through a university class may help promote researchers' adoption of "epistemological pluralism", and thereby facilitate the movement of a study from being "multidisciplinary" to "transdisciplinary".

Gathering Diverse Perspectives to Tackle "Wicked Problems": Racial/Ethnic Disproportionality in Educational Placement

Among students receiving behavioral health and special education services, racial/ethnic minority students are consistently overrepresented in settings separate from general classrooms. Once separated, many young people struggle to improve academically and face significant difficulty upon trying to return to a general education setting. Given the complex, ongoing, and multifaceted nature of this challenge, racial/ethnic disproportionality can be identified as a "wicked problem," for which solutions are not easily identified. Here, we describe our community-engaged research efforts, eliciting perspectives from relevant partners in an ongoing dialogue, to better integrate diverse stakeholders' perspectives when attempting to address such disparities. We conducted focus groups and qualitative interviews with members of three stakeholder groups: community-serving organizations, individuals with lived experience of behavioral health conditions, and state-level policymakers, with a shared interest in addressing racial and ethnic disparities. Participant responses illustrated the "wickedness" of this problem and highlighted the need for additional supports for students, families, and school personnel, increased collaboration across relevant systems and agencies, and reduced barriers related to funding. Overall, this methodology bridged differing perspectives to develop, in concert with our partners, a shared language of the problem and a core set of issues to consider when seeking to effect change.

A systemic approach to achieving population-level impact in injury and violence prevention

The contemporary public health model for injury and violence prevention is a four-step process, which has been difficult to fully actualize in real-world contexts. This difficulty results from challenges in bridging science to practice and developing and applying population-level approaches. Prevention programmes and policies are embedded within and impacted by a range of system-level factors, which must be considered and actively managed when addressing complex public health challenges involving multiple sectors and stakeholders. To address these concerns, a systemic approach to population-level injury and violence prevention is being developed and explored by the Division of Analysis, Research, and Practice Integration in the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. This article makes the case for and provides a high-level overview of this systemic approach, its various components, and how it is being applied in one governmental unit.

Plastics Waste Metabolism in a Petro-Island State: Towards Solving a “Wicked Problem” in Trinidad and Tobago

Island systems have limited geographical, ecological, and social capacity to metabolize waste materials produced by the economic activities of their growing populations. Conceptualized as a ‘wicked problem’, the faults and weaknesses in waste management systems on islands continue to cause acute and cumulative ecological and human health impacts. Trinidad and Tobago is one such island jurisdiction grappling with this situation, particularly being a petroleum-dependent economy. Through the lens of neo-institutional theory, this case study of waste management in Trinidad and Tobago unpacks the efforts, reactions, drivers and circumstances that have led to various successes and failures but no definitive solutions over time, especially regarding plastics and packaging materials. We identify three temporal phases of policy evolution that have altered the waste metabolism trajectory to date: (1) government led patriarchal approach of traditional landfilling combined with behavioral change campaigns to reduce, reuse, and recycle, (2) to a more democratic, shared burden, public-private partnership approach combined with attempts at incentive-based regulations, (3) to the present, more private sector-led voluntary bans on production and use of plastics. This study contributes to our understanding of the institutional factors that shape the search for solutions to the wicked problem of island waste metabolism.

Using systems thinking and open innovation to strengthen aquaculture policy for the United Nations Sustainable Development Goals

In a world of 9 billion people and a widening income gap between the rich and poor, it is time to rethink how aquaculture can strengthen its contribution to the second UN Sustainable Development Goal (SDG) of zero hunger in our generation. The disparity in the level of sustainable aquaculture development at present, between and within countries, especially regarding human access to farmed aquatic food remains highly variable across the globe. This paper offers a fresh look at the opportunities from using systems thinking and new open innovation measuring tools to grow sustainable aquaculture. Political will in many nations is the main constraint to aquaculture in realising its potential as an: accessible source of micronutrients and nutritious protein; aid to meeting conservation goals; economic prosperity generator where benefits extend to locals and provider of indirect social benefits such as access to education and well-being, among others. Resources to enable strong partnerships (SDG 17) between academia, civic society, government and industry should be prioritised by governments to build a sustainable aquatic food system, accessible to all, forever.

Integrated Knowledge Translation with Public Health Policy Makers: A Scoping Review

Integrated knowledge translation (iKT) refers to the engagement of knowledge users (e.g., policy makers, clinicians, patients) as active participants in the research process. Theoretically, this involvement enhances research relevancy and usefulness, thereby supporting health system change. However, evidence to support best practices for iKT is lacking, particularly in a public health context and with non-clinical decision-makers. The objectives of this research were to report how decision-maker involvement in public health iKT research has been described and operationalized and whether the process was evaluated. We conducted a scoping review of published literature from January 2005 to December 2017 and extracted information related to iKT involvement, barriers and facilitators and outcomes. Studies typically did not distinguish between different kinds of knowledge users, making it impossible to comment specifically on decision-makers' involvement. Authors believed knowledge user involvement was beneficial to the quality and potential impact of research activities, although corroborating evaluation data were unavailable. Broad research-knowledge user partnerships spanning multiple projects, as well as flexible involvement of knowledge users, enhanced engagement and supported the iKT process.

Games as Tools to Address Conservation Conflicts

Conservation conflicts represent complex multilayered problems that are challenging to study. We explore the utility of theoretical, experimental, and constructivist approaches to games to help to understand and manage these challenges. We show how these approaches can help to develop theory, understand patterns in conflict, and highlight potentially effective management solutions. The choice of approach should be guided by the research question and by whether the focus is on testing hypotheses, predicting behaviour, or engaging stakeholders. Games provide an exciting opportunity to help to unravel the complexity in conflicts, while researchers need an awareness of the limitations and ethical constraints involved. Given the opportunities, this field will benefit from greater investment and development.

The Global Wicked Problem of Corruption and Its Risks for Access to HIV/AIDS Medicines

We discuss how corruption affects access to antiretroviral therapies (ARVs) globally. Recent cases of theft of ARVs, collusion, and manipulation in procurement found in countries such as Central African Republic, Bangladesh, Malawi, and Guinea, show there is still much work to be done to reduce the risk of corruption. This includes addressing the structural weaknesses in procurement mechanisms and supply chain management systems of health commodities and medicines.

Navigating systems ideas for health practice: Towards a common learning device

Systems thinking and reference to complexity science have gained currency in health sector practice and research. The extent to which such ideas might represent a mere passing fad or might more usefully be mobilized to tackle wicked problems in health systems is a concern underpinning this paper. Developing the usefulness of the systems idea requires appreciating how systems ideas are used essentially as constructs conceptually bounded by practitioners. Systems are used for purposes of understanding and engaging the reality of health issues, with the intent of transforming the reality into one that is more manageable, equitable, and sustainable. We examine some manifestations of the systems idea in health practice and the traditions of systems practice that variously make use of them. This provides a platform for proposing a systems thinking in (health) practice heuristic: a learning device supporting how different tools and methods can address "wicked problems" in health praxis. The device is built on the use of "conversation" as a metaphor to help practitioners use systems ideas in tandem with existing disciplinary and professional skills and methods. We consider how the application of the heuristic requires, and helps to develop, human characteristics of humility, empathy, and recognition of fallibility.

Assessment of Environmental Health Research Centers in Iran due to knowledge production and utilization

BACKGROUND

Knowledge production in environmental health promotion is one of the most important goals at the national level and establishing environmental health research centers (EHRCs) is one of the main strategies that will lead to achieving this goal. In this study, we are going to present the results of knowledge production and research performance evaluation of EHRCs in Iran.

METHODS

In this cross sectional study, a specific check list has been used to assess Knowledge production and utilization through annual evaluations undertaken by research centers in Iran. This article has the results of the 4-year evaluation (2011-2014).

RESULTS

The total number of EHRCs under the supervision of universities of medical sciences (UMS) is 34. The number of faculty members at these centers is 291 and the total approved projects by research council of UMS during 2011-2014, were 538. The number of published article increased from 282 in 2011 to 709 in 2014. During this period, the number of citations to EHRCs' articles was 4488 in Scopus database. The number of EHRCs' articles which have been referred in text books were 39. The proportion of published articles per academic member in environmental health has been 1.8 per year.

CONCLUSION

Based on research performance evaluation, knowledge production and research is desirable in EHRCs, but research utilization to health environmental promotion is still inadequate and should be assessed by qualitative evaluation.