Diarrheal disease and associations with water access and sanitation in Indigenous Shawi children along the Armanayacu River basin in Peru

INTRODUCTION

Diarrheal disease, particularly in children under 5 years old, remains a global health challenge due to its high prevalence and chronic health consequences. Public health interventions that reduce diarrheal disease risk include improving access to water, sanitation, and hygiene. Although Peru achieved the 2015 Millennium Development Goal (MDG) indicators for water access, less progress was achieved on sanitation. Furthermore, many Indigenous Peoples were overlooked in the MDG indicators, resulting in a prioritization of Indigenous Peoples in the 2030 Sustainable Development Goals (SDGs). This study aimed to estimate the prevalence of childhood diarrhea, characterize access to water and sanitation, and determine the association of childhood diarrhea with water access and sanitation indicators in 10 Shawi Indigenous communities along the Armanayacu River in the Peruvian Amazon.

METHODS

A cross-sectional survey (n=82) that captured data on diarrheal disease, sociodemographic variables, and water and sanitation exposures was conducted in 10 Shawi communities. Nutritional status of children under 5 was also assessed via physical examination. Descriptive and comparative statistics were conducted.

RESULTS

A small proportion (n=7; 8.54%) of participating children reported an episode of diarrhea in the previous month. Almost half (46.30%) of participating children had stunting, wasting, or both. Although not statistically significant, children living in households that used latrines were 4.29 times (95% confidence interval (CI) 1.01-18.19) more likely to report an episode of diarrhea than children living in households that practiced open defecation. Although not statistically significant, children living in households that used water treatment methods were 4.25 times (95%CI 0.54-33.71) more likely to report an episode of diarrhea than children living in households that did not.

CONCLUSION

The prevalence of childhood diarrhea was lower for Shawi than for other Amazon areas. The higher prevalence of childhood diarrhea in households that used latrines and water treatments warrants further investigation into local risk and protective factors. These Shawi communities scored low for the WHO/UNICEF Joint Monitoring Programme indicators for water and sanitation, indicating that they should be prioritized in future water, sanitation, and hygiene initiatives. Research will be required to understand and incorporate local Indigenous values and cultural practices into water, sanitation, and hygiene initiatives to maximize intervention uptake and effectiveness.

Policy responses to COVID-19 in Sri Lanka and the consideration of Indigenous Peoples

COVID-19 has had uneven impacts on health and well-being, with Indigenous communities in the Global South facing some of the highest risks. Focusing on the experience of Sri Lanka, this study identifies key policy responses to COVID-19, documents how they evolved over two years of the pandemic, and examines if and how government responses have addressed issues pertaining to Indigenous Peoples. Drawing upon an analysis of policy documents (n = 110) and interviews with policymakers (n = 20), we characterize seven key policy responses implemented by the Sri Lankan government: i) testing for and identifying COVID-19; ii) quarantine procedures; iii) provisional clinical treatments; iv) handling other diseases during COVID-19; v) movement; vi) guidelines to be adhered to by the general public; and vii) health and vaccination. The nature of these responses changed as the pandemic progressed. There is no evidence that policy development or implementation incorporated the voices and needs of Indigenous Peoples.

Indigenous peoples and the COVID-19 pandemic: a systematic scoping review

Past influenza pandemics including the Spanish flu and H1N1 have disproportionately affected Indigenous Peoples. We conducted a systematic scoping review to provide an overview of the state of understanding of the experience of Indigenous peoples during the first 18 months of the COVID-19 pandemic, in doing so we capture the state of knowledge available to governments and decision makers for addressing the needs of Indigenous peoples in these early months of the pandemic. We addressed three questions: (a) How is COVID-19 impacting the health and livelihoods of Indigenous peoples, (b) What system level challenges are Indigenous peoples experiencing, (c) How are Indigenous peoples responding? We searched Web of Science, Scopus, and PubMed databases and UN organization websites for publications about Indigenous peoples and COVID-19. Results were analyzed using descriptive statistics and content analysis. A total of 153 publications were included: 140 peer-reviewed articles and 13 from UN organizations. Editorial/commentaries were the most (43%) frequent type of publication. Analysis identified Indigenous peoples from 19 different countries, although 56% of publications were centered upon those in Brazil, United States, and Canada. The majority (90%) of articles focused upon the general adult population, few (<2%) used a gender lens. A small number of articles documented COVID-19 testing (0.04%), incidence (18%), or mortality (16%). Five themes of system level challenges affecting exposure and livelihoods evolved: ecological, poverty, communication, education and health care services. Responses were formal and informal strategies from governments, Indigenous organizations and communities. A lack of ethnically disaggregated health data and a gender lens are constraining our knowledge, which is clustered around a limited number of Indigenous peoples in mostly high-income countries. Many Indigenous peoples have autonomously implemented their own coping strategies while government responses have been largely reactive and inadequate. To 'build back better' we must address these knowledge gaps.

Interactions between climate and COVID-19

In this Personal View, we explain the ways that climatic risks affect the transmission, perception, response, and lived experience of COVID-19. First, temperature, wind, and humidity influence the transmission of COVID-19 in ways not fully understood, although non-climatic factors appear more important than climatic factors in explaining disease transmission. Second, climatic extremes coinciding with COVID-19 have affected disease exposure, increased susceptibility of people to COVID-19, compromised emergency responses, and reduced health system resilience to multiple stresses. Third, long-term climate change and prepandemic vulnerabilities have increased COVID-19 risk for some populations (eg, marginalised communities). The ways climate and COVID-19 interact vary considerably between and within populations and regions, and are affected by dynamic and complex interactions with underlying socioeconomic, political, demographic, and cultural conditions. These conditions can lead to vulnerability, resilience, transformation, or collapse of health systems, communities, and livelihoods throughout varying timescales. It is important that COVID-19 response and recovery measures consider climatic risks, particularly in locations that are susceptible to climate extremes, through integrated planning that includes public health, disaster preparedness, emergency management, sustainable development, and humanitarian response.

Sea level rise risks and societal adaptation benefits in low-lying coastal areas

Sea level rise (SLR) will increase adaptation needs along low-lying coasts worldwide. Despite centuries of experience with coastal risk, knowledge about the effectiveness and feasibility of societal adaptation on the scale required in a warmer world remains limited. This paper contrasts end-century SLR risks under two warming and two adaptation scenarios, for four coastal settlement archetypes (Urban Atoll Islands, Arctic Communities, Large Tropical Agricultural Deltas, Resource-Rich Cities). We show that adaptation will be substantially beneficial to the continued habitability of most low-lying settlements over this century, at least until the RCP8.5 median SLR level is reached. However, diverse locations worldwide will experience adaptation limits over the course of this century, indicating situations where even ambitious adaptation cannot sufficiently offset a failure to effectively mitigate greenhouse-gas emissions.

Monitoring the dynamic vulnerability of an Arctic subsistence food system to climate change: The case of Ulukhaktok, NT

Vulnerability to climate change is highly dynamic, varying between and within communities over different timescales. This paper draws upon complex adaptive systems thinking to develop an approach for capturing, understanding, and monitoring climate vulnerability in a case study from northern Canada, focusing on Inuit food systems. In the community of Ulukhaktok, Northwest Territories, we followed 10 hunters over a 2-year period, asking them to document their harvesting activities and discuss their lived experience of harvesting under changing environmental and societal conditions. GPS monitoring and participatory mapping sessions were used to document 23,996km of trails (n = 409), with conversational bi-weekly semi-structured interviews and secondary instrumental weather data used to contextualise climate change within a nexus of other socioeconomic, cultural, and political stressors that also affect harvesting. Our results demonstrate that climate change has considerable potential to affect harvesting activities, particularly when its impacts manifest as anomalous/extreme events. However, climate change impacts are not necessarily the most salient issues affecting harvesting on a day-to-day basis. Instead, factors relating to economics (particularly financial capital and the wage-based economy), social networks, and institutions are found to have a greater influence, either as standalone factors with cascading effects or when acting synchronously to augment the impacts of environmental change.

Understanding Determinants of Hunting Trip Productivity in an Arctic Community

We examine factors underlying hunting productivity among Inuit in Ulukhaktok, Northwest Territories, Canada. Specifically, we focus on the role of gasoline use as the main variable of interest—commonly cited as a crucial determinant of hunting participation. Over the course of 12 months, 10 hunters recorded their on-the-land activities using a GPS tracking system, participatory mapping sessions, and bi-weekly interviews. A multivariable linear regression model (MvLRM) was applied to assess whether factors such as consumables used (i.e. heating fuel, gasoline, oil, food), distances traveled, or the number of companions on a trip were associated with the mass of edible foods returned to the community. Results indicate that, despite being positively associated with hunting trip productivity when assessed through a univariable linear regression model, gasoline is not a statistically significant determinant of standalone trip yield when adjusting for other variables in a multivariable linear regression. Instead, factors relating to seasonality, number of companions, and days on the land emerged as more significant and substantive drivers of productivity while out on the land. The findings do not suggest that access to, or the availability of, gasoline does not affect whether a hunting trip commences or is planned, nor that an increase in the amount of gasoline available to a hunter might increase the frequency of trips (and therefore annual productivity). Rather, this work demonstrates that the volume of gasoline used by harvesters on standalone hunting trips represent a poor a priori predictor of the edible weight that harvesters are likely to return to the community.

The effects on public health of climate change adaptation responses: a systematic review of evidence from low- and middle-income countries

Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the 'Global Adaptation Mapping Initiative' database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013-2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action.

Seasonality, climate change, and food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda: Implications for maternal-infant health

BACKGROUND

Climate change is expected to decrease food security globally. Many Indigenous communities have heightened sensitivity to climate change and food insecurity for multifactorial reasons including close relationships with the local environment and socioeconomic inequities which increase exposures and challenge adaptation to climate change. Pregnant women have additional sensitivity to food insecurity, as antenatal undernutrition is linked with poor maternal-infant health. This study examined pathways through which climate change influenced food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda. Specific objectives were to characterize: 1) sensitivities to climate-associated declines in food security for pregnant Indigenous women; 2) women's perceptions of climate impacts on food security during pregnancy; and 3) changes in food security and maternal-infant health over time, as observed by women.

METHODS

Using a community-based research approach, we conducted eight focus group discussions-four in Indigenous Batwa communities and four in non-Indigenous communities-in Kanungu District, Uganda, on the subject of climate and food security during pregnancy. Thirty-six women with ≥1 pregnancy participated. Data were analysed using a constant comparative method and thematic analysis.

RESULTS

Women indicated that food insecurity was common during pregnancy and had a bidirectional relationship with antenatal health issues. Food security was thought to be decreasing due to weather changes including extended droughts and unpredictable seasons harming agriculture. Women linked food insecurity with declines in maternal-infant health over time, despite improved antenatal healthcare. While all communities described food security struggles, the challenges Indigenous women identified and described were more severe.

CONCLUSIONS

Programs promoting women's adaptive capacity to climate change are required to improve food security for pregnant women and maternal-infant health. These interventions are particularly needed in Indigenous communities, which often face underlying health inequities. However, resiliency among mothers was strong and, with supports, they can reduce food security challenges in a changing climate.

Participatory Modeling of Water Vulnerability in Remote Alaskan Households Using Causal Loop Diagrams

Despite perceptions of high water availability, adequate access to sufficient water resources remains a major challenge in Alaska. This paper uses a participatory modeling approach to investigate household water vulnerability in remote Alaska and to examine factors that affect water availability and water access. Specifically, the work asks: how do water policy stakeholders conceptualize the key processes that affect household water vulnerability in the context of rural Alaska? Fourteen water policy stakeholders participated in the modeling process, which included defining the problem of household water vulnerability and constructing individual causal loop diagrams (CLDs) that represent their conceptualization of household water vulnerability. Individual CLDs were subsequently combined and five sub-models emerged: environmental, economic, infrastructure, social, and health. The environmental and economic sub-models of the CLD are explored in depth. In the environmental sub-model, climate change and environmental barriers due to geography influence household water vulnerability. In the economic sub-model, four processes and one feedback loop affect household water vulnerability, including operations and maintenance funding, the strength of the rural Alaskan economy, and the impact of regulations. To overcome household water vulnerability and make households more resilient, stakeholders highlighted policy solutions under five themes: economics, social, regulatory, technological, and environmental.

Sewing and Inuit women's health in the Canadian Arctic

Traditional Inuit cultural values and practices are integral to an Inuit understanding of health. We examine the role of sewing in Inuit women's health in the Canadian Arctic in a case study of Ulukhaktok, Northwest Territories, Canada. An analysis of data collected using semi-structured interviews with 30 Inuit women reveals that sewing contributes to participant's health and the collective health of the community in several ways including: pride and sense of accomplishment; cultural identity; relaxation, decompression, and socialization; and spirituality and healing. As a cultural practice, sewing is about older generations teaching younger generations about their identity, who they are and where they come from. For some participants, sewing is a way through which they express their culture. Sewing brings people together at a time when social isolation is becoming more apparent, and gives women the chance to learn vital, tangible skills that continue to have social, economic, and cultural importance. Sewing is also a form of healing that helps women ease their minds and focus on a challenging and productive task that brings them satisfaction, self-worth, and value. We conclude that sewing is important for cultural continuity, enabling Inuit to both practice and carryon their culture, and contributing positively to individual and the collective health of the community.

Climate change and community fisheries in the arctic: A case study from Pangnirtung, Canada

Coastal fishery systems in the Arctic are undergoing rapid change. This paper examines the ways in which Inuit fishers experience and respond to such change, using a case study from Pangnirtung, Canada. The work is based on over two years of fieldwork, during which semi-structured interviews (n = 62), focus group discussions (n = 6, 31 participants) and key informant interviews (n = 25) were conducted. The changes that most Inuit fishers experience are: changes in sea-ice conditions, Inuit people themselves, the landscape and the seascape, fish-related changes, and changes in weather conditions, markets and fish selling prices. Inuit fishers respond to change individually as well as collectively. Fishers' responses were examined using the characteristics of a resilience-based conceptual framework focusing on place, human agency, collective action and collaboration, institutions, indigenous and local knowledge systems, and learning. Based on results, this paper identified three community-level adaptive strategies, which are diversification, technology use and fisheries governance that employs a co-management approach. Further, this work recognised four place-specific attributes that can shape community adaptations, which are Inuit worldviews, Inuit-owned institutions, a culture of sharing and collaborating, and indigenous and local knowledge systems. An examination of the ways in which Inuit fishers experience and respond to change is essential to better understand adaptations to climate change. This study delivers new insights to communities, scientists, and policymakers to work together to foster community adaptation.

An integrative climate change vulnerability index for Arctic aviation and marine transportation

Climate change vulnerability research methods are often divergent, drawing from siloed biophysical risk approaches or social-contextual frameworks, lacking methods for integrative approaches. This substantial gap has been noted by scientists, policymakers and communities, inhibiting decision-makers' capacity to implement adaptation policies responsive to both physical risks and social sensitivities. Aiming to contribute to the growing literature on integrated vulnerability approaches, we conceptualize and translate new integrative theoretical insights of vulnerability research to a scalable quantitative method. Piloted through a climate change vulnerability index for aviation and marine sectors in the Canadian Arctic, this study demonstrates an avenue of applying vulnerability concepts to assess both biophysical and social components analyzing future changes with linked RCP climate projections. The iterative process we outline is transferable and adaptable across the circumpolar north, as well as other global regions and shows that transportation vulnerability varies across Inuit regions depending on modeled hazards and transportation infrastructures.

What role can unmanned aerial vehicles play in emergency response in the Arctic: A case study from Canada

This paper examines search and rescue and backcountry medical response constraints in the Canadian Arctic and potential for unmanned aerial vehicles (UAV) to aid in response and preparedness. Semi-structured interviews (n = 18) were conducted with search and rescue responders, Elders, and emergency management officials to collect data on current emergency response and potential for UAV use. UAV test flights (n = 17) were undertaken with community members. We analyzed five years of weather data to examine UAV flight suitability. Numerous challenges face Arctic search and rescue and backcountry emergency response. Changing social and environmental conditions were described as increasing vulnerability to backcountry emergencies. Responders desired additional first aid and emergency training. Legal and weather restrictions were found to limit where, when and who could fly UAVs. UAVs were demonstrated to have potential benefits for hazard monitoring but not for SAR or medical response due to legal restrictions, weather margins, and local capacity. We find that communities are ill-prepared for ongoing SAR demands, let alone a larger disaster. There are numerous limitations to the use of consumer UAVs by Arctic communities. Prevention of backcountry medical emergencies, building resilience to disasters, and first responder training should be prioritized over introducing UAVs to the response system.

The Impacts of Climate and Social Changes on Cloudberry (Bakeapple) Picking: a Case Study from Southeastern Labrador

The traditional subsistence activities of Indigenous communities in Canada's subarctic are being affected by the impacts of climate change, compounding the effects of social, economic and political changes. Most research has focused on hunting and fishing activities, overlooking berry picking as an important socio-cultural activity and contributor to the diversity of food systems. We examined the vulnerability of cloudberry (referred to as 'bakeapple' consistent with local terminology) picking to environmental changes in the community of Cartwright, Labrador using semi-structured interviews (n = 18), field surveys, and satellite imagery. We identified the components of vulnerability including: the environmental changes affecting the abundance, quality, and ripening time of bakeapples (i.e., exposure), the characteristics of the community that affect how these changes have local impacts (i.e., sensitivity), and the ways in which the community is responding to environmental changes (i.e., adaptive capacity). Our results confirm that environmental changes related to permafrost, vegetation, and water have occurred at the bakeapple picking grounds with observed impacts on bakeapples. It is becoming increasingly difficult for bakeapple pickers to respond to variable growth as in the past because of changes in summer settlement patterns that place families farther from their bakeapple patches. We conclude that harvesters in Cartwright have high adaptive capacity to respond to environmental changes due to their knowledge of their bakeapple patches, and at present, socioeconomic changes have had a greater impact than environmental changes on their harvesting capacity.

Water quality and health in northern Canada: stored drinking water and acute gastrointestinal illness in Labrador Inuit

One of the highest self-reported incidence rates of acute gastrointestinal illness (AGI) in the global peer-reviewed literature occurs in Inuit communities in the Canadian Arctic. This high incidence of illness could be due, in part, to the consumption of contaminated water, as many northern communities face challenges related to the quality of municipal drinking water. Furthermore, many Inuit store drinking water in containers in the home, which could increase the risk of contamination between source and point-of-use (i.e., water recontamination during storage). To examine this risk, this research characterized drinking water collection and storage practices, identified potential risk factors for water contamination between source and point-of-use, and examined possible associations between drinking water contamination and self-reported AGI in the Inuit community of Rigolet, Canada. The study included a cross-sectional census survey that captured data on types of drinking water used, household practices related to drinking water (e.g., how it was collected and stored), physical characteristics of water storage containers, and self-reported AGI. Additionally, water samples were collected from all identified drinking water containers in homes and analyzed for presence of Escherichia coli and total coliforms. Despite municipally treated tap water being available in all homes, 77.6% of households had alternative sources of drinking water stored in containers, and of these containers, 25.2% tested positive for total coliforms. The use of transfer devices and water dippers (i.e., smaller bowls or measuring cups) for the collection and retrieval of water from containers were both significantly associated with increased odds of total coliform presence in stored water (OR_{transfer device} = 3.4, 95% CI 1.2-11.7; OR_dipper = 13.4, 95% CI 3.8-47.1). Twenty-eight-day period prevalence of self-reported AGI during the month before the survey was 17.2% (95% CI 13.0-22.5), which yielded an annual incidence rate of 2.4 cases per person per year (95% CI 1.8-3.1); no water-related risk factors were significantly associated with AGI. Considering the high prevalence of, and risk factors associated with, indicator bacteria in drinking water stored in containers, potential exposure to waterborne pathogens may be minimized through interventions at the household level.

Evaluating the effectiveness of hazard mapping as climate change adaptation for community planning in degrading permafrost terrain

Permafrost in northern Canada is susceptible to degradation due to rapid climate change, with hazard mapping promoted as an important activity to guide sustainable community adaptation and planning. This paper presents a framework for evaluating permafrost mapping exercises designed to inform climate change adaptation actions. We apply the framework using a case study of the Incorporating Climate Change into Land Development-Terrain Analysis project (ICCiLD). ICCiLD is a hazard mapping project utilizing interferometric synthetic aperture radar to monitor ground disturbance and categorize land development suitability in seven communities in the territory of Nunavut, Canada. We looked at one of the communities, Arviat, as our case study. We examined technical data and drew upon semi-structured interviews (n = 19) with map creators and users. We found ICCiLD added new and relevant information for community planning, increased awareness of the risks posed by permafrost thaw and built stakeholder relations. Strong coordination and high public consciousness of local climate impacts emerged as key factors underpinning project success. Nevertheless, in the case of Arviat, the effectiveness of the hazard maps in influencing land-use planning was constrained by communication challenges between project creators and end-users. These challenges included limited community access to the data and uncertainty surrounding how to operationalize the map suitability classifications. Broader climate change adaptation challenges included the presence of other more immediate community planning priorities and a limited ability to incorporate Indigenous ways of knowing into a technical mapping project. The lessons from this evaluation provide insight for the development of mapping-based adaptations across Arctic regions.

How are perceptions associated with water consumption in Canadian Inuit? A cross-sectional survey in Rigolet, Labrador

Concerns regarding the safety and aesthetic qualities of one's municipal drinking water supply are important factors influencing drinking water perceptions and consumption patterns (i.e. sources used and daily volume of consumption). In northern Canada, Inuit communities face challenges with drinking water quality, and many Inuit have reported concerns regarding the safety of their drinking water. The objectives of this research were to describe perceptions of municipal tap water, examine use of water sources and changes following the installation of a potable water dispensing unit (PWDU) in 2014, and identify factors associated with water consumption in the Inuit community of Rigolet. This study used data from three cross-sectional census surveys conducted between 2012 and 2014. Principal component analysis (PCA) was used to aggregate data from multiple variables related to perceptions of water, and logistic regressions were used to identify variables associated with water consumption patterns. Three quarters of residents reported using the PWDU after its installation, with concomitant declines reported in consumption of bottled, tap, and brook water. Negative perceptions of tap water were associated with lower odds of consuming tap water (OR_{PCAcomponent1}=0.73, 95% CI 0.56-0.94; OR_{PCAcomponent2}=0.67, 95% CI 0.49-0.93); women had higher odds of drinking purchased water compared to men (OR=1.90, 95% CI 1.11-3.26). The median amount of water consumed per day was 1L. Using brook water (OR=2.60, 95% CI 1.22-5.56) and living in a household where no one had full-time employment (OR=2.94, 95% CI 1.35-6.39) were associated with consuming >2L of water per day. Results of this study may inform drinking water interventions, risk assessments, and public health messaging in Rigolet and other Indigenous communities.

Readiness for climate change adaptation in the Arctic: a case study from Nunavut, Canada

There is limited knowledge on institutional factors constraining and enabling climate change adaptation in Arctic regions, or the overall readiness of governing bodies and communities to develop, implement, and promote adaptation. This paper examines the preparedness of different levels of government to adapt in the Canadian Arctic territory of Nunavut, drawing upon semi-structured interviews with government personnel and organizations involved in adaptation. In the Government of Nunavut, there have been notable developments around adaptation planning and examples of adaptation champions, but readiness for adaptation is challenged by a number of factors including the existence of pressing socio-economic problems, and institutional and governmental barriers. Federally, there is evidence of high-level leadership on adaptation, the creation of adaptation programs, and allocation of funds for adaptation, although the focus has been mostly on researching adaptation options as opposed to supporting actual actions or policy change. The 2016 Pan-Canadian Framework on Clean Growth and Climate Change, and increasing emphasis on climate change federally and in the Government of Nunavut, offer opportunities for advancing adaptation, but concrete steps are needed to ensure readiness is enhanced.

Food insecurity and food consumption by season in households with children in an Arctic city: a cross-sectional study

BACKGROUND

High rates of food insecurity are documented among Inuit households in Canada; however, data on food insecurity prevalence and seasonality for Inuit households with children are lacking, especially in city centres. This project: (1) compared food consumption patterns for households with and without children, (2) compared the prevalence of food insecurity for households with and without children, (3) compared food consumption patterns and food insecurity prevalence between seasons, and (4) identified factors associated with food insecurity in households with children in Iqaluit, Nunavut, Canada.

METHODS

Randomly selected households were surveyed in Iqaluit in September 2012 and May 2013. Household food security status was determined using an adapted United States Department of Agriculture Household Food Security Survey Module. Univariable logistic regressions were used to examine unconditional associations between food security status and demographics, socioeconomics, frequency of food consumption, and method of food preparation in households with children by season.

RESULTS

Households with children (n = 431) and without children (n = 468) participated in the survey. Food insecurity was identified in 32.9% (95% CI: 28.5-37.4%) of households with children; this was significantly higher than in households without children (23.2%, 95% CI: 19.4-27.1%). The prevalence of household food insecurity did not significantly differ by season. Demographic and socioeconomic characteristics of the person responsible for food preparation, including low formal education attainment (ORSept = 4.3, 95% CI: 2.3-8.0; ORMay = 3.2, 95% CI: 1.8-5.8), unemployment (ORSept = 1.1, 95% CI: 1.1-1.3; ORMay = 1.3, 95% CI: 1.1-1.5), and Inuit identity (ORSept = 8.9, 95% CI: 3.4-23.5; ORMay = 21.8, 95% CI: 6.6-72.4), were associated with increased odds of food insecurity in households with children. Fruit and vegetable consumption (ORSept = 0.4, 95% CI: 0.2-0.8; ORMay = 0.5, 95% CI: 0.2-0.9), as well as eating cooked (ORSept = 0.5, 95% CI: 0.3-1.0; ORMay = 0.5, 95% CI: 0.3-0.9) and raw (ORSept = 1.7, 95% CI: 0.9-3.0; ORMay = 1.8, 95% CI: 1.0-3.1) fish were associated with decreased odds of food insecurity among households with children, while eating frozen meat and/or fish (ORSept = 2.6, 95% CI: 1.4-5.0; ORMay = 2.0, 95% CI: 1.1-3.7) was associated with increased odds of food insecurity.

CONCLUSIONS

Food insecurity is high among households with children in Iqaluit. Despite the partial subsistence livelihoods of many Inuit in the city, we found no seasonal differences in food security and food consumption for households with children. Interventions aiming to decrease food insecurity in these households should consider food consumption habits, and the reported demographic and socioeconomic determinants of food insecurity.

Representation of Indigenous peoples in climate change reporting

This article examines how newspapers reporting on climate change have covered and framed Indigenous peoples. Focusing on eight newspapers in Canada, the USA, Australia, and New Zealand, we examine articles published from 1995 to 2015, and analyze them using content and framing analyses. The impacts of climate change are portrayed as having severe ecological, sociocultural, and health/safety impacts for Indigenous peoples, who are often framed as victims and "harbingers" of climate change. There is a strong focus on stories reporting on the Arctic. The lack of substantive discussion of colonialism or marginalization in the reviewed stories limits media portrayal of the structural roots of vulnerability, rendering climate change as a problem for, rather than of society. Indigenous and traditional knowledge is widely discussed, but principally as a means of corroborating scientific knowledge, or in accordance with romanticized portrayals of Indigenous peoples. Widespread disparities in the volume, content, and framing of coverage are also observed across the four nations.

Vulnerability to unintentional injuries associated with land-use activities and search and rescue in Nunavut, Canada

Injury is the leading cause of death for Canadians aged 1 to 44, occurring disproportionately across regions and communities. In the Inuit territory of Nunavut, for instance, unintentional injury rates are over three times the Canadian average. In this paper, we develop a framework for assessing vulnerability to injury and use it to identify and characterize the determinants of injuries on the land in Nunavut. We specifically examine unintentional injuries on the land (outside of hamlets) because of the importance of land-based activities to Inuit culture, health, and well-being. Semi-structured interviews (n = 45) were conducted in three communities that have varying rates of search and rescue (SAR), complemented by an analysis of SAR case data for the territory. We found that risk of land-based injuries is affected by socioeconomic status, Inuit traditional knowledge, community organizations, and territorial and national policies. Notably, by moving beyond common conceptualizations of unintentional injury, we are able to better assess root causes of unintentional injury and outline paths for prevention.

Public Health Adaptation to Climate Change in OECD Countries

Climate change is a major challenge facing public health. National governments play a key role in public health adaptation to climate change, but there are competing views on what responsibilities and obligations this will—or should—include in different nations. This study aims to: (1) examine how national-level public health adaptation is occurring in Organization for Economic Cooperation and Development (OECD) countries; (2) examine the roles national governments are taking in public health adaptation; and (3) critically appraise three key governance dimensions of national-level health adaptation—cross-sectoral collaboration, vertical coordination and national health adaptation planning—and identify practical examples suited to different contexts. We systematically reviewed publicly available public health adaptation to climate change documents and webpages by national governments in ten OECD countries using systematic web searches, assessment of self-reporting, and content analysis. Our findings suggest national governments are primarily addressing infectious disease and heat-related risks posed by climate change, typically emphasizing capacity building or information-based groundwork initiatives. We find national governments are taking a variety of approaches to public health adaptation to climate change that do not follow expected convergence and divergence by governance structure. We discuss practical options for incorporating cross-sectoral collaboration, vertical coordination and national health adaptation planning into a variety of contexts and identify leaders national governments can look to to inform their public health adaptation planning. Following the adoption of the Paris Agreement and subsequent increased momentum for adaptation, research tracking adaptation is needed to define what health adaptation looks like in practice, reveal insights that can be taken up across states and sectors, and ensure policy orientated learning.

The role of environmental factors in search and rescue incidents in Nunavut, Canada

OBJECTIVES

Unintentional injury is a leading cause of morbidity and mortality in Nunavut, where the importance of land-based activities and reliance on semi-permanent trails create unique risk profiles. Climate change is believed to be exacerbating these risks, although no studies have quantitatively examined links between environmental conditions and injury and distress in the Canadian Arctic. We examine the correlation between environmental conditions and land-based search and rescue (SAR) incidents across Nunavut.

STUDY DESIGN

Case study.

METHODS

Case data were acquired from the Canadian National Search and Rescue Secretariat. Gasoline sales from across the territory are then used to model land-use and exposure. We compare weather and ice conditions during 202 SAR incidents to conditions during 755 non-SAR days (controls) between 2013 and 2014.

RESULTS

We show daily ambient temperature, ice concentration, ice thickness, and variation in types of ice to be correlated with SAR rates across the territory during the study period.

CONCLUSIONS

These conditions are projected to be affected by future climate change, which could increase demand for SAR and increase injury rates in the absence of targeted efforts aimed at prevention and treatment. This study provides health practitioners and public health communities with clearer understanding to prepare, respond to, and prevent injuries across the Arctic.

Community-based adaptation research in the Canadian Arctic

Community-based adaptation (CBA) has emerged over the last decade as an approach to empowering communities to plan for and cope with the impacts of climate change. While such approaches have been widely advocated, few have critically examined the tensions and challenges that CBA brings. Responding to this gap, this article critically examines the use of CBA approaches with Inuit communities in Canada. We suggest that CBA holds significant promise to make adaptation research more democratic and responsive to local needs, providing a basis for developing locally appropriate adaptations based on local/indigenous and Western knowledge. Yet, we argue that CBA is not a panacea, and its common portrayal as such obscures its limitations, nuances, and challenges. Indeed, if uncritically adopted, CBA can potentially lead to maladaptation, may be inappropriate in some instances, can legitimize outside intervention and control, and may further marginalize communities. We identify responsibilities for researchers engaging in CBA work to manage these challenges, emphasizing the centrality of how knowledge is generated, the need for project flexibility and openness to change, and the importance of ensuring partnerships between researchers and communities are transparent. Researchers also need to be realistic about what CBA can achieve, and should not assume that research has a positive role to play in community adaptation just because it utilizes participatory approaches. WIREs Clim Change 2016, 7:175-191. doi: 10.1002/wcc.376 For further resources related to this article, please visit the WIREs website.

The 4Cs of adaptation tracking: consistency, comparability, comprehensiveness, coherency

Adaptation tracking seeks to characterize, monitor, and compare general trends in climate change adaptation over time and across nations. Recognized as essential for evaluating adaptation progress, there have been few attempts to develop systematic approaches for tracking adaptation. This is reflected in polarized opinions, contradictory findings, and lack of understanding on the state of adaptation globally. In this paper, we outline key methodological considerations necessary for adaptation tracking research to produce systematic, rigorous, comparable, and usable insights that can capture the current state of adaptation globally, provide the basis for characterizing and evaluating adaptations taking place, facilitate examination of what conditions explain differences in adaptation action across jurisdictions, and can underpin the monitoring of change in adaptation over time. Specifically, we argue that approaches to adaptation tracking need to (i) utilize a consistent and operational conceptualization of adaptation, (ii) focus on comparable units of analysis, (iii) use and develop comprehensive datasets on adaptation action, and (iv) be coherent with our understanding of what constitutes real adaptation. Collectively, these form the 4Cs of adaptation tracking (consistency, comparability, comprehensiveness, and coherency).

Public Health Adaptation to Climate Change in Large Cities: A Global Baseline

Climate change will have significant impacts on human health, and urban populations are expected to be highly sensitive. The health risks from climate change in cities are compounded by rapid urbanization, high population density, and climate-sensitive built environments. Local governments are positioned to protect populations from climate health risks, but it is unclear whether municipalities are producing climate-adaptive policies. In this article, we develop and apply systematic methods to assess the state of public health adaptation in 401 urban areas globally with more than 1 million people, creating the first global baseline for urban public health adaptation. We find that only 10% of the sampled urban areas report any public health adaptation initiatives. The initiatives identified most frequently address risks posed by extreme weather events and involve direct changes in management or behavior rather than capacity building, research, or long-term investments in infrastructure. Based on our characterization of the current urban health adaptation landscape, we identify several gaps: limited evidence of reporting of institutional adaptation at the municipal level in urban areas in the Global South; lack of information-based adaptation initiatives; limited focus on initiatives addressing infectious disease risks; and absence of monitoring, reporting, and evaluation.

Public Health Adaptation to Climate Change in Large Cities: A Global Baseline

Climate change will have significant impacts on human health, and urban populations are expected to be highly sensitive. The health risks from climate change in cities are compounded by rapid urbanization, high population density, and climate-sensitive built environments. Local governments are positioned to protect populations from climate health risks, but it is unclear whether municipalities are producing climate-adaptive policies. In this article, we develop and apply systematic methods to assess the state of public health adaptation in 401 urban areas globally with more than 1 million people, creating the first global baseline for urban public health adaptation. We find that only 10% of the sampled urban areas report any public health adaptation initiatives. The initiatives identified most frequently address risks posed by extreme weather events and involve direct changes in management or behavior rather than capacity building, research, or long-term investments in infrastructure. Based on our characterization of the current urban health adaptation landscape, we identify several gaps: limited evidence of reporting of institutional adaptation at the municipal level in urban areas in the Global South; lack of information-based adaptation initiatives; limited focus on initiatives addressing infectious disease risks; and absence of monitoring, reporting, and evaluation.

Protective factors for mental health and well-being in a changing climate: Perspectives from Inuit youth in Nunatsiavut, Labrador

The Canadian Arctic is experiencing rapid changes in climatic conditions, with implications for Inuit communities widely documented. Youth have been identified as an at-risk population, with likely impacts on mental health and well-being. This study identifies and characterizes youth-specific protective factors that enhance well-being in light of a rapidly changing climate, and examines how climatic and environmental change challenges these. In-depth conversational interviews were conducted with youth aged 15-25 from the five communities of the Nunatsiavut region of Labrador, Canada: Nain, Hopedale, Postville, Makkovik, and Rigolet. Five key protective factors were identified as enhancing their mental health and well-being: being on the land; connecting to Inuit culture; strong communities; relationships with family and friends; and staying busy. Changing sea ice and weather conditions were widely reported to be compromising these protective factors by reducing access to the land, and increasing the danger of land-based activities. This study contributes to existing work on Northern climate change adaptation by identifying factors that enhance youth resilience and, if incorporated into adaptation strategies, may contribute to creating successful and effective adaptation responses.

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.

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.

A review of national-level adaptation planning with regards to the risks posed by climate change on infectious diseases in 14 OECD nations

Climate change is likely to have significant implications for human health, particularly through alterations of the incidence, prevalence, and distribution of infectious diseases. In the context of these risks, governments in high income nations have begun developing strategies to reduce potential climate change impacts and increase health system resilience (i.e., adaptation). In this paper, we review and evaluate national-level adaptation planning in relation to infectious disease risks in 14 OECD countries with respect to "best practices" for adaptation identified in peer-reviewed literature. We find a number of limitations to current planning, including negligible consideration of the needs of vulnerable population groups, limited emphasis on local risks, and inadequate attention to implementation logistics, such as available funding and timelines for evaluation. The nature of planning documents varies widely between nations, four of which currently lack adaptation plans. In those countries where planning documents were available, adaptations were mainstreamed into existing public health programs, and prioritized a sectoral, rather than multidisciplinary, approach. The findings are consistent with other scholarship examining adaptation planning indicating an ad hoc and fragmented process, and support the need for enhanced attention to adaptation to infectious disease risks in public health policy at a national level.

A review of protective factors and causal mechanisms that enhance the mental health of Indigenous Circumpolar youth

OBJECTIVES

To review the protective factors and causal mechanisms which promote and enhance Indigenous youth mental health in the Circumpolar North.

STUDY DESIGN

A systematic literature review of peer-reviewed English-language research was conducted to systematically examine the protective factors and causal mechanisms which promote and enhance Indigenous youth mental health in the Circumpolar North.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with elements of a realist review. From 160 records identified in the initial search of 3 databases, 15 met the inclusion criteria and were retained for full review. Data were extracted using a codebook to organize and synthesize relevant information from the articles.

RESULTS

More than 40 protective factors at the individual, family, and community levels were identified as enhancing Indigenous youth mental health. These included practicing and holding traditional knowledge and skills, the desire to be useful and to contribute meaningfully to one's community, having positive role models, and believing in one's self. Broadly, protective factors at the family and community levels were identified as positively creating and impacting one's social environment, which interacts with factors at the individual level to enhance resilience. An emphasis on the roles of cultural and land-based activities, history, and language, as well as on the importance of social and family supports, also emerged throughout the literature. More than 40 protective factors at the individual, family, and community levels were identified as enhancing Indigenous youth mental health. These included practicing and holding traditional knowledge and skills, the desire to be useful and to contribute meaningfully to one's community, having positive role models, and believing in one's self. Broadly, protective factors at the family and community levels were identified as positively creating and impacting one's social environment, which interacts with factors at the individual level to enhance resilience. An emphasis on the roles of cultural and land-based activities, history, and language, as well as on the importance of social and family supports, also emerged throughout the literature.

CONCLUSIONS

Healthy communities and families foster and support youth who are resilient to mental health challenges and able to adapt and cope with multiple stressors, be they social, economic, or environmental. Creating opportunities and environments where youth can successfully navigate challenges and enhance their resilience can in turn contribute to fostering healthy Circumpolar communities. Looking at the role of new social media in the way youth communicate and interact is one way of understanding how to create such opportunities. Youth perspectives of mental health programmes are crucial to developing appropriate mental health support and meaningful engagement of youth can inform locally appropriate and culturally relevant mental health resources, programmes and community resilience strategies.

Community food program use in Inuvik, Northwest Territories

Background

Community food programs (CFPs) provide an important safety-net for highly food insecure community members in the larger settlements of the Canadian Arctic. This study identifies who is using CFPs and why, drawing upon a case study from Inuvik, Northwest Territories. This work is compared with a similar study from Iqaluit, Nunavut, allowing the development of an Arctic-wide understanding of CFP use – a neglected topic in the northern food security literature.

Methods

Photovoice workshops (n=7), a modified USDA food security survey and open ended interviews with CFP users (n=54) in Inuvik.

Results

Users of CFPs in Inuvik are more likely to be housing insecure, female, middle aged (35–64), unemployed, Aboriginal, and lack a high school education. Participants are primarily chronic users, and depend on CFPs for regular food access.

Conclusions

This work indicates the presence of chronically food insecure groups who have not benefited from the economic development and job opportunities offered in larger regional centers of the Canadian Arctic, and for whom traditional kinship-based food sharing networks have been unable to fully meet their dietary needs. While CFPs do not address the underlying causes of food insecurity, they provide an important service for communities undergoing rapid change, and need greater focus in food policy herein.

Mapping human dimensions of climate change research in the Canadian Arctic

This study maps current understanding and research trends on the human dimensions of climate change (HDCC) in the eastern and central Canadian Arctic. Developing a systematic literature review methodology, 117 peer reviewed articles are identified and examined using quantitative and qualitative methods. The research highlights the rapid expansion of HDCC studies over the last decade. Early scholarship was dominated by work documenting Inuit observations of climate change, with research employing vulnerability concepts and terminology now common. Adaptation studies which seek to identify and evaluate opportunities to reduce vulnerability to climate change and take advantage of new opportunities remain in their infancy. Over the last 5 years there has been an increase social science-led research, with many studies employing key principles of community-based research. We currently have baseline understanding of climate change impacts, adaptation, and vulnerability in the region, but key gaps are evident. Future research needs to target significant geographic disparities in understanding, consider risks and opportunities posed by climate change outside of the subsistence hunting sector, complement case study research with regional analyses, and focus on identifying and characterizing sustainable and feasible adaptation interventions.

Indigenous health and climate change

Indigenous populations have been identified as vulnerable to climate change. This framing, however, is detached from the diverse geographies of how people experience, understand, and respond to climate-related health outcomes, and overlooks nonclimatic determinants. I reviewed research on indigenous health and climate change to capture place-based dimensions of vulnerability and broader determining factors. Studies focused primarily on Australia and the Arctic, and indicated significant adaptive capacity, with active responses to climate-related health risks. However, nonclimatic stresses including poverty, land dispossession, globalization, and associated sociocultural transitions challenge this adaptability. Addressing geographic gaps in existing studies alongside greater focus on indigenous conceptualizations on and approaches to health, examination of global-local interactions shaping local vulnerability, enhanced surveillance, and an evaluation of policy support opportunities are key foci for future research.

Adaptation to climate change in the Ontario public health sector

BACKGROUND

Climate change is among the major challenges for health this century, and adaptation to manage adverse health outcomes will be unavoidable. The risks in Ontario - Canada's most populous province - include increasing temperatures, more frequent and intense extreme weather events, and alterations to precipitation regimes. Socio-economic-demographic patterns could magnify the implications climate change has for Ontario, including the presence of rapidly growing vulnerable populations, exacerbation of warming trends by heat-islands in large urban areas, and connectedness to global transportation networks. This study examines climate change adaptation in the public health sector in Ontario using information from interviews with government officials.

METHODS

Fifty-three semi-structured interviews were conducted, four with provincial and federal health officials and 49 with actors in public health and health relevant sectors at the municipal level. We identify adaptation efforts, barriers and opportunities for current and future intervention.

RESULTS

Results indicate recognition that climate change will affect the health of Ontarians. Health officials are concerned about how a changing climate could exacerbate existing health issues or create new health burdens, specifically extreme heat (71%), severe weather (68%) and poor air-quality (57%). Adaptation is currently taking the form of mainstreaming climate change into existing public health programs. While adaptive progress has relied on local leadership, federal support, political will, and inter-agency efforts, a lack of resources constrains the sustainability of long-term adaptation programs and the acquisition of data necessary to support effective policies.

CONCLUSIONS

This study provides a snapshot of climate change adaptation and needs in the public health sector in Ontario. Public health departments will need to capitalize on opportunities to integrate climate change into policies and programs, while higher levels of government must improve efforts to support local adaptation and provide the capacity through which local adaptation can succeed.

"From this place and of this place:" climate change, sense of place, and health in Nunatsiavut, Canada

As climate change impacts are felt around the globe, people are increasingly exposed to changes in weather patterns, wildlife and vegetation, and water and food quality, access and availability in their local regions. These changes can impact human health and well-being in a variety of ways: increased risk of foodborne and waterborne diseases; increased frequency and distribution of vector-borne disease; increased mortality and injury due to extreme weather events and heat waves; increased respiratory and cardiovascular disease due to changes in air quality and increased allergens in the air; and increased susceptibility to mental and emotional health challenges. While climate change is a global phenomenon, the impacts are experienced most acutely in place; as such, a sense of place, place-attachment, and place-based identities are important indicators for climate-related health and adaptation. Representing one of the first qualitative case studies to examine the connections among climate change, a changing sense of place, and health in an Inuit context, this research draws data from a multi-year community-driven case study situated in the Inuit community of Rigolet, Nunatsiavut, Canada. Data informing this paper were drawn from the narrative analysis of 72 in-depth interviews conducted from November 2009 to October 2010, as well as from the descriptive analysis of 112 questionnaires from a survey in October 2010 (95% response rate). The findings illustrated that climate change is negatively affecting feelings of place attachment by disrupting hunting, fishing, foraging, trapping, and traveling, and changing local landscapes-changes which subsequently impact physical, mental, and emotional health and well-being. These results also highlight the need to develop context-specific climate-health planning and adaptation programs, and call for an understanding of place-attachment as a vital indicator of health and well-being and for climate change to be framed as an important determinant of health.

Authorship in IPCC AR5 and its implications for content: climate change and Indigenous populations in WGII

This essay examines the extent to which we can expect Indigenous Knowledge, understanding, and voices on climate change ('Indigenous content') to be captured in WGII of the IPCC Fifth Assessment Report (AR5), based on an analysis of chapter authorship. Reviewing the publishing history of 309 chapter authors (CAs) to WGII, we document 9 (2.9%) to have published on climate change and Indigenous populations and involved as authors in 6/30 chapters. Drawing upon recent scholarship highlighting how authorship affect structure and content of assessment reports, we argue that, unaddressed, this will affect the extent to which Indigenous content is examined and assessed. While it is too late to alter the structure of AR5, there are opportunities to prioritize the recruitment of contributing authors and reviewers with expertise on Indigenous issues, raise awareness among CAs on the characteristics of impacts, adaptation, and vulnerability faced by Indigenous peoples, and highlight how Indigenous perspectives can help broaden our understanding of climate change and policy interventions.

Canadian federal support for climate change and health research compared with the risks posed

For emerging public health risks such as climate change, the Canadian federal government has a mandate to provide information and resources to protect citizens' health. Research is a key component of this mandate and is essential if Canada is to moderate the health effects of a changing climate. We assessed whether federal support for climate change and health research is consistent with the risks posed. We audited projects receiving federal support between 1999 and 2009, representing an investment of Can$16 million in 105 projects. Although funding has increased in recent years, it remains inadequate, with negligible focus on vulnerable populations, limited research on adaptation, and volatility in funding allocations. A federal strategy to guide research support is overdue.

Feeding the family during times of stress: experience and determinants of food insecurity in an Inuit community

This paper uses a mixed methods approach to characterise the experience of food insecurity among Inuit community members in Igloolik, Nunavut, and examine the conditions and processes that constrain access, availability, and quality of food. We conducted semi-structured interviews (n= 66) and focus groups (n= 10) with community members, and key informant interviews with local and territorial health professionals and policymakers (n= 19). The study indicates widespread experience of food insecurity. Even individuals and households who were food secure at the time of the research had experienced food insecurity in the recent past, with food insecurity largely transitory in nature. Multiple determinants of food insecurity operating over different spatial-temporal scales are identified, including food affordability and budgeting, food knowledge and preferences, food quality and availability, environmental stress, declining hunting activity, and the cost of harvesting. These determinants are operating in the context of changing livelihoods and climate change, which in many cases are exacerbating food insecurity, although high-order manifestations of food insecurity (that is, starvation) are no longer experienced.