Psychedelic Science, Contemplative Practices, and Indigenous and Other Traditional Knowledge Systems: Towards Integrative Community-Based Approaches in Global Health

As individuals and communities around the world confront mounting physical, psychological, and social threats, three complimentary mind-body-spirit pathways toward health, wellbeing, and human flourishing remain underappreciated within conventional practice among the biomedical, public health, and policy communities. This paper reviews literature on psychedelic science, contemplative practices, and Indigenous and other traditional knowledge systems to make the case that combining them in integrative models of care delivered through community-based approaches backed by strong and accountable health systems could prove transformative for global health. Both contemplative practices and certain psychedelic substances reliably induce self-transcendent experiences that can generate positive effects on health, well-being, and prosocial behavior, and combining them appears to have synergistic effects. Traditional knowledge systems can be rich sources of ethnobotanical expertise and repertoires of time-tested practices. A decolonized agenda for psychedelic research and practice involves engaging with the stewards of such traditional knowledges in collaborative ways to codevelop evidence-based models of integrative care accessible to the members of these very same communities. Going forward, health systems could consider Indigenous and other traditional healers or spiritual guides as stakeholders in the design, implementation, and evaluation of community-based approaches for safely scaling up access to effective psychedelic treatments.

Psychedelic Research and Therapeutic Practices: Embracing Communities, Groups, and Traditional Knowledge

The global prevalence of substance abuse and mental disorders continues to challenge healthcare systems, with one in eight individuals affected. The therapeutic potential of psychedelics is recognized not only for treating mental disorders but also for enhancing well-being and promoting pro-social behaviors. Conventional biomedical research models fall short in addressing the broader health needs of populations and poorly suited for overcoming barriers to service delivery. This special issue includes six articles that explore alternative approaches to psychedelic research and practice, emphasizing collaboration with diverse actors, including indigenous communities, and incorporating traditional knowledge systems into contemporary psychedelic research. They underscore the need for innovative research methods that engage multidisciplinary approaches while promoting culturally relevant outcome measures. They emphasize the importance of shifting from punitive drug policies to those grounded in public health and human rights, allowing for multi-country studies and the development of evidence-based care models for community mental health. Incorporating traditional knowledge and community-based methodologies into psychedelic science is vital for its evolution beyond biomedical research for widespread dissemination, offering new avenues for improved health outcomes and promotion of human flourishing.

Policy considerations that support equitable access to responsible, accountable, safe, and ethical uses of psychedelic medicines

There is mounting evidence suggesting psychedelic and entactogen medicines (namely psilocybin and 3,4-methylenedioxymethamphetamine [MDMA]), in conjunction with proper psychosocial support, hold the potential to provide safe, rapid acting, and robust clinical improvements with durable effects. In the US, both psilocybin and MDMA have been granted Breakthrough Therapy designations by the US Food and Drug Administration and may potentially receive full FDA approval with similar regulatory considerations occurring in multiple countries. At the same time, regulatory changes are poised to increase access to legal or decriminalized psychedelic use in various non-medical settings. This review provides a brief discussion on the historical use of psychedelic medicines, the status of the empirical evidence, and numerous significant policy considerations that must be thoughtfully addressed regarding standards-of-practice, consumer protection, engagement of communities, safeguarding access for all, and developing data standards, which supports the responsible, accountable, safe, and ethical uses of these medicines in clinical, faith-based, and other contexts. We provide suggestions for how public health and harm reduction can be supported through a public-private partnership that engages a community of stakeholders from various disciplines in the co-creation and dissemination of best practices and public policies.

Applying the Innov8 approach for reviewing national health programmes to leave no one behind: lessons learnt from Indonesia

The World Health Organization's Innov8 Approach for Reviewing National Health Programmes to Leave No One Behind is an eight-step process that supports the operationalization of the Sustainable Development Goals' commitment to 'leave no one behind'. In 2014-2015, Innov8 was adapted and applied in Indonesia to review how the national neonatal and maternal health action plans could become more equity-oriented, rights-based and gender-responsive, and better address critical social determinants of health. The process was led by the Indonesian Ministry of Health, with the support of WHO. It involved a wide range of actors and aligned with/fed into the drafting of the maternal newborn health action plan and the implementation planning of the newborn action plan. Key activities included a sensitization meeting, diagnostic checklist, review workshop and in-country work by the review teams. This 'methods forum' article describes this adaptation and application process, the outcomes and lessons learnt. In conjunction with other sources, Innov8 findings and recommendations informed national and sub-national maternal and neonatal action plans and programming to strengthen a 'leave no one behind' approach. As follow-up during 2015-2017, components of the Innov8 methodology were integrated into district-level planning processes for maternal and newborn health, and Innov8 helped generate demand for health inequality monitoring and its use in planning. In Indonesia, Innov8 enhanced national capacity for equity-oriented, rights-based and gender-responsive approaches and addressing critical social determinants of health. Adaptation for the national planning context (e.g. decentralized structure) and linking with health inequality monitoring capacity building were important lessons learnt. The pilot of Innov8 in Indonesia suggests that this approach can help operationalize the SDGs' commitment to leave no one behind, in particular in relation to influencing programming and monitoring and evaluation.

Gender, health and the 2030 agenda for sustainable development

Gender refers to the social relationships between males and females in terms of their roles, behaviours, activities, attributes and opportunities, and which are based on different levels of power. Gender interacts with, but is distinct from, the binary categories of biological sex. In this paper we consider how gender interacts with the 2030 agenda for sustainable development, including sustainable development goal (SDG) 3 and its targets for health and well-being, and the impact on health equity. We propose a conceptual framework for understanding the interactions between gender (SDG 5) and health (SDG 3) and 13 other SDGs, which influence health outcomes. We explore the empirical evidence for these interactions in relation to three domains of gender and health: gender as a social determinant of health; gender as a driver of health behaviours; and the gendered response of health systems. The paper highlights the complex relationship between health and gender, and how these domains interact with the broad 2030 agenda. Across all three domains (social determinants, health behaviours and health system), we find evidence of the links between gender, health and other SDGs. For example, education (SDG 4) has a measurable impact on health outcomes of women and children, while decent work (SDG 8) affects the rates of occupation-related morbidity and mortality, for both men and women. We propose concerted and collaborative actions across the interlinked SDGs to deliver health equity, health and well-being for all, as well as to enhance gender equality and women’s empowerment. These proposals are summarized in an agenda for action.

Tools and approaches to operationalize the commitment to equity, gender and human rights: towards leaving no one behind in the Sustainable Development Goals

The objective of this article is to present specific resources developed by the World Health Organization on equity, gender and human rights in order to support Member States in operationalizing their commitment to leave no one behind in the health Sustainable Development Goals (SDGs), and other health-related goals and targets. The resources cover: (i) health inequality monitoring; (ii) barrier analysis using mixed methods; (iii) human rights monitoring; (iv) leaving no one behind in national and subnational health sector planning; and (v) equity, gender and human rights in national health programme reviews. Examples of the application of the tools in a range of country contexts are provided for each resource.

A life-course approach to health: synergy with sustainable development goals

A life-course approach to health encompasses strategies across individuals’ lives that optimize their functional ability (taking into account the interdependence of individual, social, environmental, temporal and intergenerational factors), thereby enabling well-being and the realization of rights. The approach is a perfect fit with efforts to achieve universal health coverage and meet the sustainable development goals (SDGs). Properly applied, a life-course approach can increase the effectiveness of the former and help realize the vision of the latter, especially in ensuring health and well-being for all at all ages. Its implementation requires a shared understanding by individuals and societies of how health is shaped by multiple factors throughout life and across generations. Most studies have focused on noncommunicable disease and ageing populations in high-income countries and on epidemiological, theoretical and clinical issues. The aim of this article is to show how the life-course approach to health can be extended to all age groups, health topics and countries by building on a synthesis of existing scientific evidence, experience in different countries and advances in health strategies and programmes. A conceptual framework for the approach is presented along with implications for implementation in the areas of: (i) policy and investment; (ii) health services and systems; (iii) local, multisectoral and multistakeholder action; and (iv) measurement, monitoring and research. The SDGs provide a unique context for applying a holistic, multisectoral approach to achieving transformative outcomes for people, prosperity and the environment. A life-course approach can reinforce these efforts, particularly given its emphasis on rights and equity.

Assessing the Impact of a Human Rights-Based Approach across a Spectrum of Change for Women's, Children's, and Adolescents' Health

Global momentum around women's, children's, and adolescents' health, coupled with the ambitious and equalizing agenda of the Sustainable Development Goals (SDGs), has exposed a tension between the need for comprehensive, multi-actor, rights-based approaches that seek to "close the gaps" and a growing economic and political imperative to demonstrate efficiency, effectiveness, and returns on specific investments. To address this challenge, this paper proposes a framework to measure "results" in a way that offers a more nuanced understanding of the impact of human rights-based approaches and their complexity, as well as their contextual, multi-sectoral, and evolving nature. We argue that the impact of human rights-based approaches is best measured across a spectrum of change-at the individual, programmatic, structural, and societal levels. Such an analysis would allow for more accurate assessments of the cumulative effect of these changes. The paper also underscores the long-overdue need to better define the parameters of a human rights-based approach to health. This is an important part of the research agenda on human rights and health in the context of the SDGs and the Global Strategy for Women's, Children's and Adolescents' Health, and amid calls for better measurement and greater accountability for resources, results, and rights at all levels. While this paper focuses on women's, children's, and adolescents' health, the proposed framework can apply as readily to other areas of health and provides a new frame of reference for assessing the impact of human rights-based approaches.

Sexing development and relocating gender: an organisational case study

While gender has become increasingly mainstreamed in international development, it has lost its sharpness as an analytical tool and operational means to women's liberation. Sexuality, while it intersects with gender as a social construct, has been largely ignored within development contexts. This paper draws on findings that emerged from the gains and struggles experienced by project staff in a large international development agency engaging communities on issues related to sexual and women's rights. In so doing, it illustrates how a sexuality lens can move beyond gender equity and sexual health programmes focused on women's vulnerability (largely framed around protecting women and promoting access to services and contraceptive or condom use) to richer understandings of the range of social and cultural factors shaping sexual meanings and gender roles. Reshaping understandings of gender and sexuality requires a change from the conventional development discourse based on biomedical and moral-based sensibilities that associates sex with risk and danger, towards one that also recognises pleasure and agency. Sexuality is a vital aspect of development and sexual rights are a precondition not only for HIV/AIDS prevention, reproductive health or rights, but also for gender equality and social inclusion more widely. While personal and organisational transformation is fundamental, broader social, cultural and political forces, from community groups to governments and donors at large, must lie at the heart of change.

Power, pleasure, pain, and shame: assimilating gender and sexuality into community-centred reproductive health and HIV prevention programmes in India

Inspired by the vision of the Millennium Declaration, CARE and ICRW (International Centre for Research on Women) partnered with the Inner Spaces, Outer Faces Initiative (ISOFI) to learn how to more effectively integrate gender and sexuality into CARE's sexual and reproductive health programmes. Drawing from lessons learned from gender mainstreaming, ISOFI focuses initially on fostering personal change among staff, helping them to explore their own gender and sexuality 'baggage' and supporting transformation of their 'inner space'. ISOFI then gradually integrates mechanisms to promote organizational change, and finally extends to community development practice, the 'outer face'. As a system promoting change in organizational culture and practice, ISOFI features structured iterative loops of reflection and learning, action and experimentation, and analysis and assimilation. This article describes the ISOFI Innovation System, and reports on ISOFI-generated learning and innovation in sex positive HIV prevention programming for truckers and reproductive health interventions for women in India.

Chromium geochemistry and bioaccumulation in sediments from the lower Hackensack River, New Jersey

Total and hexavalent chromium [Cr(VI)] were measured in sediment and sediment porewater in the lower Hackensack River (NJ) to assess the relationship between sediment geochemistry and chromium speciation, which in turn controls the mobility, bioavailability, and toxicity of chromium. Between 2003 and 2005, >100 surface (0 to 15 cm) sediment samples were tested for total chromium and Cr(VI), acid-volatile sulfides (AVS), ferrous iron (Fe(II)), divalent manganese (Mn(II)), ammonia, and organic carbon. Sediment porewater samples were collected by centrifugation or using in situ samplers colocated with the collection of sediments. In whole sediments, total chromium and Cr(VI) concentrations ranged from 5 to 9190 mg/kg dry weight (dw) and from <0.47 to 31 mg/kg dw, respectively. Sediment porewater concentrations ranged from <10 to 83 microg/l for total chromium; Cr(VI) was not detected in sediment porewater (n = 78). Concentrations of AVS (ranging between <10.6 to 4178 mg/kg) and other geochemistry measurements indicated anoxic, reducing conditions in the majority of sediment samples. In polychaetes (Nereis virens) and clams (Macoma nasuta) exposed in the laboratory for 28 days to sediments contained between 135 and 1780 mg/kg dw total chromium, concentrations in whole tissues after 24-hour depuration ranged between 1.2 and 14.8 mg/kg wet weight (ww; median 1.6 mg/kg ww) total chromium. In whole tissues of indigenous polychaetes collected from the sediment, tissue concentrations of total chromium ranged between 1.0 and 37.5 mg/kg ww (median = 2.1 mg/kg ww). Chromium concentrations in whole tissues of animals exposed in the field or in the laboratory showed no relationship with total chromium or Cr(VI) concentrations in the sediment. There were no statistical differences among animals exposed to sediments from site and reference locations. The results of this study are consistent with sediment studies conducted elsewhere indicating low chromium bioavailability in sediment under reducing conditions. This study also highlights the importance of sediment geochemistry and in situ porewater measurements to understand the ecological significance of chromium in sediment and the potential for human health and ecological exposures.

Health care needs of Central American refugees

Public health nurses working with undocumented refugees from Central America encounter afflictions ranging from parasitic infection, emotional trauma, and homelessness. Helping this population requires the skills of a diplomat, advocate, and public health professional--as the experience of one Los Angeles public health nurse demonstrates.