Perceptions, priorities, and project delivery problems in women's and environmental health in Peru: a qualitative study.

BACKGROUND: Women living in low-income and-middle-income countries experience increased exposure and worse effects of environmental threats and climate change. Peru is especially susceptible to a range of environmental exposures, including high levels of pollutants, contamination associated with extractive industries, and flooding exacerbated by the ongoing climate emergency. International policies and movements are increasingly calling for a gendered approach to planetary health. However, little research has been done explicitly examining environmental threats to women's health in Peru. We aimed to understand the current Peruvian research, advocacy, and policy landscape at the environment-gender health nexus. METHODS: We did in-depth semi-structured interviews in Spanish via online Zoom video conferencing (audio only) with key informants from the Peruvian Government, academia, and non-governmental organisations to explore their perception of environmental health threats and priorities, population vulnerability factors, awareness of projects and collaborations on these topics, and the role of gender in their work. We used thematic analysis to compare priorities, gender sensitivity, and barriers and facilitators to delivering successful women's environmental health projects in the country. FINDINGS: Since July 14, 2020, we have interviewed 16 people, with four further interviews planned to take place before the end of May, 2021. Several interviewees mentioned the detrimental role of weak institutions, multilevel corruption, and the absence of interdisciplinarity and intersectorality across programmes and research. Barriers to successful collaboration across organisations and sectors were clearly identified, including funding scandals related to extractive economies, high staff turnovers impairing long-term programme implementation, and machismo culture in both organisations and communities. By contrast, some interviewees highlighted that successful collaborations were instead built on direct relationships, reputation, trust, and transparency. Women's empowerment was also described as important for successful programme delivery, especially in female-led associations. Some interviewees emphasised the so-called invisibilisation of vulnerable groups, such as girls, teenagers, pregnant women, victims of gender-based violence, and LGBTQI people. Existing health inequalities varied by setting and cultural context and were deeply and silently exacerbated by the COVID-19 pandemic. INTERPRETATION: These qualitative findings highlight the multiple and inter-related contextual issues faced by environmentally threatened communities in Peru, and how macrostructural barriers contribute to a paucity of sustainable, gender-oriented, environmental health projects. FUNDING: Partially funded by the UK's Economic and Social Research Council

Momento Económico (27)

En este número Temas de hoy, 2/ Reaganomics: Seis años despues, Elaine Levine, 3/ Las relaciones México-Estados Unidos: Hacia un replanteamiento de fondo, Ma. Teresa Gutiérrez Haces, 6/ El transporte en la ciudad de México: Su funcionamiento contradictorio, Bernardo Navarro B., 10/ Impuesto a la importación de petróleo en Estados Unidos, Miguel Ángel Flores, 13/ Comentarios a la Ley Simpson-Rodino, Mónica Verea C., 14

Climate change, mental health, and reproductive decision-making: A systematic review

The impact of climate change on reproductive decision-making is becoming a significant issue, with anecdotal evidence indicating a growing number of people factoring their concerns about climate change into their childbearing plans. Although empirical research has explored climate change and its relationship to mental health, as well as the motivations behind reproductive decision-making independently, a gap in the literature remains that bridges these topics at their nexus. This review endeavours to fill this gap by synthesising the available evidence connecting climate change-related concerns with reproductive decision-making and exploring the reasons and motivations behind this relationship. A systematic review using six databases was conducted to identify relevant literature. Included studies reported quantitative, qualitative, and mixed-methods data related to: (1) climate change, (2) mental health and wellbeing concerns, and (3) reproductive decision-making. Findings were synthesised narratively using a parallel-results convergent synthesis design and the quality of studies was appraised using three validated assessment tools. Four hundred and forty-six documents were screened using pre-defined inclusion criteria, resulting in the inclusion of thirteen studies. The studies were conducted between 2012 and 2022 primarily in Global North countries (e.g., USA, Canada, New Zealand, and European countries). Climate change concerns were typically associated with less positive attitudes towards reproduction and a desire and/or intent for fewer children or none at all. Four themes explaining this relationship were identified: uncertainty about the future of an unborn child, environmentalist views centred on overpopulation and overconsumption, meeting family subsistence needs, and environmental and political sentiments. The current evidence reveals a complex relationship between climate change concerns and reproductive decision-making, grounded in ethical, environmental, livelihood, and political considerations. Further research is required to better understand and address this issue with an intercultural approach, particularly among many highly affected Global South populations, to ensure comparability and generalisable results

Mental health among the sugarcane industry farmers and non-farmers in Peru: a cross-sectional study on occupational health.

OBJECTIVE: Describe the occupational characteristics of farmer and non-farmer workers and investigate critical occupational risk factors for mental disorders in sugarcane farmers in Peru. METHOD: We conducted a cross-sectional study with occupational health and safety focus among farmers and non-farmers. Mental disorder symptoms were evaluated through the local validated version of the 12-Item General Health Questionnaire (GHQ-12). We explored the association between mental disorder symptoms, work conditions and known occupational risk factors (weekly working hours, pesticide exposures, heat stress and heavy workload). Negative binomial regression models were fitted, and 95% CIs were calculated. RESULTS: We assessed 281 workers between December 2019 and February 2020. One hundred and six (37.7%) respondents identified themselves as farmworkers. The mean GHQ-12 scores for farmers and non-farmers were 3.1 and 1.3, respectively. In the fully adjusted multivariable model, mental disorder symptom counts among farmers were more than twice as high as those of non-farmers (β: 2.11; 95% CI: 1.48 to 3.01). The heavy workload increased the mean number of mental disorder symptoms by 68% (95% CI: 21% to 133%), and each additional working hour per day increased the mean number of mental disorder symptoms by 13% (95% CI: 1% to 25%). CONCLUSION: Farmers have higher mental disorder symptoms than non-farmers. A heavy workload and more working hours per day are independently associated with more mental disorder symptoms. Our findings highlight the importance of including mental health within occupational programmes and early interventions tailored to sugarcane industrial mill workers in the Latin American context

Mental health and wellbeing outcomes of climate change mitigation and adaptation strategies: a systematic review

Abstract Climate change has already impacted the health and wellbeing of ∼5 billion people globally. However, the potential influence of climate change mitigation and adaptation strategies on mental health and wellbeing outcomes in low-and-middle-income countries (LMICs) remains insufficiently understood. We aimed to determine the effect of these strategies on mental health and wellbeing outcomes among LMIC beneficiaries. We carried out a systematic review to identify intervention and case studies published from 2013 to 2022, searching OVID Medline, Embase, PsycINFO, Global Health, Cochrane Library, GreenFile, Web of Science, and a subset of studies from the ‘Global Adaptation Mapping Initiative’ database. We included controlled, quasi-experimental, pilot, and focussed case studies reporting mental health or wellbeing outcomes assessments of climate change mitigation and adaptation strategies. We categorised studies by design, geographic region, target population, setting, environmental hazard, strategy type and primary outcomes. PROSPERO registry: CRD42021262711. A total of 9532 studies were initially retrieved, and 15 studies involving 12 255 participants met the inclusion criteria. Among these, twelve studies described evidence from single-adaptation strategies in nine LMICs, while three reported mitigation programmes. Only two randomised evaluations assessed common mental disorders such as depression, trauma or anxiety using validated scales. Most studies evaluated broader wellbeing at the community and individual levels. Nine studies (53.3%) reported significant beneficial changes in mental health or wellbeing outcomes among beneficiaries, while six (46.7%) obtained mixed results linked to local and sociocultural factors. The interventions ‘practical significance and overall impact remained unclear due to the heterogeneous reporting in program effectiveness, gaps in effect size assessments or qualitative insights. Our review highlights the scarcity and limited nature of the current evidence, underscoring the need for further equitable research. The ongoing global climate and mental health crises press us to fully understand and address these strategies’ psychosocial impacts and translate these findings into effective policy and transdisciplinary action as an opportunity to prevent and ameliorate significant, long-term problems in the population’s mental health and wellbeing

Mental health impact of social capital interventions: a systematic review.

PURPOSE: Mental disorders are a major contributor to the global burden of disease and disability, and can be extremely costly at both individual and community level. Social capital, (SC) defined as an individual's social relationships and participation in community networks, may lower the risk of mental disorders while increasing resilience capacity, adaptation and recovery. SC interventions may be a cost-effective way of preventing and ameliorating these conditions. However, the impact of these SC interventions on mental health still needs research. METHODS: We conducted a systematic review of SC-based interventions to investigate their effect on mental health outcomes from controlled, quasi-experimental studies or pilot trials. We searched twelve academic databases, three clinical trials registries, hand-searched references and contacted field experts. Studies' quality was assessed with the Cochrane Risk of Bias tools for randomized and non-randomized studies. RESULTS: Seven studies were included in the review, published between 2006 and 2016. There was substantial heterogeneity in the definitions of both SC and mental disorders among the studies, preventing us from calculating pooled effect sizes. The interventions included community engagement and educative programs, cognitive processing therapy and sociotherapy for trauma survivors, and neighbourhood projects. CONCLUSIONS: There are paucity of SC interventions investigating the effect on mental health outcomes. This study showed that both SC scores and mental health outcomes improved over time but there was little evidence of benefit compared to control groups in the long term. Further high-quality trials are needed, especially among adverse populations to assess sustainability of effect

A Call to Action for Gender Equity in Climate Leadership.

Climate action is not advancing quickly enough to prevent catastrophic harm. Understanding why might require looking at existing leadership structures and the inequitable gender representation therein. Critically examining dominant power structures could pave the way toward more comprehensive, innovative, and expedient environmental solutions-and we argue that elevating women's climate leadership is key to safeguarding planetary health. Women have historically been left out of climate science and governance leadership. Women are disproportionately impacted by the health effects of climate change, particularly in Indigenous and low- and middle-income settings. Therefore, our call for women's climate leadership is both an issue of justice and a matter of effectiveness, given evidence that inclusive leadership rooted in gender justice leads to more equitable outcomes. Here, we present evidence for why gender equity in climate leadership matters along with considerations for how to attain it across sectors and stakeholders

A healthy planet for a healthy mind

The evidence base connecting planetary and human health is growing, but thus far the research community has primarily focused on the physical health implications. This Voices asks: how does environmental degradation affect mental health, and what are the emerging needs and research priorities

Identifying gaps on health impacts, exposures, and vulnerabilities to climate change on human health and wellbeing in South America: a scoping review

There is an important gap in regional information on climate change and health, limiting the development of science-based climate policies in South American countries. This study aims to identify the main gaps in the existing scientific literature on the impacts, exposure, and vulnerabilities of climate change on population health. A scoping review was performed guided by four sub-questions focused on the impacts of climate change on physical and mental health, exposure and vulnerability factors of population to climate hazards. The main findings showed that physical impacts mainly included infectious diseases, while mental health impacts included trauma, depression, and anxiety. Evidence on population exposure to climate hazards is limited, and social determinants of health and individual factors were identified as vulnerability factors. Overall, evidence on the intersection between climate change and health is limited in South America and has been generated in silos, with limited transdisciplinary research. More formal and systematic information should be generated to inform public policy