Responding to Climate and Environmental Change Impacts on Human Health via Integrated Surveillance in the Circumpolar North: A Systematic Realist Review

Abstract

Environments are shifting rapidly in the Circumpolar Arctic and Subarctic regions as a result of climate change and other external stressors, and this has a substantial impact on the health of northern populations. Thus, there is a need for integrated surveillance systems designed to monitor the impacts of climate change on human health outcomes as part of broader adaptation strategies in these regions. This review aimed to identify, describe, and synthesize literature on integrated surveillance systems in Circumpolar Arctic and Subarctic regions, that are used for research or practice. Following a systematic realist review approach, relevant articles were identified using search strings developed for MEDLINE® and Web of Science™ databases, and screened by two independent reviewers. Articles that met the inclusion criteria were retained for descriptive quantitative analysis, as well as thematic qualitative analysis, using a realist lens. Of the 3431 articles retrieved in the database searches, 85 met the inclusion criteria and were analyzed. Thematic analysis identified components of integrated surveillance systems that were categorized into three main groups: structural, processual, and relational components. These components were linked to surveillance attributes and activities that supported the operations and management of integrated surveillance. This review advances understandings of the distinct contributions of integrated surveillance systems and data to discerning the nature of changes in climate and environmental conditions that affect population health outcomes and determinants in the Circumpolar North. Findings from this review can be used to inform the planning, design, and evaluation of integrated surveillance systems that support evidence-based public health research and practice in the context of increasing climate change and the need for adaptation.

From participatory engagement to co-production: modelling climate-sensitive processes in the Arctic

“…In climate research, positivist forms of knowledge have previously been prioritised at the expense of experiential knowledge, which can result in the creation of knowledge both detached from its local context and embedded in Western scientific epistemologies that are shaped by histories of colonisation (Conway et al, 2019). Engaging citizens and rightsholders in research and decision-making is one way to challenge these in-grained hierarchies of knowledge and their problematic manifestations in the creation of knowledge relevant to climate change (Sawatzky et al, 2018;Kipp et al, 2019;van Bavel et al, 2020). Participatory processes, including collaborative, co-productive, and cross-cultural methods for knowledge production, can provide more place-based and contextual nuance to previously positivist climate and environmental modelling processes (Lynam et al, 2007;Nakashima et al, 2012;Alshaikh, 2013;Crate et al, 2019;Gotts et al, 2019;Mach et al, 2020).…”

Integrating climate in Ugandan health and subsistence food systems: where diverse knowledges meet

“…This research maps existing networks of trusted relationships already used for integrating diverse knowledges, information, and administrative action. As researchers and public health practitioners, we tend to focus on the implementation stage of surveillance as being an easy entry point for opening the process up to others [28,32,41,90]. In this way, we allow for extractive approaches in practice that disregard alternative, and sometimes divergent, ways of knowing embedded in diverse (non-western scientific) knowledge systems [33,40].…”

“…Existing surveillance systems and conventional epidemiological approaches, however, do not always consider broader contextual, cultural, historical, social and political processes of health inequities, and thus have the tendency to further discriminate against and omit marginalized groups of people [22][23][24][25][26]. Place-and community-based forms of monitoring and response are important in underpinning the development of both an integrated as well as equitable evidence base that will inform our understanding of climate-health impacts [27][28][29][30][31][32]. Meaningful engagement of local communities, Indigenous peoples, and experts in this surveillance process not only helps build an evidence base that is equitably diverse and locally meaningful, but also informs the usability of information and connects knowledges 1 into decisionmaking and action-oriented processes [32][33][34][35][36][37][38].…”

"All the problems in the community are multi-faceted and related to each other": Inuit concerns in an era of climate change

“…While much of this research focuses on food security and subsistence hunting , the AV approach has also been applied in the study of health. Examples of work in this mode include the developments of methods for applying AV frameworks to the study of Inuit health , cataloguing and describing potential health consequences of climate change and possible adaptations (Berner and Furgal, 2004;Furgal and Seguin, 2006;Ford et al, 2010), examinations of the links between perceived climate change and health priorities (Harper et al, 2015), and investigating the links between vulnerability to climate change and health outcomes (Brubaker et al, 2011;Dudley et al, 2015;Sawatzky et al, 2018).…”