No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Integrating human health, ecology and built environment design: A Gardens Intervention case study with an informal slum community in the Peruvian Amazon
Abstract
This dissertation investigates the intertwined relationship between the built environment and human and ecological health. The project developed and implemented a collaborative action approach to explore the potential for transdisciplinary urban ecological design interventions to be creative, effective, resource efficient and sustainable strategies to relieve burdens of disease, improve degraded urban environments, and address social inequities. The research explored the context of slum communities – places having harsh human, environmental and ecological health conditions. Using an applied Transdisciplinary Action Research (TDAR) approach to investigation, the team conducted a design-build-research project that implemented household and community gardens with residents of the informal floating slum community of Claverito in Iquitos, Peru and measured changes in human and ecological health over one year. This project tested the incorporation of health research into design practice, community design interventions as part of health initiatives, and deep community engagement to maximize impact. This dissertation presents the research in three manuscripts in preparation for publication: 1) Assessing social-ecological
health conditions in a Latin American slum community, 2) Human and ecological health outcomes of a Gardens Intervention in a Latin American slum community, 3) Using Transdisciplinary Action Research (TDAR) and a Gardens Intervention project to target human and ecological health issues in an urban slum community.
Outcomes of this research include: a) the development of a Community Social-Ecological Assessment Framework for gathering human-species-environment data in slum communities, applied to Claverito; b) analysis of the modification of the TDAR framework to target human and ecological health issues in Claverito and include a participatory design approach; c) results of the human and ecological health assessment after the Gardens Intervention: positive trend in land pollution and biodiversity of plants (change in H’ = 15.48 and 1-D = .73), birds
(change in H’ = 15.48 and 1-D = .07), and butterflies (change in H’ = .51 and 1-D = .01), significant positive changes in community beautification (p <.001), social relationships (p <.001), injuries and falls (p <.001), access to medicine (p <.001), self grown medicinal plants (p <.001), food security (p <.001), and mental wellbeing (p =.02), with household beautification not statistically significant (p = .53) and a slight decline in biodiversity of amphibians (change in H’ = .09 and 1-D = -.02); d) results of the Design Impact Assessment: residents perceived the Gardens Intervention to have meaningful positive change across all indicators of land pollution, environment, beautification, social wellbeing, medicine security, food security and mental wellbeing; and e) outcomes of the Design Sustainability Assessment: positive indication of project sustainability and stewardship in Claverito across indicators of financial investment, emotional investment, durability and use, ownership, economics and education.
... Adicionalmente, estos entornos pueden ser indicadores tanto de la salud humana como ecológica, pues en ellos están impresos los hábitos culturales, las condiciones socioeconómicas, los procesos naturales y el comportamiento de los organismos vivos a lo largo de la historia. Son como cápsulas de tiempo y códigos de barras que expresan la buena o mala salud de sus habitantes (11) . ...
... A pesar del creciente interés en estos nuevos diseños, los arquitectos paisajistas y otros diseñadores del entorno construido no reciben capacitación en su formación académica para entender y abordar los problemas de salud en las comunidades y rara vez trabajan en proyectos que evalúan las condiciones de salud para comprender los impactos de su trabajo y aumentar el conocimiento profesional de su campo (11) . De manera similar, los modelos de salud contemporáneos a menudo ignoran las dimensiones ecológicas de la salud humana, y los profesionales de la salud y ecología no reciben capacitación en su formación académica para interactuar con las comunidades y comprender cómo se pueden rediseñar el entorno y/o ambiente físico para maximizar los beneficios para la salud (25) . ...
... Fuente: Gráfico elaborado sobre la base de la definición de «Una Salud» propuesta por King, et al. (11) Simposio: Una salud • Ha producido un gran volumen de evidencias científicas para muchas disciplinas simultáneamente y en un plazo relativamente corto. • Ha creado oportunidades para la interacción de disciplinas que usualmente no están relacionadas. ...
RESUMEN Este artículo hace breve referencia a los antecedentes del concepto de "Una Salud" en el contexto mundial y peruano, y la forma como esta perspectiva holística de salud sirvió de fundamento para la creación del Centro de Investigaciones, Tecnológicas, Biomédicas y Medioambientales (CITBM) en la Universidad Nacional Mayor de San Marcos. Seguidamente, describe el proyecto InterACTION Labs, una de las experiencias que usa el enfoque de "Una Salud", liderado por el CITBM, la Universidad de Washington y Traction, esta última una organización no gubernamental enfocada en el diseño e investigación en salud y ecología. InterACTION Labs es un programa de diseño e investigación-acción transdisciplinaria (TDAR, por sus siglas en inglés) que se desarrolla en "Claverito", una comunidad flotante en la ciudad de Iquitos en la Amazonía peruana, y que se sustenta en la hipótesis de que el entorno construido es determinante de la salud, tanto del ser humano como de otras especies (aves, reptiles, plantas, etc.). También, discute el concepto de entorno construido en relación a la teoría y práctica de la salud pública, la arquitectura paisajista, la epidemiología y otros campos de la salud y del medio ambiente. Finalmente, reflexiona en los logros y desafíos del proyecto que comenzó en 2015, y describe el plan de trabajo para los próximos años, en los que se propone extender el programa y el uso del enfoque de "Una Salud" para promover la salud humana, ecológica y ambiental en el Perú y otras partes del mundo.
... Since 2015, an interdisciplinary team of Peruvian and United States researchers has worked with an informal floating slum community called Claverito, located in Iquitos, Peru on the Itaya River, a tributary floodplain of the Amazon River ( Figure 1). The program, called InterACTION Labs, has focused on using targeted interventions to the built environment in order to improve health outcomes for the community (Alarcón et al., 2018;Andrews, 2018;Andrews et al., 2022;Bachman, 2020;Conery, 2019). Notably, the program found the potential pathogen burden of water upon which the 280 community members live is large, reaching 7,700 Escherichia coli colony-forming units (CFU) per 100 mL of river water ( Figure 5). ...
... In Claverito, when the community is floating on water, interaction with the river is unavoidable. Therefore, it is not surprising that over 80% of adults and children in the community were diagnosed with at least one parasitic infection with 42% of these collected stools categorized as soft to watery (Andrews, 2018;Bachman, 2020). ...
Floating communities exist throughout the world. Many live on water with a high pathogen load due to difficulties associated with sewage management. In Claverito, an informal floating community in Iquitos, Peru, we conducted a controlled experiment to test the ability of water hyacinth (Eichhornia crassipes) to remove Escherichia coli from water. When river E. coli concentrations were at or below ∼1,500 CFU 100 mL⁻¹, water hyacinth reduced shallow concentrations (8 cm depth) down to levels deemed safe by U.S. EPA for recreational use. Above this threshold, plants were able to reduce E. coli levels within shallow water, but not down to “safe” levels. At deeper depths (>25 cm), there was evidence that plants increased E. coli concentrations. Water hyacinth removed E. coli from shallow water by providing a surface (i.e., submerged roots) onto which E. coli sorbed and by protecting organisms that can potentially consume E. coli. Unfortunately, because of root association, the total E. coli load within the water column was greater with water hyacinth present. The use of water hyacinth to keep surface water around floating communities low in E. coli could be beneficial as this is the water layer with which people most likely interact. Aquatic vegetation naturally proliferates in and around Claverito. While this study was based on curating aquatic plants in order to achieve a water‐quality outcome, it nonetheless supports concrete actions for Claverito residents under non‐curated conditions, which are outlined at the end of the manuscript.
... is not surprising that over 80% of adults and children in the community were diagnosed with at 543 least one parasitic infection with 42% of these collected stools categorized as soft to diarrhea 544 (Andrews, 2018;Bachman, 2020). 545 546 ...
... In Claverito, 541 when the community is floating on water, interacting with the river is unavoidable. Therefore, it 542 is not surprising that over 80% of adults and children in the community were diagnosed with at 543 least one parasitic infection with 42% of these collected stools categorized as soft to diarrhea 544 (Andrews, 2018;Bachman, 2020). 545 546 ...
Floating communities exist throughout the world. Many live on water with a high pathogen load due to difficulties associated with sewage management. In Claverito, an informal floating community in Iquitos, Peru, we conducted a controlled experiment to test the ability of water hyacinth (Eichhornia crassipes) to remove Escherichia coli from water. When river E. coli concentrations were at or below ~1500 CFU 100 mL-1, water hyacinth reduced shallow concentrations (8-cm depth) down to levels deemed safe by U.S. EPA for recreational use. Above this threshold, plants were able to reduce E. coli levels within shallow water, but not down to “safe” levels. At deeper depths (>25 cm), there was evidence that plants increased E. coli concentrations. Water hyacinth removed E. coli from shallow water by providing a surface (i.e., submerged roots) onto which pathogens sorbed and by protecting organisms that consume E. coli. Unfortunately, because of root association, the total E. coli load within the water column was greater with water hyacinth present, and results hinted that the plants’ protective environment also harbored parasites. The use of water hyacinth to keep surface water around floating communities low in E. coli could be beneficial as this is the water layer with which people most likely interact. Aquatic vegetation naturally proliferates in and around Claverito. While this study was based on curating aquatic plants in order to achieve a water-quality outcome, it nonetheless supports concrete actions for Claverito residents under non-curated conditions, which are outlined at the end of the manuscript.
... It is the same water where people bathe, wash clothes and dishes, recreate, and, sometimes, obtain food and water for consumption. As such, people in these floating communities regularly suffer from diarrheal illnesses caused by sewage-related pathogens (Andrews, 2018;Pandey et al., 2014). Located in Peru, there is a community that has a similar scenario to our study area, called the Claverito community, which does not have access to drinking water, sanitation, and waste management, among other infrastructures and improved conditions (Bachman, 2020). ...
This investigation addressed the environment where residents of the Lago do Catalão Community live in the municipality of Iranduba, in the state of Amazonas, from the sustainability perspective. The justification is that it is in a floodplain, subject to the Solimões River's seasonality since it is a completely floating community. In this sense, this work presents possible sustainable measures that can be applied in this community. We used the observation method to analyze sustainable activities in the community and their implications for the implementation of ecological actions, investigating the reason for failures in conducting ecological movements in the community so that sustainable practice options could be suggested for residents, considering that the community is a crossroads for tourist routes. The steps of the method were a) collecting data about the community, b) conducting dialogues with the community representative, c) identifying the main difficulties in implementing sustainable projects, d) analyzing these difficulties, and e) designing solutions capable of overcoming these difficulties. The results showed that a) an experimental structure for a dry toilet in the community was created and approved, b) a river water treatment system for domestic consumption was proposed, c) another proposal was the implementation of Handy Pod systems to filter wastewater and c) the implementation of aquatic macrophytes was suggested for phytoremediation of the area. The conclusion shows that the waters are the primary source of life for everyone in the community; as they get their food from them, through them, they move around, and around them, their lives revolve and constantly adapt to their reality. Therefore, caring for and preserving rivers and lakes is necessary. Each Lago do Catalão community resident is aware of their responsibility towards their environment.
... Floating structures are built on the Amazon River floodplains, and these have become home for many immigrants. Due to such precarious housing and poor environmental conditions, residents of these communities experience chronic illnesses, vector-borne and infectious diseases, exposure to severe storms and flooding, and lack of water, sanitary infrastructure, and access to food [11]. In 2017, a collaborative group from the University of Washington (School of Dentistry, Department of Civil and Environmental Engineering, Department of Environmental and Occupational Health, Department of Global Health, Department of Landscape Architecture, Department of Neurology, and School of Nursing) partnered with the Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, the Universidad Nacional de la Amazonía Peruana, and the Instituto Nacional de Salud in Peru and developed a transdisciplinary action research program, InterACTION Labs, to gather baseline health data and design and implement built environment improvement projects aimed at advancing the health, community strength, and future development of residents of one of these informal river communities-the Community of Claverito [12,13]. ...
Aims:
Increasing evidence supports a relationship between poor oral health and growth in children. Our objective was to assess the association between the presence of dental caries and anthropometric measurements of children residing in Claverito, a floating slum community in the Peruvian Amazon.
Methods:
For this cross-sectional study, presence of caries was assessed using dmft/DMFT (decayed, missing, filled teeth) scores and the SiC Index (mean dmft/DMFT of one-third of the study group with the highest caries score). Anthropometric categories for age-sex-specific z-scores for height and weight were calculated based on WHO standardized procedures and definitions. The association between SiC (measured by dmft/DMFT) and anthropometric measures was estimated using unadjusted and adjusted multivariable linear regression models. Critical value was established at 5%.
Results:
Our study population consisted of 67 children between the ages of 1 and 18 years old. Mean age was 9.5 years old (SD: 4.5), and the majority were female (52.2%). Almost all had dental caries (97.0%) and the mean dmft/DMFT score was 7.2 (SD: 4.7). The SiC Index of this population was 9.0. After adjusting for confounding variables, participants who had permanent dentition with the highest dmft/DMFT levels had statistically significant decreased height-for-age z-scores (HAZ) (p=0.04).
Conclusions:
We found an inverse linear association between SiC Index and height-for-age z-scores (HAZ) among children living in poverty in a floating Amazonian community in Peru. Children from under-resourced communities, like floating slums, are at high risk for oral disease possibly negatively impacting their growth and development.
... Floating structures are built on the Amazon River floodplains, and these have become home for many immigrants. Due to such precarious housing and poor environmental conditions, residents of these communities experience chronic illnesses, vector-borne and infectious diseases, exposure to severe storms and flooding, and lack of water, sanitary infrastructure, and access to food [11]. In 2017, a collaborative group from the University of Washington (School of Dentistry, Department of Civil and Environmental Engineering, Department of Environmental and Occupational Health, Department of Global Health, Department of Landscape Architecture, Department of Neurology, and School of Nursing) partnered with the Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, the Universidad Nacional de la Amazonía Peruana, and the Instituto Nacional de Salud in Peru and developed a transdisciplinary action research program, InterACTION Labs, to gather baseline health data and design and implement built environment improvement projects aimed at advancing the health, community strength, and future development of residents of one of these informal river communities-the Community of Claverito [12,13]. ...
Abstracto
Antecedentes: las enfermedades bucodentales se encuentran entre las enfermedades no transmisibles más prevalentes en todo el mundo y afectan de manera desproporcionada a las poblaciones vulnerables. La Comunidad de Claverito es una de las muchas comunidades urbanas flotantes informales ubicadas en el río Amazonas en Perú.
Objetivos: Evaluar el estado de salud dental del niño y el cuidador (DHS) y medir las asociaciones entre el DHS del niño y la calidad de vida del niño y la familia en la comunidad informal de Claverito.
Métodos: La DHS, medida por los dientes cariados y obturados (DFT / dft), se registró para 66 niños y 35 cuidadores utilizando el formulario de Evaluación Oral de la OMS. La calidad de vida relacionada con la salud bucal se midió mediante el Cuestionario de percepción de los padres y cuidadores (P-CPQ). El impacto familiar de los trastornos bucales infantiles se midió mediante la Escala de impacto familiar (FIS). Se utilizaron estadísticas descriptivas, correlaciones y análisis de regresión para evaluar las asociaciones entre las puntuaciones DFT / dft, P-CPQ y FIS (p <0,05).
Hallazgos: La mayoría de los niños evaluados eran mujeres (52%) con una edad media de 9,4 años (DE ± 4,4). La prevalencia de caries dental infantil no tratada fue del 97%. Las puntuaciones medias de DFT / dft del niño y del cuidador fueron 6,8 (DE ± 4,5) y 8,7 (DE ± 13,3), respectivamente. La media total de P-CPQ y las puntuaciones totales de FIS fueron 33,4 y 12,5, respectivamente. Se observó una asociación positiva significativa entre las puntuaciones de DFT / dft de los niños y las puntuaciones totales de FIS (p <0,01). También se observaron asociaciones significativas entre las puntuaciones de DFT / dft del niño y la edad del cuidador (p <0,01) y las puntuaciones de DFT / dft del niño y las puntuaciones de DFT del cuidador (p <0,01).
Conclusiones: Los niños y sus cuidadores residentes en la Comunidad de Claverito presentaron altos niveles de caries dental. La caries dental no tratada de los niños se asoció tanto con la calidad de vida de la familia como con la caries dental no tratada de los cuidadores. Se necesita más investigación sobre cómo mejorar la disponibilidad y el acceso a los servicios de salud bucal tiene el potencial de beneficiar la salud de los residentes de comunidades informales como la de Claverito.
Copyright: © 2021 El autor (es).
... Floating structures are built on the Amazon River floodplains, and these have become home for many immigrants. Due to such precarious housing and poor environmental conditions, residents of these communities experience chronic illnesses, vector-borne and infectious diseases, exposure to severe storms and flooding, and lack of water, sanitary infrastructure, and access to food [11]. In 2017, a collaborative group from the University of Washington (School of Dentistry, Department of Civil and Environmental Engineering, Department of Environmental and Occupational Health, Department of Global Health, Department of Landscape Architecture, Department of Neurology, and School of Nursing) partnered with the Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, the Universidad Nacional de la Amazonía Peruana, and the Instituto Nacional de Salud in Peru and developed a transdisciplinary action research program, InterACTION Labs, to gather baseline health data and design and implement built environment improvement projects aimed at advancing the health, community strength, and future development of residents of one of these informal river communities-the Community of Claverito [12,13]. ...
Background:
Oral diseases are among the most prevalent non-communicable diseases worldwide, disproportionally affecting vulnerable populations. The Community of Claverito is one of many informal urban floating communities located on the Amazon River in Peru.
Objectives:
To assess child and caregiver dental health status (DHS) and to measure the associations between child DHS and child and family quality of life in the informal Community of Claverito.
Methods:
DHS, as measured by decayed and filled teeth (DFT/dft), was recorded for 66 children and 35 caregivers using the WHO Oral Assessment form. Oral health-related quality of life was measured using the Parental-Caregiver Perceptions Questionnaire (P-CPQ). The family impact of child oral disorders was measured using the Family Impact Scale (FIS). Descriptive statistics, correlations, and regression analyses were used to evaluate the associations between DFT/dft, P-CPQ, and FIS scores (p < 0.05).
Findings:
The majority of children assessed were female (52%) with a mean age of 9.4 years (SD ± 4.4). The prevalence of untreated child dental caries was 97%. The child and caregiver's mean DFT/dft scores were 6.8 (SD ± 4.5) and 8.7 (SD ± 13.3), respectively. Mean total P-CPQ and total FIS scores were 33.4 and 12.5, respectively. A significant positive association was observed between child DFT/dft scores and total FIS scores (p < 0.01). Significant associations were also observed between child DFT/dft scores and caregiver age (p < 0.01) and child DFT/dft scores and caregiver DFT scores (p < 0.01).
Conclusions:
Children and their caregivers living in the Community of Claverito exhibited high levels of dental caries. Children's untreated dental caries were associated with both family's quality of life and caregivers' untreated dental caries. Further research is needed on how improving availability and access to oral health services have the potential to benefit the health of residents of informal communities like the one of Claverito.
... Hence, they claim that health models frequently ignore ecological dimensions of human health and disease, and that the professionals are not trained to engaging with communities in order to understand the ability of the environments health benefits maximization. Likewise, Andrews (2018) points out professionals of the built environment, health sciences and ecology fields recognizing those limitations and calling for collaborative approaches across disciplines and stakeholders. This coincides with the earlier theory of health ecology. ...
Public health services, as a preventive aspect of health care, are essential for the sustainability of the entire health care system. However, the context of public health services, which focus is primarily on prevention, is not a common setting when measuring the efficiency within nonparametric evidence-based approach. The aim of this study is to measure the efficiency of the financial performance of organizational units of the public health institute in Croatia, the Health Ecology Department in particular, during the period 2016–2018 using data envelopment analysis. Among the many reasons behind choosing this nonparametric method is the fact that it identifies the sources of inefficiency and specifies the directions and magnitudes of improvements required. Two input-oriented models – CCR under constant and BCC under variable returns-to-scale assumption – are employed for evaluating three types of efficiency – technical, pure technical and scale efficiency. Two hypotheses are examined and empirically confirmed: first, that there is significant between-unit variability in financial performance, and second, that investments are the major source of inefficiency among the observed indicators. The results have additionally revealed that the mentioned differences are less pronounced in the case of pure technical efficiency, implying that the overall inefficiency of the Health Ecology Department units can be generally attributed to scale efficiency. Besides, only three out of twelve department units are considered efficient. The implications of the research results are aimed at further research and testing the efficiency of the entire network of public health institutes, as well as to provide policy makers with new insights when considering different modes of organizing and delivering public health services.
Cleveland has experienced population loss in the past decade because of the economic and foreclosure crisis, which caused many of the residents to move away, creating an increase in vacant homes and lots. Urban community gardens are a form of greenspace that repurposes vacant homes and lots that would otherwise be potential sites for debris, dumping, arson, squatters, and crime. Other forms of greenspace have been shown to positively increase feelings of community, ties to place, and create feelings of safety while offering social space and recreation areas in urban environments. I conducted a survey at three urban community gardens in different Cleveland neighborhoods to determine who was using the gardens, how they were using them and if garden participation increased feelings of community, community strength, and improved how the participants felt about their neighbors and neighborhood. Non-gardeners were also surveyed for comparison. Survey results indicate that the gardens are similar to other forms of urban greenspace in that they serve to increase feelings of community, create ties to place by creating neighborhood satisfaction, and increasing feelings of safety. This research suggests that urban gardens are a positive way to repurpose vacant land in residential neighborhoods by offering greenspace and strengthening the community.
Several holistic and interdisciplinary approaches exist to safeguard health. Three of the most influential concepts at the moment, One Health, EcoHealth, and Planetary Health, are analyzed in this paper, revealing similarities and differences at the theoretical conceptual level. These approaches may appear synonymous, as they all promote the underlying assumption of humans and other animals sharing the same planet and the same environmental challenges, infections and infectious agents as well as other aspects of physical—and possibly mental—health. However, we would like to illuminate the differences between these three concepts or approaches, and how the choice of terms may, deliberately or involuntary, signal the focus, and underlying values of the approaches. In this paper, we have chosen some proposed and well-known suggestions of definitions. In our theoretical analysis, we will focus on at least two areas. These are (1) the value of the potential scientific areas which could be included and (2) core values present within the approach. In the first area, our main concern is whether the approaches are interdisciplinary and whether the core scientific areas are assigned equal importance. For the second area, which is rather wide, we analyze core values such as biodiversity, health, and how one values humans, animals, and ecosystems. One Health has been described as either a narrow approach combining public health and veterinary medicine or as a wide approach as in the wide-spread “umbrella” depiction including both scientific fields, core concepts, and interdisciplinary research areas. In both cases, however, safeguarding the health of vertebrates is usually in focus although ecosystems are also included in the model. The EcoHealth approach seems to have more of a biodiversity focus, with an emphasis on all living creatures, implying that parasites, unicellular organisms, and possibly also viruses have a value and should be protected. Planetary Health, on the other hand, has been put forward as a fruitful approach to deal with growing threats in the health area, not least globally. We conclude that there are actually important differences between these three approaches, which should be kept in mind when using any of these terms.
This thesis explores the relationship between health and the built environment and the capacity and challenges faced by the designer to positively affect this relationship. Health is viewed in a holistic sense, understanding that economic structures, social fabrics, ecological systems and general well-being are directly linked with physical and mental health. The hope is that an increased understanding of health consequences within the design process will achieve more comprehensive and salubrious results. This research thesis gives a background of the relationship between health and design, identifies the potential need for a third party mediator, creates an evidence based design framework for designers to better understand the health implications of their design actions, and tests the framework on a group of landscape architecture graduate students doing their capstone project on a Superfund site outside of Portland Oregon.
Local governments attempting to respond to environmental change face an array of challenges. To better understand policy responses and factors influencing local government capacity to respond to environmental change, we studied three environmental issues affecting rural or peri-urban towns in different regions of New York State: climate change in the Adirondacks (n = 63 towns), loss of open space due to residential/commercial development in the Hudson Valley (n = 50), and natural gas development in the Southern Tier (n = 62). Our analysis focused on towns’ progression through three key stages of the environmental policy process (issue awareness and salience, common goals and agenda setting, policy development and implementation) and the factors that affect this progression and overall capacity for environmental governance. We found that—when compared to towns addressing open space development and natural gas development—towns confronted with climate change were at a much earlier stage in the policy process and were generally less likely to display the essential resources, social support, and political legitimacy needed for an effective policy response. Social capital cultivated through collaboration and networking was strongly associated with towns’ policy response across all regions and could help municipalities overcome omnipresent resource constraints. By comparing and contrasting municipal responses to each issue, this study highlights the processes and factors influencing local government capacity to address a range of environmental changes across diverse management contexts.
Community gardens are critical ecological infrastructure in cities providing an important link between people and urban nature. The documented benefits of community gardens include food production, recreational opportunities, and a wide number of social benefits such as improving community stability, reducing crime, and physical and mental health benefits. While much of the literature cites community gardens as providing environmental benefits for cities, there is little empirical evidence of these benefits. Here we examine the stormwater runoff benefits of community gardens by comparing two methods to estimate absorption rates of stormwater runoff in urban community gardens of New York City. The first method uses general land cover classes as determined by a land cover dataset; the second methods adds a land cover specific to community gardens — raised beds, typically used for food production. We find that in addition to the stormwater mitigation performed by pervious surfaces within a garden site, community gardens in New York City may be retaining an additional 12 million gallons (~45 million liters) of stormwater annually due to the widespread use of raised beds with compost as a soil amendment.
The business community has learned the value of design thinking as a way to innovate in addressing people’s needs – and health systems could benefit enormously from doing the same. This paper lays out how design thinking applies to healthcare challenges and how systems might utilize this proven and accessible problem-solving process. We show how design thinking can foster new approaches to complex and persistent healthcare problems through human-centered research, collective and diverse teamwork and rapid prototyping. We introduce the core elements of design thinking for a healthcare audience and show how it can supplement current healthcare management, innovation and practice.
As marginalized neighborhoods benefit from cleanup and environmental amenities often brought by municipal sustainability planning, recent trends of land revaluation, investments, and gentrification are posing a conundrum and paradox for environmental justice (EJ) activists. In this article, I examine the progression of the urban EJ agenda—from fighting contamination to mobilizing for environmental goods and resisting environmental gentrification—and analyze how the EJ scholarship has reflected upon the complexification of this agenda. I argue that locally unwanted land uses can be reconceptualized from contamination sources to new green amenities because of the displacement they seem to trigger or accelerate.
Researchers are increasingly exploring how neighborhood greenness, or vegetation, may affect health behaviors and outcomes. Greenness may influence health by promoting physical activity and social contact; decreasing stress; and mitigating air pollution, noise, and heat exposure. Greenness is generally measured using satellite-based vegetation indices or land-use databases linked to participants’ addresses. In this review, we found fairly strong evidence for a positive association between greenness and physical activity and a less consistent negative association between greenness and body weight. Research suggests greenness is protective against adverse mental health outcomes, cardiovascular disease, and mortality, though most studies were limited by cross-sectional or ecological design. There is consistent evidence that greenness exposure during pregnancy is positively associated with birth weight, though findings for other birth outcomes are less conclusive. Future research should follow subjects prospectively, differentiate between greenness quantity and quality, and identify mediators and effect modifiers of greenness-health associations.
The aim of this paper is to establish a broad overview of the impact urban areas have on biodiversity and to determine the predicted major impacts that biodiversity loss and ecosystem degradation have and will have on the built environment. Common built environment responses to these impacts will also be examined. Regenerative design that uses the ecosystem services analysis method is proposed as a way of responding to biodiversity loss while simultaneously addressing climate change mitigation and adaption in a built environment context. This is examined for potential benefits and disadvantages.
Biodiversity, a multidimensional property of natural systems, is difficult to quantify partly because of the multitude of indices proposed for this purpose. Indices aim to describe general properties of communities that allow us to compare different regions, taxa, and trophic levels. Therefore, they are of fundamental importance for environmental monitoring and conservation, although there is no consensus about which indices are more appropriate and informative. We tested several common diversity indices in a range of simple to complex statistical analyses in order to determine whether some were better suited for certain analyses than others. We used data collected around the focal plant Plantago lanceolata on 60 temperate grassland plots embedded in an agricultural landscape to explore relationships between the common diversity indices of species richness (S), Shannon's diversity (H'), Simpson's diversity (D1), Simpson's dominance (D2), Simpson's evenness (E), and Berger–Parker dominance (BP). We calculated each of these indices for herbaceous plants, arbuscular mycorrhizal fungi, aboveground arthropods, belowground insect larvae, and P. lanceolata molecular and chemical diversity. Including these trait-based measures of diversity allowed us to test whether or not they behaved similarly to the better studied species diversity. We used path analysis to determine whether compound indices detected more relationships between diversities of different organisms and traits than more basic indices. In the path models, more paths were significant when using H', even though all models except that with E were equally reliable. This demonstrates that while common diversity indices may appear interchangeable in simple analyses, when considering complex interactions, the choice of index can profoundly alter the interpretation of results. Data mining in order to identify the index producing the most significant results should be avoided, but simultaneously considering analyses using multiple indices can provide greater insight into the interactions in a system.
Insufficient attention has been paid to how research can be leveraged to promote health policy or how locality-based research strategies, in particular community-based participatory research (CBPR), influences health policy to eliminate racial and ethnic health inequities. To address this gap, we highlighted the efforts of 2 CBPR partnerships in California to explore how these initiatives made substantial contributions to policymaking for health equity. We presented a new conceptual model and 2 case studies to illustrate the connections among CBPR contexts and processes, policymaking processes and strategies, and outcomes. We extended the critical role of civic engagement by those communities that were most burdened by health inequities by focusing on their political participation as research brokers in bridging evidence and policymaking. (Am J Public Health. Published online ahead of print July 17, 2014: e1-e9. doi:10.2105/AJPH.2014.301961).
The appropriate choice in study design is essential for the successful execution of biomedical and public health research. There are many study designs to choose from within two broad categories of observational and interventional studies. Each design has its own strengths and weaknesses, and the need to understand these limitations is necessary to arrive at correct study conclusions.
Observational study designs, also called epidemiologic study designs, are often retrospective and are used to assess potential causation in exposure-outcome relationships and therefore influence preventive methods. Observational study designs include ecological designs, cross sectional, case-control, case-crossover, retrospective and prospective cohorts. An important subset of observational studies is diagnostic study designs, which evaluate the accuracy of diagnostic procedures and tests as compared to other diagnostic measures. These include diagnostic accuracy designs, diagnostic cohort designs, and diagnostic randomized controlled trials.
Interventional studies are often prospective and are specifically tailored to evaluate direct impacts of treatment or preventive measures on disease. Each study design has specific outcome measures that rely on the type and quality of data utilized. Additionally, each study design has potential limitations that are more severe and need to be addressed in the design phase of the study. This manuscript is meant to provide an overview of study design types, strengths and weaknesses of common observational and interventional study designs.
Background
An estimated 863 million people–a third of the world’s urban population–live in slums, yet there is little information on the disease burden in these settings, particularly regarding chronic preventable diseases.
Methods
From March to May 2012, we conducted a cluster randomized survey to estimate the prevalence of noncommunicable diseases (NCDs) and associated risk factors in a peri-urban shantytown north of Lima, Peru. Field workers administered a questionnaire that included items from the WHO World Health Survey and the WHO STEPS survey of chronic disease risk factors. We used logistic regression to assess the associations of NCDs and related risk factors with age and gender. We accounted for sampling weights and the clustered sampling design using statistical survey methods.
Results
A total of 142 adults were surveyed and had a weighted mean age of 36 years (range 18–81). The most prevalent diseases were depression (12%) and chronic respiratory disease (8%), while lifetime prevalence of cancer, arthritis, myocardial infarction, and diabetes were all less than 5%. Fifteen percent of respondents were hypertensive and the majority (67%) was unaware of their condition. Being overweight or obese was common for both genders (53%), but abdominal obesity was more prevalent in women (54% vs. 10% in men, p < 0.001). Thirty-five percent of men binge drank and 34% reported current smoking; these behaviors were less common among women (4% binge drank, p < 0.001; 8% smoked, p = 0.002). Increasing age was associated with an increased risk of abdominal obesity (Odds Ratio (OR) = 1.04, 95% CI = 1.01, 1.07, p = 0.02), hypertension (OR = 1.06, 95% CI = 1.02, 1.10, p = 0.006), arthritis (OR = 1.07, 95% CI = 1.03, 1.11, p < 0.001) and cancer (OR = 1.13, 95% CI = 1.07, 1.20, p < 0.001) in adjusted models. The prevalences of other NCDs and related risk factors were similar when stratified by age or gender.
Conclusions
This study underlines the important burden of noncommunicable disease in informal settlements in Peru and suggests that prevention and treatment interventions could be optimized according to age and gender.
We review the academic literature (n=113) that addresses effects on human health and well-being that occur when people interact with open spaces and nature in urban settings. We identify key design elements and research principles as well as commonly used research methodologies and outcome variables. We identify and discuss a critical balance between reductionism in design and research and a holistic and integrative approach. That balance is as critical to successful designs of open spaces intended to improve human health and well-being as it is to successful research to document those effects. We also address gaps in the existing evidence base and recommend directions that researchers and practitioners should adopt in order to further advance the ability to design and research open spaces in urban areas to improve human health and well-being. Overall, we call for efforts to build a stronger evidence base to better inform policy- makers and practitioners in the future.
Rapid population growth, high population density, poverty, differential access to housing, public services, and poor sanitation have led to increasing vul¬ner¬ability in India’s urban centers. Globalization and climatic change have further undermined the resilience and coping capacities of the poor and vulner¬able communities. In this paper, twelve slums in Chandigarh have been selected as examples. Chandigarh is one of the planned cities of post-independent India, yet it has more than a 30 percent slum population. This paper proposes a differential health vulnerability index that takes into consideration biophysical, socio-¬eco¬nomic and institutional indicators related to health vulnerability in a local context. The twelve slums were categorized in three groups: highly, moderately and lightly (low) vulnerable. The indicators of individual slums were analyzed through participant observation and in-depth discussion with community repre¬sentatives. The difference between highly and less vulnerable slums can be de¬termined on the basis of their lack of basic infrastructural facilities and of in¬dividual “quality of life”. The study concludes that there is a need for multi-sec¬toral efforts in addressing health issues within slums. These efforts must dif¬ferentiate as regards the “vulnerability” of slums.
This paper introduces the Special Issue on slum tourism with a reflection on the state of the art on this new area of tourism research. After a review of the literature we discuss the breadth of research that was presented at the conference 'Destination Slum', the first international conference on slum tourism. Identifying various dimensions, as well as similarities and differences, in slum tourism in different parts of the world, we contest that slum tourism has evolved from being practised at only a limited number of places into a truly global phenomenon which now is performed on five continents. Equally the variety of services and ways in which tourists visit the slums has increased. The widening scope and diversity of slum tourism is clearly reflected in the variety of papers presented at the conference and in this Special Issue. Whilst academic discussion on the theme is evolving rapidly, slum tourism is still a relatively young area of research. Most papers at the conference and, indeed, most slum tourism research as a whole appears to remain focused on understanding issues of representation, often concentrating on a reflection of slum tourists rather than tourism. Aspects, such as the position of local people, remain underexposed as well as empirical work on the actual practice of slum tourism. To address these issues, we set out a research agenda in the final part of the article with potential avenues for future research to further the knowledge on slum tourism.
Globally, rapid urbanisation has substantially reduced the amount of viable agricultural land – a food security issue. Food security is bringing a renewed scholarly interest in community gardens. This paper reviews the extent of English academic literature on community gardens, including: who has undertaken the research, where it has been published, the geographical location of the gardens studied, and the various methods used to undertake the research. The characteristics of the community gardens are summarised, including what types of plants are grown, who is involved in the gardens, and who owns the land. The motivations, benefits and limitations of community gardening are also examined. Finally, potential directions for research into community gardens are highlighted. Academic literature on community gardens is dominated by studies investigating gardens in low-income areas with diverse cultural backgrounds. Research based in cities in the USA also dominates the literature. Scholars from a wide diversity of disciplines have examined community gardens but research is mostly concentrated in the social sciences. The natural sciences are notably under-represented, yet they have much to offer including assessing gardening practices to better understand the agro-biodiversity conservation potential of community gardens.
Our contemporary social and ecological problems, including climate change, peak oil and food security, necessitate solutions informed by multiple backgrounds that singular disciplines seem unable to provide, and possibly, are even incapable of providing. The increasing occurrence of multi-, inter- and transdisciplinary (MIT) research projects speak to the recognition of that necessity. But as the literature and our own experiences bear out, just calling a project “beyond disciplinary” or integrated does not necessarily yield the intended outcomes or make progress toward alleviating the hurdles of bridging disciplines. Here we examine the distinctions between three categories (multidisciplinary, interdisciplinary and transdisciplinary) of integrated research and offer reflections on how sustainability researchers can categorize their research to improve common understandings.
The goal of this paper is to introduce community gardening as a promising method of furthering well-being and resilience on multiple levels: individual, social group, and natural environment. We examine empirical evidence for the benefits of gardening, and we advocate the development and testing of social ecological models of community resilience through examination of the impact of community gardens, especially in urban areas. The definition of community is extended beyond human social ties to include connections with other species and the earth itself, what Berry (1988) has called an Earth community. We discuss the potential contribution of an extensive network of community gardens to easing the global climate change crisis and address the role of community psychologists in community gardening research and policy-oriented action.
To save biodiversity, on-the-ground agencies need to set the conservation research agenda, not distant academics and non-governmental organizations, argue Robert J. Smith and colleagues.
Community gardens are viewed as a potentially useful environmental change strategy to promote active and healthy lifestyles but the scientific evidence base for gardens is limited. As a step towards understanding whether gardens are a viable health promotion strategy for local communities, we set out to examine the social processes that might explain the connection between gardens, garden participation and health. We analyzed data from semi-structured interviews with community gardeners in Denver. The analysis examined social processes described by community gardeners and how those social processes were cultivated by or supportive of activities in community gardens. After presenting results describing these social processes and the activities supporting them, we discuss the potential for the place-based social processes found in community gardens to support collective efficacy, a powerful mechanism for enhancing the role of gardens in promoting health.
Critical environmental regions - concepts, distinctions and issues Amazonia the Aral Sea basin the Nepal middle mountains the Ukambani region of Kenya the Llano Estacado of the American Southern High Plains the Basin of Mexico the North Sea the Ordos Plateau of China the eastern Sunderland region of South-East Asia comparisons and conclusions.
Biological Diversity provides an up-to-date, authoritative review of the methods of measuring and assessing biological diversity, together with their application. The book's emphasis is on quantifying the variety, abundance, and occurrence of taxa, and on providing objective and clear guidance for both scientists and managers. This is a fast-moving field and one that is the focus of intense research interest. However the rapid development of new methods, the inconsistent and sometimes confusing application of old ones, and the lack of consensus in the literature about the best approach, means that there is a real need for a current synthesis. Biological Diversity covers fundamental measurement issues such as sampling, re-examines familiar diversity metrics (including species richness, diversity statistics, and estimates of spatial and temporal turnover), discusses species abundance distributions and how best to fit them, explores species occurrence and the spatial structure of biodiversity, and investigates alternative approaches used to assess trait, phylogenetic, and genetic diversity. The final section of the book turns to a selection of contemporary challenges such as measuring microbial diversity, evaluating the impact of disturbance, assessing biodiversity in managed landscapes, measuring diversity in the imperfect fossil record, and using species density estimates in management and conservation.
The future of Earth's ecosystems is increasingly influenced by the pace and patterns of urbanization. One of the greatest challenges for natural and social scientists is to understand how urbanizing regions evolve through the complex interactions between humans and ecological processes. Questions and methods of inquiry specific to our traditional disciplinary domains yield partial views that reflect different epistemologies and understandings of the world. In order to achieve the level of synthesis required to see the urban ecosystem as a whole we must change the way we pose questions and search for answers. Cities are the result of human and ecological processes occurring simultaneously in time and in space and the legacy of the simultaneous processes of the past. Urban ecology is the study of the co-evolution of human-ecological systems. Scholars of both urban systems and ecology must challenge the assumptions and world views within their disciplines and work towards a hybrid theory that builds on multiple world views. The synthesis of research findings provided in this book is a first step towards articulating the challenge for scholars of urban ecosystems; it leads the way toward the integration we must achieve if we are to better understand and solve emerging issues in urban ecosystems. © 2008 Springer Science+Business Media, LLC All rights reserved.
Despite the increasing acceptance of traditional medicines in peri-urban areas in South Africa, this rich indigenous knowledge is not adequately documented. Therefore, an ethnobotanical study was undertaken to document medicinal plants grown and maintained in per-urban domestic gardens in the Capricorn District, Limpopo Province. Semi-structured interviews, observation and guided walks with 62 participants were employed to obtain ethnobotanical data on medicinal plants grown and maintained in peri-urban domestic gardens. Data collected included the names of plant species growing and maintained in domestic gardens as medicines, plant parts used, methods of herbal preparation and administration. A total of 37 species belonging to 34 genera and 27 families were recorded. Carica papaya, Catharanthus roseus, Cotyledon orbiculata, Crassula capitella, Erythrina lysistemon, Pelargonium peltatum, Pelargonium zonale, Sansevieria hyacinthoides, Schinus terebinthifolius and Sclerocarya birrea had the highest values of Relative Frequency of Citation (RFC) and widely grown and managed by the inhabitants of the Limpopo Province. Cold, cough, sore throat, gastrointestinal disorders, fever, headache, injuries, circulatory system problems and sexually transmitted infections were treated with at least five species each. This study established that traditional medicines still play an important role in meeting basic health care needs of the local communities in the Limpopo Province. © 2014 National Institute of Science Communication and Information Resources (NISCAIR). All rights reserved.
Nature contact may benefit health, a relationship supported by both theoretical and empirical considerations.
Nature contact may take many forms in the built environment, such as plantings in buildings, views out windows, biophilic building design, community gardens, and parks and greenspace.
Evidence supports many benefits of such nature contact, ranging from stress reduction to improved recovery from illness and surgery.
Much remains to be learned about the benefits of nature contact, such as what kinds of nature contact offer the greatest benefit, at what “dose” and frequency, and for which people.
Providing nature contact may not only improve health but also yield co-benefits such as more energy-efficient buildings, improved access to healthy foods, and conservation of natural resources.
Research with human subjects is an essential part of modern medicine. Since the 1960s, when knowledge of research abuses surfaced and federal regulation of human subject research began, it has been a focus of ethical and regulatory controversy. Today, a regulatory system of prior review by mixed-peer bodies, called "institutional review boards" (IRBs), is firmly in place in every hospital, medical school, and research facility in the country.Robert Levine's Ethics and Regulation of Clinical Research is an excellent summary of the key ethical and regulatory issues that arise in running the IRB system. The author draws on his wide experience in human subject research as chair of the Human Use Committee of the Yale University School of Medicine, as consultant and member of various national commissions, as editor of Clinical Research and IRB: A Review of Human Subject Research, and as a prolific writer and speaker on the subject.
Community-based conservation is experiencing a crisis of identity and purpose as a result of a disappointing track record and unresolved deficiencies. The latter include over-simplified assumptions and misconceptions of “community,” the imposition of externally designed and driven projects at the community level, a focus on conservation outcomes at the expense of community empowerment and social justice, and limited attention to participatory processes. New approaches are urgently needed to address these weaknesses and to counter a rising trend towards environmental protectionism and a preference for conservation approaches at an eco-regional scale that threaten the interests of local and Indigenous communities. We propose that three core principles of community-based participatory research (CBPR)—(1) community-defined research agenda; (2) collaborative research process; and (3) meaningful research outcomes—hold much promise. Drawing on the experience of a research partnership involving the James Bay Cree community of Wemindji, northern Quebec, and academic researchers from four Canadian universities, we document the process of applying these principles to a community-based conservation project that uses protected areas as a political strategy to redefine relations with governments in terms of a shared responsibility to care for land and sea. We suggest that basic assumptions of CBPR, including collaborative, equitable partnerships in all phases of the research, promotion of co-learning and capacity building among all partners, emphasis on local relevance, and commitment to long-term engagement, can provide the basis for a revamped phase of community-based conservation that supports environmental protection while strengthening local institutions, building capacity, and contributing to cultural survival.
Landscape architects have always felt that they benefit, in practice and education, from fundamental and applied research. The results of recent surveys among landscape architecture educators now make it possible to conduct a substantive discussion about the connections between research on the one hand and teaching and practice on the other. Such connections, it seems, are still weak. To develop these connections and be able to define landscape architecture as a discipline that relies on its own body of knowledge, it is important to build a common framework of theory and methods, and to start developing specific standards for academic quality assurance, such as the evaluation of research. Strategies to put these objectives into practice include organising conferences, colloquia and seminars on research and research methodologies, and developing network activities for academic exchange, including links with research communities outside landscape architecture.
Alliances among public health, planning, and design disciplines illustrate the use of scale-based approaches to mobilize actors across space and time. Obesity prevention efforts demonstrate the use of strategies across organizational and geographical boundaries to change policies and environmental determinants that affect the level of physical activity in community settings. One framework for landscape praxis based on a social ecology of scale centers on three interrelated processes: place imaginaries, place narratives, and place polities. This trialectic highlights the possibilities for transdisciplinary practice that: (1) creates social imaginations to produce identities and give meaning, (2) produces discursive framings to legitimize particular imaginaries and identities, and (3) facilitates the formation of political communities where project identities are formed, negotiated, and mobilized toward specific goals. The obesity prevention program of the Pennsylvania Advocates for Nutrition and Activity (PANA) draws attention to social ecological approaches sensitive to various scales of social and spatial production and the possibilities for professional engagement ranging from design to policymaking. © 2011 by the Board of Regents of the University of Wisconsin System.
The current academic discourse around interdisciplinary scholarship and dissemination has major implications for plural design, a prominent area of academic engagement in landscape architecture. The engagement of citizens in dialogues on public policy indicates increasing consensus that plural design must be embedded in larger, interdisciplinary systems that will advance the work of creating public policy. This paper participates in an inquiry of Stokols's Transdisciplinary Action Research (TDAR) (2006) methodology and its potential to extend current theoretical and methodological limits in plural design research. Aligning with others, the author argues the importance of a structuring framework for plural design research and queries the philosophical and ethical changes necessary to advance environmental and community-based knowledge into higher levels of interdisciplinary discourse. The first or "theory" section juxtaposes plural design in academia with Stokols (2006) and other interpretations of transdisciplinary research. The second section uses the TDAR model to frame plural design research in three Susquehanna River towns in Pennsylvania. The discussion and conclusion speculate on the methodology's specific applicability to the case study research and the value of TDAR for university plural design practice in general. © 2011 by the Board of Regents of the University of Wisconsin System.
Urban agriculture offers a framework for local self-reliance by provisioning food security, employment opportunities, and other community benefits. However, urban agriculture must rely on the supporting and regulating services of the soil food web. Hence, we quantified belowground biocontrol activity in urban gardens and vacant lots in two post-industrial cities using an in situ insect baiting technique. Due to the differences in habitat structure, we hypothesized that belowground biocontrol services will differ between gardens and vacant lots and the influence of habitat structure would differ with the type of biocontrol organism. Results revealed that biocontrol activity, as assessed by % mortality of baited insects, varied between 51% and 98% with higher activity often recorded in vacant lots than gardens. Major contributions to bait insect mortality were by ants, followed by microbial pathogens and entomopathogenic nematodes, respectively. Ants showed higher (p
There is considerable scientific and policy interest in reducing socioeconomic and racial/ethnic disparities in healthcare and health status. Currently, much of the policy focus around reducing health disparities has been geared toward improving access, coverage, quality, and the intensity of healthcare. However, health is more a function of lifestyles linked to living and working conditions than of healthcare. Accordingly, effective efforts to improve health and reduce gaps in health need to pay greater attention to addressing the social determinants of health within and outside of the healthcare system. This article highlights research evidence documenting that tackling the social determinants of health can lead to reductions in health disparities. It focuses both on interventions within the healthcare system that address some of the social determinants of health and on interventions in upstream factors such as housing, neighborhood conditions, and increased socioeconomic status that can lead to improvements in health. The studies reviewed highlight the importance of systematic evaluation of social and economic policies that might have health consequences and the need for policy makers, healthcare providers, and leaders across multiple sectors of society to apply currently available knowledge to improve the underlying conditions that impact the health of populations.
A major problem worldwide is the potential loss of fisheries, forests, and water resources. Understanding of the processes
that lead to improvements in or deterioration of natural resources is limited, because scientific disciplines use different
concepts and languages to describe and explain complex social-ecological systems (SESs). Without a common framework to organize
findings, isolated knowledge does not cumulate. Until recently, accepted theory has assumed that resource users will never
self-organize to maintain their resources and that governments must impose solutions. Research in multiple disciplines, however,
has found that some government policies accelerate resource destruction, whereas some resource users have invested their time
and energy to achieve sustainability. A general framework is used to identify 10 subsystem variables that affect the likelihood
of self-organization in efforts to achieve a sustainable SES.
Despite an increasing arsenal of effective treatments, there are mounting challenges in developing strategies that prevent and control cardiovascular diseases, and that can be sustained and scaled to meet the needs of those most vulnerable to their impact. Community-based participatory research (CBPR) is an approach to conducting research by equitably partnering researchers and those directly affected by and knowledgeable of the local circumstances that impact health. To inform research design, implementation and dissemination, this approach challenges academic and community partners to invest in team building, share resources, and mutually exchange ideas and expertise. CBPR has led to a deeper understanding of the myriad factors influencing health and illness, a stream of ideas and innovations, and there are expanding opportunities for funding and academic advancement. To maximize the chance that CBPR will lead to tangible, lasting health benefits for communities, researchers will need to balance rigorous research with routine adoption of its conduct in ways that respectfully, productively and equally involve local partners. If successful, lessons learned should inform policy and inspire structural changes in healthcare systems and in communities.