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International Journal of
and Public Health
Project Earthrise: Proceedings of the Ninth Annual Conference
of inVIVO Planetary Health
Susan L. Prescott 1, 2,3 ,4,*,†, Ganesa Wegienka 5, Remco Kort 6,7, David H. Nelson 8, Sabine Gabrysch 9,10,11 ,
Trevor Hancock 12,‡, Anita Kozyrskyj 13 , Christopher A. Lowry 14 , Nicole Redvers 15 , Blake Poland 16,
Jake Robinson 17 , Jean-Claude Moubarac 18 , Sara Warber 4,19 , Janet Jansson 20, Aki Sinkkonen 21,
John Penders 22 , Susan Erdman 23, Ralph Nanan 24 , Matilda van den Bosch 25 , Kirk Schneider 26, 27 ,28 ,
Nicholas J. Schroeck 29, Tanja Sobko 30 , Jamie Harvie 31, George A. Kaplan 4,32, Rob Moodie 33 ,
Laura Lengnick 34, Isaac Prilleltensky 35 , Yuria Celidwen 36, Susan H. Berman 4, Alan C. Logan 4and Brian Berman 4
Citation: Prescott, S.L.; Wegienka, G.;
Kort, R.; Nelson, D.H.; Gabrysch, S.;
Hancock, T.; Kozyrskyj, A.; Lowry,
C.A.; Redvers, N.; Poland, B.; et al.
Project Earthrise: Proceedings of the
Ninth Annual Conference of inVIVO
Planetary Health. Int. J. Environ. Res.
Public Health 2021,18, 10654. https://
Academic Editor: Jon Øyvind Odland
Received: 16 August 2021
Accepted: 18 September 2021
Published: 12 October 2021
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1NOVA Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA
2School of Medicine, University of Western Australia, Nedlands, WA 6009, Australia
3ORIGINS Project, Telethon Kids Institute at Perth Children’s Hospital, Nedlands, WA 6009, Australia
4Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland
School of Medicine, Baltimore, MD 21201, USA; email@example.com (S.W.);
firstname.lastname@example.org (G.A.K.); email@example.com (S.H.B.); firstname.lastname@example.org (A.C.L.);
5Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI 48202, USA; email@example.com
6Department of Molecular Cell Biology, Vrije Universiteit Amsterdam, De Boelelaan 1108,
1081 HZ Amsterdam, The Netherlands; firstname.lastname@example.org
7ARTIS_Micropia, Plantage Kerklaan 38-40, 1018 CZ Amsterdam, The Netherlands
8Independent Researcher, Woodstock, ON N4S 6Y9, Canada; email@example.com
9Heidelberg Institute of Global Health, Heidelberg University, 69120 Heidelberg, Germany;
10 Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association,
14412 Potsdam, Germany
11 Institute of Public Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
12 School of Public Health and Social Policy, University of Victoria, Victoria, BC V8W 2Y2, Canada;
13 Department of Pediatrics, Faculty of Medicine & Dentistry, Alberta, Edmonton Clinic Health Academy,
Edmonton, AB T6G 1C9, Canada; firstname.lastname@example.org
14 Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA;
15 School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA;
16 Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
17 Department of Landscape, The University of Shefﬁeld, Shefﬁeld S10 2TN, UK; jmrobinson3@shefﬁeld.ac.uk
18 Department of Nutrition, Faculty of Medicine, University of Montréal, Montreal, QC H3T 1J4, Canada;
19 Department of Family Medicine, University of Michigan, Ann Arbor, MI 48109, USA
Biological Sciences Division, Paciﬁc Northwest National Laboratory, Richland, Washington, DC 99352, USA;
21 Natural Resources Institute Finland, Itäinen Pitkäkatu 4, 20520 Turku, Finland; aki.sinkkonen@luke.ﬁ
22 Department of Medical Microbiology, School for Nutrition & Translational Research in
Metabolism (NUTRIM) and Care and Public Health Research Institute (CAPHRI), Maastricht UMC+
[University Medical Centre], 6202 AZ Maastricht, The Netherlands; email@example.com
23 Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA;
24 Sydney Medical School–Nepean, University of Sydney, Camperdown, NSW 2006, Australia;
25 School of Population and Public Health, The University of British Columbia,
Vancouver, BC V6T 1Z4, Canada; firstname.lastname@example.org
26 Existential-Humanistic Institute, San Francisco, CA 94901, USA; Kschneider56@gmail.com
27 Department of Humanistic and Clinical Psychology, Saybrook University, Pasadena, CA 91103, USA
28 Teachers College, Columbia University, New York, NY 10027, USA
Int. J. Environ. Res. Public Health 2021,18, 10654. https://doi.org/10.3390/ijerph182010654 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2021,18, 10654 2 of 101
29 School of Law, University of Detroit Mercy, 651 East Jefferson Ave., Detroit, MI 48226, USA;
30 School of Biological Sciences, University of Hong Kong, Hong Kong, China; email@example.com
31 Institute for a Sustainable Future, Duluth, MN 55802, USA; firstname.lastname@example.org
32 School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
33 School of Population and Global Health (MSPGH), University of Melbourne, Parkville, VIC 3010, Australia;
34 Cultivating Resilience, LLC, Asheville, NC 28805, USA; email@example.com
35 School of Education and Human Development, University of Miami, Coral Gables, FL 33124, USA;
36 Independent Researcher, New York, NY 10017, USA; firstname.lastname@example.org
† On behalf of the inVIVO Planetary Health Community.
The “Earthrise” photograph, taken on the 1968 Apollo 8 mission, became one of the most
signiﬁcant images of the 20th Century. It triggered a profound shift in environmental awareness and
the potential for human unity—inspiring the ﬁrst Earth Day in 1970. Taking inspiration from these
events 50 years later, we initiated Project Earthrise at our 2020 annual conference of inVIVO Planetary
Health. This builds on the emergent concept of planetary health, which provides a shared narrative
to integrate rich and diverse approaches from all aspects of society towards shared solutions to
global challenges. The acute catastrophe of the COVID-19 pandemic has drawn greater attention to
many other interconnected global health, environmental, social, spiritual, and economic problems
that have been underappreciated or neglected for decades. This is accelerating opportunities for
greater collaborative action, as many groups now focus on the necessity of a “Great Transition”.
While ambitious integrative efforts have never been more important, it is imperative to apply these
with mutualistic value systems as a compass, as we seek to make wiser choices. Project Earthrise is
our contribution to this important process. This underscores the imperative for creative ecological
solutions to challenges in all systems, on all scales with advancing global urbanization in the digital
age—for personal, environmental, economic and societal health alike. At the same time, our agenda
seeks to equally consider our social and spiritual ecology as it does natural ecology. Revisiting the
inspiration of “Earthrise”, we welcome diverse perspectives from across all dimensions of the arts
and the sciences, to explore novel solutions and new normative values. Building on academic rigor,
we seek to place greater value on imagination, kindness and mutualism as we address our greatest
challenges, for the health of people, places and planet.
planetary health; grand challenges; Anthropocene; Symbiocene; collaboration;
interdependence; social and economic justice; interdisciplinary research; resilience thinking; the
great transition; biodiversity losses; climate change; environmental degradation; public health;
ecology; anthropology; political/social/environmental sciences; philosophy; geography; spirituality;
human culture; history and tradition; architecture and design; arts; ethics; wisdom; and Indigenous
1. Introduction—Setting the Scene for Project Earthrise
There could not be a more important time to imagine a better world, and fundamen-
tally question the way we choose to live on our planet. How we see ourselves. How we
treat others. How we care for our place, our communities, and our ecosystems. Even the
way that we approach our problems. In this sense, our greatest challenges may also create
our greatest opportunities to change how we do things, and how we work together on a
global scale—in ways we never have before .
The grand challenges of the Anthropocene are of our making, and ultimately stem
from human attitudes and relationships to each other and to our environment—with war
and destruction, poverty and inequality, disease and despair, biodiversity loss, climate
Int. J. Environ. Res. Public Health 2021,18, 10654 3 of 101
change, famine, pandemics, increasing polarization, and social unrest, as a consequence.
The future of human and environmental health is enmeshed with politics, economics,
public policies (or lack, thereof), and social values. Concepts of planetary health recognize
these interwoven complexities but must also confront the underlying worldview that
created and continue to perpetuate these interconnected problems.
Cross-sectoral, transdisciplinary approaches are therefore fundamental to address
these entwined issues [
], and to place a higher value on shared guiding principles that
encourage altruism and deeper awareness of interdependence [
]. It is increasingly critical
to remove artiﬁcial lines of distinction between disciplines, and create more opportunities
for specialists in all professions, to share and integrate information. Moreover, if we are
to realistically ﬁnd, evaluate and implement meaningful solutions, vigorous melding of
transdisciplinary thought must also be applied with deeper ethical considerations, as
an urgent necessity—addressing the underlying value systems that created our greatest
challenges in the ﬁrst place.
It was with these many notions that we launched Project Earthrise at our ninth annual
conference of inVIVO Planetary Health in 2020. In an age of convergence, this initiative
promotes awareness of interdependence on all scales—across the continuum of people,
places and planet—and creates opportunities through connectivity by nourishing a diverse
community of change. In addition to our established history of robust science [
Earthrise aims to normalize more mutualistic, creative approaches to positively inﬂuence
normative value systems—placing greater importance on spiritual perspectives from all
cultures, including Indigenous traditions and practices [
]. It is vital to redeﬁne “progress”
and “growth” in more meaningful ways, recognizing that not all innovation is improve-
ment, and placing greater value on deeper wisdom and happiness. While technology may
be a vital part of the solutions, it is best applied with more mutualistic value systems as
Project Earthrise seeks to equally consider our social and spiritual ecology as it does
natural ecology; to address “broken spirit” as well as “broken systems” manifest in mount-
ing social unrest, hopelessness, and unparalleled adversity [
]. Our agenda seeks to place
a higher value on self-development, creativity, and imagination in solving challenges at
all scales. This includes greater emphasis on positive assets in health and resilience on all
scales (awe, wonder, joy, love, compassion). Normalizing empathy, kindness, hope, creativ-
ity, and mutualistic values—the deeper values that unite, empower, and refocus priorities
of individuals and groups—also mediates greater social responsibility and environmental
concern. Too often, these qualities are devalued or dismissed in scientiﬁc discussions, and
doing so, we fail to recognize this is part of the problem, despite these being arguably our
greatest assets in overcoming our most difﬁcult challenges.
2. Reinvigorating Past Inspirations—As We Step Forward
Project Earthrise is inspired by one of the most profound moments in modern history.
The “Earthrise” photograph, taken on the 1968 Apollo 8 mission, became one of the
most signiﬁcant images of the 20th Century, triggering a profound shift in environmental
awareness and the potential for human unity. It provided a “wake up” call on every level,
from personal awareness to planetary consciousness.
Apollo 8 left behind a world in turmoil, war, riots, a pandemic (H3N2), famine, social
upheaval, and environmental destruction—with many parallels to our current challenges
50 years later. While focus of the journey was largely on the promise of the moon, it was
the unscheduled photograph of the Earth that unexpectedly changed our world. “We
came all the way to the moon to discover Earth”, reﬂected astronaut Bill Anders who took
the photograph, on the moment that shifted collective human consciousness [
]. This has
an utterly profound effect on personal and planetary awareness, and “
. . .
began to bend
human consciousness” [
]. In other words, it was argued that the 19
ﬁlm became the most
important part of the multi-billion-dollar project [
], stirring collective imagination, awe,
wonder, and a new sense of unity. The resulting frameshift in perspective led to large-scale
Int. J. Environ. Res. Public Health 2021,18, 10654 4 of 101
environmental and social movements and inspired the ﬁrst Earth Day in 1970. This event
had a far broader agenda than it has today, addressing manifold issues ranging from
growing poverty, blight, racism, and war, to broad-ranging environmental decay—with
exploitative economic systems as the common denominator, stemming from a culture of
proﬁt over people, and self-interest over the beauty and mystery of nature [
]. In short, it
was a call to address fundamental value systems .
This remarkable outward journey had the even more profound effect by turning
awareness inward to our own condition and that of our troubled planet [
the same kind of shift in consciousness that we need to reignite now, employing all of our
“resources” by valuing our humanity at least as much as our technology.
In an era that also holds much promise, as many groups now focus on the necessity of
a “Great Transition”, it is even more important to revisit these values and principles as we
seek wiser choices. Project Earthrise is our contribution to this important process.
“We have today the knowledge and the tools to look at the whole earth, to look at everybody
on it, to look at its resources, to look at the state of our technology, and to begin to deal
with the whole problem. I think that the tenderness that lies in seeing the Earth as small
and lonely and blue is probably one of the most valuable things that we have now.”
Margaret Mead, anthropologist, Earth Day, 1970 .
Project Earthrise was launched in December 2020, as an ongoing and evolving initiative
to reinvigorate and advance this planetary health perspective. Held virtually because of
the COVID-19 pandemic, we had the opportunity to record discussions as a resource for
others to share on an ongoing basis [
]. Here, we share the initial phase that formed the
basis of our ninth annual conference of inVIVO Planetary Health.
Building on the diverse experience and foundations of our global network, our agenda
underscores the imperative for creative ecological solutions for the challenges we face
in all systems and all scales with advancing global urbanization in the digital age—for
personal, environmental, economic, and societal health alike. We brought together diverse
perspectives from across many dimensions of the arts and the sciences, to explore novel
solutions and new normative values.
This reﬂects our ongoing focus on understanding and improving the complex rela-
tionships between human health and planetary health. We seek to emphasize the socio-eco-
biological interactions in our living environment (including urbanization, food systems,
education, social inequity, climate change, biodiversity loss, and microbial ecology) that
impact physical, mental, social, and spiritual wellbeing, together with the wider com-
munity and societal factors that govern these. We continue to have a long-range vision
that includes trans-generational and “life-course” approaches to disease prevention and
The meeting celebrates a tremendous network of like-minded people from diverse
ﬁelds whose interests span from planetary/population/environmental health to microbial
ecology/systems biology and the deep biological mechanisms—all aiming to work “sym-
biotically” to connect traditional “silos” through a more integrated systems framework
as we seek to improve personal, environmental, economic and societal health alike. Our
emphasis on meaningful collaborations and productive friendships is as important as the
data and opportunities we generate. In this way, Project Earthrise provides a space for
kindred spirits whose work is pathbreaking enough for them to feel at times isolated in
their own immediate academic (or other) environments—and enables the kind of global
convergence that exempliﬁes our goals.
Together, we have begun to create a mosaic narrative of diverse perspectives, not
just for a clearer picture of possibility, but for the spirit of hope and connectivity we have
generated in the process. As we each connect our work to the bigger picture with shared
purpose, we empower and magnify potential for change. Below, we share the submitted
abstracts, and an open invitation for all readers to watch the on-line proceeding, available
through our virtual proceedings , and to join in ongoing discussions and activities.
Int. J. Environ. Res. Public Health 2021,18, 10654 5 of 101
Our program was designed to capture this mosaic—as an evolving story to under-
score interconnections between diverse ﬁelds and encourage novel perspective for new
collaborations. The overall map for the conference sessions is shown in Figure 1, to assist
the reader in navigating and searching the content presented here.
Overview of the sessions presented within the initial Project Earthrise discussions at our
annual conference (and the corresponding sections of these proceedings).
This diverse agenda continues to unfold through ongoing conversations and op-
portunities for collaborative action—on an evolving basis. We welcome new ideas and
new collaborations and hope that the content below and the on-line discussions provide
inspiration and opportunity for many.
We encouraged all contributors, no matter the topic, to consider the ways in which
their work is relevant to the larger agenda, and to imagine how they would like to see their
ﬁeld evolve in an ideal world. Recognizing that imagining the future is the ﬁrst step to
getting there, we encouraged all to draw on the inspiration of “Earthrise” and consider the
fundamental question: “What kind of world do we want to live in?”
Int. J. Environ. Res. Public Health 2021,18, 10654 6 of 101
3. Broadening Our Vision to Set the Stage for Change
Our opening session sets the scene and scope for the meeting and introduced Project
Earthrise as both the theme of the meeting, and an ongoing collaborative venture for
change—for creating convergence of ideologies, actions and inspirations. The abstracts
presented below (summarized in Figure 2) capture some of these core elements, and video
recordings are also available online .
Broadening our vision to set the stage for change. Overview of topics and speakers in the
Int. J. Environ. Res. Public Health 2021,18, 10654 7 of 101
3.1. Messages from the Elders and Dedication of Our Meeting to Mother Earth—From Both Sides
of Her Equator
Be’sha Blondin 1, Nicole Redvers 1,2, Marlikka Perdrisat 3and Anne Poelina 4
Indigenous Wellness Foundation, Box 603, Yellowknife, NT X1A 2N5, Canada;
Medicine & Health Sciences, University of North Dakota, 1301 N Columbia Rd Stop, Grand
Forks, ND 58202, USA;
Sydney Law School, The University of Sydney, New Law Building,
Eastern Avenue, Camperdown Campus, Sydney, NSW 2006, Australia;
Institute, University of Notre Dame Australia, P.O. Box 2747, Broome, WA 6725, Australia).
We were privileged to share wisdom from the Elders of both the Arctic (Dene Peoples)
and Western Australia (the Mardoowarra Peoples). As we celebrate the unique beauty and
Natural or First Laws of each place, we can also appreciate the shared deeper resonance
within the science and values from our very different regions of the world. Each of our
collective traditions underscores the importance of balance in all things—including using
our minds, heart and spirit in making wise decisions that ensure a healthy environment for
the generations that follow.
Natural or First Law stories from all regions teach about ethics, values, codes of
conduct and how to live in a civil society. They teach the next generations to work with
one mind and one spirit, and the importance of taking responsibility for the way that
we live, and work to overcome separation and division. Natural or First Law provides a
timeless perspective of our relationship with the Earth—as the past, present and future are
fused in this moment—teaching us to care about things beyond what is human, and to
respond to protect Mother Earth. Our deep and harmonious relationships within Nature
shows that there must also be balance in society and removal of hierarchy. This helps
promote accountability, compassion, and responsibility in a life-long journey of meaning
We come from a world of “we” not “me” that considers the collective wellbeing of
communities, not just for Indigenous Peoples, but all citizens of the world. The oldest
living cultures in the world hold ancient wisdom and stories that will greatly beneﬁt many
societies in dealing with complexity, and in codesigning solutions going forward—but only
when our rights and the rights of Mother Earth are acknowledged.
Wisdom, love, and ethics of care can be gifts from Indigenous Peoples to the world
with a deep respect for our self-determination and sovereignty—symbolizing that we must
walk hand in hand together as one people for the health our planet.
3.2. Project Earthrise: Inspiring Health of People, Places and Planet
(School of Medicine, University of Western Australia, the ORIGINS Projects
at Telethon Kids Institute and Perth Children’s Hospital, Perth, WA, Australia; Department
of Family and Community Medicine, Center for Integrative Medicine, University of Mary-
land School of Medicine, Baltimore, MD, USA; and The Institute for Integrative Health,
Baltimore, MD 21231, USA).
COVID-19 has precipitated sudden and unprecedented change, underscoring the
interdependence of all systems and the direct connections between personal and planetary
health. This acute event has drawn new attention to many chronic problems and revealed
how rapidly priorities and behaviours can change. It has also created a greater imperative
to shift our trajectory towards a more sustainable and resilient future. Drawing on the same
sense of awe and unity that shifted human consciousness when we ﬁrst saw our home
across the void of space in the “Earthrise” image, Project Earthrise provides an opportunity
to reassess collective values, priorities, our sense of self and community on all scales—in
the same spirit of the ﬁrst Earth Day in 1970.
The Project Earthrise agenda creates a health narrative across all scales, emphasizing
multidimensional interactions and bi-directional relationships for ﬂourishing of people,
places and planet. It seeks to place a higher value on self-development, creativity, and
imagination in solving challenges at all scales. It recognizes that the future of health
depends not only on reducing adversity, but restoring positive and protective effects of
Int. J. Environ. Res. Public Health 2021,18, 10654 8 of 101
nature, biodiversity, traditional foods, community, and purpose—the elements that are
often neglected, undervalued and underestimated. This underscores the importance of
grassroot efforts in every sense—from restoring foundational ecosystems, such as microbial
ecology that underpins all life (including our own), to community solutions that bring out
the best of human “nature” for multi-dimensional personal and collective beneﬁts. Starting
“at the roots” also means starting at the foundations of life, recognizing the fundamental
importance of a developmental and transgenerational vision to life-long physical, emotional
health, attitudes and behaviours.
For this, we encourage work in the space “between siloes” of expertise, and harness
the spirit of connectivity, community, to promote collaboration, purpose and belonging.
We aim to bring together diverse expertise and rich perspectives to create a shared change
narrative, recognizing that seeing a problem from more angles brings solutions into clearer
focus. Together with robust science, this agenda emphasizes the importance of cultural
expression, artistic creations and narrative in linking the health of people, places and planet.
3.3. KEYNOTE LECTURE: Beyond Polarity: Seeking Unity of Spirit across Ideologies. A Legacy
of Telling the Truth and Bearing Witness to Love and Justice for People, Place and Planet
(Professor of the Practice of Public Philosophy, Harvard Divinity School,
Cambridge, MA 02138, USA; Professor Emeritus at Princeton University, Princeton, NJ
No abstract available: a recording of Dr. Cornel West’s inspirational Keynote Lecture
is available for viewing through our online proceedings .
3.4. Making Connections, Finding Balance: Remembering the Social and Spiritual Dimensions
(Retired Professor, School of Public Health and Social Policy, University
of Victoria, Victoria, BC V8W 2Y2, Canada).
Perhaps the central problem of our time is that we have lost both our connection to
nature and our sense of perspective with respect to nature. We face massive and rapid
human-created global ecological changes—The Anthropocene—driven by the combination
of population growth, economic growth and the growth in the power and ubiquity of our
technology. We have come to see ourselves as both separate from and superior to nature
and other living things, over which we have a (God-given) dominion. We can no longer
see the stars at night, we do not know our place in the universe.
Of course, it was not always so. Until comparatively recently—and still in many
Indigenous cultures—the Earth was a living being, our Mother, and other species were our
relations. Interestingly, James Lovelock’s Gaia Theory and Earth system science tells us the
same thing: The Earth “behaves as a single, self-regulating system comprised of physical,
chemical, biological and human components”. We are part of the Earth system; in fact, E.O.
Wilson’s Biophilia hypothesis says that because we evolved in nature, we have an innate
need for nature and subconsciously seek connections with the rest of life.
We are also connected to all other life through our DNA. Not only do we share 99.9% of
our DNA with other humans but 99% with chimps and bonobos and 98% with gorillas. We
share 84% with dogs, 60% with the chickens we eat and with fruit ﬂies, and even 26% with
yeast and 15% with mustard grass. Moreover, we are connected to all the people, animals
and plants that came before us through the atoms we inhale or ingest, and which once
were part of their bodies. In short, we are all deeply connected to and entirely dependent
upon the great web of life which sustains us in many ways.
The ultimate connection, perhaps, is to the universe. All our atoms—yours, mine, all
other living things, all the materials of the Earth, the solar system and beyond—have a
common origin: We are all star stuff, forged in the heart of collapsing and exploding stars.
I ﬁnd it a comforting thought that when my time is done, I will become recycled star stuff,
my borrowed atoms living on as part of the great web of life, but if you cannot see the stars
at night, you cannot see where we came from.
Int. J. Environ. Res. Public Health 2021,18, 10654 9 of 101
Suggested reading: Amsterdam Declaration on Earth System Science, 2001 (http:
//www.essp.org/ accessed on 1 August 2021).
3.5. The Lowest Common Dominator: Shifting the Underlying Value Systems That Undermine
Planetary Health on All Fronts
(Professor and Deputy Head of School of Population and Global Health
(MSPGH), University of Melbourne, Parkville, VIC 3010, Australia).
The problems I deal with are the problems of unhealthy commerce. These are the
“other” twenty-ﬁrst century pandemics—of preventable cancers, heart attacks and strokes,
diabetes and lung diseases across the globe. They are driven by the Supra National
Corporations that produce, promote and market unhealthy commodities. The values that
underly unhealthy commerce are the accumulation of money, power and inﬂuence derived
from the exploitation of consumers and resources. This produces giant power asymmetries
where governments struggle to ﬁnd any forms of national economic and social balance. Of
the world’s 100 largest economies, more than 70 are now corporations. Power is shifting
away from nation states to the Supra National Corporations. Yet, we know that what
produces the best social, economic, health and wellbeing outcomes are balance and equity:
•Balance in the way we lead our lives and the way we use resources;
Equity resulting in increasing life expectancy, literacy and numeracy and trust, and
decreasing infant mortality, mental illness, obesity, imprisonment levels and homi-
Those interested in planetary health will inevitably be in conﬂict, particularly when
we know how dramatically some of these corporations are harming our planet.
How do we resolve conﬂict? We can choose collaboration—where we have a very
high level of assertiveness (in this case about planetary health) combined with a very high
level of cooperation (in this case for-proﬁt enterprises making sustainable proﬁts). We can
support, encourage, and work with for-proﬁt companies that want to balance proﬁt and
purpose. There are some! But this approach will not work in many cases. This is where
we have to assert ourselves and compete. This is where evidence, relentless advocacy,
community mobilisation and policy change work synergistically.
And back to the theme of balance. We need to balance ourselves.
To achieve the values that drive a healthy planet—loving kindness, compassion,
empathy, sympathetic joy and liberation from our egos, we need to commit time, effort and
practice to nurture ourselves. We need to look after ourselves. This generates hope—and
hope is an essential element we require for a healthy planet.
Can we imagine a future where it becomes the norm for those born with advantage,
privilege and entitlement to become major drivers of equity, fairness, love and respect,
rather than further entrenching inequity? Healthy commerce can and must play a central
role in planetary health. Imagining is a wonderful way we give structure to our hope. It
gives us the scaffold on which we can generate and nurture our hope.
3.6. Marketing and Advertising-Based Artiﬁcial Selection: Intended and Unintended Consequences
of Mass Mimicry in Contemporary Culture
Yogi Hale Hendlin
(Erasmus University College, Burgemeester Oudlaan 50, 3062 PA
Rotterdam, The Netherlands).
From the perspective of an environmental philosopher and public health policy sci-
entist, this talk examines the intended and unintended consequences of advertising in
contemporary culture. The thesis holds that too much advertising based on short-term
private proﬁt, rather than the common good, is (de)sensitizing us in ways leading to both
human devolution and environmental degradation.
“Artiﬁcial selection” (advertising) prescribes selection according to vested interests
in a particular end goal. This type of selection can be contrasted with the processes of
natural selection which proscribe without a predetermined endgame—it is open-ended, but
limits excess through natural constraints to allow beauty to ﬂourish. Artiﬁcial selection
Int. J. Environ. Res. Public Health 2021,18, 10654 10 of 101
capitalizes on the heuristics of the human brain (cognitive shortcuts) to allow automatic
processes and avoid cognitive overload in daily function. These instinctive behaviours
are triggered by shapes, colours, and objects, which may suggest threat, security or status.
Advertising creates artiﬁcially pumped-up “supernormal stimuli” which play on these
heuristics to promote unreﬂective behaviours which lead to product consumption.
The environmental fallout of excessive consumption is obvious and are the health
consequences, with many of the unhealthiest products (such as soda drinks and ultra-
processed foods) speciﬁcally targeted to the poorer members of societies. Advertising in
general ampliﬁes dissatisfaction and resentment, particularly by those who cannot afford
more elite products—as 80% of advertising is targeted at the top 10% of earners. This
leads to a “blackhole of self-doubt” and growing mistrust of external stimuli. People
start to doubt the world around them, and eventually inside them, in growing existential
insecurity. There is growing isolation from world and from ourselves—as we forget who we
are without these commodities. It spreads ignorance, inculcates separation and gaslights
our own bodily wisdom. In all this, those least equipped to defend against their tactics are
the most susceptible.
The undermining catch of this “catch-22” is that “by trying to seem, we get further
away from where we want to be”. Thus, advertising is a form of “soft pollution” that is
appropriating our attention and canalizing our experiences—but the wider consequences
of the resulting changes in mass behaviour incur a mounting personal and planetary toll.
We have the cognitive ability to step back and see what is really going on and begin to
deconstruct these artiﬁcially constructed norms that are affecting the health of people,
places and planet.
3.7. The Crossroads of the Planetary Health Paradigm: An Indigenous Perspective on Land
(School of Medicine and Health Sciences, University of North Dakota,
Grand Forks, ND 58202, USA).
The Planetary Health movement is gaining signiﬁcant traction in and around both
universities and organizations in North America and abroad. Planetary health is by no
means a new innovative discipline, as often is suggested in academic circles, but a deeply
rooted connection that all of our Indigenous ancestors had to the land as a medicine and
healing place. To understand the planet and its functions is to understand oneself in the
Our Elders predicated the awakening of hidden diseases trapped in permafrost, to
the tilting of the planet’s axis due to the polar cap melt, to the sinking of the ground due
to sumps forming from permafrost melt and talked speciﬁcally about these changes that
were coming. From our Elders having a pure reverence for the land, reality became clear
through the lessons given by the water, animals, the sky, and through ceremony passing
the responsibility to us to learn from those lessons and enact change for the progression
We are at a crossroads as a human species in regard to the state of our mother earth.
There has been increasing calls for Indigenous involvement and leadership around the globe
at the grassroots level to support the health and stewardship of our planet. Indigenous
peoples have a large role to play in this leadership process. With organizational structures
being put in place to ensure the next seven generations have the opportunity for a healthy
life, we must ensure the traditional ways of knowing of health and disease are honoured in
a good way which starts from our original teachings. The land healing relationship is our
connection back to balance.
3.8. Rising the Feathered Serpent: Indigenous Contemplative Traditions
(Indigenous Scholar, Speaker, Advocate for Indigenous Rights and the
Rights of the Earth, New York, NY 10017, USA).
Int. J. Environ. Res. Public Health 2021,18, 10654 11 of 101
The emergent ﬁeld of contemplative studies-and its manifestation as the mindfulness
movement-draws inspiration mostly from Buddhist-derived meditation practices, texts,
and principles. These practices have been largely adopted in the West as a popular source
for health-related beneﬁts mainly related with stress reduction and focused attention. The
beneﬁts of these practices for only physical and psychological wellbeing do not represent
the higher resolve of realization of spiritual development and the structure of ethical goals.
On this note, more recently, after undergoing secularization, the popularized practices in
the West have expanded their focus to include compassion and loving–kindness practices
and the enhancement of prosocial behaviour. While these practices have been pertinent and
effective, they only represent a very selected variety of practices across Asian traditions.
Moreover, although the ﬁeld has engaged with other religious traditions and their practices
of contemplation, these studies have been scarce.
Indigenous religious traditions have likewise engaged in a diversity of contemplative
practices with similar spiritual impact, and physical and psychological beneﬁts. With
the intention and motivation of expanding the circle of inclusion, I have been working
to include Indigenous religious traditions in the conversation of contemplative science
and practice. From my work on Indigenous contemplative science, I developed my thesis
on the earth-based experience of the Ethics of Belonging. This ethos engenders conscious
social responsibility for self, community, and environment. It implies a renewed sense
of order (cosmos) through a system of integration of ecological and ethical awareness of
individual and collective, material and subtle, adaptive and interactive, and meaningful
relational purpose within a community. Within this work, I examine how our personal
stories relate to cultural accounts that can transform our identities and the social and racial
injustices of our times. This proposal is intended to invite dialogue among contemplative
Indigenous religious practices and to reclaim Indigenous traditional wisdom and revitalize
Indigenous voices as similar keepers of profound sophistication and variety. I am certain
that this dialogue not only creates inclusive and diverse ways of knowing, but it will enrich
the scope of impact of these contemplative practices to engender social change for social
and environmental justice.
3.9. Every Species Has a Song: Plant Intelligence and the Importance of Imagination in Science
(Research Associate Professor in Evolutionary Ecology at Southern Cross
University, Lismore, NSW 2480, Australia).
No abstract available.
3.10. Planetary Health: An Emerging Public Health Concern in Nepal
Sagun Paudel (President, Public Health Youth Society of Nepal, Kaski 33700, Nepal).
Background: Natural resource degradation, climate change, and global warming have
become widespread concerns and Nepal is no exception. After a long decade of political
instability, Nepal is in the transition phase of development and industrialization; the
utilization of natural resources, expansion of roadways, construction of large hydro powers,
the establishment of big industries are gradually increased. Nepal lies in between two
larges economically developing countries; China and India. The industrial development of
the neighbour country, directly and indirectly, effects on the ecosystem of Nepal.
Objective: The objective of this paper is to analyse the environmental situation, natural
resources depletion and consequences in human health in the context of Nepal. Method:
To prepare this paper, journals, articles and national reports were retrieved and analysed to
prepare a manuscript. This paper was prepared by using various secondary data sources
available on internet web pages, journals, government reports, and articles.
Findings: More than 80% of Nepalese depend on forests for livelihoods and 66% of
the total gainfully employed population is engaged in natural resource sectors. Eighty
percent of the population are at risk with the VPDs and NTDs which are only endemic in
the few districts, the population at risk will likely increase in the future due to the shifting
of disease vectors into highland areas. The ambient air appears to be polluted with high
Int. J. Environ. Res. Public Health 2021,18, 10654 12 of 101
levels of PM2.5 and NO
. These indicators reﬂect that there is a possible consequence to
increase the mortality of respiratory illness mainly on COPD and pneumonia.
Conclusion: Nepal is at risk of suffering from the consequences of global warming,
carbon emission, and other environmental threats. The protection of the environment
and ecosystem should be initiated through collective action, awareness, and implemen-
tation of activities in the frame of planetary health. It should be introduced within the
3.11. Planetary Health Perceptions Versus Priorities in Fijian Communities
Sarah Nelson, Joel Negin, Seye Abimbola, Jacqueline Thomas and Aaron Jenkins
versity of Sydney, Camperdown, NSW 2006, Australia).
Introduction: Rural Fijian communities have close relationships with land and water
and depend on it for their livelihoods and security. Correct water management is a top
priority for Fiji and planetary health at an individual community level and at the wider
ecosystem health of the catchment level. Understanding the perceptions and priorities
of water resource management for planetary health allows for action to build maintain
climate-resilient planetary health systems and for communities to understand changing
priorities and linkages.
Methods: A mixed methods approach was used. Semi-structured interviews at
community, provincial and national were used to understand what individuals view as
the water priorities for planetary health. Water quality testing and mapping were used to
determine if their perceptions of planetary health priorities were correct.
Results: Planetary health perceptions were found to be to be different through qualita-
tive and antiquate data. Water access was found to be intermittent; often dirty after heavy
rain and communities were aware of these issues. Community practices were found to
cause issues for ecosystem health particularly through alteration of water quality. Commu-
nities thought current practices and alternative water sources were usable, however, water
quality testing revealed the impacts of land use, farming and water management practices
lead to contamination of water. Community natural resource management varied amongst
communities. Community practices impacted the wider ecosystem, at the catchment level
and sub catchment level.
Conclusion: Planetary health perceptions versus priorities are important to understand
at the community level as the only one part of a nested system that and impacts the wider
ecosystem. Creating appropriate understanding of community planetary health actions,
can help create a healthier ecosystem, reducing disease, improving farming techniques,
land use practices and improving water quality.
3.12. Transforming Ecological Grief through Hypnotherapeutic Storytelling Traditions
Ryan Jenkins 1and Aaron Jenkins 2,3
Hypnotherapy in Barcelona, 08024 Barcelona,
University of Sydney, Camperdown, NSW 2006, Australia;
Edith Cowan Univer-
sity, Bentley, WA 6027, Australia).
Psychotherapists worldwide are increasingly documenting a sense of loss and grief
attached to the systematic dismemberment of the natural world. This inner anguish is
referred to as ecological grief, in relation to either experienced or anticipated ecological
losses due to acute or chronic environmental change. Often unmeasured, and largely
immeasurable, this mental health condition is a pivotal psychological reality of the Anthro-
pocene. While we rely on modern science to shed light on our planetary condition and
provide guidance on improving our relationship with the biosphere, our motivation to act
is unlikely to stem from the largely uncomforting scientiﬁc mythos. Storytelling, however,
is evolutionarily advantageous.
Stories with humans in a central role, preserve our mystery and dignity, helping pass
on valuable information in memorable, repeatable and actionable forms thereby enhancing
our chances of survival. We draw upon ﬁelds of Ericksonian hypnotherapy, ecopsychology,
ethnomusicology and medical anthropology to create a novel therapeutic storytelling
Int. J. Environ. Res. Public Health 2021,18, 10654 13 of 101
practice speciﬁcally designed to help acknowledge, release, legitimise and transform our
diverse and often repressed emotional responses to our rapidly changing planet.
Our model therapeutic practice is derived from storytelling traditions of Papua New
Guinean hunter–gatherers, West African and Amerindian shamanism, folkloric and con-
temporary dystopian ﬁction, Scandinavian cinema and modern musical traditions. We
provide a framework for transforming ecological grief using therapeutic methods of indi-
rect hypnosis and neuro–linguistic programming, narrated in a story and augmented by
visual and audio media.
We contend that hypnotherapeutic storytelling can help transform natural feelings
of ecological grief from a dulled, frustrated inertia, caused by forces of market capitalism
and the Palaeolithic architecture of our minds, into the seeds of ecological awareness and
3.13. Interplanetary Health Equity: Implications of Dominant Value Systems in Space Exploration
for Human Cultural Identity and Equitable Survival
Evelyne de Leeuw
(Centre for Health Equity Training, Research and Education CHETRE,
Ingham Institute, 1 Campbell Street, Liverpool, NSW 2049 Australia).
Some believe that traveling to the stars (or, rather, moons and planets in our own solar
system) is a futile endeavour, and that we should ﬁrst and foremost focus on our own
planet(ary health). As true as this is, and as depressing the hunt for interplanetary mining
and colonisation may appear, it is very much on the books of global stakeholders. These
not only include nation–states (such as the UAE, China, India, Japan, European Union
and USA) but increasingly private industries. We should be concerned about the impact
of these efforts on health and wellbeing equity on Planet Terra. Spending billions if not
trillions (whether or not garnered from state sources through taxpayer schemes or from
private capital through proﬁt and philanthropy) on space exploration is at the detriment
of investments in sustainable food systems, water management, healthcare and health
protection, etc. A warning should be sounded. However, there is a phenomenon that
is potentially even more challenging, even if planetary health equity is assured. That is
interplanetary health equity. The Outer Space Treaty (entered into force in 1967) forbids
colonisation or exclusive rights to anything beyond Earth’s atmosphere and regards space
travellers as envoys of humankind. However, in a move that possibly further illustrates the
Unites States’ retreat from the global order of nations (as much as its withdrawal from UN
agencies such as WHO and bullying of others such as UNESCO), its National Aeronautics
and Space Administration (NASA) has drawn up the “Artemis Accords”. The world has
been invited to join NASA in this—as if UNOOSA is incapable of implementing globally
agreed on treaties. Under these Accords space may be free, but anything that is mined and
produced out there is not. This is a severe threat to humankind and our equitable survival.
3.14. Biomimicry and Nature as Sympoiesis: A Case Study into Living Machines
Laetitia Van den Bergen
(Erasmus University College, 13011 HP Rotterdam, The Netherlands).
Providing water in acceptable quality while ensuring its future availability constitutes
one of the major challenges of our century. While Western countries’ water infrastruc-
tures have solved sanitary issues, they are at odds with the contemporary sustainability
paradigm. Designers and engineers have therefore turned to biomimicry, moved by the as-
sumption that taking nature as a model, a measure, and a mentor will produce sustainable
devices. However great is biomimicry potential for sustainable design, it is under-exploited
because of the ﬁeld’s lack of philosophical conceptualization. This work uses both philo-
sophical speculation and scientiﬁc literature to investigate how biomimicry should be
practiced to generate truly sustainable technologies, meaning technologies that create
conditions conducive to Life.
Philosophical speculation suggests that the paradigm opposing Nature to Humanity
in which scientists currently operate restrains biomimicry ability to achieve sustainability
and humans’ capacity to understand and respond to the ecological crisis. It was proposed
Int. J. Environ. Res. Public Health 2021,18, 10654 14 of 101
that biomimicry should be performed according to a paradigm that conceives humans
in their entanglement with non-humans. By following a bio-inclusive and bio-synergetic
approach aimed at fulﬁlling our needs while serving the ones of other species and sys-
tems, biomimetists could work with Nature to solve challenges we have in common—i.e.,
Living Machines (technologies that emulate wetlands form, process, and system) were
proposed as an admirable example of the application of biomimicry. My scientiﬁc literature
review suggests that using constructed wetlands reduces not only the costs and outputs
of wastewater treatment but also energy, material, and water demands. More, it favours
Overall, this study provides an interdisciplinary framework to inform a more sustain-
able practice of biomimicry. Propositions for further research include the application of
bio-inclusive ethics as a framework guiding the transition to a circular, bio-based economy,
and the clariﬁcation of constructed wetlands’ role in the latter.
3.15. The Reciprocal Requirements for Undisciplined Cross-Sectoralism
Aaron Jenkins 1,2, Anthony Capon 3and Pierre Horwitz 2
University of Sydney, Camper-
down, NSW 2006, Australia;
Edith Cowan University, Bentley, WA 6027, Australia;
3Monash University, Clayton, VIC 3800, Australia).
Modern society is gradually appreciating that deep understanding of the ecological
foundations of health can help guide global sustainability. Our current discourse and
action, however, rarely engages meaningfully across sectors or allows the undisciplined
space where (all) disciplines are involved but none takes control.
To facilitate a broad planetary agenda, we sought to understand the reciprocal require-
ments for undisciplined cross-sectoralism at individual, organizational and systemic levels.
We convened leaders in indigenous health, infectious disease, urbanization, nutrition,
immunology, aquatic and landscape ecology, in a roundtable discussion to explore collabo-
rations to connect environmental change to human health outcomes. We focused discussion
on the personal and organizational qualities needed to translate discourse into action.
We agreed that individuals who excelled at cross-sectoral and undisciplined ap-
proaches see themselves as life-long learners, usually with a particular interpersonal skill
set and a specialist discipline to which they are not necessarily wedded; they are willing
to learn the language of others, and are careful listeners, often at the expense of inter-
preting problems in the ways in which they have been (res)trained. They help link the
individual to the organizational through place-based, empathetic, and iterative processes
including those most affected, while addressing critical power dynamics in co-design
of solutions. Organisations designed well for cross-sectoral collaboration have a shared
vision, are inﬂuenced by other organisations in a reciprocal way, and more likely to adopt a
horizontal business model, without being insular. Systems designed well for cross-sectoral
collaborations provide incentives, promote attitudes and capabilities that have empathy
for the whole, and encourage organisations and individual behaviours that are supportive
The nature of transformative action is not about efﬁciency. It is metamorphic and
participatory, where processes and outcomes are blurred and not predetermined. It is
subversive of disciplines and sectors where these structures operate to exclude broader
4. What Kind of World Do We Want to Live in? Urban and Social Systems for Health
and Fulﬁlment on All Scales
This session explores the challenges of changing social and urban environments—
including increasing immersion and dependence on digital environments, as a rapidly
emerging factor in “nature disconnection”, especially in younger generations. We also
examine the social changes that may be needed to promote healthier, equitable, thriving
systems that support ﬂourishing across scales of people, places and planet. This includes
Int. J. Environ. Res. Public Health 2021,18, 10654 15 of 101
pathways to efforts to promote social cohesion and connection to nature through artistic
ventures and urban green initiatives. The topics are summarized in Figure 3, and recordings
are also available .
What kind of world do we want to live in? Overview of topics and speakers in the session
on urban and social systems for health and fulﬁlment.
4.1. Rethinking Social Change: Regenerative Sustainability, Reciprocity and Joy
(Dalla Lana School of Public Health, University of Toronto, Toronto, ON
M5T 3M7, Canada).
Emerging threats to planetary health and health equity, including climate change,
ecological degradation, resource depletion, energy insecurity, and widening socio-economic
disparities, are converging in ways that some now predict could bring down civilization
Int. J. Environ. Res. Public Health 2021,18, 10654 16 of 101
as we know it within the lifetimes of many alive today. Risk management, the dominant
system response, is not up to the challenge, and indeed, by seeking to predict and control
the negative outcomes of current systems and prevent or bounce back from adversity is
tilted in favour of maintenance of the status quo. Something more “radical” (as in getting
to the roots of the crisis) is required. In this presentation, three promising directions for
reimagining sustainability are proposed, from a landscape of possibilities.
First, decolonizing ourselves from the dominant western paradigm that naturalizes
inequality, “meritocracy”, competition, domination, scarcity mentality, a story of separation,
and that imagines sustainability as a greening of business as usual. Fortunately, there are
many other non-dominant knowledge traditions we can draw inspiration from to help us
see that things can be other than we currently imagine them, from critical and progressive
traditions at the margins in the Global North (degrowth, political ecology, ecofeminism,
deep ecology) to Indigenous ways of knowing and Global South epistemologies. We are
brought to the question: what if the sustainability crisis is not a technical problem (as we
are often led to believe) but rather a relationship problem, in the sense that we’ve fallen
out of right relationship with ourselves, each other, and the more-than-human world?
A second promising direction for reimagining sustainability follows: embracing
animism and a relational world view, where all life is seen as animate, sentient and
possessing agency and spirit, a world that is fully alive, in contrast to one that modern
Western culture sees as a world of “things” and “resources” at our disposal.
Third, we are invited to “unleash a pandemic of positivity”, to conjoin a clear-eyed
realism about the current state of affairs with a clear vision of “the more beautiful world our
hearts know is possible”, reﬂecting the power of vision and dreams to call a better future
into being (not only railing against what we do not want). What if, to quote Rob Hopkins
from the Transition movement, “if it’s not fun, it’s not sustainable”? We are invited into the
sweet spot at the intersection of what you love, what you are good at, and what serves the
world, as your unique contribution to realizing the momentous transition underway that
Joanna Macy calls The Great Turning.
4.2. Addressing the “Social Dilemma”: Can We Realign Digital Technology with Humanity’s
David H. Nelson
(Independent Researcher, Woodstock, ON N4S 6Y9, Canada; inVIVO
Planetary Health, West New York, NJ 07093, USA).
Over the last decade, international researchers have been investigating the relation-
ships between excessive screen time (e.g., television, computer, smartphone) and social
media use (e.g., Facebook, Twitter, Instagram, TikTok) and human health, particularly
in children. The global pandemic has been associated with massive increases in screen
time—up by over 50% in children in North America. This has increased the urgency with
which researchers must understand the consequences of screen time, and the ways in which
it might promote, or detract, from health at scales of person, place and planet. Here, the
discussion focuses on the ways in which screen time, and social media in particular, inﬂu-
ences arousal within the limbic system and the brain’s reward pathways, and compromises
sleep. Behavioural solutions, those promoting judicious use of screen time, are offered.
4.3. Managing the Digital Environment for Our Children: Physical, Mental and Social
Implications for a Post-COVID Generation
(University of Western Australia, Nedlands, Western Australia 6009, Aus-
tralia; Joondalup Health Campus, Western Australia 6027, Australia).
There has been rapid change in digital technology and use since the iPhone was
ﬁrst developed in 2007. The use of devises at an early age are related to parental use. In
Australia, 9% of infants (<2 years) and 33% of preschool children (3–6 years old) own their
own mobile/tablet device and use it 2 h and 4 h/day respectively. This has led to increasing
concerns around how this may be inﬂuencing patterns of early childhood development in
this crucial period of life.
Int. J. Environ. Res. Public Health 2021,18, 10654 17 of 101
In the early postnatal period, there are already concerns that increasing parental screen
time is affecting eye contact and bonding. Similarly, there is also an increasing tendency to
use mobile devises as “babysitters” to occupy, distract and quiet behaviour of babies and
children for prolonged periods. This reduced personal social contact may be contributing
to social and emotional immaturity—including increasing anecdotal observations of delay
in infant social smiling by paediatricians and child health nurses.
While there have been some beneﬁts of early electronic devise use for family con-
nectedness, especially during the COVID-19 pandemic, long-term studies are needed to
determine if this has been out-weighed by the delayed speech, motor and social develop-
ment identiﬁed during this period. In adolescents, the need to be connected to the digital
world is also increases, as families struggle to deal with the associated adverse effects of
excessive electronic use—including obesity, sleep insomnia, irritability, poor self-regulation,
inattention, anxiety, depression and “digital displacement” of traditional in-person sociali-
sation. Excess digital use is likely to displace outdoor play and relationships with nature,
with additional adverse—also essential for physical, mental and social wellbeing.
While there are Australian guidelines for screentime use, few families achieve this.
There is still a confusion, lack of awareness, or denial of potential detrimental effects of
excessive electronic use on social and emotional development. Those families struggling to
control device experience guilt as this becomes increasingly challenging.
This is one important focus in The ORIGINS project. This is a landmark birth cohort
in Western Australia aimed at addressing many of these contemporary challenges. The
study commenced in 2017 and will follow 10,000 families for 5 years. Embedded in this
cohort platform, there are a number of speciﬁc studies, including the impact electronic use
and interventions to address this—including strategies to increase nature connectedness in
families. We are working with local groups, such as Nature Play WA to promote a new
approach which includes ways to reduce, replace and balance digital devices especially in
children who have sleep and behaviour issues.
We hope the results of this study will help shape policy on mobile technology use in
young children especially in the post COVID-19 period.
4.4. Nature as an Antidote to Digital Displacement: Increasing the Awareness of Nature-Based
Solutions for Human Health in Urban Settings Post COVID
Matilda van den Bosch
(The University of British Columbia, Vancouver Campus,
V6T 1Z4, Canada).
Over the last decade, research on human health impacts of urban natural spaces
has rapidly developed. An increasing number of epidemiological studies demonstrates
direct and indirect health beneﬁts by exposure to urban green and blue spaces. While
these studies have signiﬁcantly contributed to conﬁrming associations between nature
exposure and various health outcomes, a number of challenges remain before evidence on
mechanisms and causality can be established. These challenges range from uncertainty
about optimal exposure measures to what physiological effects can be expected from nature
contact. Nevertheless, the side effects of “urban green interventions” are limited. By also
taking co-beneﬁts, such as increased biodiversity and climate change mitigation from urban
natural spaces, into account there seems to be little to lose from a policy perspective by
advocating for more natural spaces in our cities, although the evidence is still insufﬁcient.
This presentation provides an outline of the current evidence level and present research
challenges in on-going studies around urban nature and human health. It will also discuss
the prevailing discourse around pathways and mechanisms. Finally, the goal is to initiate a
debate around opportunities and risks with taking a “nothing-to-lose” approach to urban
green initiatives across the world.
4.5. The Future of Urban Systems: Saving Our Cities to Save Our Health in the Post-COVID Era
Mark J. Nieuwenhuijsen
(Director of Urban Planning, Environment and Health, ISGlobal,
08003 Barcelona, Spain).
Int. J. Environ. Res. Public Health 2021,18, 10654 18 of 101
Over 50% of the world’s population is living in cities and this is expected to rise to
70% over the next few decades. Cities are society’s predominant engine of innovation
and wealth creation, but also main sources of pollution, and disease. Partly due to poor
urban and transport planning, or the lack thereof, we have cities that are too car dominated.
All the urban planning in the world seems for cars; people do not matter. This has led to
high air pollution and noise levels, heat island effects and lack of green space and physical
activity that are all detrimental to health. For example, a recent health impact assessment
in Barcelona estimated that 20% of premature mortality was due to urban and transport
The COVID-19 has shown the importance of public space in cities and cities have
started to transform their public spaces by for example increasing cycling lanes and creating
low trafﬁc or car free areas. Furthermore, more green space is being introduced as there is a
real need. COVID-19 has been an accelerator in many ways. This talk will review the latest
developments on urban and transport planning pathways leading to low carbon, liveable
and healthy cities.
Electric cars and/or autonomous vehicles have been mentioned as possible solutions,
but they are unlikely to be, and solutions need to be sought elsewhere. A new long-term
visioning of healthy urban future is needed that bring health, sustainability and liveable at
the forefront of urban and transport planning. Systemic approaches to the current problems
and a shift away from our grey car centric cities towards cities with more public and active
transportation and green space are urgently needed. New urban models such as car-free
cities, the 15 min city and the Superblocks are urgently needed. Collaboration between
e.g., urban and transport planners, environmentalists and public health professionals is
essential to create carbon neutral, liveable and healthy cities.
4.6. Inspiring Children to Imagine the Future: What They Can Teach Us through Art
Alanna Berman (The Institute for Integrative Health, Baltimore, MD 21231, USA).
Art provides a valuable avenue for children, and people of all ages, to be part of global
conversations that celebrates our planet, as well as efforts to overcome our challenges.
Creativity is also an invaluable tool in expressing feelings, seeing the “bigger picture” and
ﬁnding personal and/or shared hope at times of stress. I am an artist and art teacher
working in a public elementary school just outside of Baltimore, Maryland in the United
States, and this was an opportunity for me to share an art project designed to help our
students cope with the events of 2020—including their work and their thoughts.
With the COVID-19 pandemic, we, as many other schools, transitioned to a virtual
learning environment, and many students and families faced the challenges of social
isolation. Our school is highly diverse, with students’ families from all around the world
across a wide socioeconomic range. Anxiety mounted as the pandemic continued and
events, such as the death of George Floyd, ampliﬁed social unrest across the USA and
the world. Artistic creativity was an important avenue for my students to process these
signiﬁcant events and share their feelings.
Inspired by the concepts behind Project Earthrise (Logan et al., 2020), I created an inspi-
rational video to spark the students’ imaginative thinking and to help them express their
emotions and aspirations. Drawing on the awe and wonder of the Earthrise photograph
taken by the Apollo 8 astronauts, and how this had inspired new awareness and new
possibilities at the time, I encouraged them to draw from their imaginations to create a
picture of what a better world might look like—and what matters most to them.
A number of key themes emerged from work of our young artists and their
explanations—ranging from environmental and social justice concerns, to sharing
toys and playing with their sister. Even at the age of 8 years, many artists expressed
deep caring for nature. Along with frequent depictions of vibrant nature scenes, they
included explanations of why trees are important, with comments such as “grow trees,
save the world”. Even those who depicted the negative impact of humans on the planet
also depicted hope and desire for change, with comments that we need to “change
Int. J. Environ. Res. Public Health 2021,18, 10654 19 of 101
how humans and animals live together and how animals are going extinct due to
the population taking over their homes and taking down forests”. Another emergent
theme was the desire for more caring communities—a general desire for more “love”
and “no bad people”; a wish for more unity as “people of all colours and nations,
standing together, working together proudly” and kindness “if someone gets knocked
down you help them back up”. Importantly, the very process of reflection, creation and
sharing also generated hope and positivity with comments such as “drawing makes
Signiﬁcantly, both children and their families (many experiencing great hardship)
expressed profound gratitude in the knowledge that their art and their thoughts would be
shared with the international inVIVO community. It was meaningful and empowering for
them to feel connected to something bigger in this way.
While anecdotal, this illustrates the personal and collective value of creativity and
imagination in sharing inspirations and creating hope, and wonderful opportunities to give
children a voice in important conversations—because it is ever true to say that children are
Alan C. Logan, et al. Project Earthrise: Inspiring Creativity, Kindness and Imagination
in Planetary Health. Challenges 2020, 11 (2).
4.7. Imagining Our Future: Comparing Green and Sci-Fi Utopian Themes and Effects on Social
(School of Psychology, Deakin University, Melbourne, School of Psychol-
ogy, Deakin University, Melbourne Burwood, VIC 3125, Australia)
Utopian thinking is an emerging topic of research in social psychology and related
areas. Early work has shown that thinking about one’s ideal society tends to predict
greater criticism of one’s existing society and great motivation to change it. Here, I discuss
two prominent contemporary utopian visions—a Green utopia and a Sci-Fi utopia—and
some experiments designed to assess the motivational capacity of those utopian visions.
These studies showed that when asked to think and write about a Green utopia people (1)
ascribed to that society greater warmth, positive emotions and other positive characteristics
(e.g., peace, democracy), and (2) were more motivated to change their society and perform
pro-environmental behaviours. When asked to think and write about a Sci-Fi society,
however, no such effects were observed. It was also observed that the motivational capacity
of the Green utopia could be partly accounted for by an increased sense of self-efﬁcacy (the
feeling that one can make a difference in bringing about that kind of society). These results
completement those of other research showing that people see future societies as becoming
more competent and technological, but less warm and moral. Thus, people may view the
Sci-Fi utopia as a fulﬁlment of the current societal trajectory (requiring no action), but the
Green utopia as requiring a diversion of the current society trajectory. My colleagues and I
are continuing our work to understand the motivational function of utopian thinking, in
particular, the effects of different kinds of environmentally friendly utopian visions.
4.8. The Artist as Rebel: Enhancing Awe, Wonder and Connectivity to People, Places and Planet
Catherine Sarah Young
(Obama Leader, Asia Paciﬁc and Scientia scholar, Art and Design,
University of New South Wales, Sydney, NSW 2052, Australia).
How can art affect connection to the planet? The artist and scholar explores this
through the lens of original artworks that have been created and exhibited internationally
and recontextualised through the years, speciﬁcally through two artistic bodies of work:
The Apocalypse Project (2013–present), which explores climate change and our environ-
mental futures; and Wild Science (2018–present), which investigated the relationships
between science and society. The Projects include, but are not limited to: The Ephemeral
Marvels Perfume Store, an olfactory installation of things we could lose because of climate
change; The Sewer Soaperie, soaps created from raw sewage that will further exacerbate
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urban ﬂooding that is caused by stronger typhoons; Climate Change Couture, potential
garments of the future under speciﬁc environmental impacts; Experiments in Nature, a
video performance series that depicts scientiﬁc experiments in the wild to interrogate the
role of science in society; and Letters for Science, a participatory project that asks the public
to write letters to science denialists to ask them to reconsider their views, etc. Finally,
the artist discusses at length her latest piece, The Weighing of the Heart, a sculptural
installation series that casts the ashes and remains from the Australian bushﬁre crisis into
human hearts as an invitation to reﬂect on the human toll that this crisis has wrought.
4.9. Parent Use of Smartphones and Tablet Computers and Prenatal Attachment
Rebecca Hood (Curtin University, Bentley, WA 6102, Australia).
This Prenatal attachment (the relationship between a parent and their baby during
pregnancy) is of great importance, as evidence suggests it leads to secure attachment in
early childhood and to better child developmental outcomes in the future. Many potential
inﬂuences on prenatal attachment have previously been explored. However, one possible
inﬂuence on prenatal attachment yet to be considered is the use of mobile touch screen
devices such as smartphones and tablet computers. The advancement of screen technology
in recent years has led to devices having a pervasive impact on expecting parents’ lives
during their transition to parenthood.
This study aimed to investigate how the use of mobile touch screen devices inﬂu-
ences parents’ thoughts, feelings and behaviours towards their baby during pregnancy.
Interviews of 27 expectant parents/parents of newborns found that all used devices for a
variety of purposes, and all described secure prenatal attachment. Many parents indicated
they had not previously considered the inﬂuence of device use on their relationship with
their baby. On reﬂection, parents described both negative and positive inﬂuences on their
relationship with their baby. For example, some described feeling distracted while using
their device and feeling more anxious due to reading information online. Others described
feeling closer to their baby due to reading about their baby’s development and playing
music for their baby on their device while pregnant.
These ﬁndings show how devices can be used by parents to feel more connected to
their baby during pregnancy while being aware of potential downsides, which may lead to
better parent–child relationships after birth as well as better future child outcomes.
4.10. “Desirable Green”: Informing Design Guidelines for Restorative Small Urban Green Spaces
(Department of Landscape Architecture, University of Shefﬁeld, Shefﬁeld
S10 2TN, UK).
The positive mental health implications of exposure to green space and its potential
to reduce stress, i.e., to be restorative, has attracted much interest, but does immersion
in a green environment systematically lead to a restorative experience or is the pathway
more complex? What is perceived as “desirable green” could be an important factor that
either enables or hinders this restorative effect. This research project explores to what
degree the restorative experience made possible in green spaces is mediated by perceived
attractiveness, or preference.
The approach taken in this thesis is to view these aspects as outcomes of processes
of socialization and culture. Although research on restoration does incorporate socio-
demographic variables, to what degree these inﬂuence the restorative experience of nature
has not yet been explored systematically. This is what this thesis aims to do.
The theoretical framework uses theories from sociologists such as Pierre Bourdieu,
Pierre Moscovici, or Henri Lefebvre, incorporating a constructionist approach where
both the landscape experience of the viewer and the landscape itself are expressions of
At the inVIVO 2020 annual meeting, I presented ﬁndings from a questionnaire taken
by around 450 participants representative of various sociodemographic groups. The
questionnaire examines the green space characteristics and features considered by the
Int. J. Environ. Res. Public Health 2021,18, 10654 21 of 101
participants to be conducive of restoration and stress relief. The questionnaire was open-
ended, analysed with thematic coding, and the correlation of the answers with the social
categories statistically examined. The results provide precious insights into the degree to
which representations, expectations and preferences regarding green spaces vary between
respondents from different social categories, and the similarities and differences between
these groups. To examine whether the preferences of each group moderate their restorative
experience, the emotional responses to experimental park designs will be visually tested in
the second stage of the research.
4.11. Knowledge Translation in the Response to the COVID-19 and Climate Change
Co-Emergencies of Our Time
Cecilia Sierra-Heredia 1, Perla Araiza-Viramontes 1, Kerri Klein 2, Trevor Hancock 3,
Mira Ziolo 4, Maya Gislason 1, Christopher Buse 5and Tim Takaro 1
Faculty of Health
Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada;
Surrey, BC V4A 2H9, Canada;
University of Victoria, Victoria, BC V8P 5C2, Canada;
University of British Columbia, West Mall Vancouver, BC V6T 1Z4, Canada;
Environmental Assessment Research, University of British Columbia, 3247 University Way,
Kelowna, BC V1V 1V7, Canada).
UN Secretary General Antonio Guterres claimed early on in the pandemic that the
social and economic devastation caused by climate change will be greater than that of
COVID-19 without appropriate actions from multiple sectors (Fearnow, 2020). As part
of the broader set of global ecological changes that constitute the Anthropocene, climate
change exacerbates existing health inequalities which are being further compounded by
the pandemic. However, climate change has also been described as “the greatest global
health opportunity of the 21st century”. It is important that public health professionals and
students are involved in the design of mitigation and adaptation strategies in partnership
with other organizations and sectors.
The webinar series “Learning for Planetary Health: Lessons from a Pandemic” is a
collection of session recordings and ﬁles from the SFU Planetary Health research group and
other scholars and practitioners. In eleven sessions, the presenters covered a range of topics
regarding the relationship between COVID-19 pandemic, planetary health, climate change
and human health. The webinars explored policy options to “bounce forward and not back”
into a post-COVID future focusing on actions that transform the way we live and improve
health for all as we face the overarching threat of climate change. Knowledge Translation is
the process of sharing research ﬁndings to multiple stakeholders and practitioners in order
to inform policy decisions. In order to broaden the learning of stakeholders, such as non-
academic audiences, we have created a toolkit with policy briefs, infographics, and op-eds
that expand the reach of knowledge presented by these webinars to two speciﬁc audiences,
grade 12 students and policy makers. The toolkit is a platform for work produced by
researchers and presented in webinars to communicate climate action opportunities and
strategies emerging from the COVID-19 pandemic.
4.12. A History of the Psychologies of the Environment
(Research Fellow, Department of History, University of Sydney, Camperdown,
NSW 2006, Australia).
This paper will brieﬂy sketch the history of the psychologies of the environment,
from environmental psychology to psychologies of survival and conservation psychology.
Environmental psychology emerged in the middle of the twentieth century in urban
contexts, focusing on the built environment and the various risks that it posed to human
health. As the ﬁeld came to encompass the physical environment, it retained the risk matrix.
“Global” psychologies or psychologies of survival appeared from the 1980s, integrating
methodology and insights from diverse psychological schools to meet the perceived global
crises represented by ecological and other crises at a global scale, while conservation
psychology, modelled on conservation biology and conservation medicine, addressed
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problematic aspects of the human–animal relationship with a view to stemming those still-
developing crises. The paper will trace through lines across these approaches, including
the constitution and scale of the “environment” which each addresses, and the relationship
between the human psyche and this environment which each approach theorises. It will
conclude with a discussion of global mental health and planetary mental health in light of
this psychological terrain.
4.13. Change in Complex Systems: Lessons about Policy and Practice for Healthy,
Sarah Walpole (Royal Victoria Inﬁrmary, Newcastle upon Tyne NE1 4LP, UK).
Healthcare, as other sectors, has a duty to reduce its environmental impacts; and an
opportunity to do this as part of a positive transformation, beneﬁting both those working
in the sector and the public.
Healthcare systems are complex, containing multiple sub-systems and comprising
multiple, varied relationships with external actors, environments and systems. Through
her research on transition to more sustainable healthcare systems, Charlesworth (2016)
highlighted six key elements to facilitate this: clear vision, innovation to redesign systems
and processes, staff and patient engagement, effective information management, good
performance management and good leadership.
This presentation considered the goals of healthcare systems and outlines a “whole
system” perspective. It draws on the SusQI model to consider resource inputs and social,
environmental and ﬁnancial impacts. It draws on case studies of healthcare systems around
the world that are already modelling healthy and sustainable practices, and explores how
different healthcare system structures, ﬁnancing and governance may facilitate or inhibit
Good leadership at every level is essential to motivate and facilitate good practice.
Both numbers and narratives have a role to play in articulating, modelling and stewarding
a sustainable healthcare system. Measurable outcomes are important, but less measurable
outcomes may even be more important.
A health system requires both shared goals and responsiveness and respect for diverse
views, perspectives and values. Being inclusive of diversity of experiences and perspectives
can enhance responsiveness (including to the needs of patients), adaptability, dynamism
and resilience of the health system (Murray and Frenk, 2000), all of which are essential
Charlesworth, K. et al. (2016) “Transformational change in healthcare: An examination
of four case studies”, AHR, 40 (2), pp. 163–167;
Murray, C. and Frenk, J. (2000) “A framework for assessing the performance of health
systems”, B WHO, 78 (6), pp. 717–731.
4.14. Strategies Caregivers Use to Support Adolescents Who Experience Climate Grief
Taylor Hirschberg and Chris Lowry
(University of Colorado-Boulder, Boulder, CO 80309, USA).
Climate change poses a great threat to all living species. As people come to understand
the urgency and the depth of the multi-layered problems associated with the climate crisis,
they may come to experience what some scholars have come to label “climate grief” or
“climate distress”. Here, this refers to a deep sense of unease, fear, sadness, and sense of
loss associated with the changing climate.
The wide-ranging impacts of climate change on adults’ emotional wellbeing has
been an increasing focus of scholarly concern over the past decade. Children, however,
remain an understudied population, although some anecdotal reports suggest that they
are especially prone to experiencing climate grief. As children grapple with how climate
change will affect their lives, it is important to understand how they process climate-related
grief and how their caregivers are supporting them to cope with future environmental
realities. To ﬁll a gap in the literature, this research explores climate grief through the
Int. J. Environ. Res. Public Health 2021,18, 10654 23 of 101
lens of caregivers as well as their adolescent child. It also examines how caregivers are
supporting young people, and what, from the perspective of adolescents, is helping them
to cope. This project involves open-ended interviews with 20 caregivers and 20 adolescents.
It also draws on data obtained through the 21-item Nature Relatedness Scale (NR), which
uses a ﬁve-point Likert scale to assess human connections to the environment. This study
will test the hypothesis that children and caregivers with higher nature relatedness scores
experience more climate anxiety, potentially due to a greater sense of Solastalgia.
Improving understanding of the dimensions of climate grief and strategies to support
coping provides an opportunity to inform responsive programming and early interventions
that can positively impact life course trajectories for both children and their families.
4.15. Designing a Carbon Neutral Health System through Sustainable Quality Improvement
Kathleen Leedham-Green and Steﬁ Barna
(Centre for Sustainable Healthcare, Banbury
Road, Oxford OX2 7JQ, UK)
Healthcare, as all human activities, takes place within a social and environmental
context. Growing numbers of healthcare professionals express concern about the health
implications of environmental challenges facing us, and national health bodies are calling
for radical reductions in health sector carbon and waste. Sustainability is one of the domains
of quality in healthcare. The sustainable quality improvement movement aims to create
a sustainable health service whilst improving patient outcomes. Clinicians involved in
sustainable quality improvement projects report greater job satisfaction when they engage
work on the “triple bottom line” (ﬁnancial, environmental, social) to improve patient
outcomes, increase staff work satisfaction, and future proof the health service and the
communities it supports. Sustainable quality improvement (SusQI) methods include health
system changes to promote health, prevent disease, increase patient agency, and develop
lean care pathways. This session examines how the perspective of sustainable value can
enrich clinical teaching and practice while tackling real-life ethical issues in healthcare
delivery. Practical cases are used to illustrate the key principles of sustainable practice
and measure the triple bottom line, thus safeguarding the health system for the patients of
today and of tomorrow.
4.16. Implementation of an Air Quality Forecasting Operating System for Health Surveillance and
Sustainability in the Salvador Metropolitan Region, Brazil
Nelzair Vianna 1, Larissa Zanutto 2, Fanny Velay-Lasry 2, Samya Pinheiro 2and Andre
Oswaldo Cruz Foundation, Rio de Janeiro 40296-710, Brazil;
Secretary of Sustainability, Innovation and Resilience, Brazilian government, Rio
de Janeiro 40010-010, Brazil).
Air pollution is a threat to public health in the 21st century. In Latin America, more
than 100 million people are exposed to air pollution. There is a gap in air quality moni-
toring in cities around the world. Environmental risk factor monitoring and forecasting
systems are strategic for the adoption of preventive measures and health surveillance alerts.
The engagement of stakeholders is crucial to develop strategies to control air pollution.
Objective: To deﬁne air quality and health risk indicators relevant to health surveillance
and civil defence, allowing the mapping of areas of higher risk and vulnerability for the
population. Methodology: The SOPRAR project was built through an articulated intersec-
toral mobilization, scientiﬁc institutions, private and public sector, The project includes
the conﬁguration of emission, chemical, and transportation models to represent the local
conditions. The system operates based on CHIMERE model runs (48 h forecast) forced
by weather forecast simulations (WRF) performed by the local civil defence, integrating
an updated emissions inventory. Model results, pollutants concentration maps and air
quality index will be available by WEB service. A tailored health risk indicator will be
developed to make the SOPRAR system. The project is committed with the technology and
know-how transfer to local actors. Results: The emission inventory was updated based
on available local data regarding trafﬁc, road network, industries processes and land use.
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Total emissions in the Salvador Metropolitan Region corresponds to 3327.03 tons/year of
particulate matter, 14,964.32 tons/year of sulphur dioxide, 75,572.28 tons/year of carbon
monoxide, 24,756.30 tons/year of nitrogen oxides and 21,756.64 tons/year of volatile or-
ganic compounds. Conclusions: The system is as an innovative management tool based on
urban environment air quality modelling and will provide support for the activation of air
quality protection and communication service protocols for use in research, public policies
for primary care and health surveillance.
5. Food Systems from the Ground up: Can Food Solutions Also Be Climate Solutions?
This session explores the complex challenges of global food systems, the adverse
impact on natural ecosystems (soil and water contamination, waste and emissions), local
communities and growers, and human health. Speakers consider aspects of the modern
food environment, spanning from personal ecology to the social, economic and marketing
forces that affect both food choices and access to healthy food. We consider the necessary
shift to regenerative agro-ecological systems, which restore soils, retain water, increase
biodiversity, cycle nutrients to produce more nutrient-rich foods, and ﬁx carbon for climate
solutions (see Figure 4).
5.1. Why Think Resilience: New Tools for Shaping Change
Laura Lengnick (Cultivating Resilience, LLC, Asheville, NC 28805, USA).
There is a growing sense in government, business and civil society worldwide that
“business as usual” is no longer an option when it comes to food. It is widely acknowl-
edged that the global industrial food system fuels the wicked challenges of our times—
concentration of wealth, loss of biodiversity, energy use, population growth and climate
change—that have put us on the path to planetary collapse. The question is not IF, but
HOW we change the way we eat. Many different solutions—how do we choose among
them? Resilience thinking can help. Social–ecological resilience thinking offers new con-
cepts, a new language and an effective framework for decision making that is uniquely
suited to the novel uncertainties of our times. Resilience thinking encourages us to remem-
ber that resilience is about much more than simply bouncing back. Research shows that
investments that cultivate high response and transformation capacity in the food system
and in other critical resource systems are less expensive and more effective ways to sustain
community wellbeing over the long term. Resilience thinking identiﬁes solutions that
cultivate the social–ecological behaviours associated with high response, recovery and
transformation capacity: networks of equitable relationship; regional self-reliance; and the
local accumulation of community-based wealth, including natural, human, social, ﬁnancial,
and technological resources. Because these resilient behaviours are well aligned with the
core principles of the US sustainable agriculture and food movements, sustainable food
advocates have sown the seeds of our resilient food future through more than 40 years
of work to develop, for example: cooperative processing, distribution and marketing
networks such as Shepherds Grains in the Paciﬁc northwest, Co-op Partners Warehouse in the
Midwest, and Hickory Nut Gap Meats in the Southeast; regional food systems assessments
such as A New England Food Vision;Maine Harvest, the ﬁrst federal credit union in the US
to focus investments on regional food system development; and The Agriculture Resilience
Act which supports investment in regionally led research and development to promote
climate-resilient agriculture and food systems.
Int. J. Environ. Res. Public Health 2021,18, 10654 25 of 101
Food systems from the ground up: can food solutions also be climate solutions? Overview
of topics and speakers in the session on food systems.
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5.2. From the Ground up: Soil Microbes, (Carbon Storage) and Our 3Rs from a
Grass + Roots Perspective
(farmer and educator, Three Ridges Ecological Farm, Aylmer, ON N5H
We summarize our guiding principles as ecological farmers in “3Rs”: Relationships,
Regeneration and Resilience.
A vast network of relationships emerges when we promote a diversity of plants,
animals, microbes and people on the farm. Myriad relationships facilitate nutrient cy-
cling and energy ﬂows, soil regeneration, pest and disease management and wildlife and
We use tools such as managed rotational grazing, silvopasture, water retention earth-
works, and ecological forestry to design a landscape that captures, sinks and stores water.
These tools also help us create a diversity of microclimates to grow a diversity of plants
and move a diversity of animals on pasture. This diversity, in turn, stimulates a diversify
of microbes to build soil organic matter in life (through decomposition and soil aggrega-
tion) and in death (through necromass, or dead microbial cells). Fostering diverse and
strong relationships is how we grow nutrient-rich food and regenerate nature’s cycles and,
ultimately, bring ecological and economic resilience back to this land.
5.3. The Future of Food: Addressing Value Chains and Value Systems
Sabine Gabrysch 1,2,3
Potsdam Institute for Climate Impact Research (PIK), Member of
the Leibniz Association, 14412 Potsdam, Germany;
10117 Berlin, Germany;
Heidelberg Institute of Global Health, Heidelberg University,
69120 Heidelberg, Germany).
A “planetary health” perspective is required for transformative food solutions that
are more beneﬁcial to human health, other species and the environment. The current food
system is failing on multiple levels, and is hugely wasteful, with at least one quarter of
food lost or wasted. Poor nutrition is the leading cause of disease globally—two billion
people are undernourished or deﬁcient in micronutrients, and two billion are overweight or
obese—driving the growing “double burden” of disease. Agriculture also has devastating
impacts on natural systems, pushing us beyond several planetary boundaries. This includes
(1) land use for monocultures of crops that replace natural ecosystems and their species,
contributing to biodiversity loss, (2) fresh water overuse and contamination with nitrogen
fertilisers, pesticides and plastic waste, and (3) greenhouse gas emissions, including from
deforestation, degrading soils, energy use, methane from livestock and nitrous oxide from
fertiliser, generating approximately one quarter of anthropogenic greenhouse gases, thus
contributing substantially to climate change.
Our destructive model of progress is fundamentally driven by an obsession with
economic growth and a wasteful consumerist ideology, failing to recognise ﬁnite systems,
ecological interdependence or the value of life on our planet. The food system is geared to
beneﬁt multinational companies, including agribusiness and producers of ultra-processed
foods and beverages, largely at the expense of consumers, communities, local farmers, and
the environment (see Raj Patel’s Stuffed and Starved).
Jared Diamond describes in “Collapse” that survival of societies depends on their
capacity for long-term planning, willingness to reconsider core values and beliefs, and
wisdom to change trajectory. There is a pressing need to revisit our current values, and
to recognise and appreciate our interdependence with the web of life, with our planet.
This also means changing policies and practices to prevent predatory behaviour and place
greater value on the health of people, communities and environments on all scales.
We are currently faced with a “syndemic” of multiple global challenges with common
systemic drivers. Understanding that these are interrelated means we do not need to solve
each separately. Indeed, we can learn from nature in terms of multi-solving strategies and
shared solutions. For food production, this involves nutrient cycling, multi-functionality,
diversity and resilience through regenerative agroecological systems that restore soils,
Int. J. Environ. Res. Public Health 2021,18, 10654 27 of 101
retain water, increase biodiversity and produce nutrient-rich foods, with low greenhouse
gas emissions, even carbon negative. Shifting to a healthier and sustainable diet (with more
vegetables and less meat and dairy) will release land, reduce emissions and be better for
animal and human health. Many such win–win–win strategies are already occurring at the
local “niche” level.
Sudden events, such as the pandemic, and megatrends can open windows of oppor-
tunities that makes these previously niche-level initiatives more mainstream, to alter the
dominant norms, but societal change will not happen by itself, or from above. It will de-
pend on alliances of grassroots change-makers to empower themselves and work together
to build vision into action for healthier people on a healthier planet.
Raj Patel. Stuffed and Starved: The Hidden Battle for the World Food System. 2012,
Melville House, Brooklyn, USA.
Jared Diamond. Collapse: How Societies Choose to Fail or Succeed. 2004, Viking
Press. New York, USA.
Boyd A Swinburn et al. The Global Syndemic of Obesity, Undernutrition, and Climate
Change: The Lancet Commission report. The Lancet 2019; 393 (10173): 791–846.
5.4. The Challenge of Transforming Food Systems in an “Ultra-Processed” Society Prone to
Corporate Capture and Overconsumption
(Department of Nutrition, Faculty of Medicine, University of
Montréal, Montreal, QC H3T 1J4, Canada).
Transforming food systems such that they become healthy, just and sustainable is a
political project that requires a common set of values and beliefs about food, nutrition and
health. Food are commons goods and food practices should aim to nourish and protect
human and planetary health, while beneﬁting local communities and livelihoods. However,
there exists an inherent tension between public health objectives to protect and promote
health, and commercial interests of corporations to produce and promote ultra-processed
products that are highly proﬁtable but unhealthy and destructive (known as “commercial
determinants of health”). Indeed, these products are formulations of reﬁned substances
and additives that are nutritionally poor, linked to severe adverse health outcomes and
cause harm to the planet, but they are extremely proﬁtable, and they are designed to favour
overconsumption. Food corporations that make ultra-processed products are, however,
legally obliged to create growth and therefore cannot be held responsible for the health
consequences associated with them. Indeed, in front of the law, corporations are given the
status of “moral persons” with the rights and freedom to buy and sell food, regardless of
the consequences on society. In this situation, changing food systems will require changing
the nature of corporations in order to favour the development of a private sector that is
in harmony, not in conﬂict, with public health goals to promote and protect human and
5.5. The Implications of Ultra-Processed Diets and Food Additives for the Gut Microbiome
(The Charles Perkins Centre, School of Medical Sciences, Faculty of
Medicine and Health, The University of Sydney, Sydney 2006, Australia).
The interaction between gut microbiota and host plays a central role in health. Dys-
biosis, detrimental changes in gut microbiota and inﬂammation have been reported in
non-communicable diseases. While diet has a profound impact on gut microbiota compo-
sition and function, the role of food additives such as titanium dioxide (TiO
in processed food, is less established. We investigated the impact of food grade TiO
gut microbiota of mice when orally administered via drinking water. While TiO
minimal impact on the composition of the microbiota in the small intestine and colon, we
found that TiO
treatment could alter the release of bacterial metabolites
the spatial distribution of commensal bacteria
by promoting bioﬁlm formation.
We also found reduced expression of the colonic mucin 2 gene, a key component of the
Int. J. Environ. Res. Public Health 2021,18, 10654 28 of 101
intestinal mucus layer, and increased expression of the beta defensin gene, indicating that
signiﬁcantly impacts gut homeostasis. These changes were associated with colonic
inﬂammation, as shown by inﬁltration of CD8
T cells, increased macrophages as well
as increased expression of inﬂammatory cytokines. These ﬁndings collectively show that
is not inert, but rather impairs gut homeostasis which may in turn prime the host for
5.6. Multi-Dimensional Advantages of Beneﬁcial Microbes for Food: From Nutrition to Prosperity
and Empowerment of Women in Developing Regions
(Lawson Health Research Institute and Western University, London, ON N6A
We are born into a microbial world having no say in the country or living standards
we enter into. In time, we learn from what is around us. For some, it is easy to forget
that we are equal in terms of species if not the imprint we can make on the planet, but
equality is a term with many features. Disease can strike everyone, except if a person is
poor, malnourished, homeless, uneducated and without access to good healthcare, the
consequences can be very different. While a single 1 g sachet containing a fermentative
Streptococcus thermophilus and a probiotic Lactobacillus rhamnosus strain cannot address
all these issues, it can create a surprisingly important dent. Shown to ferment milk, cereal,
fruits and vegetables, the organisms can enhance immunity, counter pathogens, detoxify
certain pollutants and produce nutritious good tasting foods. Moreover, one sachet can
produce 100 L of yoghurt, form the basis of a proﬁtable microenterprise and value chain,
and empower women, men and youth in communities without their challenges to seek.
In Uganda, Tanzania and Kenya this initiative reached over 260,000 consumers, helped
create hundreds of small businesses and improved school food programs. Now led by
Western Heads East and Maimuna Kanyamala in Tanzania and Yoba-for-life in Uganda and
other countries, the opportunities to grow locally are continuing. Meanwhile, our lab has
expanded the research to use probiotic strains to reduce honeybee colony collapse caused
by pathogens and pesticides. As these pollinators are critical to the food chain, efforts are
needed to save them. In addition, we are assessing whether probiotic strains can reduce
death and failure to thrive in Chinook salmon. This application is challenging because
of water temperature and the absence of a permanent gut microbiota. Nevertheless, ﬁsh
are a critically important staple for many people around the world and while salmon are
not found in Lake Victoria, Tilapia and other ﬁsh there, as well as off the coast of China,
are exposed to an excessive range of pollutants that certain probiotic strains might help to
counter. Feeding probiotics to farm ﬁsheries is logistically easier than lakes and oceans, but
humans have never been deterred by challenges. If researchers in developed countries can
partner with researchers and communities in developing countries, the least it will teach us
is that we are one species, and the colour of our blood is the same. We have much to learn
from each other—this is not a one-way street. Beneﬁcial microbes can be the tools through
which humanity and the ecosystem can grow and learn together. Let us encourage the next
generation of talented students to make this area fulﬁl its potential.
5.7. Beneﬁcial Microbes in Apiculture: A Multi-Purpose Solution to Improve Honeybee Health and
Reduce the Environmental Spread of Antimicrobial Resistance
Brendan Daisley, Andrew Pitek, John Chmiel, Shaeley Gibbons, Anna Chernyshova,
Kait Al, Kyrillos Faragalla, Jeremy Burton, Graham Thompson and Gregor Reid
ern University, London, ON N6A 3K7, Canada).
Antibiotic administration in apiculture is intended to prevent bacterial disease but
inadvertently contributes to the global dissemination of antimicrobial resistance and can
harm honeybee (Apis mellifera) symbionts via broad-spectrum activities. For example,
we ﬁnd that routine administration of oxytetracycline increases tetB (an efﬂux pump-
based resistance gene) abundance in the gut microbiota of nurse-age worker bees and at
the same time depletes key symbionts known to regulate immune function and nutrient
Int. J. Environ. Res. Public Health 2021,18, 10654 29 of 101
metabolism, such as Frischella perrera and Lactobacillus Firm-5 strains. Functionally, these
microbial changes are associated with a ~50% decrease in capped brood (marker of hive
nutritional status and productivity) and a ~30% reduction in antimicrobial capacity of
adult hemolymph (indicator of immune competence). To assess how probiotic lactobacilli
might be used to counter these negative effects on hives and potentially reduce the need
for antibiotics, we fed three probiotic strains of lactobacilli (2 strains exogenous and 1 strain
endogenous) to bee colonies using an edible BioPatty. The ﬁndings demonstrate that combi-
nation therapy with probiotics can: (i) rescue brood count deﬁcits during antibiotic recovery,
(ii) mitigate antibiotic-associated microbiota dysbiosis via host-mediated immunoselective
regulation of core microbiota members, and (iii) maximize the intended beneﬁt of oxytetra-
cycline by suppressing larval pathogen loads to near-undetectable levels. We conclude that
microbial-based therapeutics may offer a simple but effective multi-purpose solution to
reduce honeybee disease burden, environmental pollution by xenobiotics, and spread of
5.8. Biochar-Urine Nutrient Cycling for Health: A Carbon Intelligence Project
Jillian Waid 1,2,3
Heidelberg Institute of Global Health, Heidelberg University, Hei-
Helen Keller International, Bangladesh Country Ofﬁce;
Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz
Association, 14473 Potsdam, Germany).
The Food and Agriculture Approaches to Reducing Malnutrition (FAARM) cluster-
randomized trial evaluates the impacts of a homestead food production program in Sylhet
Division, Bangladesh. During formative research, low soil fertility was found a production
constraint by the majority of farmers. The intervention sought to test and scale the use of a
locally produced, low-cost, urine-enriched biochar-based fertilizer to increase yields. This
fertilizer combines liquid organic nutrients and biomass transformed into biochar. Urine
is a highly efﬁcient fertilizer but underused because of odour. Biochar can be produced
from crop waste in soil-pit kilns at the village level. It is a porous material that can soak up
urine and transform it into an odourless solid fertilizer. This intervention was tested for
acceptability and scaled through two projects (BUNCH 2016–2017, BUNCH2Scale 2017–
2020) nested within the FAARM trial (FAARM website: https://bit.ly/2NJud9y accessed
on 1 August 2021).
The fertilization system’s performance was measured through four rounds of partic-
ipatory farmer trials piloted in 2017 and scaled in 2018. The use of the technology was
examined through multiple rounds of the FAARM surveillance system, including all regis-
tered trial participants (early areas from May to June 2017, all areas from July to October
2018, and sustainability assessment from November 2018 to August 2019).
By July 2018, 94% of farmers in the intervention group had heard of urine–biochar
fertilizer, 87% had attended training, and 81% had tried the new fertilizer. Reported beneﬁts
included better yields, healthier plants, fewer pests, lower input costs, and better-tasting
vegetables. During each growing season following project scale-down, well over one-third
of farmers continued to use biochar-based fertilizer. In farmer ﬁeld trials, where one
plot fertilized with usual practice was compared to another plot fertilized with nutrient-
enriched biochar, biochar-based fertilizers increased yields from 28% to 68%, depending on
the crop type.
Biochar–urine fertilizer was thus found to be an acceptable and effective technology
for increasing home garden yields in the FAARM project area in Sylhet, with the potential
to scale this technology further within Bangladesh and similar settings. Biochar is a win for
yields, soil fertility, and the planet. These fertilizers increase soil organic matter, biological
activity, and water-holding capacity, in contrast to commercial mineral fertilizers that
allow soluble nutrients to leach into groundwater. While the production of commercial
mineral fertilizers is energy intensive and contributes to greenhouse gas emissions, biochar
functions as a carbon sink.
Int. J. Environ. Res. Public Health 2021,18, 10654 30 of 101
Further reading: Sutradhar, I., Jackson-deGraffenried, M., Akter, S. et al. Introducing
urine-enriched biochar-based fertilizer for vegetable production: acceptability and results from
rural Bangladesh. Environ Dev Sustain (2021). https://doi.org/10.1007/s10668-020-01194-y.
5.9. A Real-Life Nutritional Study and a Double-Blind Placebo-Controlled Nutritional Trial on
Health Outcomes of a Probiotic Yoghurt Intervention among Schoolchildren from Three to Six Years
Old in Southwest Uganda
Nieke Westerick 1,2, Wilbert Sybesma 1and Remco Kort 1,2,3
Yoba for Life foundation,
Amsterdam, The Netherlands;
ARTIS-Micropia, Amsterdam, The Netherlands;
ment of Molecular Cell Biology, VU University Amsterdam (VUA), De Boelelaan 1085, 1081
HV Amsterdam, The Netherlands).
Children in Southwestern Uganda have poor growth indicators and a high incidence of
common childhood diseases such as respiratory tract infection, skin disease and diarrhoea.
In response to these challenges, the consumption of locally produced milk and probiotic
yoghurt containing Lactobacillus rhamnosus yoba 2012 is currently promoted at pre-primary
and primary schools in seven districts in Southwestern Uganda. Parents are encouraged
to pay approximately USD 3 per school term of 3 months, for their child to take 125 mL
of probiotic yoghurt daily, as produced by one of the local probiotic yoghurt producers.
Currently over 20,000 children participate in this program. The health impact of probiotic
yoghurt consumption in this program versus milk was assessed in a real-life interrupted
time series study. A total of 1116 children from three to six years old (probiotic yoghurt
n = 584,
milk n = 532) were assessed on daily basis with regards to incidences skin disease
and common cold during three weeks of baseline and eight weeks of intervention. The
study found a signiﬁcant reduction over time in the incidence of skin diseases (RR 0.62, CI:
0.43–0.88) and a trend indicating a reduction of the common cold symptoms (RR 0.85, CI:
0.52–1.41) in the intervention group as compared to the control group after eight weeks
of intervention. In a second phase of the research, a double-blinded placebo-controlled
interrupted time series study was conducted to conﬁrm the results of the ﬁrst study, in
which a total of 195 children from three to six years old (probiotic yoghurt n = 100, placebo
dairy product n = 95) participated. The study showed a reduction over time in the incidence
of common cold (pvalue = 0.0032) and showed a trend for a reduction in the incidence of
skin conditions (pvalue = 0.2950) for the probiotic yoghurt group versus the placebo group.
However, at baseline, the incidence of skin conditions as well as common cold were higher
in the intervention group, hence despite the signiﬁcant relative decrease in the incidence of
the disease, the ﬁnal risk ratios (RR) of respectively 1.0 (CI: 0.87–1.2) and 1.0 (CI: 0.71–1.4)
did not show a signiﬁcant effect of the intervention on either condition.
5.10. Probiotic Approach for Mitigation of the Risk Effects of Aﬂatoxin: The Application of
Lactobacillus rhamnosus Yoba to Enrich and Decontaminate Aﬂatoxins in Fermented Foods
Alex Paul Wacoo 1,2,3, Nieke Westerik 1,2, Wilbert Sybesma 1and Remco Kort 1,2,4
for Life Foundation, Hunzestraat 133-A, 1079 WB Amsterdam;
Department of Molec-
ular Cell Physiology, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amster-
Department of Medical Biochemistry, School of Biomedical Sciences, College of
Health Sciences, Makerere University, Kampala, Uganda;
Background and rationale: Food safety require urgent attention especially in devel-
oping countries where regulation of local food is neglected. In the 2018–2019 ﬁnancial
year, Uganda lost USD 52.4 million due to rejection of maize resulting from high aﬂatoxin
contamination. There was no record of the rejected maize being destroyed, therefore it
could have been sold and consumed locally in Uganda. Exposure to aﬂatoxins is linked
to liver cancer contributing to approximately 25,200—155,000 of 550,000 to 600,000 new
cancer cases yearly. A total of 83% of these deaths occur in Sub-Saharan Africa and East
Asia due to synergistic contribution between aﬂatoxins and highly endemic hepatitis B
infection. Since maize is a major food crop in East Africa, the development of technologies
Int. J. Environ. Res. Public Health 2021,18, 10654 31 of 101
that can reduce aﬂatoxins is highly relevant. Lactobacillus rhamnosus GG, under the generic
name Lb. rhamnosus yoba 2012, successfully ferments milk to make yogurt, maize porridge
(Uji), and Obushera, but the precise mechanism behind the reduction of aﬂatoxins during
fermentation has not yet been studied. The effect of administered L. rhamnosus yoba 2012
in minimizing the dangerous effect of ingested aﬂatoxin is unknown.
Objective: The objective of our research is to evaluate the prevalence of aﬂatoxins
in maize ﬂour in ﬁve major markets and selected households within Kampala, Uganda.
The second objective is to assess the effect of the yoba starter culture bacteria on aﬂatoxins
reduction during fermentation of maize porridge and to understand the mechanism of
action. The impact of consuming probiotic fermented foods on the reduction of aﬂatoxin
ingested in contaminated food was assessed.
Methodology: 60 maize ﬂour samples from ﬁve major markets of Kampala and
72 samples from households were analysed for aﬂatoxins contamination using a novel
immunosensor for point-of-care measurements that has been developed in our laboratory.
Kwete spiked with 120
g/Kg of total aﬂatoxin was produced by fermenting a suspension
of maize ﬂour in water at 37
C for a period of 24 h. The aﬂatoxin level in fermented Kwete
was monitored using HPLC-ﬂuorescence measurements.
Results: A total of 31.7% maize ﬂour samples from the markets were contaminated
with aﬂatoxins and 16.7% of the positive samples had concentration higher than 10
allowable level for East Africa. For household samples, 43% of the samples had aﬂatoxins
which were higher than acceptable limits with the highest concentration registered being
g/Kg. During fermentation of contaminated maize, Lb. rhamnosus yoba 2012 increased
from log 6 to log 8 cfu/g in 24 h at 37
C. Simultaneously, the aﬂatoxins levels in the porridge
were completely eliminated.
Conclusions: The study demonstrated that fermentation with the Lb. rhamnosus yoba
2012 starter culture offers a practical approach to reduce aﬂatoxins B1, B2, G1 and G2 in
maize porridge during a period of 24 h.
5.11. Bacterial Community Diversity in Gundruk—The Naturally Fermented Food from Nepal
Prajwal Rajbhandari 1and Remco Kort 2
President and co-founder, Research Institute
for Bioscience and Biotechnology, Lalitpur 44600, Nepal;
Department of Molecular Cell
Physiology, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam).
Naturally fermented foods contain complex and diverse microbial communities, which
are a source of beneﬁcial bacteria and vitamins such as B [
]. Different countries have
their own traditional fermented foods, including Kimchi in Korea, Sauerkraut in Germany,
Miso in Japan and Gundruk in Nepal. Gundruk is one of the national dishes of Nepal and
made by fermenting green leaves of mustard, cauliﬂower or radish and used as pickles,
soup or as salads. According to UN FAO, approximately 2000 tons of Gundruk are made
locally in households annually but its nutritional information and its health beneﬁts are
poorly described. Therefore, this study will isolate, identify and characterize naturally
occurring bacterial compositions of Gundruk made by local communities in different
geographical regions of Nepal. Along with that, the project aims to explore the variation in
microbial communities, its dynamics throughout the production process and characterize
the metabolites produced during fermentation with potential health beneﬁts.
5.12. Microbial Characterization of Keﬁr from Raw Milk Fermented by a Commercial Culture or a
Symbiotic Consortium of Bacteria and Yeast
Luuk van Ooijen 1, Ton Baars 2and Remco Kort 1,3
Department of Molecular Cell
Biology, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands;
ment of Immunopharmacology, Utrecht University, 3584 CL Utrecht, The Netherlands;
3ARTIS-Micropia, 1018 CZ Amsterdam, The Netherlands).
The modern western lifestyle resulted in improvement of personal hygiene and
thereby reduction of the prevalence of communicable diseases. Food preservation tech-
niques further reduced the incidence of foodborne pathogens. These developments led to
Int. J. Environ. Res. Public Health 2021,18, 10654 32 of 101
reduced environmental exposure of humans to microbes with adverse effects. Reduced
microbial exposure, particularly in early life, is associated to an increased risk for inﬂamma-
tory diseases. The consumption of raw milk has been associated with a reduced incidence
of asthma and allergies. These properties could be explained trough immunomodulatory
properties of raw milk believed to be caused by speciﬁc peptides, proteins and microorgan-
isms. Consumption of raw milk is not without health risks, zoonotic organisms including
Salmonella, Campylobacter and Listeria can be present. Preventive measurements in the
form of proper milking and zoonosis detection techniques can limit the health risk for
consumers. Fermentation of raw milk could be the solution in consuming raw milk with
a further reduced risk of exposure to harmful microorganisms. Keﬁr is a dairy beverage
traditionally fermented by a consortium of bacteria and yeasts. The high microbial load
of keﬁr might aid in restoring the dietary intake of microbes. Knowledge is limited re-
garding the presence of beneﬁcial raw milk microbes in keﬁr. Therefore, this study will
use amplicon 16s and ITS sequencing of several stages of raw milk fermentation in order
to determine which bacteria and yeast are present. By using a genomic spike-in the ratio
between yeast and bacteria could be quantiﬁed. Furthermore, comparisons will be made
between the microbial diversity of raw milk keﬁr and pasteurized milk keﬁr based on
a commercial culture or an in-house SCOBY. The outcome of this research will provide
additional insight for strategies to enhance dietary uptake of microorganisms in order to
diversify and improve the human microbiome. This can potentially assist in tackling the
non-communicable diseases pandemic.
5.13. Screening of β-Galactosidase Production from Lactic Acid Bacteria Isolated from Different
Livestock of Nepal
Manila Poudel, Shyam Suwal and Prajwal Rajbhandari
(Research Institute for Bioscience
and Biotechnology, Lalitpur 44600, Nepal).
The dairy industry is one of the most dynamic sectors of Nepal where production
of cheese and its market is in constant growth. As a starter for the production of dairy
products, Gram-positive Lactic acid bacteria (LAB) are generally regarded as safe. In
addition, some of the LAB can produce
-GAL) that are responsible for
the breakdown of lactose into its simpler forms and form galactooligosaccharides (GOS). A
large quantity of cheese whey produced as a by-product from the dairy processing consists
of lactose (80–85% dry mass) which can be fermented by the
-GAL into GOS. GOS are
prebiotic compounds that enhance the performance and function of gut microﬂora which
could potentially improve human health. The main purpose of this study is to isolate
industrially useful lactic acid bacteria producing
-GAL enzyme from milk of various
livestock found in varying altitude in Nepal. The milk samples were collected from various
livestock (cow, buffalo and goat) at different altitudes (Bishnupurkatti—80 m, Sindhuli—
1273 m, Khokana—1450 m and Chitlang—1750 m) in Nepal. LAB present in milk were
isolated on selective media (MRS agar for Lactobacillus spp. and M17 agar for Lactococcus
spp.). A total of 85 bacteria isolated from samples were identiﬁed via morphological and
biochemical characterization. Among the isolates, 40 LAB strains were screened for
production by using X-gal/IPTG assay which showed blue colonies.
5.14. From Agricultural Health to Climate Change’s Health Threat among Farmers and
Vivien How, Raihanah Chokeli, Nurul Syazani, Yuswir and Zailina Hashim
Putra Malaysia, Serdang, 43400 Seri Kembangan, Selangor, Malaysia).
While chemicals have played a key role in agriculture, they also pose potentially
signiﬁcant threats to healthy ecosystems and human health. A ﬁve-year study on envi-
ronmental, occupational and genetic factors on the health of farmers and farm families
explores the potential links between agricultural exposures and chronic diseases. Farm
workers performing hand labour tasks in pesticide-treated areas have increased exposure
to direct spraying, aerial drift, or contact with pesticide residues in the crop and soil via
Int. J. Environ. Res. Public Health 2021,18, 10654 33 of 101
skin and inhalation. These environmental residues have cross-contaminated the farm
children and affected their neurodevelopment. The risk of genotoxicity, on the other hand,
has been found to cause farm children’s cells to experience early cell damage that leads to
uncontrolled cell proliferation during their adulthood. Since pesticides could bioaccumu-
late in the human body, pesticide residual was found in the urine of children who live near
to this pesticide-treated farmland. Our work also found that heavy metals as impurities
that soil receives from agricultural practices bioaccumulated in the ﬁsh collected from the
paddy trench. The dietary health risks from the low-level accumulative consumption of
these contaminated ﬁsh have found to increase with ages and body mass index among
farming villagers. Exposure to extreme heat stress is yet another growing concern for
farming communities due to global climate change, particularly in tropical developing
countries. Our recent study also found that there is a disparity in the physiological health
status among conventional and agroecology farmers, where the former bears the increased
physiological health risk burden under extreme climatic effects. For years, our work
provides the evidence-based agricultural health study. Today, it supports the action of
sustainable healthy agricultural practices that can lead to lasting change for both individual
5.15. The Under-Appreciated Role of Tropical Forests in Nutrition and Food Security
Sarah Gergel 1, Bronwen Powell 2, Laura Rasmussen 3and Frédéric Baudron 4
versity of British Columbia, Vancouver, BC V6T 1Z4, Canada;
Pennsylvania State Uni-
versity, State College, PA 16801, USA;
University of Copenhagen, 1165 København,
CIMMYT [International Maize and Wheat Improvement Centre], Mount Pleas-
ant, Harare, Zimbabwe).
Malnutrition impacts at least two billion people. Yet, the role of forests as a source
of nutrition is underappreciated. Here, we explore the role of landscape diversity (the
combined patterns of forests and ﬁelds) in supporting dietary diversity by examining
linkages between nutritious diets and forests within the rural tropics. To do so, we synthe-
size and merge long-term and high spatial resolution imagery of landscape change with
household diet surveys across a range of sites in Africa and Southeast Asia to uncover
associations between primary forests, forest patches, as well as disturbed and edge habitats
in bolstering dietary diversity. This approach helps illuminate direct and indirect pathways
(agro-ecological, energy, and market pathways) connecting forested landscapes to diet
diversity. Improved evaluation of the role of land cover complexity in food security and
nutrition can help avoid overly simplistic views of food security and uncover nutritional
synergies with forest conservation and restoration.
5.16. Protein for a Healthy Future: How to Increase Protein Intake in an Environmentally
Sustainable Way in Older Adults in The Netherlands
Alessandra Grasso 1, Margreet R. Olthof 1, Cornévan Dooren 2, Roline Broekema 3,
Marjolein Visser 1and Ingeborg A. Brouwer
Vrije Universiteit Amsterdam, 1081 HV;
2Voedingscentrum, 2594 AC; 3Blonk Consultant, 2805 PJ, Amsterdam).
Protein intake greater than the recommended amount is suggested to improve physical
functioning and wellbeing in older adults, yet it is likely to increase the climate footprint
of the diet if environmental sustainability is not considered. Therefore, there is a need
to delineate ways to increase protein intake in an environmentally friendly manner in
older adults. This study aimed to identify dietary changes needed to simultaneously
increase protein intake and reduce greenhouse gas emissions (GHGE) in the diet of Dutch
community-dwelling older adults. Mathematical diet optimization was used to model high-
protein diets with minimized departure from the habitual intake of 1354 Dutch older adults.
First, a high-protein diet deﬁned as one providing >1.2 g protein/kg body weight/day
was developed isocalorically while maintaining or improving nutritional adequacy of the
diet. Second, adherence to the Dutch food-based dietary guidelines (FBDG) was imposed.
Third, a stepwise 10% GHGE reduction was applied. Achieving a high-protein diet aligned
Int. J. Environ. Res. Public Health 2021,18, 10654 34 of 101
with the FBDG without considering GHGE resulted in 5% increase in GHGE in men and
9% increase in women. When a stepwise GHGE reduction was additionally applied,
total meat stayed constant until a 50–60% GHGE reduction, with a stepwise increase in
poultry and pork (mainly for women) and stepwise decrease in beef/lamb and processed
meat, and increases in whole grains, nuts, and meat/dairy alternatives and decreases
in discretionary products were needed. A high-protein diet aligned with FBDG can be
achieved in concert with reductions in GHGE in Dutch older adults by consuming no more
than the recommended 500 g meat per week while replacing beef and lamb and processed
meat with poultry and pork and increasing intake of diverse plant–protein sources.
5.17. An Integrated Scalar Analysis of the Cumulative Health Impacts of Multiple Land Uses:
Focus on British Columbia, Canada
Chris Buse (University of British Columbia, Kelowna, BC VIV 1V7, Canada).
Natural resource extraction and development activities interact with a host of land
uses that can leave lasting consequences for environmental, community and human
health values. Novel research methods are required to account for past, present and
future “cumulative impacts” of resource extraction and development across broad
geographic areas, and the multiple nested ecological scales they comprise. Devel-
oping an integrated understanding of the interrelationships between environments,
communities and health is therefore increasingly required to develop next generation
research and policy action that can improve health equity and sustainability for all
in the face of the grand ecological challenges of the 21st century. Leveraging insights
from environmental, social and health impact assessment, this presentation utilizes
the case study of British Columbia, Canada to introduce a suite of research methods to
conceptualize a novel integrated assessment method merging quantitative and qualita-
tive data to inform an understanding of the cumulative environmental, community
and health impacts of natural resource development. These include qualitative “data-
driven story-telling” approaches with local stakeholders and Indigenous rightsholders
comprising over 1000 person hours of community participation, collaborative quanti-
tative indicator development, and a resulting geospatial analysis of environmental,
community and health impacts by applying the CalEnviroScreen method—a novel
environmental health justice screening tool. By merging statistical representations with
narratives that articulate the lived experience of cumulative impacts, this presentation
comments on the current state of cumulative impacts assessment, and contemporary
policy approaches to natural resource development in relation to the pursuit of health
equity. Implications for exploring cumulative impacts across multiple temporal and
geographical scales (e.g., watersheds, airsheds, multiple governing jurisdictions) and
their implications for driving healthy public policy are discussed.
5.18. Altered Eating in the Anthropocene and Brain “Injuries”: Is It Fundamentally Altering
Duika Burges Watson 1and Vincent Deary 2
Newcastle University, Newcastle upon
Tyne NE1 7RU, UK; 2Northumbria University, Newcastle upon Tyne NE1 8ST, UK).
Many people live with an altered sense of taste as a result of illness, life course
transitions or environmental disruptions. For instance, the 2018 SHEFBIT cohort study of
altered eating in traumatic brain injury suggests that 43.5% of people with severe injury and
9.55% with mild have complete smell loss. However, almost no studies in any population,
included brain injury, have examined the extent or impact of diminished or altered (as
opposed to completely lost) olfaction on taste, eating preferences and pleasure. Part of the
reason for this lack of data appears to be a general lack of interest in olfactory function in
relation to health, eating and wellbeing. Yet smell largely governs our overall experience of
the “ﬂavour” of food and a diminished or altered sense of smell can have major impacts on
ﬂavour, food choice and wellbeing. In this presentation we argue that the modern food
environment has fundamentally altered our smell and taste through “injuring” the brain
Int. J. Environ. Res. Public Health 2021,18, 10654 35 of 101
structures that subtend these senses. There is a high degree of neuroplasticity of the brain
in relation to what tastes “good to eat”. Consequently, researchers have raised concerns
that a diet of ultra-processed food products, typically high in salt fat and sugar, is rewiring
neural networks in a way that shapes preferences for foods that are neither good for health
nor for the environment. In short, a diminished sense of smell may be as much the result of
the spread of ultra-processed foods and the rising dominance of transnational food as it is
the result of direct physical injury. Drawing on the work of the Altered Eating Research
Network with traumatic brain injury and other illnesses, we reﬂect on the potential for
olfactory training and multi-sensory awareness to “rewire”, repair and restore consumers
pleasure in foods.
6. Building Mutualism through Nature Connectedness: Inspiring Wellbeing, Meaning,
Social and Environmental Responsibility
Human connection to nature is known to be a basic psychological need: emerging
research shows relationships between nature connectedness as a psychological asset and
pro-environmental and pro-social behaviour, as well as human wellness. This session
explored the value of nature connection in promoting creativity and mutualistic value
systems (as summarised in Figure 5).
6.1. Imagining New Ways of Living: At the Intersection of Art, Nature and Health
(Clinical Professor Emerita, Family Medicine, University of Michigan, Ann
Arbor, MI USA, Scholar, The Institute for Integrative Health, Baltimore, MD 21231, USA).
The health of humans and the health of the planet are interconnected, yet humans
perpetuate destruction in denial of this truth. Expressive arts and creativity speak to us in
ways that can touch our hearts and motivate future action for planetary health. My overall
goal is to inspire others to imagine anew our human ways of living, such that we have a
template for transformative action through multiple pathways, all supporting an expanded
view of health including both humans and the environment. I present here visual images,
predominately by women, as a way to unpack signiﬁcant human-environment issues and
to elicit deep emotion among viewers. The curated images explore what art does for us,
ecological grief, art as activism, new inspirations for living, interconnectivity and reciprocal
healing, and ﬁnding our new map to the future.
Going forward, my transdisciplinary team and I have identiﬁed ways in which art and
other image-based forms of communication bring our awareness to the natural world and
the predicament of humans in relationship to environmental catastrophe. However, few
existing two-dimensional works focus on the known salutogenic aspects of our relationship
with nature, nor do they link the impending environmental catastrophe explicitly to its
effects on human health. Our plan is to build on this work by soliciting new works that will
bring an experience of these reciprocal beneﬁts and perils to ordinary people, encouraging
and empowering them towards action as individuals and in communities of varying scales.
We invite you to engage with us and follow our progress at www.mutualreawakening.org
accessed on 1 August 2021.
Int. J. Environ. Res. Public Health 2021,18, 10654 36 of 101
Building mutualism through nature connectedness. Overview of topics and speakers in the
session on nature and wellbeing on all scales.
6.2. The Green Road Project a Therapeutic Nature Space Veterans Struggling with the Unseen
Injuries of War
Fred Foote and Brian Berman
(The Institute for Integrative Health, Baltimore, MD 21231, USA).
Completed in 2018, the Green Road is the Nation’s largest wild-type healing garden. It
was designed to provide healing and stress relief to the 12,000 military personnel at Naval
Support Activity, Bethesda, MD (NSA/B), home of the Walter Reed National Military
Medical Center (WRB), especially for those with traumatic brain injury and post-traumatic
Int. J. Environ. Res. Public Health 2021,18, 10654 37 of 101
stress disorder (TBI/PTSD). The Green Road serves as a source of holistic healing in
TBI/PTSD, as a model for the use of green space in urban environments, and as a national
laboratory for studying the health effects of nature.
The Green Road consists of a half-mile long ADA-compliant path (along an existing
natural stream) and a central woodland healing garden. Along with access from the Walter
Reed hospital, the path allows users to avoid trafﬁc and other stressors while moving about
the Base. The two-acre central garden sits in an eight-acre woodland ravine, surrounding
the stream. The pedestrian path traverses the garden, with branches leading to a variety of
forest and stream encounters. The garden site was modiﬁed to give enhanced exposure to
trees, water, stone, and wild animals (deer, aquatic life, and other fauna). A Communal
and a Commemorative Pavilion were also constructed.
Adjacency to the National Institutes of Health and the Uniformed Services University
of the Health Sciences (USUHS) has facilitated research into the health beneﬁts of the
Project—including a recent comparison of the Green Road with a parallel experience of
walking in an urban environment (Ameli R, et al., 2021). The Green Road was unanimously
rated as positive (100%). The Green Road yielded mainly positive themes such as enjoyment
of nature, relaxation, and feelings of privacy and safety. The Urban Road produced
signiﬁcantly more negative themes. Quantitative assessment showed that a walk on the
Green Road signiﬁcantly decreased distress and increased mindfulness compared to a walk
on the Urban Road. Further funded research focused on stress biometrics will be reported
This Project is a public/private partnership between the Navy Base and the Insti-
tute for Integrative Health (Baltimore) with substantial funding from TKF Foundation
(Annapolis, MD), the friends of Shockey Gillet, Capital Funding, LLC, and other donors.
Rezvan Ameli, Perry Skeath, Preetha Abraham et al., 2021. A nature-based health
intervention at a military healthcare center: a randomized, controlled, cross-over study.
PeerJ 9: e10519.
6.3. Group Activities in Nature: Growing Resilience and Buffering Adversity
(University of Surrey, Environmental Psychology Research Group, Guild-
ford GU2 7XH, UK; De Montfort University, Leicester LE1 9BH, UK).
We currently live in a time with signiﬁcant stress and risk of poor mental health.
Nature-based activities have been used as therapeutic interventions for those experiencing
stress and mental ill health.
This study investigates whether nature-based group walks could be a public health
intervention to foster resilience and protect against adversity. An observational research
design with propensity score-matched samples compared the mental health of individuals
who partook in nature-based group walks once a week or more (frequent nature-based
Group Walkers, n = 631) to a comparison group (n = 435). Results showed that nature-based
group walks did not buffer the effects of stressful life events on mental health. However,
nature-based group walkers had better mental health—both when experiencing stressful
life event and not—than the comparison group. This suggests that nature-based group
walks at least once per week may be a good treatment to lessen the impact of a stressful
life events on mental health. In another study, we investigated whether the type of natural
environment for a group walk matters for mental health. Compared to group walks in
an urban environment, group walks in the countryside and urban green corridors were
associated with signiﬁcantly less stress and negative emotions—suggesting that contact
with these spaces can boost resilience. Our research shows how nature-based group walks
could be a public health intervention for mental health and coping with adversity.
6.4. Let Nature Be Thy Medicine: A Socio-Ecological Exploration of Green Prescriptions in the UK
(Department of Landscape, The University of Sheffield, Sheffield S10 2TN, UK).
Int. J. Environ. Res. Public Health 2021,18, 10654 38 of 101
Chronic, non-infectious diseases are on the rise and social isolation is emerging as a
major risk factor for mortality. Spending time in natural environments, immersed in the
sights, sounds, and smells can bring important health and wellbeing beneﬁts to humans.
Furthermore, we are thought to interact with an array of invisible health-regulating biogenic
compounds in these natural environments. Indeed, a plethora of studies now support
the nature-health nexus and several mechanistic pathways have been proposed. A green
prescription is an emerging method of prescribing time spent interacting with nature, e.g.,
a nature walk, conservation volunteering, or therapeutic horticulture. Green prescriptions
are typically provided by general practitioners and social care professionals in conjunction
with environment-centric groups. Green prescribing is designed to be a holistic intervention
with the potential to help prevent (proactive) and alleviate (reactive) noncommunicable
diseases and social isolation. However, little is known about the perceptions and awareness
of, and opportunities and constraints (e.g., social, spatial, ecological) associated with
green prescribing in the UK. To explore these factors from the perspective of both green
prescribing providers and prescribers, we formulated and distributed online questionnaires
and collected data from across the UK. A total of N = 261 respondents were included in the
analysis. The respondents consisted of general practitioners (n = 118) and nature-based
organisations (n = 143). We also collected baseline data to provide an estimation of the
spatial distribution of green prescribing activity in the UK. Using geographic information
systems (GIS) we will conduct further analyses to explore the socio-spatial and ecological
relationships associated with green prescribing, for example, using the Index of Multiple
Deprivation and various landscape metrics. At the time of writing this abstract, the analysis
for this study is only partially complete. Therefore, we discussed the preliminary ﬁndings
of this study during the inVIVO Planetary Health 2020 annual meeting.
6.5. Can Nature Contact Build Character Strengths: Wider Implications for
(Department of Management, Comillas Pontiﬁcal University Calle de
Alberto Aguilera, 23, 28015 Madrid, Spain).
The rupture between our self and nature is arguably one central reason behind the
current environmental crisis (Lieﬂänder et al., 2013). In fact, a large body of evidence shows
that nature relatedness is an antecedent of pro-environmental concern and behaviour
(Zelenski et al., 2015). Consequently, fostering interconnectedness with nature has become
a central goal of environmental education. Exposing students to natural sites has been
common practice in environmental education to nurture this connection among students.
However, activities in nature are not always feasible in classroom-based programs nor is
it clear that these activities equally accrue nature relatedness among students. Therefore,
there are calls for greater understanding of psychological factors that may impinge into
greater connectedness. Yet, only limitedly have studies examined the antecedents or
correlates of connectedness with nature, which have prompted calls for more research.
Responding to these calls, in a sample of 967 students (Merino et al., 2020), we draw
from positive psychology in order to examine whether character strengths (i.e., dispositions
to thinking, feeling, and acting towards a moral goal) are antecedents of nature relatedness
and which character strengths are more predictive of greater nature relatedness. Our results
evidence that intellectual character strengths (i.e., appreciation of beauty, love of learning,
and curiosity) are strongly associated with nature relatedness. In addition, they unveil
that nurturing the character strength of appreciation of beauty might be the most effective
route to increase nature relatedness among learners. These ﬁndings allow to suggest
that training this strength is a particularly productive route to higher levels of nature
relatedness; hence, it merits particular attention in environmental education. Moreover,
as beauty is everywhere, it might be trained in a number of contexts, in a diversity of
individuals, and through a wide range of resources, approaches and methods, either in
nature/outdoor-based or in classroom-based programs.
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The evidence provided about the prominence of appreciation of beauty in nurturing
our interdependence with nature supports the idea that developing a sense of wholeness,
relatedness and interconnectedness is necessary such that we can deconstruct the frames of
reference that lay the foundation of our unsustainable societies (Mochizuki and Fadeeva,
2010). In this sense, it helps to unveil a pathway for environmental (and other disciplines)
educators towards the aim of cultivating such sense.
Lieﬂaänder, A.K., Fröhlich, G., Bogner, F.X., and Schultz, P.W. (2013). Promoting
connectedness with nature through environmental education. Environmental Education
Research, 19 (3), 370–384.
Merino, A.; Valor, C.; Redondo, R. (2020). Connectedness is in my character: the
relationship between nature relatedness and character strengths, Environmental Education
Research, 26: 12, 1707–1728.
Mochizuki, Y. and Fadeeva, Z. (2010). Competences for sustainable development and
sustainability: Signiﬁcance and challenges for ESD. International Journal of Sustainability
in Higher Education, 11 (4), 391–403.
Zelenski, J.M., Dopko, R.L., and Capaldi, C.A. (2015). Cooperation is in our nature:
Nature exposure may promote cooperative and environmentally sustainable behaviour.
Journal of Environmental Psychology, 42, 24–31.
6.6. Nature and Spiritual Wellbeing: A Simple Path to Improving Human Potential
Margaret Hansen 1and Reo Jones 2
School of Nursing and Health Professions, Univer-
sity of San Francisco, California, USA;
School of Nursing, Oregon Health and Science
University, Portland, Oregon, USA).
This presentation reviewed Shinrin-yoku (Forest Bathing) as an integrative practice,
known to improve humans’ physiologic and psychologic health and wellbeing—by mind-
fully using the ﬁve human senses while relaxing in natural environments. In addition, it
may be effective in enhancing or revealing human spirituality. The World Health Organiza-
tion deﬁnes an individual’s wellbeing as an awareness of one’s fullest possible physical,
psychologic, social, spiritual, and economic self. Recent evidence suggests that nature
promotes spiritual wellbeing. Hence, we performed a scoping review of the literature with
regard to the evidence of the interrelationship of Shinrin-yoku/nature and spirituality with
an aim to identify gaps in knowledge and assist with furthering empirical research.
The PRISMA extension for Scoping Reviews (PRISMA-ScR) methodological approach
was utilized by searching the electronic databases, CINAHL, Google Scholar, Scopus,
PubMed, PsychInfo, and ScienceDirect separately, for authors using key terms shinrin-
yoku, forest bathing, nature-based therapy, spirituality, health, wellbeing, awe, and wonder.
Of the 30 publications, 13 met the eligibility criteria and were included in the synthesis
(see full report in suggested reading below). The ﬁndings revealed that, despite the different
research methodologies and publications, nature may have a positive effect on human
spirituality and, therefore, enriching individuals’ wellbeing.
Thus, Shinrin-yoku is an integrative practice that may enhance or actualize human
spirituality. More research is needed to determine the interrelationship of Shinrin-yoku
and human spirituality in achieving one’s fullest possible self.
Margaret Mary Hansen and Reo Jones. The Interrelationship of Shinrin-Yoku and
Spirituality: A Scoping Review. J Alt Comp Med. 2020 Dec; 26 (12): 1093–1104.
6.7. Bac2Nature—Biodiversity Is at the Core of Our Health and Happiness: An
Marco van Es 1, Erin Kiemeney 2and Remco Kort 3,4
ative Business, University of Applied Sciences, Weesperzijde 190, 1097 DZ Amsterdam, The
ARTIS Micropia, 1018 CZ Amsterdam, The Netherlands;
De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands).
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Biodiversity is at the core of our health and happiness. Bac2Nature is an explanatory
animation about our connection to nature and a call for modern recovery of biodiversity
for our health. The animation explains the importance of exposing our immune system to
microbial diversity for the beneﬁt of our physical and mental health. It connects the care for
our planet to the care for our health. Our immune system is at the core of our health. It has
evolved in a highly diverse microbial environment. Therefore, the exposure to microbes
is required for a proper development and functioning of the immune system. Since the
industrial revolution we have reduced this exposure throughout our lives by decreasing
biodiversity of our environment (urbanization), process our food and overuse antimicrobial
cleaning agents and antibiotics. The consequence is a malfunctioning immune system
leading to an increased risk of several physical and mental chronic diseases. The animation
will explain that biodiversity connects our health to the health of our planet and inspires
the public with this novel paradigm. It will show the reduction of microbial exposure in
our modern society, and sparks the development of innovative solutions, leading to actions
to regain our health and happiness.
6.8. Do Natural Environments Promote Childhood Mental Health and Development? A Systematic
Review and Assessment of Different Exposure Measurements
Zoe Davis 1, Martin Guhn 1, Ingrid Jarvis 1, Michael Jerrett 2, Lorien Nesbitt 1, Tim
Oberlander 1, Hind Sbihi 1, Jason Su 3and Matilda van den Bosch 1
of British Columbia, Vancouver campus, V6T 1Z4, Canada;
University of California, Los
Angeles, CA 90095, USA; 3University of California, Berkeley, CA 94720, USA).
Background: Several studies have assessed the relationship between natural envi-
ronments (NEs) and childhood mental health and development. However, results are
inconsistent and association strength unclear, which may reﬂect the heterogeneity in NE-
measurements. We conducted a systematic review to evaluate the relationship between
NE-measurements and various indicators of childhood mental health and development,
focusing on relative strength of association depending on type of NE-measurement.
Methods: We used a PRISMA protocol to identify eligible studies following pre-
deﬁned inclusion criteria. After searching four databases using a number of keywords, 55
articles were included. From these articles, we extracted data on NE-measurement and
relative association to childhood mental health and development indicators. Additionally,
to evaluate evidence level, a systematic assessment of study quality and risk of bias
Findings: The most common NE-measurement was normalized difference vegetation
index (NDVI) derived from Landsat (30m resolution). Other measurements included land
use/land cover (LULC) datasets, expert audits, and surveys. NE-exposure was typically
assigned to participants in various buffer sizes around their residential address, and we
found the most consistent association to health outcomes for Euclidian distances of 250 m,
500 m, and within administrative polygons. We found sufﬁcient evidence for an association
between NDVI or LULC and improved birth outcomes, general behaviour and social
functioning, and decreased ADHD/ADD symptoms. We found limited evidence for an
association between LULC and academic achievement and insufﬁcient evidence for an
association between NE and mental disorders, memory function, and wellbeing.
Conclusions: This review suggests that several NE-measurements must be evaluated
further and compared with each other. It also indicates that research efforts should be
coordinated, using consistent NE-measurements to improve evidence level of associations
and effect sizes for different health outcomes. Strengthened evidence could contribute to
policies that beneﬁt the mental health and development of children by promoting contact
6.9. Childhood Experiences of Nature Inﬂuence Outdoor Preferences as Adults
(Department of Tourism Science Graduate School of Urban Environmental
Sciences Tokyo Metropolitan University, Minami-Osawa 1-1, Hachiouji, Tokyo 192-0397, Japan).
Int. J. Environ. Res. Public Health 2021,18, 10654 41 of 101
Individuals who frequently play in wild environments during childhood have more
positive perceptions towards nature, outdoor recreation activities, and potential future
occupations in outdoor environments. However, many people may have fewer chances
to interact with nature due to the loss of available natural environments and changes in
lifestyle, such as increasing indoor activity. Especially, the loss of childhood nature experi-
ences could decrease people’s emotional connection to nature, including nature relatedness
or likeability of living things. However, there is surprisingly limited information on how
negative emotions towards nature inﬂuence people’s contact with nature. In the presen-
tation, I introduced a study: how negative perceptions evoked from outdoor activities
inﬂuence preferences for later outdoor activities. The results showed that childhood nature
experiences decreased levels of disgust sensitivity and fear expectancy later in life. Disgust
sensitivity inﬂuenced outdoor activity preferences, whereas fear expectancy did not. The
SEM results suggest that childhood nature experiences are a strong predictor of perceptions
of outdoor activities. Therefore, I concluded that increasing contact with nature during
childhood would be useful for decreasing negative perceptions of nature later on.
6.10. The Allure of Healing Nature: Examining the Impact of Light on Mental Health
Brent Erickson (San Diego State University, San Diego, CA 92182, USA).
This thesis examines historical and contemporary attempts to utilize nature, speciﬁ-
cally light, therapeutically. Incorporating research from an array of disciplines, I review
and investigate the potential clinical utility of altering light regimens in support of mental
health in humans. The mechanics of how light impacts mammalian health are established
in a review of animal studies. Paired with epidemiological meta-analyses and experimental
human studies evidencing strong correlation between light exposure regimens, health
markers, and outcomes, recent evidence indicates a need for both further research and
immediate action. One of the most compelling research areas covers the arousing effects of
blue light exposure, occurring via human’s non-visual photo-receptive system. Cortisol
release and arousing effects from blue light exposure are well documented in animal trials,
meanwhile epidemiological meta-analyses show high correlation between the rapid adop-
tion of ﬂuorescent lighting, with the highest intensity in the blue spectrum, and worldwide
incidents of depression. This relationship has been observed in experimental studies of
human exposure to blue light in the evenings correlating with disturbed circadian rhythms,
depression, and anxiety. Epidemiological meta-analyses connect regular sun exposure with
positive cardiac health impacts as well as improvements in energy and mood, upending the
current clinical doctrine which recommends largely avoiding direct sunlight and replacing
Vitamin D with supplements. The extent of artiﬁcial indoor lighting and screen use has
drastically altered humans’ light exposure. Sunlight’s spectrum changes throughout the
day with the blue spectrum most prevalent early in the day shifting towards red in the
evening. This appears to synchronize circadian rhythm with the daily cycle of the sun.
Ubiquitous artiﬁcial lighting and screen use is being labelled a public health crisis. Adapt-
ing lighting design to more closely replicate sunlight’s natural rhythms of light spectrum,
timing, and intensity may provide tangible, low-cost beneﬁts to mental health.
6.11. The Inﬂuence of Different Types of Natural Environments on Self-Reported Health and
Ingrid Jarvis, Sarah Gergel, Mieke Koehoorn and Matilda van den Bosch
British Columbia, Vancouver, BC V6T 1Z4 Canada).
Background: Growing evidence suggests health beneﬁts of natural environments.
However, the effects of different types of natural environments (including water) and
forms of human-nature contact (access versus exposure) remain relatively unexplored.
Methods: This study uses a cross-sectional design to analyse the relationship between
self-reported health and both access and exposure to different types of natural environments
in Metro Vancouver, Canada. Data was acquired from the 2013–2014 Canadian Community
Health Survey on self-reported general health, mental health, and mood and/or anxiety
Int. J. Environ. Res. Public Health 2021,18, 10654 42 of 101
disorder (weighted n = 1,960,575). Natural environments were estimated using local land
use and land designation data and a high-resolution land cover dataset. Access was deﬁned
as living within 300 m of a public park (
1 hectare) and exposure as the percentage of
different land cover types within several buffer zones of residential postal codes. Separate
logistic regression models were used to estimate associations between access and exposure
to natural environments and the respective health outcomes.
Results: Exposure to water within 1000 m of residential postal codes was signiﬁcantly
associated with lower odds of self-reported poor general health, adjusted for confounders
(OR = 0.98, 95% CI = 0.96, 0.99). A similar association was found for exposure to shrub and
grass-herb vegetation types. Exposure to paved surfaces increased the odds of poor general
and mental health, while exposure to buildings was associated with higher odds of mood
and/or anxiety disorder. Neither access to public greenspace nor aggregated greenspace
exposure were associated with self-reported health.
Conclusions: Results suggest that type of natural environment should be considered
in future research studying the health-promoting aspects of natural environments and that
positive health effects appear to be more consistent for daily life exposure than for access
to public greenspaces.
6.12. Walking the Talk—Putting Healthy and Ecologically Mindful Living into Practice
Sheelin Coates (Director, Optimal Ecology, Noosa Heads, QLD 4567, Australia).
In this paper, I outline my efforts to create and model an optimally healthy and sustain-
able environment at home and in a broader context. I have drawn upon the diverse range
of experiences and insights gained from my rural Australian background, my veterinary
training and experience in the US intensive animal sector, and subsequent work experience
across a variety of industries including the pharmaceutical, construction, ﬁnancial and
natural health sectors, my husband’s prolonged illness and death due to brain cancer,
widowhood and single parenthood, and more recently, further post graduate studies in
food and sustainability, and the construction of a “healthy” sustainable house, lifestyle
and community. In light of my life experience and variety of learnings, I have set out to
create a living environment and lifestyle that incorporates as many aspects pertaining to
sustainability and health as possible. I have built an optimally healthy, sustainable home
in the Noosa UNESCO biosphere, that is adapted to the local environmental conditions
and context, is constructed for longevity, utilises minimal toxic inputs, and that is designed
to conserve resources (energy, water and other inputs). Food production, water storage
and conservation, energy production, thermal regulation, electromagnetic minimisation
and a seamless nature interface are all essential elements of the house design. In addition
to the built environment, I also adopt many other sustainable and healthy practices with
the aim of minimising as many toxic inputs and outputs as possible to create and model
an optimally healthy and sustainable lifestyle. A variety of additional aspects have been
taken into consideration, including but not limited to: the creation of circular systems,
recycling and minimal wastage of resources, enhancement and rehabilitation of the broader
ecological habitat, aspects of social sustainability including integration of surrounding
community and actively creating and strengthening local and broader community and
6.13. Nature Nearby and Its Association with Physical Activity in Older Adults in Delhi, India
Danielle MacCarthy 1, Suresh Rohilla 2, Geraint Ellis 1and Deepti Adlakha 1
Keir Building, Queen’s University Belfast, University Rd, Belfast BT7 1NN, Northern
Centre for Science and Environment 41, Tughlakabad Institutional Area, New
Delhi 110062, India).
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In the context of the rapid urbanisation taking place in many developing cities around
the world, the impact on both people and nature can be profound. It has become urgent
to understand the simultaneous beneﬁt of both a greater ecological presence in urban
environments and its relationship for people and health. With rising NCD’s and growing
ageing societies, environments play a key role in facilitating health for this population,
and in particular countering the effects of sedentary lifestyles. Less well understood are
the psychosocial mechanisms which underpin physical activity and its relationship to
attachment to place and nature connectedness, and in particular how these operate within
the developing world context.
Based on surveys, (n = 228) we assessed people’s rates of nature dose, time spent in
nature nearby—parks within four different neighbourhoods, varying in terms of socio-
economic status, i.e., high and low levels of greenness, high or low vegetation, rates of
physical activity as a whole, as well as measuring levels of place attachment and nature
connectedness for each respondent. Preliminary results conﬁrm that a relationship between
greener neighbourhoods and physical activity may be witnessed and that nature–dose
response may be mediated by nature connectedness. At the time of writing this abstract
however, the analysis for this study is only partially complete. I propose to discuss the full
ﬁndings of this study during the inVIVO Planetary Health 2020 annual meeting.
These ﬁndings could contribute to our understanding for the future planning of cities
and ageing in place discourse, with ramiﬁcations for health but also health budgets and
wider ecological beneﬁts. The importance of green cities is increasingly recognised for their
role in preventative health as well as the wide-reaching beneﬁts for cities with regards to
climate adaptation and the range of ecological services greenspaces provide.
6.14. Therapeutic Landscapes in Brussels City for Human Health Promotion and
Vitalija Povilaityte 1, Pierre Duez 2and Katriina Kilpi 3
Faculty of Medicine and
Pharmacy, University of Mons, 25 Chemin du Champ de Mars, B-7000 Mons, Belgium;
Faculty of Medicine and Pharmacy, University of Mons, 25 Chemin du Champ de Mars,
B-7000 Mons, Belgium;
Swedish University of Agricultural Sciences, SLU, Slottsvägen 5,
SE-230 53 Alnarp, Sweden).
An increasing problem in cities is loneliness that directly inﬂuences people’s quality
of life and susceptibility for unhealthy lifestyles and resulting sickness. According to Dr.
Cindy McPherson Frantz, the need to belong is one of the most powerful motivators of
human behaviour. It has been suggested that a meaningful psychological relationship with
the natural world, i.e., nature connectedness can fulﬁl our need of belongings and can
play a very important role in building human resilience, which results in connection with
oneself, nature and the larger community. Places that enable enjoying and meaningfully
interacting with the natural world can offer such opportunities to connect with nature. In
our study, we assessed the potential of natural environments (e.g., urban gardens, parks
and forest) to become a therapeutic landscape in Brussels city and their possible positive
health outcomes for human health promotion and disease prevention. Our study showed
that constructing a therapeutic landscape becomes possible when using nature-based
interventions and nature therapies as efﬁcient practices associated with human health and
healing. The evidence of the efﬁcacy of green exercise, garden therapy, eco-therapy and
forest therapy are starting to build up, though further studies are required. Nature based
solutions for health and wellbeing can produce supportive nature and social spaces that
can function as restorative places for human health. Signiﬁcant impacts of connectedness
with nature, one-self and social interactions transform the cultural and social urban fabric
into a therapeutic landscape with numerous beneﬁts for human health. Aesthetic qualities
and social networks offering a sense of security and inclusion, play a key role in every day
green care spaces through the transformative power of making urban nature spots into
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6.15. A Biography of Richard St. Barbe Baker’s 1950 New Earth Charter; An Ecological Manifesto
Calling for Harmony between People and Nature
(Department of Landscape Architecture, The University of Shefﬁeld, Shefﬁeld
S10 2TN, UK).
In 1950, the Men of the Trees, a society formed by the British forester and environmen-
talist Richard St. Barbe Baker (1889–1982), published a document called the New Earth
Charter which set out the foundations of the society’s ecological philosophy. The society
had been founded in Kenya as the Watu Wa Miti (People of the Trees) in 1922 when Baker
was working as a colonial forester and which aimed to foster a culture of tree-planting
to counter deforestation. In 1924 Baker founded a Men of the Trees group in Britain and
furthering the aims of the society—to plant and protect trees across the world—became
his life’s work. He was a proliﬁc self-publicist and unofﬁcial diplomat, whilst publishing
numerous books about his exploits and philosophy, including three autobiographies.
The New Earth Charter declares, “We believe in the development of a fuller under-
standing of the true relationship between all forms of life in an endeavour to maintain a
natural balance between minerals, vegetation, animals and mankind”. This plea for knowl-
edge, peace, and reconciliation preceded many of the twentieth century’s environmental
proclamations and publications and followed the 1945 Charter of the United Nations.
Within this context, the New Earth Charter represents an important distillation of his ethos,
and his desire to mediate between people and nature. Instead of Baker’s biography taking
precedence, the paper presents two biographies: that of Baker and—within and beyond
that—of the New Earth Charter. It questions the intention and efﬁcacy of the charter, as
well as its later reinterpretation as the Earth Charter as important artefacts within the story
of human nature relationships.
6.16. Important Park Features for Encouraging Adolescents’ Park Visitation, Physical Activity and
Social Interaction: A Conjoint Analysis
Elise Rivera 1, Jenny Veitch 2, Anna Timperio 1, Venurs Loh 1and Benedicte Deforche 3
Institute for Physical Activity and Nutrition at Deakin University, 221 Burwood Highway,
Burwood, VIC 3125, Australia;
Institute for Physical Activity and Nutrition at Deakin
University, 221 Burwood Highway, Burwood, VIC 3125, Australia;
Department of Public
Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University,
Corneel Heymanslaan 10, 9000 Ghent, Belgium).
Parks are key health-supportive settings that offer opportunities to be active, socially
interact and connect with nature. Despite their beneﬁts, park visitation and physical activity
levels during park visits are low among adolescents—a highly inactive sub-population.
Little is known about what park features may encourage adolescents to visit parks and
be active and social whilst visiting. This study examined the relative importance of park
features for encouraging adolescents’ visitation, physical activity and social interaction
Adolescents (13–18 years) were recruited in 2019–2020 from ﬁve secondary schools
located in socio-economically diverse areas of Melbourne, Australia. As part of an in-class
activity, participants completed an online survey, which included adaptive choice-based
conjoint (ACBC) tasks. This methodology enabled the relative importance of park features
for encouraging park visitation and active and social park use to be determined. Included
park features (n = 13) for each ACBC task were based on ﬁndings from a previous study
with adolescents. For each feature, part-worth utility and relative importance scores were
estimated with Hierarchical Bayes analyses using Sawtooth Software.
Participants (n = 244) had a mean age of 14.7 years (SD = 1.3), and 54% were male.
The three most important features for park visitation were large swings, large grassy open
space and a café; for physical activity, were sports courts, large grassy open space and
outdoor ﬁtness equipment; and for social interaction, were a café, barbecue/picnic areas
and sports courts. Gender differences were observed; sports features were more important
for males, while slides and swings were more important for females across the outcomes.
Int. J. Environ. Res. Public Health 2021,18, 10654 45 of 101
These results can inform stakeholders regarding which park features to prioritise
for optimal park development and refurbishment that maximises visitation and active
and social park use among adolescents. Findings highlight the importance of considering
speciﬁc needs of adolescents when planning park (re)design.
6.17. Urban Landscape Multifunctionality: Integrating Socio-Cultural Values to Ensure
Sustainable Urban Futures
Elizabeth Schrammeijer and Peter Verburg
(Vrije Universiteit Amsterdam, 1081 HZ Am-
sterdam, The Netherlands).
Green spaces are essential for sustainable cities. They provide social-cultural as well as
biophysical functions, such as importance for biodiversity, habitat provision and recreation,
and are considered important for human wellbeing. Densiﬁcation of urban areas are
thought to provide more efﬁcient infrastructure, reducing trafﬁc and related pollution. In
reality, more compact urban forms have a negative impact on the quality of life. Amongst
other impacts, green, public, open spaces are lost, while demand for their important
functions increase due to an increased number of residents.
Ensuring sufﬁcient and good quality urban green space faces a number of challenges
in compact cities and urban development areas. Improved knowledge of green space
qualities and how they fulﬁl the needs of residents is essential for socially sustainable
development. However, trade-off analysis that integrates different forms of values and
beneﬁts (such as biophysical, social and ecological) and appropriately considers relevant
cultural ecosystem services continues to be a major challenge.
Public participatory GIS (PPGIS) is an accepted way to identify citizens’ values and
has been used at a city level to inform city-wide planning decisions regarding densiﬁcation.
Building on these studies, we zoom in on a speciﬁc case in Amsterdam where densiﬁcation
is being planned. We present a framework whereby insights obtained with PPGIS can be
combined with ecological and physical spatial attributes of the landscape in an integrated
analysis of urban multifunctionality. Using PPGIS we deﬁne the needs of current residents
and workers and identify their perception of and preferences for existing green spaces.
With spatial analysis we map the demand and supply of social and ecological functions and
the beneﬁts provided by the current landscape. We then analyse the mismatches between
social expectations and ecological functions in different development scenarios and assess
how different green space qualities could be utilised to alleviate trade-offs.
7. Targeting Ecological Foundations: Rewilding Environmental Microbiomes:
Implications for Human Health and Microbial Ecology
In recent decades, we have begun to see that microbes are the foundation of all
life, not only in evolutionary terms, but in every modern ecosystem. Virtually every
aspect of human health also depends on microbes for healthy functioning. The health of
“our” microbes depends on the health of the wider ecosystems in which we reside. With
this knowledge, we can work with nature to restore ecosystems from “the bottom up”.
Moreover, microbial symbiosis exempliﬁes collaboration in nature. A simple unifying
principle that is much needed across every domain of human society today. This session
explored creative ways in which understanding and harnessing microbial ecology can
provide beneﬁts for healthier systems on all scales (Figure 6).
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Targeting Ecological Foundations: Rewilding Environmental Microbiomes. Overview of
topics and speakers in the session on microbial ecology for health at all scales.
Int. J. Environ. Res. Public Health 2021,18, 10654 47 of 101
7.1. “Earth” Rise: Soil Ecosystems Connecting the Health of People, Place and Planet (Celebrating
World Soil Day)
(Paciﬁc Northwest National Laboratory, Biological Sciences Division, Rich-
land, Washington, DC 99352, USA).
Soil is one of Earth’s most precious resources. It supports the growth of plants and the
animals and humans that feed on them. Soil is also a living resource with a huge biodi-
versity of microorganisms. A single teaspoon of soil contains billions of microorganisms.
These microbes are largely responsible for cycling of essential nutrients that are needed for
growth of plants and animals. In addition, soil microbes are the funnel through which soil
organic carbon is cycled. Depending on the soil properties and soil microbial activity, soil
organic carbon is either retained in the soil, which is beneﬁcial for soil fertility, or lost as
CO2to the atmosphere, which is deleterious for climate warming.
Our research focuses on the impact of climate change on functions carried out by soil
microorganisms that are essential for ecosystem functioning. This research spans different
ecosystem types, from permafrost in the Arctic to native prairie soils. As the climate warms
permafrost is starting to thaw. Permafrost is a huge reservoir of terrestrial carbon and
contains as much carbon as the Earth’s atmosphere and vegetation combined. As the
permafrost is thawed this enormous carbon freezer starts to warm and microbial activity
increases as a result. Microbes can survive in frozen permafrost but have low activity and
thus the soil organic carbon turns over very slowly. However, in thawed permafrost active
microorganisms start to metabolize the organic carbon, churning out CO
This leads to aggravation of the greenhouse gas effect and results in increased warming.
The other ecosystem that we study are prairie grasslands. As the climate changes
there are shifts in temperature and precipitation patterns that result in either increased
precipitation in northeast grasslands or decreased precipitation and drought in southwest
grasslands. The resulting shifts in soil moisture have profound impacts on soil microorgan-
isms and their ability to cycle carbon and other nutrients.
By using a “multi-omics” approach, we were able to assess not only how changes in
soil moisture impact the microbial community composition, but also their functional genes
and expression. For example, we found that genes and pathways for production of stress
protecting compounds “osmolytes” were enriched in dry soil when compared to wet soil.
These results indicate that soil microorganisms respond in speciﬁc ways to changes in their
environment. Whether these shifts will be permanent, or not, depend on the resilience of
the soil microbial community to short and long-term changes in their environment.
This knowledge is important for being able to model and predict how future climate
change will inﬂuence soil microorganisms and their ability to support plant and animal life.
7.2. Soils and Forest Materials to Rewild the Human Microbiome: Using Environmental Microbes
in Topical Preparations
(Head of Adele consortium *, Natural Resources Institute Finland, Itäinen
Pitkäkatu 4, 20520 Turku, Finland). * Adele research group members: Cerrone D, Grönroos
M, Mäkelä I, Nurminen N, Oikarinen S, Puhakka R, Roslund MI, Saarenpää M, Soininen L,
Sun Y, Laitinen OH, Rajaniemi J, Hyöty H, Sinkkonen A.
Before World War Two, green infrastructure and dirt were linked to serious illnesses
and child mortality. When serious pathogens and pests were largely eliminated in western-
ized societies, immune-mediated non-communicable diseases became common. Nowadays,
evidence suggests poor contacts with environmental microbial communities are a reason
for the high incidence of immune-mediated diseases (Haahtela et al., 2021).
In urban environments, typical playground sand contains magnitudes less microbes
than natural forest soils do. We recently realized how humans carry less microbes indoors
in urban compared to rural environment. We also found an association between diverse
yard vegetation and gut microbial diversity (Vari et al., 2021). Finally, we performed a
biodiversity intervention among daycare children (Roslund et al., 2020). In the interven-
Int. J. Environ. Res. Public Health 2021,18, 10654 48 of 101
tion, diverse vegetation and environmental bacterial communities were associated with
enhanced immune modulation (Roslund et al., 2020).
Based on these associations and ﬁndings, we designed a diverse microbial inoculant
that was manufactured from commercially available, microbiologically diverse gardening
soil and plant materials. We tested that the inoculant diversiﬁes skin and gut microbiota
(Grönroos et al., 2019), and that its use is associated with immune response (Nurminen
et al., 2018). Today, we are performing a randomized double-blind biodiversity intervention
study among infants. In the trial, 2 m old infants receive either placebo or lotion and linen
containing high microbial biodiversity. Children participate the intervention until 12 m
age, and they are followed for two additional years. Thus far, the results show that the trial
is safe. The vision is that those who have no access or who are not interested in exposing
themselves to rich environmental microbial communities, will eventually have a change to
receive the beneﬁts of diverse environmental microbiota indoors.
Grönroos M, Parajuli A, Laitinen OH, Roslund M, Vari H, Hyöty H, Puhakka R, Sinkko-
nen A. 2019. Short-term direct contact with soil and plant materials leads to an immediate
increase in diversity of skin microbiota. MicrobiologyOpen 8: e645. doi:10.1002/mbo3.645
Haahtela T, Alenius H, Lehtimäki J, Sinkkonen A, Fyhrquist N, Hyöty H, Ruokolainen
L, Mäkelä M. 2021. Immunological resilience and biodiversity for prevention. Authorea
Nurminen N, Lin J, Grönroos M, Puhakka R, Kramna L, Vari HK, Viskari H, Oikarinen
S, Roslund M, Parajuli A, Cinek O, Laitinen OH, Hyöty H, Sinkkonen A. 2018. Nature-
derived microbiota exposure as a novel immunomodulatory approach. Future Microbiol-
ogy, 13 (7): 737–744. doi:10.2217/fmb-2017-0286
Roslund M, Puhakka R, Grönroos M, Nurminen N, Oikarinen S, Gazali AM, Cinek O,
KramnáL, Siter N, Vari HJ, Soininen L, Parajuli A, Rajaniemi J, Kinnunen T, Laitinen OH,
Hyöty H, Sinkkonen A. 2020. Biodiversity intervention enhances immune regulation and
health-associated commensal microbiota among daycare children. Science Advances 6 (42):
eaba2578. DOI: 10.1126/sciadv.aba2578
Vari HK, Roslund MI, Oikarinen S, Nurminen N, Puhakka R, Parajuli A, Grönroos M,
Siter N, Laitinen OH, Hyöty H, Rajaniemi J, Anna-Lea Rantalainen A-L, Sinkkonen A. 2021.
Associations between land use types, gaseous PAH levels in ambient air and endocrine
signaling predicted from gut bacterial metagenome among the elderly. Chemosphere 265
(February 2021): 128965. DOI: 10.1016/j.chemosphere.2020.128965.
7.3. Restoring the Environmental Microbiome—A Public Health Intervention?
Martin Breed (Flinders University, Bedford Park, SA 5042, Australia).
It is widely accepted that ecosystem restoration—the repaid of degraded ecosystems—
offers multiple values across the peoples-places-planet continuum. Accordingly, the role
of environmental microbiota in ecological restoration, particularly in the context of urban
ecosystems, has received international attention. Diverse and functional microbial com-
munities are essential for soil formation, nutrient cycling and decomposition, symbiotic
relationships between ﬂora and fauna, and are highly biodiverse in their own right. Given
that environmental microbiota are also essential to human health, it raises a series of im-
portant questions. How does human exposure to environmental microbiota change with
ecosystem restoration? What types of restoration interventions promote the restoration of
health-associated environmental microbiota? Can ecological restoration—specially restora-
tion that targets the environmental microbiota—have positive effects on human health via
7.4. Transfer of Environmental Microbes to the Skin and Respiratory Tract of Humans after Urban
Green Space Exposure
Caitlin Selway 1, Jacob Mills 1, Philip Weinstein 1, Chris Skelly 2, Sudesh Yadav 3, An-
drew Lowe 1, Martin Breed 4and Laura Weyrich 5
University of Adelaide, Adelaide,
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SA 5005, Australia;
Public Health Dorset, Prince’s St, Dorchester DT1 1TP, UK;
harlal Nehru University, Delhi 110067, India;
Flinders University, Bedford Park, SA 5042,
Australia; 5The Pennsylvania State University, State College, PA 16802, USA).
In industrialized countries, non-communicable diseases have been increasing in preva-
lence since the middle of the 20th century. While the causal mechanisms remain poorly un-
derstood, increased population density, pollution, sedentary behaviour, smoking, changes
in diet, and limited outdoor exposure have all been proposed as signiﬁcant contributors.
Several hypotheses (e.g., Hygiene, Old Friends, and Biodiversity Hypotheses) also sug-
gest that limited environmental microbial exposures may underpin part of this rise in
In response, the Microbiome Rewilding Hypothesis proposes that adequate envi-
ronmental microbial exposures could be achieved by restoring urban green spaces and
could potentially decrease the prevalence of non-communicable diseases. However, the
microbial interactions between humans and their surrounding environment and the pas-
saging of microbes between both entities remains poorly understood, especially within an
Here, we survey human skin (n = 90 swabs) and nasal (n = 90) microbiota of three sub-
jects that were exposed to air (n = 15), soil (n = 15), and leaves (n = 15) from different urban
green space environments in three different cities across different continents (Adelaide,
Australia; Bournemouth, United Kingdom; New Delhi, India). Using 16S ribosomal RNA
metabarcoding, we examined baseline controls (pre-exposure) of both skin (n = 16) and
nasal (n = 16) swabs and tracked microbiota transfer from the environment to the human
body after exposure events. Microbial richness and phylogenetic diversity increased after
urban green space exposure in skin and nasal samples collected in two of the three locations.
The microbial composition of skin samples also became more similar to soil microbiota
after exposure, while nasal samples became more similar to air samples. Nasal samples
were more variable between sites and individuals than skin samples.
Our study improves our understanding of human-environmental microbial inter-
actions and suggests that increased exposure to diverse outdoor environments may in-
crease the microbial diversity, which could lead to positive health outcomes for non-
7.5. Health-Associated Microbiome Is Altered in Urban Environments: Daycare Biodiversity
Interventions Improve Children’s Microbiome and Immune Regulation
Marja Roslund 1, Anirudra Parajuli 2, Riikka Puhakka 1, Anna-Lea Rantalainen 1, Mira
Grönroos 1, Laura Soininen 1, Sami Oikarinen 3, Noora Nurminen 3, Olli H. Laitinen 3,
Heikki Hyöty 3and Aki Sinkkonen 4
University of Helsinki, FI-15140 Helsinki, Finland;
Karolinska Institutet, SE-17177 Solna, Sweden;
Tampere University, FI-33014 Tampere,
Finland; 4Natural Resources Institute, FI-20520 Helsinki, Finland).
Today, the vast majority of people are living in urban environments where the environ-
mental microbiota is different from that found in biodiverse nature. In urban areas, there
is a lack of natural green spaces with diverse microbiota. At the same time, the pollution
levels in urban areas alter microbial communities. We asked what happens to the human
commensal microbiota when living under pollution stress and how does this affect our
health? We have studied how biodiversity and polycyclic aromatic hydrocarbons (PAH)
from trafﬁc emissions and domestic wood burning alter environmental and human com-
mensal microbiota. Importantly, we have estimated how these alterations affect immune
response and endocrine signalling pathways. First, we studied PAH induced microbiota
shifts in urban environments, and estimated associations between PAHs, microbiota and
endocrine signalling. Secondly, we compared environmental and commensal microbial
communities in typical urban versus biodiverse environments. The study participants
included elderly people living in urban and rural environments, and small children living
in urban environment.
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Pollution studies showed that PAHs levels are associated with both environmental and
commensal microbiota. Microbiota alterations in the gut were associated with endocrine
signalling, which can affect hormonally mediated processes. Since commensal microbes
are able to affect PAH metabolism and detoxiﬁcation, future research should ﬁnd out if
certain microbial taxa can improve human health by reducing the negative health outcomes
induced by PAHs. The results support the altered environmental microbiome hypothesis;
both biodiversity loss and pollution contribute to altered microbiomes in the environment
and in the human body.
7.6. Urban Rewilding by Green Printing: Ecological Restoration of Microbial Diversity on
Remco Kort 1, Joris Laarman 1, Tim Geurtjens 1, Olivier de Gruijter 1, Jasper Buikx 2
and Remco Kort 2,3
Joris Laarman Studio, Ottho Heldringstraat 3, 1066 AZ Amsterdam;
Artis-Micropia, Plantage Kerklaan 38-40, 1018 CZ Amsterdam;
Systems Biology Lab,
Vrije Universiteit, De Boelelaan 1108, 1081 HZ Amsterdam).
According to recent estimates, 68% of the global population will live in cities in 2050.
An important prerequisite for liveable and sustainable cities is the presence of green infras-
tructure. This assists in mitigating effects of climate change, the “urban heat island” effect in
cities and has a profound effect on the aesthetics of a city. In addition, there is a clear health
beneﬁt, as green infrastructures are associated with and enhance exposure to microbes,
which is important for the development of our immune system and contributes to our phys-
ical and mental wellbeing. The current epidemic of inﬂammatory diseases in modern urban
environments is partly resulting from diminished exposure to microbes, which educate our
immune system leading to the suppression of inappropriate inﬂammation responses. Such
diseases include allergies, asthma, and neurodevelopmental disorders, including anxiety
and depression. Here we propose to contribute to the ecological restoration of microbial
diversity by transforming grey concrete city facades into living green walls. In order to
realize our ambition, we plan to develop a robot, which is able to reach the entire surface
of the wall by vertical movements. The robot is able to apply water, substrate, algae, fungi
and bacteria on the wall, allowing the creation of a living, colourful and dynamic piece of
microbial art. The purpose of our project is twofold. On one hand we aim to contribute to
an improved living environment in the city, on the other we would like to create awareness
for the importance of a diverse microbial environment for our own health, which may
contribute to a change in mindset leading to restoration of natural ecosystems.
7.7. Fear and the City: How Exposure to Environmental Microbes Enhances Fear Extinction
Christopher A. Lowry (University of Colorado Boulder, Boulder, CO 80309, USA).
Anxiety disorders, affective disorders, and trauma and stressor-related disorders,
such as posttraumatic stress disorder (PTSD) represent a signiﬁcant social and economic
burden to individuals, their families, and society. Chronic low-grade inﬂammation has
been identiﬁed as a risk factor for these stress-related psychiatric disorders and, indeed,
machine learning approaches have identiﬁed biological signatures of inﬂammation as
among the highest-ranking features predicting subsequent development of a diagnosis of
PTSD (Schultebraucks et al., 2020).
The “Old Friends” hypothesis posits that a lack of exposure to diverse microbial
environments in modern Western societies is resulting in impaired immunoregulation and,
consequently, inappropriate inﬂammation. The “Old Friends” hypothesis may be relevant
to risk of developing stress-related psychiatric disorders. We have shown that individuals
raised in an urban environment without daily exposure to pets respond to the Trier Social
Stress Test (TSST) with an exaggerated stress-induced inﬂammatory response, relative to
individuals raised on a farm with daily contact with farm animals (Böbel et al., 2018).
Thus, exposure to environmental microorganisms with anti-inﬂammatory and im-
munoregulatory properties has promise for the prevention and treatment of inﬂammatory
conditions, such as allergic asthma, and stress-related psychiatric disorders, in which
Int. J. Environ. Res. Public Health 2021,18, 10654 51 of 101
inﬂammation is a risk factor. Mycobacterium vaccae NCTC 11659 is an environmental sapro-
phyte isolated from mud along the shores of Lake Kyoga in Uganda. It has previously
been shown to prevent allergic airway inﬂammation in murine models of allergic asthma
(Zuany-Amorim et al., 2002). More recent preclinical work from our lab also shows that
immunization with M. vaccae NCTC 11659 induces a number of behavioural responses
to stress consistent with prevention of a PTSD-like syndrome. These effects of M. vaccae
NCTC 11659 include: (1) decreases in stress-induced anxiety-like defensive behavioural
responses; (2) prevention of surgery-induced microglial priming and cognitive impairment;
(3) prevention of stress- and sleep-deprivation induced behavioural impairments; (4) pre-
vention of stress-induced cortical hyperarousal; and (5) enhancement of fear extinction in
the fear-potentiated startle model.
Together, these data support the hypothesis that exposure to single strains of environ-
mental bacteria with anti-inﬂammatory and immunoregulatory properties is sufﬁcient to
promote stress resilience and prevent endophenotypes relevant to stress-related psychi-
Schultebraucks K, Qian M, Abu-Amara D et al. Pre-deployment risk factors for PTSD
in active-duty personnel deployed to Afghanistan: a machine-learning approach for
analyzing multivariate predictors. Mol Psychiatry 2020; https://doi.org/10.1038/s4
Böbel TS, Hackl SB, Langgartner D et al. Less immune activation following social stress
in rural vs. urban participants raised with regular or no animal contact, respectively.
Proc Natl Acad Sci U S A 2018; 115: 5259–5264.
Zuany-Amorim C, Sawicka E, Manlius C et al. Suppression of airway eosinophilia by
killed Mycobacterium vaccae-induced allergen-speciﬁc regulatory T-cells. Nat Med
2002; 8: 625–629.
7.8. Urbanized Early Life Microbiota Increases the Risk of Asthma and Atopic Traits
Jenni Lehtimäki 1, Jonathan Thorsen 2and Jakob Stokholm 2
Institute, 00790 Helsinki, Finland;
Clinical Research Unit COPSAC, Ledreborg Alle 34,
2820 Gentofte, Denmark).
Urban populations have higher prevalence of asthma and atopic diseases than rural
populations. Accumulating evidence suggests that differing microbial exposures between
urban and rural areas can be underlined reason for this difference. However, most of this
evidence comes from research focusing on the effect of farming related microbes, especially
considering indoor microbiota.
We studied differences in the infant microbiota and indoor microbiota infants are
exposed to in rural and urban children. We utilized birth cohort data from Denmark (COP-
SAC2010) including 700 prospectively followed children. Asthma, allergic rhinitis, eczema
and sensitization are deﬁned by COPSAC paediatricians at six years of age following
common criteria. Cohort included hardly any children from farms.
We found that children born in urban areas had higher risk of asthma and atopic
traits at six years of age than rural children. Both airway and gut microbiota differed
between urban and rural children, but differences were more pronounced in airways.
Indoor microbiota was clearly dissimilar between rural and urban areas. Urbanization of
all these microbial communities increased the risk of later developing asthma, and asso-
ciations with allergic rhinitis, eczema and sensitization were also discovered. Urbanized
airway microbiota also produced major shifts in the immune marker concentrations on the
With comprehensive data, we show that urban associated microbial communities in
infants can mediate increased risk of asthma and atopic traits in urban areas. The potential
mechanism for this is disturbed immune development.
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7.9. What Is a Healthy Skin Microbiome? Leveraging Ancestral Microbiomes for Guidance in
Restoration of a Healthy Western Skin Microbiota
Julia Durack 1, Yvette Piceno 1, Brian Fanelli 2, David Good 3and Larry Weiss 1
biome, Indiana St, San Francisco, CA 94107, USA;
CosmosID, Rockville, MD 20850, USA;
3The Good Project 13 Appian Way Cambridge, MA 02138, USA).
Skin microbiota, similar to all other niche-speciﬁc human microbial assemblages, are
shaped by environmental exposures inﬂuenced by lifestyle choices. Growing evidence
implicates skin microbiome perturbation in a number of dermatological conditions im-
pacting western society, but how much do we really know about what deﬁnes a healthy
skin microbiome? To answer this question, we examined the human skin microbiome
of individuals from a semi-nomadic hunter–gatherer tribe in the Amazon. Metagenomic
sequencing provided insights to the composition and function of a healthy ancestral hu-
man microbiome before we were impacted by the urban-industrialized lifestyles of the
7.10. Urban Green Space Aerobiomes: Exposure to Airborne Bacteria Depends upon Vertical
Stratiﬁcation and Vegetation Complexity
Jake Robinson 1,2,3, Christian Cando-Dumancela 2,3, Craig Liddicoat 2,3,4, Philip We-
instein 3,4, Ross Cameron 1and Martin F. Breed 2,3
Department of Landscape, The
University of Shefﬁeld, Shefﬁeld S10 2TN, UK;
College of Science and Engineering,
Flinders University, Bedford Park 5042, Australia;
The Healthy Urban Microbiome Ini-
tiative (HUMI), Adelaide 5005, Australia;
School of Public Health and the Environment
Institute, University of Adelaide, Adelaide 5005, Australia).
Exposure to diverse environmental microbiota is thought to have an important role in
“training” the immune system and maintaining human health and wellbeing. Vegetation
and soil are both known to be important sources of airborne microbiota, i.e., constituents
of the aerobiome. A limited number of studies have attempted to characterise the spa-
tiotemporal dynamics of the aerobiome; however, no known studies have investigated
these dynamics from a vertical perspective. Support for its existence can be drawn from
studies of pollution and allergenic pollen where vertical stratiﬁcation occurs at various
scales. The existence of aerobiome vertical stratiﬁcation could have important implications
for public health and for the design and management of urban green spaces. For example,
do children receive the same exposure to airborne microbiota as adults (or taller humans),
and is this inﬂuenced by vegetation composition, structure and surrounding land-use?
Furthermore, the potential differences in aerobiome composition based on different
land cover types are still poorly understood. In this study we developed and combined an
innovative columnar sampling method (using passive petri dish sampling stations), remote
sensing techniques, and high-throughput sequencing of the bacterial 16S rRNA gene to
assess whether signiﬁcant vertical stratiﬁcation of the aerobiome occurs. We also assessed
whether there were differences in the aerobiome between land cover types in the Adelaide
Park Lands, in South Australia. The land cover types included in the study were as follows:
1. Amenity grassland/lawn; 2. Scrub/trees; 3. Bare ground. Site selection was determined
using a combination of remote sensing approaches (such as habitat classiﬁcation indices
and random point algorithms), and ground-based site assessments. We also installed
dataloggers to record microclimate data.
Results presented provide evidence of vertical stratiﬁcation in both alpha and beta
(compositional) diversity of airborne bacterial communities, with diversity decreasing
roughly with height. We also found signiﬁcant vertical stratiﬁcation in potentially pathogenic
and beneﬁcial bacterial taxa.
Although additional research is needed, these preliminary ﬁndings point to potentially
different exposure attributes that may be contingent on human height and activity type.
Our results lay the foundations for further research into the vertical characteristics of urban
green space aerobiomes and their implications for public health and urban planning.
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Further Reading: Jake Robinson, Christian Cando-Dumancela, Craig Liddicoat, Philip
Weinstein, Ross Cameron, and Martin Breed. (2020). Vertical Stratiﬁcation in Urban Green
Space Aerobiomes. Environmental Health Perspectives. 128. 10.1289/EHP7807.
7.11. Using the Human Skin Microbiota to Measure Nature Exposure in a Longitudinal Study
Danica-Lea Larcombe 1, Eddie Van Etten 1, Alan C. Logan 2, Susan L. Prescott 2,3 and
Pierre Horwitz 1
Edith Cowan University, Joondalup, WA 6027, Australia;
for Integrative Health, Baltimore, MD 21231, USA;
University of Western Australia,
Nedlands, WA 6009, Australia).
Evidence indicates that soil (which contains a rich diversity of microbes) is an im-
portant component in maintaining human health, and indoor plants have been shown to
stabilise the indoor environment. As high-rise apartment dwellers are at a disadvantage in
being further away from environmental biodiversity (and reducing the transfer of microbes
onto their skin from soil and plants) the question was asked “do soil and plants cause
changes in skin microbial diversity and species richness over time”?
This study investigated relationships between high rise apartments, environmental
biodiversity and the biodiversity of the human skin microbiota. Fifty-nine eligible partic-
ipants living in Perth, Western Australia randomly received either three real or artiﬁcial
indoor plants and were tested for communities of skin bacteria (16S DNA Sequencing) over
a 12-month period. Skin microbiota (16S DNA) results from a pilot sample of ten real and
fake plant recipients were analysed for respondent’s microbial diversity before and after
The main bacterial phyla were Thermi, Actinobacteria, Bacteroidetes, Firmicutes,
Fusobacteria and Proteobacteria. Skin microbiome proﬁles were unique to each person,
and the genus Staphylococcus was found to be dominant (>30%) in the study population,
in line with studies from China, Venezuela and Brazil but not the USA. A near signiﬁcant
interaction between time and treatment was found, with participants receiving real plants
having a greater increase in OTU richness on average than those receiving fake plants,
signiﬁcant at the ~p< 0.1 level. In addition, there was a putative increase in abundance of
the Kocuria environmental genus for real plant respondents.
The intervention appears to have resulted in an increase in OTU richness, and as
humans (as a holobiont) are a microcosm of the ecological environment it makes sense that
their microbiome would also reﬂect this habitat that includes bacteria normally residing in
soil and plant roots.
7.12. Investigating the Effect of Chlorinated Drinking Water on the Assembly of the Infant
Kimberley Parkin 1, David Martino 1and Claus Christophersen 2
Telethon Kids Insti-
tute, Nedlands, WA 6009, Australia; 2Curtin University, Bentley, WA 6102, Australia).
The gut microbiome has been particularly interesting in recent years due to its links to
health and disease. In infants, the gut microbiome is highly plastic, and easily inﬂuenced
by environmental factors. The development of a healthy gut microbiome is essential for a
stable, diverse, and species-rich gut microbiome as an adult, and improper development of
the gut microbiome in this sensitive period can lead to gut dysbiosis. Chlorine is one of
the most effective ways to deliver safe drinkable water to the public free from microbial
contamination because it produces a residual disinfectant that persists in the distribution
system. Due to the antimicrobial effects of chlorine in tap water, this raises the question
if persistent exposure to low levels of chlorinated tap water may have a mild antibiotic
effect to the diverse ecosystem of microorganisms that colonise the gastrointestinal tract.
Thus, residual chlorine in tap water could be a potential unrecognised risk factor of gut
dysbiosis. This project will investigate whether chlorine effects the natural spatial and
temporal organisation of the gut microbiome in infancy and early childhood.
We hypothesise that persistent exposure to low levels of residual chlorine in early
childhood may alter stereotypical colonisation of the infant gut microbiome, by reducing
Int. J. Environ. Res. Public Health 2021,18, 10654 54 of 101
richness and diversity. We will use a randomised control trial study design to install water
ﬁlters in participant’s homes that remove residual chlorine from tap water.
We will compare longitudinal changes in the infant gut microbiome from 6 months of
age to 18 months of age via faecal samples between the intervention (unchlorinated water)
and control (chlorinated water) groups. We will use metagenomics technology to identify
novel links between the two groups and early childhood health outcomes, such as asthma
7.13. Algae as Allies: Learning Algal Patterns to Better Understand Ecosystem Health
Yogi Hendlin 1, Sergio Mungai 1, Johanna Weggelaar 2and Nathalia Derossi 1
mus University College, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands;
2Het Nieuwe Instituut, Museumpark 25, 3015 CB Rotterdam, The Netherlands).
Algae are the most prominent generators of oxygen and absorbers of CO
earth. The various forms of algae such as unicellular heterokont algae, diatoms, are also
one of the most diverse groups of protists and in addition to ﬁxing carbon and producing
oxygen, they generate through photosynthesis basic lipids key to planetary food webs.
This presentation surveys human-algae relations through non-instrumental means. Rather
than focusing on using algae for fuel production, the dominant technological-scientiﬁc
discussion of algal applications currently, we ask what do algae need from humans in order
to sustain their life-giving ecosystem services?
One of the most underappreciated organisms, discourses around algae currently
focus on control, such as geoengineering schemes using iron ﬁling dumping to precipitate
plankton algal blooms to draw out masses of oxygen. Such manipulative actions carry
unintended counteractions that ignore the complex relationships algae have with sea pH,
salinity, water turbidity, and other organisms. Algal quorum sensing allows them abilities to
simultaneously be separate organisms, superorganisms, and interspecies conglomerations
of organisms. We stand to learn as much or more, we claim, from their communicative and
cooperative capacities, as we do from exploiting their metabolic processes.
Looking at Gregory Bateson’s concept of “mindedness” in all living organisms, we
inquire into the various ways in which algae mind their habitats, in both senses of the
term. How they take care of and create their habitats and circulate resources and energy
through directed and passive action is key to understanding how (especially marine)
ecosystems sustain and renew themselves. By learning from algae, we suggest that human
processes that impinge on algal processes can and must be attenuated through biomimetic
technologies and cyclical rather than continuous extraction schedules.
7.14. Insights into the Circadian Rhythms on Parasitic Infections and Planetary Health
Mona El-Sherbini (Department of Parasitology, Cairo University, Gisa 12613, Egypt).
Planetary health explores the constant interaction between natural and human forces
and the resultant state of harmony that arises as an outcome. Of especially increasing
importance are the circadian rhythm and night and day cycles governed by the planet
earth’s rotation; such automated rhythm appears to play a signiﬁcant role in system-wide
biotics in the atlas of biodiverse species.
We take a look at how modern-day life may have affected human–parasite interactions
by studying the effect of circadian rhythms on human immunity and parasite adaptations.
Timing matters in all cells of the immune system, orchestration of circadian oscillators
as cytokines and chemokines that drive rhythms in synthesis and regulations of various
immune responses, inﬂuence time-of-day susceptibility to pathogens. For example, the
onset of Leishmania infection during late day led to a larger lesion compared to late night
infection. Conversely, rhythms in Leishmania parasite load were notably observed in night-
time collected blood samples. Clinical and experimental observations have highlighted
circadian rhythms of parasites as either intrinsic, generated by endogenous clocks as
indicated in Trypanosoma brucei infection or conferred by a rhythmically active vector
as in the case of Plasmodium species and microﬁlariae of Wucheraria bancrofti infections.
Int. J. Environ. Res. Public Health 2021,18, 10654 55 of 101
Rhythmic pattern in the course of infection potentially encodes and predicts circadian
environment system and coordinates the parasite’s metabolism, life cycle and transmission
with the host’s circadian rhythm.
Therefore, appreciating how external ecosystems interface with internal ecosystems to
differentially inﬂuence physiology, we can consider circadian biology at the core of human
physiology as to anticipate the time of parasitic infection and optimize cellular defence.
Hence, better knowledge about host-parasite dynamics may help with new preventive
care and personalized treatment strategies in hopes of reducing morbidity and mortality
associated with parasitic infections and to achieve harmony between our body clocks and
challenges in the outside world.
7.15. Can Soil Microbes Modulate the Plasma Metabolome in an Animal Model?
Saydie Sago 1, Ahmed Elsayed 1, Christine Foxx 1, Jared Heinze 1, Antonio Gonzalez 2,
Fernando Vargas 2, Jessica Stewart 1, Philip Siebler 1, Kyo Lee 1, Sandra Appiah 1, Mor-
gan Panitchpakdi 2, Nicole Sikora 2, Kelly Weldon 2, Christopher Stamper 1, Dominic
Schmidt 1and Christopher A. Lowry 1
University of Colorado Boulder, Boulder, CO
80309, USA; 2University of California at San Diego, La Jolla, CA 92093, USA).
Regulation of the immune system by biodiversity from the natural environment may
play an ecosystem service essential to physical and emotional health, in part, through
effects on microbiome–gut–brain axis signalling. Mycobacterium vaccae NCTC 11659 (M.
vaccae), a soil-derived bacterium with anti-inﬂammatory and immunoregulatory properties,
is a potentially useful countermeasure against negative outcomes to stressors.
Here, we used male C57BL/6NCrl mice to determine if repeated immunization with
M. vaccae is an effective countermeasure in a “two hit” stress exposure model of chronically
disrupted circadian rhythms (CDR) followed by acute social defeat (SD). On day 28, mice
received implants of telemetric recording devices for monitoring 24 h rhythms of locomotor
activity. Mice were subsequently treated with a heat-killed preparation of M. vaccae (0.1 mg
administered subcutaneously on days 21, 14, 7, and 27) or borate-buffered saline (BBS)
vehicle. Mice were then exposed to either stable normal 12:12 light:dark (LD) conditions
or CDR, consisting of 12 h reversals of the LD cycle every 7 days, for 8 weeks (days 0–56).
Finally, mice were exposed to either a 10 min SD or a novel cage control condition on day
54. All mice were exposed to object location memory testing 24 h following SD. The gut
metabolome was assessed in faecal samples collected on days 1, 48, and 62 and the host
plasma metabolome was assessed on day 64 using LC-MS/MS spectral data. Network-
based analysis of the host plasma metabolome suggested that immunization with M.
vaccae increased the relative abundance of a molecular family of lysophosphatidylcholines,
Together, these data support previous literature demonstrating that increased plasma
concentrations of lysophospholipids may be biomarkers of exposures to mycobacterial
strains such as M. vaccae. Additionally, lysophosphatidylcholines emerge as interesting
candidates for mediating some of the physiological and behavioural responses that have
been described following immunization with M. vaccae.
7.16. Do Soil Microbes Inﬂuence Stress-Coping Behaviours and Cognitive Performance in an
Kyo Lee, Jessica Stewart, Christine Foxx, Jared Heinze, Michael Baratta, Ahmed El-
sayed, Kelsey Loupy, Mathew Arnold, Philip Siebler, Lauren Milton, Margaret Lieb,
James Hassell, Sandra Appiah, Dominic Schmidt, David Duggan and Christopher A.
Lowry (University of Colorado Boulder, Boulder, CO 80309, USA).
Regulation of the immune system by biodiversity from the natural environment may
play an ecosystem service essential to health. Mycobacterium vaccae NCTC 11659 (M. vaccae),
a soil-derived bacterium with anti-inﬂammatory and immunoregulatory properties, is
a potentially useful countermeasure against negative outcomes to stressors. Here we
used male C57BL/6NCrl mice to determine if repeated immunization with M. vaccae is an
Int. J. Environ. Res. Public Health 2021,18, 10654 56 of 101
effective countermeasure in a “two hit” stress exposure model consisting of chronically
disrupted circadian rhythms (CDR) followed by acute social defeat (SD). On day 28, mice
received implants of telemetric recording devices for monitoring 24 h rhythms of locomotor
activity. Mice were subsequently treated with a heat-killed preparation of M. vaccae (0.1 mg
administered subcutaneously on days 21, 14, 7, and 27) or borate-buffered saline (BBS)
vehicle. Mice were then exposed to either stable normal 12:12 light:dark (LD) conditions
or CDR, consisting of 12-h reversals of the LD cycle every 7 days, for 8 weeks (days 0–56).
Finally, mice were exposed to either a 10 min SD or a novel cage control condition on
day 54. All mice were exposed to object location memory (OLM) testing 24 h following
SD. Immunization with M. vaccae induced a shift toward a more proactive behavioural
coping response to SD as measured by increases in scouting and avoiding an approaching
male CD-1 male aggressor and decreases in submissive upright defensive postures. In the
OLM test, exposure to SD increased cognitive function in M. vaccae-immunized CDR mice.
Consistent with the hypothesis that immunization with M. vaccae altered microbiome–
gut–brain axis signalling relevant to stress resilience, M. vaccae altered serotonergic gene
expression in the dorsal raphe nucleus (DR). Together, these data support the hypothesis
that immunization with M. vaccae induces a shift toward a more proactive response to stress
exposure and promotes stress resilience through microbiome-gut-brain axis signalling.
7.17. Effects of Soil Microbe Mycobacterium vaccae on Faecal Microbiomes: Investigating Effects in
an Animal Model
Evan Schaefer 1, Sandra Appiah 1, Christine Foxx 1, Jared Heinze 1, Antonio Gonzalez
2, Ahmed Elsayed 1, Saydie Sago 1, Philip Siebler 1, Christopher Stamper 1, David Dug-
gan 1, Kadi Nguyen 2, Chloe Gates 2, K’loni Schnabel 2, Martha Vitaterna 3, Fred Turek
3and Christopher A. Lowry 1
University of Colorado Boulder, Boulder, CO 80309, USA;
University of California at San Diego, La Jolla, CA 92093, USA;
Evanston, IL 60208, USA).
Regulation of the immune system by biodiversity from the natural environment may
play an ecosystem service essential to physical and emotional health, in part through effects
on microbiome-gut-brain axis signalling. Mycobacterium vaccae NCTC 11659 (M. vaccae),
a soil-derived bacterium with anti-inﬂammatory and immunoregulatory properties, is a
potentially useful countermeasure against negative outcomes to stressors.
Here we used male C57BL/6NCrl mice to determine if repeated immunization with
M. vaccae is an effective countermeasure in a “two hit” stress exposure model of chronically
disrupted circadian rhythms (CDR) followed by acute social defeat (SD). On day 28, mice
received implants of telemetric recording devices for monitoring 24 h rhythms of locomotor
activity. Mice were subsequently treated with a heat-killed preparation of M. vaccae (0.1 mg
administered subcutaneously on days 21, 14, 7, and 27) or borate-buffered saline (BBS)
vehicle. Mice were then exposed to either stable normal 12:12 light:dark (LD) conditions
or CDR, consisting of 12 h reversals of the LD cycle every 7 days, for 8 weeks (days 0–56).
Finally, mice were exposed to either a 10 min SD or a novel cage control condition on day
54. All mice were exposed to object location memory testing 24 h following SD. The gut
microbiome was assessed in faecal samples collected on days 1, 48, and 62 using 16S rRNA
Immunization with M. vaccae stabilized the gut microbiome, attenuating CDR-induced
reductions in alpha diversity. Analysis of microbial beta-diversity revealed community-level sep-
aration between the faecal microbiomes of M. vaccae and vehicle-treated mice and demonstrated
that M. vaccae immunization decreased within-group measures of beta diversity.
Together, these data support the hypothesis that immunization with M. vaccae sta-
bilizes the gut microbiome in a “two hit” stressor model over several months and is an