Medicine, Faculty of
Non UBC
Population and Public Health (SPPH), School of
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International Journal of Environmental Research and Public Health 18 (20): 10654 (2021)
Prescott, Susan L.
Wegienka, Ganesa
Kort, Remco
Nelson, David H.
Gabrysch, Sabine
Hancock, Trevor
Kozyrskyj, Anita L.
Lowry, Christopher A.
Redvers, Nicole
Poland, Blake
Robinson, Jake
Moubarac, Jean-Claude
Warber, Sara
Jansson, Janet
Sinkkonen, Aki
Penders, John
Erdman, Susan
Nanan, Ralph
Bosch, Matilda van den
Schneider, Kirk
Schroeck, Nicholas J.
Sobko, Tanja
Harvie, Jamie
Kaplan, George A.
Moodie, Rob
Lengnick, Laura
Prilleltensky, Isaac
Celidwen, Yuria
Berman, Susan H.
Logan, Alan C.
Berman, Brian
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.
International Journal ofEnvironmental Researchand Public HealthConference ReportProject Earthrise: Proceedings of the Ninth Annual Conferenceof inVIVO Planetary HealthSusan 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 4 and Brian Berman 4Citation: 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 theNinth Annual Conference of inVIVOPlanetary Health. Int. J. Environ. Res.Public Health 2021, 18, 10654. https://doi.org/10.3390/ijerph182010654Academic Editor: Jon Øyvind OdlandReceived: 16 August 2021Accepted: 18 September 2021Published: 12 October 2021Publisher’s Note: MDPI stays neutralwith regard to jurisdictional claims inpublished maps and institutional affil-iations.Copyright: © 2021 by the authors.Licensee MDPI, Basel, Switzerland.This article is an open access articledistributed under the terms andconditions of the Creative CommonsAttribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).1 NOVA Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA2 School of Medicine, University of Western Australia, Nedlands, WA 6009, Australia3 ORIGINS Project, Telethon Kids Institute at Perth Children’s Hospital, Nedlands, WA 6009, Australia4 Department of Family and Community Medicine, Center for Integrative Medicine, University of MarylandSchool of Medicine, Baltimore, MD 21201, USA; swarber@med.umich.edu (S.W.);gkaplan@umich.edu (G.A.K.); sberman@tiih.org (S.H.B.); alanxlogan@gmail.com (A.C.L.);bberman@tiih.org (B.B.)5 Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI 48202, USA; gwegien1@hfhs.org6 Department of Molecular Cell Biology, Vrije Universiteit Amsterdam, De Boelelaan 1108,1081 HZ Amsterdam, The Netherlands; r.kort@vu.nl7 ARTIS_Micropia, Plantage Kerklaan 38-40, 1018 CZ Amsterdam, The Netherlands8 Independent Researcher, Woodstock, ON N4S 6Y9, Canada; davidhplanet@gmail.com9 Heidelberg Institute of Global Health, Heidelberg University, 69120 Heidelberg, Germany;sabine.gabrysch@uni-heidelberg.de10 Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association,14412 Potsdam, Germany11 Institute of Public Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany12 School of Public Health and Social Policy, University of Victoria, Victoria, BC V8W 2Y2, Canada;thancock@uvic.ca13 Department of Pediatrics, Faculty of Medicine & Dentistry, Alberta, Edmonton Clinic Health Academy,Edmonton, AB T6G 1C9, Canada; kozyrsky@ualberta.ca14 Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA;christopher.lowry@colorado.edu15 School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA;nicole.redvers@UND.edu16 Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;blake.poland@utoronto.ca17 Department of Landscape, The University of Sheffield, Sheffield S10 2TN, UK; jmrobinson3@sheffield.ac.uk18 Department of Nutrition, Faculty of Medicine, University of Montréal, Montreal, QC H3T 1J4, Canada;jc.moubarac@umontreal.ca19 Department of Family Medicine, University of Michigan, Ann Arbor, MI 48109, USA20 Biological Sciences Division, Pacific Northwest National Laboratory, Richland, Washington, DC 99352, USA;janet.jansson@pnnl.gov21 Natural Resources Institute Finland, Itäinen Pitkäkatu 4, 20520 Turku, Finland; aki.sinkkonen@luke.fi22 Department of Medical Microbiology, School for Nutrition & Translational Research inMetabolism (NUTRIM) and Care and Public Health Research Institute (CAPHRI), Maastricht UMC+[University Medical Centre], 6202 AZ Maastricht, The Netherlands; j.penders@maastrichtuniversity.nl23 Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA;serdman@mit.edu24 Sydney Medical School–Nepean, University of Sydney, Camperdown, NSW 2006, Australia;ralph.nanan@sydney.edu.au25 School of Population and Public Health, The University of British Columbia,Vancouver, BC V6T 1Z4, Canada; matilda.vandenbosch@ubc.ca26 Existential-Humanistic Institute, San Francisco, CA 94901, USA; Kschneider56@gmail.com27 Department of Humanistic and Clinical Psychology, Saybrook University, Pasadena, CA 91103, USA28 Teachers College, Columbia University, New York, NY 10027, USAInt. J. Environ. Res. Public Health 2021, 18, 10654. https://doi.org/10.3390/ijerph182010654 https://www.mdpi.com/journal/ijerphInt. J. Environ. Res. Public Health 2021, 18, 10654 2 of 10129 School of Law, University of Detroit Mercy, 651 East Jefferson Ave., Detroit, MI 48226, USA;schroenj@udmercy.edu30 School of Biological Sciences, University of Hong Kong, Hong Kong, China; tsobko@hku.hk31 Institute for a Sustainable Future, Duluth, MN 55802, USA; harvie@isfusa.org32 School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA33 School of Population and Global Health (MSPGH), University of Melbourne, Parkville, VIC 3010, Australia;r.moodie@unimelb.edu.au34 Cultivating Resilience, LLC, Asheville, NC 28805, USA; laura@cultivatingresilience.com35 School of Education and Human Development, University of Miami, Coral Gables, FL 33124, USA;isaacp@miami.edu36 Independent Researcher, New York, NY 10017, USA; celidwen@hotmail.com* Correspondence: susan.prescott@telethonkids.org.au† On behalf of the inVIVO Planetary Health Community.‡ Retired.Abstract: The “Earthrise” photograph, taken on the 1968 Apollo 8 mission, became one of the mostsignificant images of the 20th Century. It triggered a profound shift in environmental awareness andthe potential for human unity—inspiring the first Earth Day in 1970. Taking inspiration from theseevents 50 years later, we initiated Project Earthrise at our 2020 annual conference of inVIVO PlanetaryHealth. This builds on the emergent concept of planetary health, which provides a shared narrativeto integrate rich and diverse approaches from all aspects of society towards shared solutions toglobal challenges. The acute catastrophe of the COVID-19 pandemic has drawn greater attention tomany other interconnected global health, environmental, social, spiritual, and economic problemsthat have been underappreciated or neglected for decades. This is accelerating opportunities forgreater 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 thesewith mutualistic value systems as a compass, as we seek to make wiser choices. Project Earthrise isour contribution to this important process. This underscores the imperative for creative ecologicalsolutions to challenges in all systems, on all scales with advancing global urbanization in the digitalage—for personal, environmental, economic and societal health alike. At the same time, our agendaseeks to equally consider our social and spiritual ecology as it does natural ecology. Revisiting theinspiration of “Earthrise”, we welcome diverse perspectives from across all dimensions of the artsand 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 greatestchallenges, for the health of people, places and planet.Keywords: planetary health; grand challenges; Anthropocene; Symbiocene; collaboration;interdependence; social and economic justice; interdisciplinary research; resilience thinking; thegreat 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 Indigenousgovernance1. Introduction—Setting the Scene for Project EarthriseThere 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 wetreat others. How we care for our place, our communities, and our ecosystems. Even theway that we approach our problems. In this sense, our greatest challenges may also createour greatest opportunities to change how we do things, and how we work together on aglobal scale—in ways we never have before [1].The grand challenges of the Anthropocene are of our making, and ultimately stemfrom human attitudes and relationships to each other and to our environment—with warand destruction, poverty and inequality, disease and despair, biodiversity loss, climateInt. J. Environ. Res. Public Health 2021, 18, 10654 3 of 101change, 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 recognizethese interwoven complexities but must also confront the underlying worldview thatcreated and continue to perpetuate these interconnected problems.Cross-sectoral, transdisciplinary approaches are therefore fundamental to addressthese entwined issues [2], and to place a higher value on shared guiding principles thatencourage altruism and deeper awareness of interdependence [3]. It is increasingly criticalto remove artificial lines of distinction between disciplines, and create more opportunitiesfor specialists in all professions, to share and integrate information. Moreover, if we areto realistically find, evaluate and implement meaningful solutions, vigorous melding oftransdisciplinary thought must also be applied with deeper ethical considerations, asan urgent necessity—addressing the underlying value systems that created our greatestchallenges in the first place.It was with these many notions that we launched Project Earthrise at our ninth annualconference of inVIVO Planetary Health in 2020. In an age of convergence, this initiativepromotes awareness of interdependence on all scales—across the continuum of people,places and planet—and creates opportunities through connectivity by nourishing a diversecommunity of change. In addition to our established history of robust science [4], ProjectEarthrise aims to normalize more mutualistic, creative approaches to positively influencenormative value systems—placing greater importance on spiritual perspectives from allcultures, including Indigenous traditions and practices [5]. 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 maybe a vital part of the solutions, it is best applied with more mutualistic value systems asa compass.Project Earthrise seeks to equally consider our social and spiritual ecology as it doesnatural ecology; to address “broken spirit” as well as “broken systems” manifest in mount-ing social unrest, hopelessness, and unparalleled adversity [5]. Our agenda seeks to placea higher value on self-development, creativity, and imagination in solving challenges atall scales. This includes greater emphasis on positive assets in health and resilience on allscales (awe, wonder, joy, love, compassion). Normalizing empathy, kindness, hope, creativ-ity, and mutualistic values—the deeper values that unite, empower, and refocus prioritiesof individuals and groups—also mediates greater social responsibility and environmentalconcern. Too often, these qualities are devalued or dismissed in scientific discussions, anddoing so, we fail to recognize this is part of the problem, despite these being arguably ourgreatest assets in overcoming our most difficult challenges.2. Reinvigorating Past Inspirations—As We Step ForwardProject 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 themost significant images of the 20th Century, triggering a profound shift in environmentalawareness 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, socialupheaval, and environmental destruction—with many parallels to our current challenges50 years later. While focus of the journey was largely on the promise of the moon, it wasthe unscheduled photograph of the Earth that unexpectedly changed our world. “Wecame all the way to the moon to discover Earth”, reflected astronaut Bill Anders who tookthe photograph, on the moment that shifted collective human consciousness [6]. This hasan utterly profound effect on personal and planetary awareness, and “ . . . began to bendhuman consciousness” [7]. In other words, it was argued that the 19¢ film became the mostimportant part of the multi-billion-dollar project [8], stirring collective imagination, awe,wonder, and a new sense of unity. The resulting frameshift in perspective led to large-scaleInt. J. Environ. Res. Public Health 2021, 18, 10654 4 of 101environmental and social movements and inspired the first Earth Day in 1970. This eventhad a far broader agenda than it has today, addressing manifold issues ranging fromgrowing poverty, blight, racism, and war, to broad-ranging environmental decay—withexploitative economic systems as the common denominator, stemming from a culture ofprofit over people, and self-interest over the beauty and mystery of nature [9]. In short, itwas a call to address fundamental value systems [10].This remarkable outward journey had the even more profound effect by turningawareness inward to our own condition and that of our troubled planet [11]—arguablythe 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 ofa “Great Transition”, it is even more important to revisit these values and principles as weseek 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 everybodyon it, to look at its resources, to look at the state of our technology, and to begin to dealwith the whole problem. I think that the tenderness that lies in seeing the Earth as smalland lonely and blue is probably one of the most valuable things that we have now.”Margaret Mead, anthropologist, Earth Day, 1970 [9].Project Earthrise was launched in December 2020, as an ongoing and evolving initiativeto reinvigorate and advance this planetary health perspective. Held virtually because ofthe COVID-19 pandemic, we had the opportunity to record discussions as a resource forothers to share on an ongoing basis [12]. Here, we share the initial phase that formed thebasis of our ninth annual conference of inVIVO Planetary Health.Building on the diverse experience and foundations of our global network, our agendaunderscores the imperative for creative ecological solutions for the challenges we facein all systems and all scales with advancing global urbanization in the digital age—forpersonal, environmental, economic, and societal health alike. We brought together diverseperspectives from across many dimensions of the arts and the sciences, to explore novelsolutions 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) thatimpact 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 visionthat includes trans-generational and “life-course” approaches to disease prevention andenvironmental restoration.The meeting celebrates a tremendous network of like-minded people from diversefields whose interests span from planetary/population/environmental health to microbialecology/systems biology and the deep biological mechanisms—all aiming to work “sym-biotically” to connect traditional “silos” through a more integrated systems frameworkas we seek to improve personal, environmental, economic and societal health alike. Ouremphasis on meaningful collaborations and productive friendships is as important as thedata and opportunities we generate. In this way, Project Earthrise provides a space forkindred spirits whose work is pathbreaking enough for them to feel at times isolated intheir own immediate academic (or other) environments—and enables the kind of globalconvergence that exemplifies our goals.Together, we have begun to create a mosaic narrative of diverse perspectives, notjust for a clearer picture of possibility, but for the spirit of hope and connectivity we havegenerated in the process. As we each connect our work to the bigger picture with sharedpurpose, we empower and magnify potential for change. Below, we share the submittedabstracts, and an open invitation for all readers to watch the on-line proceeding, availablethrough our virtual proceedings [12], and to join in ongoing discussions and activities.Int. J. Environ. Res. Public Health 2021, 18, 10654 5 of 101Our program was designed to capture this mosaic—as an evolving story to under-score interconnections between diverse fields and encourage novel perspective for newcollaborations. The overall map for the conference sessions is shown in Figure 1, to assistthe reader in navigating and searching the content presented here.Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 5 of 104 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. This diverse agenda continues to unfold through ongoing conversations and oppor-tunities 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 inspi-ration and opportunity for many. Figure 1. Overview of the sessions presented within the initial Project Earthrise discussions at our annual conference (and the corresponding sections of these proceedings). 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”? Figure 1. Overview of the sessions presented within the initial Project Earthrise discussions at ourannual 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 andnew collaborations and hope that the content below and the on-line discussions provideinspiration and opportunity for many.We encouraged all contributors, no matter the topic, to consider the ways in whichtheir work is relevant to the larger agenda, and to imagine how they would like to see theirfield evolve in an ideal world. Recognizing that imagining the future is the first step togetting there, we encouraged all to draw on the inspiration of “Earthrise” and consider thefundamental question: “What kind of world do we want to live in?”Int. J. Environ. Res. Public Health 2021, 18, 10654 6 of 1013. Broadening Our Vision to Set the Stage for ChangeOur opening session sets the scene and scope for the meeting and introduced ProjectEarthrise as both the theme of the meeting, and an ongoing collaborative venture forchange—for creating convergence of ideologies, actions and inspirations. The abstractspresented below (summarized in Figure 2) capture some of these core elements, and videorecordings are also available online [12].Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 6 of 104 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 [12]. Figure 2. Broadening our vision to set the stage for change. Overview of topics and speakers in the opening session. Figure 2. Broadening our vision to set the stage for change. Overview of topics and speakers in theopening session.Int. J. Environ. Res. Public Health 2021, 18, 10654 7 of 1013.1. Messages from the Elders and Dedication of Our Meeting to Mother Earth—From Both Sidesof Her EquatorBe’sha Blondin 1, Nicole Redvers 1,2, Marlikka Perdrisat 3 and Anne Poelina 4 (1 ArcticIndigenous Wellness Foundation, Box 603, Yellowknife, NT X1A 2N5, Canada; 2 School ofMedicine & Health Sciences, University of North Dakota, 1301 N Columbia Rd Stop, GrandForks, ND 58202, USA; 3 Sydney Law School, The University of Sydney, New Law Building,Eastern Avenue, Camperdown Campus, Sydney, NSW 2006, Australia; 4 Nulungu ResearchInstitute, 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 andNatural or First Laws of each place, we can also appreciate the shared deeper resonancewithin the science and values from our very different regions of the world. Each of ourcollective traditions underscores the importance of balance in all things—including usingour minds, heart and spirit in making wise decisions that ensure a healthy environment forthe generations that follow.Natural or First Law stories from all regions teach about ethics, values, codes ofconduct and how to live in a civil society. They teach the next generations to work withone mind and one spirit, and the importance of taking responsibility for the way thatwe live, and work to overcome separation and division. Natural or First Law provides atimeless perspective of our relationship with the Earth—as the past, present and future arefused in this moment—teaching us to care about things beyond what is human, and torespond to protect Mother Earth. Our deep and harmonious relationships within Natureshows that there must also be balance in society and removal of hierarchy. This helpspromote accountability, compassion, and responsibility in a life-long journey of meaningand discovery.We come from a world of “we” not “me” that considers the collective wellbeing ofcommunities, not just for Indigenous Peoples, but all citizens of the world. The oldestliving cultures in the world hold ancient wisdom and stories that will greatly benefit manysocieties in dealing with complexity, and in codesigning solutions going forward—but onlywhen our rights and the rights of Mother Earth are acknowledged.Wisdom, love, and ethics of care can be gifts from Indigenous Peoples to the worldwith a deep respect for our self-determination and sovereignty—symbolizing that we mustwalk hand in hand together as one people for the health our planet.3.2. Project Earthrise: Inspiring Health of People, Places and PlanetSusan Prescott (School of Medicine, University of Western Australia, the ORIGINS Projectsat Telethon Kids Institute and Perth Children’s Hospital, Perth, WA, Australia; Departmentof 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 theinterdependence of all systems and the direct connections between personal and planetaryhealth. This acute event has drawn new attention to many chronic problems and revealedhow rapidly priorities and behaviours can change. It has also created a greater imperativeto shift our trajectory towards a more sustainable and resilient future. Drawing on the samesense of awe and unity that shifted human consciousness when we first saw our homeacross the void of space in the “Earthrise” image, Project Earthrise provides an opportunityto reassess collective values, priorities, our sense of self and community on all scales—inthe same spirit of the first Earth Day in 1970.The Project Earthrise agenda creates a health narrative across all scales, emphasizingmultidimensional interactions and bi-directional relationships for flourishing of people,places and planet. It seeks to place a higher value on self-development, creativity, andimagination in solving challenges at all scales. It recognizes that the future of healthdepends not only on reducing adversity, but restoring positive and protective effects ofInt. J. Environ. Res. Public Health 2021, 18, 10654 8 of 101nature, biodiversity, traditional foods, community, and purpose—the elements that areoften neglected, undervalued and underestimated. This underscores the importance ofgrassroot efforts in every sense—from restoring foundational ecosystems, such as microbialecology that underpins all life (including our own), to community solutions that bring outthe 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 fundamentalimportance of a developmental and transgenerational vision to life-long physical, emotionalhealth, attitudes and behaviours.For this, we encourage work in the space “between siloes” of expertise, and harnessthe spirit of connectivity, community, to promote collaboration, purpose and belonging.We aim to bring together diverse expertise and rich perspectives to create a shared changenarrative, recognizing that seeing a problem from more angles brings solutions into clearerfocus. Together with robust science, this agenda emphasizes the importance of culturalexpression, 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 Legacyof Telling the Truth and Bearing Witness to Love and Justice for People, Place and PlanetCornel West (Professor of the Practice of Public Philosophy, Harvard Divinity School,Cambridge, MA 02138, USA; Professor Emeritus at Princeton University, Princeton, NJ08544, USA).No abstract available: a recording of Dr. Cornel West’s inspirational Keynote Lectureis available for viewing through our online proceedings [12].3.4. Making Connections, Finding Balance: Remembering the Social and Spiritual Dimensionsof EcologyTrevor Hancock (Retired Professor, School of Public Health and Social Policy, Universityof Victoria, Victoria, BC V8W 2Y2, Canada).Perhaps the central problem of our time is that we have lost both our connection tonature and our sense of perspective with respect to nature. We face massive and rapidhuman-created global ecological changes—The Anthropocene—driven by the combinationof population growth, economic growth and the growth in the power and ubiquity of ourtechnology. We have come to see ourselves as both separate from and superior to natureand other living things, over which we have a (God-given) dominion. We can no longersee 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 manyIndigenous cultures—the Earth was a living being, our Mother, and other species were ourrelations. Interestingly, James Lovelock’s Gaia Theory and Earth system science tells us thesame 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 innateneed 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% ofour DNA with other humans but 99% with chimps and bonobos and 98% with gorillas. Weshare 84% with dogs, 60% with the chickens we eat and with fruit flies, and even 26% withyeast and 15% with mustard grass. Moreover, we are connected to all the people, animalsand plants that came before us through the atoms we inhale or ingest, and which oncewere part of their bodies. In short, we are all deeply connected to and entirely dependentupon the great web of life which sustains us in many ways.The ultimate connection, perhaps, is to the universe. All our atoms—yours, mine, allother living things, all the materials of the Earth, the solar system and beyond—have acommon 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 starsat night, you cannot see where we came from.Int. J. Environ. Res. Public Health 2021, 18, 10654 9 of 101Suggested 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 UnderminePlanetary Health on All FrontsRob Moodie (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 NationalCorporations that produce, promote and market unhealthy commodities. The values thatunderly unhealthy commerce are the accumulation of money, power and influence derivedfrom the exploitation of consumers and resources. This produces giant power asymmetrieswhere governments struggle to find any forms of national economic and social balance. Ofthe world’s 100 largest economies, more than 70 are now corporations. Power is shiftingaway from nation states to the Supra National Corporations. Yet, we know that whatproduces 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, anddecreasing infant mortality, mental illness, obesity, imprisonment levels and homi-cide rates.Those interested in planetary health will inevitably be in conflict, particularly whenwe know how dramatically some of these corporations are harming our planet.How do we resolve conflict? We can choose collaboration—where we have a veryhigh level of assertiveness (in this case about planetary health) combined with a very highlevel of cooperation (in this case for-profit enterprises making sustainable profits). We cansupport, encourage, and work with for-profit companies that want to balance profit andpurpose. There are some! But this approach will not work in many cases. This is wherewe 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 andpractice to nurture ourselves. We need to look after ourselves. This generates hope—andhope 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 centralrole in planetary health. Imagining is a wonderful way we give structure to our hope. Itgives us the scaffold on which we can generate and nurture our hope.3.6. Marketing and Advertising-Based Artificial Selection: Intended and Unintended Consequencesof Mass Mimicry in Contemporary CultureYogi Hale Hendlin (Erasmus University College, Burgemeester Oudlaan 50, 3062 PARotterdam, 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 incontemporary culture. The thesis holds that too much advertising based on short-termprivate profit, rather than the common good, is (de)sensitizing us in ways leading to bothhuman devolution and environmental degradation.“Artificial selection” (advertising) prescribes selection according to vested interestsin a particular end goal. This type of selection can be contrasted with the processes ofnatural selection which proscribe without a predetermined endgame—it is open-ended, butlimits excess through natural constraints to allow beauty to flourish. Artificial selectionInt. J. Environ. Res. Public Health 2021, 18, 10654 10 of 101capitalizes on the heuristics of the human brain (cognitive shortcuts) to allow automaticprocesses and avoid cognitive overload in daily function. These instinctive behavioursare triggered by shapes, colours, and objects, which may suggest threat, security or status.Advertising creates artificially pumped-up “supernormal stimuli” which play on theseheuristics to promote unreflective behaviours which lead to product consumption.The environmental fallout of excessive consumption is obvious and are the healthconsequences, with many of the unhealthiest products (such as soda drinks and ultra-processed foods) specifically targeted to the poorer members of societies. Advertising ingeneral amplifies dissatisfaction and resentment, particularly by those who cannot affordmore elite products—as 80% of advertising is targeted at the top 10% of earners. Thisleads to a “blackhole of self-doubt” and growing mistrust of external stimuli. Peoplestart to doubt the world around them, and eventually inside them, in growing existentialinsecurity. There is growing isolation from world and from ourselves—as we forget who weare without these commodities. It spreads ignorance, inculcates separation and gaslightsour own bodily wisdom. In all this, those least equipped to defend against their tactics arethe most susceptible.The undermining catch of this “catch-22” is that “by trying to seem, we get furtheraway from where we want to be”. Thus, advertising is a form of “soft pollution” that isappropriating our attention and canalizing our experiences—but the wider consequencesof 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 todeconstruct 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 LandBased HealingNicole Redvers (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 bothuniversities and organizations in North America and abroad. Planetary health is by nomeans a new innovative discipline, as often is suggested in academic circles, but a deeplyrooted connection that all of our Indigenous ancestors had to the land as a medicine andhealing place. To understand the planet and its functions is to understand oneself in theIndigenous worldview.Our Elders predicated the awakening of hidden diseases trapped in permafrost, tothe tilting of the planet’s axis due to the polar cap melt, to the sinking of the ground dueto sumps forming from permafrost melt and talked specifically about these changes thatwere coming. From our Elders having a pure reverence for the land, reality became clearthrough the lessons given by the water, animals, the sky, and through ceremony passingthe responsibility to us to learn from those lessons and enact change for the progressionof humanity.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 globeat the grassroots level to support the health and stewardship of our planet. Indigenouspeoples have a large role to play in this leadership process. With organizational structuresbeing put in place to ensure the next seven generations have the opportunity for a healthylife, we must ensure the traditional ways of knowing of health and disease are honoured ina good way which starts from our original teachings. The land healing relationship is ourconnection back to balance.3.8. Rising the Feathered Serpent: Indigenous Contemplative TraditionsYuria Celidwen (Indigenous Scholar, Speaker, Advocate for Indigenous Rights and theRights of the Earth, New York, NY 10017, USA).Int. J. Environ. Res. Public Health 2021, 18, 10654 11 of 101The emergent field of contemplative studies-and its manifestation as the mindfulnessmovement-draws inspiration mostly from Buddhist-derived meditation practices, texts,and principles. These practices have been largely adopted in the West as a popular sourcefor health-related benefits mainly related with stress reduction and focused attention. Thebenefits of these practices for only physical and psychological wellbeing do not representthe higher resolve of realization of spiritual development and the structure of ethical goals.On this note, more recently, after undergoing secularization, the popularized practices inthe West have expanded their focus to include compassion and loving–kindness practicesand the enhancement of prosocial behaviour. While these practices have been pertinent andeffective, they only represent a very selected variety of practices across Asian traditions.Moreover, although the field has engaged with other religious traditions and their practicesof contemplation, these studies have been scarce.Indigenous religious traditions have likewise engaged in a diversity of contemplativepractices with similar spiritual impact, and physical and psychological benefits. Withthe intention and motivation of expanding the circle of inclusion, I have been workingto include Indigenous religious traditions in the conversation of contemplative scienceand practice. From my work on Indigenous contemplative science, I developed my thesison the earth-based experience of the Ethics of Belonging. This ethos engenders conscioussocial responsibility for self, community, and environment. It implies a renewed senseof order (cosmos) through a system of integration of ecological and ethical awareness ofindividual and collective, material and subtle, adaptive and interactive, and meaningfulrelational purpose within a community. Within this work, I examine how our personalstories relate to cultural accounts that can transform our identities and the social and racialinjustices of our times. This proposal is intended to invite dialogue among contemplativeIndigenous religious practices and to reclaim Indigenous traditional wisdom and revitalizeIndigenous voices as similar keepers of profound sophistication and variety. I am certainthat this dialogue not only creates inclusive and diverse ways of knowing, but it will enrichthe scope of impact of these contemplative practices to engender social change for socialand environmental justice.3.9. Every Species Has a Song: Plant Intelligence and the Importance of Imagination in ScienceMonica Gagliano (Research Associate Professor in Evolutionary Ecology at Southern CrossUniversity, Lismore, NSW 2480, Australia).No abstract available.3.10. Planetary Health: An Emerging Public Health Concern in NepalSagun Paudel (President, Public Health Youth Society of Nepal, Kaski 33700, Nepal).Background: Natural resource degradation, climate change, and global warming havebecome widespread concerns and Nepal is no exception. After a long decade of politicalinstability, Nepal is in the transition phase of development and industrialization; theutilization of natural resources, expansion of roadways, construction of large hydro powers,the establishment of big industries are gradually increased. Nepal lies in between twolarges economically developing countries; China and India. The industrial development ofthe neighbour country, directly and indirectly, effects on the ecosystem of Nepal.Objective: The objective of this paper is to analyse the environmental situation, naturalresources 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 toprepare a manuscript. This paper was prepared by using various secondary data sourcesavailable on internet web pages, journals, government reports, and articles.Findings: More than 80% of Nepalese depend on forests for livelihoods and 66% ofthe total gainfully employed population is engaged in natural resource sectors. Eightypercent of the population are at risk with the VPDs and NTDs which are only endemic inthe few districts, the population at risk will likely increase in the future due to the shiftingof disease vectors into highland areas. The ambient air appears to be polluted with highInt. J. Environ. Res. Public Health 2021, 18, 10654 12 of 101levels of PM2.5 and NO2. These indicators reflect that there is a possible consequence toincrease 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 environmentand ecosystem should be initiated through collective action, awareness, and implemen-tation of activities in the frame of planetary health. It should be introduced within theregular program.3.11. Planetary Health Perceptions Versus Priorities in Fijian CommunitiesSarah Nelson, Joel Negin, Seye Abimbola, Jacqueline Thomas and Aaron Jenkins (Uni-versity of Sydney, Camperdown, NSW 2006, Australia).Introduction: Rural Fijian communities have close relationships with land and waterand depend on it for their livelihoods and security. Correct water management is a toppriority for Fiji and planetary health at an individual community level and at the widerecosystem health of the catchment level. Understanding the perceptions and prioritiesof water resource management for planetary health allows for action to build maintainclimate-resilient planetary health systems and for communities to understand changingpriorities and linkages.Methods: A mixed methods approach was used. Semi-structured interviews atcommunity, provincial and national were used to understand what individuals view asthe water priorities for planetary health. Water quality testing and mapping were used todetermine 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 heavyrain and communities were aware of these issues. Community practices were found tocause issues for ecosystem health particularly through alteration of water quality. Commu-nities thought current practices and alternative water sources were usable, however, waterquality testing revealed the impacts of land use, farming and water management practiceslead to contamination of water. Community natural resource management varied amongstcommunities. Community practices impacted the wider ecosystem, at the catchment leveland sub catchment level.Conclusion: Planetary health perceptions versus priorities are important to understandat the community level as the only one part of a nested system that and impacts the widerecosystem. 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 TraditionsRyan Jenkins 1 and Aaron Jenkins 2,3 (1 Hypnotherapy in Barcelona, 08024 Barcelona,Spain; 2 University of Sydney, Camperdown, NSW 2006, Australia; 3 Edith Cowan Univer-sity, Bentley, WA 6027, Australia).Psychotherapists worldwide are increasingly documenting a sense of loss and griefattached to the systematic dismemberment of the natural world. This inner anguish isreferred to as ecological grief, in relation to either experienced or anticipated ecologicallosses due to acute or chronic environmental change. Often unmeasured, and largelyimmeasurable, 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 andprovide guidance on improving our relationship with the biosphere, our motivation to actis 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 passon valuable information in memorable, repeatable and actionable forms thereby enhancingour chances of survival. We draw upon fields of Ericksonian hypnotherapy, ecopsychology,ethnomusicology and medical anthropology to create a novel therapeutic storytellingInt. J. Environ. Res. Public Health 2021, 18, 10654 13 of 101practice specifically designed to help acknowledge, release, legitimise and transform ourdiverse and often repressed emotional responses to our rapidly changing planet.Our model therapeutic practice is derived from storytelling traditions of Papua NewGuinean hunter–gatherers, West African and Amerindian shamanism, folkloric and con-temporary dystopian fiction, Scandinavian cinema and modern musical traditions. Weprovide a framework for transforming ecological grief using therapeutic methods of indi-rect hypnosis and neuro–linguistic programming, narrated in a story and augmented byvisual and audio media.We contend that hypnotherapeutic storytelling can help transform natural feelingsof ecological grief from a dulled, frustrated inertia, caused by forces of market capitalismand the Palaeolithic architecture of our minds, into the seeds of ecological awareness andsocial action.3.13. Interplanetary Health Equity: Implications of Dominant Value Systems in Space Explorationfor Human Cultural Identity and Equitable SurvivalEvelyne 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 solarsystem) is a futile endeavour, and that we should first and foremost focus on our ownplanet(ary health). As true as this is, and as depressing the hunt for interplanetary miningand colonisation may appear, it is very much on the books of global stakeholders. Thesenot only include nation–states (such as the UAE, China, India, Japan, European Unionand USA) but increasingly private industries. We should be concerned about the impactof these efforts on health and wellbeing equity on Planet Terra. Spending billions if nottrillions (whether or not garnered from state sources through taxpayer schemes or fromprivate capital through profit and philanthropy) on space exploration is at the detrimentof investments in sustainable food systems, water management, healthcare and healthprotection, etc. A warning should be sounded. However, there is a phenomenon thatis potentially even more challenging, even if planetary health equity is assured. That isinterplanetary health equity. The Outer Space Treaty (entered into force in 1967) forbidscolonisation or exclusive rights to anything beyond Earth’s atmosphere and regards spacetravellers as envoys of humankind. However, in a move that possibly further illustrates theUnites States’ retreat from the global order of nations (as much as its withdrawal from UNagencies such as WHO and bullying of others such as UNESCO), its National Aeronauticsand Space Administration (NASA) has drawn up the “Artemis Accords”. The world hasbeen invited to join NASA in this—as if UNOOSA is incapable of implementing globallyagreed on treaties. Under these Accords space may be free, but anything that is mined andproduced 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 MachinesLaetitia Van den Bergen (Erasmus University College, 13011 HP Rotterdam, The Netherlands).Providing water in acceptable quality while ensuring its future availability constitutesone of the major challenges of our century. While Western countries’ water infrastruc-tures have solved sanitary issues, they are at odds with the contemporary sustainabilityparadigm. 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 sustainabledevices. However great is biomimicry potential for sustainable design, it is under-exploitedbecause of the field’s lack of philosophical conceptualization. This work uses both philo-sophical speculation and scientific literature to investigate how biomimicry should bepracticed to generate truly sustainable technologies, meaning technologies that createconditions conducive to Life.Philosophical speculation suggests that the paradigm opposing Nature to Humanityin which scientists currently operate restrains biomimicry ability to achieve sustainabilityand humans’ capacity to understand and respond to the ecological crisis. It was proposedInt. J. Environ. Res. Public Health 2021, 18, 10654 14 of 101that biomimicry should be performed according to a paradigm that conceives humansin their entanglement with non-humans. By following a bio-inclusive and bio-synergeticapproach 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.,polluted water.Living Machines (technologies that emulate wetlands form, process, and system) wereproposed as an admirable example of the application of biomimicry. My scientific literaturereview suggests that using constructed wetlands reduces not only the costs and outputsof wastewater treatment but also energy, material, and water demands. More, it favourssocial sustainability.Overall, this study provides an interdisciplinary framework to inform a more sustain-able practice of biomimicry. Propositions for further research include the application ofbio-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-SectoralismAaron Jenkins 1,2, Anthony Capon 3 and Pierre Horwitz 2 (1 University of Sydney, Camper-down, NSW 2006, Australia; 2 Edith Cowan University, Bentley, WA 6027, Australia;3 Monash University, Clayton, VIC 3800, Australia).Modern society is gradually appreciating that deep understanding of the ecologicalfoundations of health can help guide global sustainability. Our current discourse andaction, however, rarely engages meaningfully across sectors or allows the undisciplinedspace 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 discussionon 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 skillset and a specialist discipline to which they are not necessarily wedded; they are willingto 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 theindividual to the organizational through place-based, empathetic, and iterative processesincluding those most affected, while addressing critical power dynamics in co-designof solutions. Organisations designed well for cross-sectoral collaboration have a sharedvision, are influenced by other organisations in a reciprocal way, and more likely to adopt ahorizontal business model, without being insular. Systems designed well for cross-sectoralcollaborations provide incentives, promote attitudes and capabilities that have empathyfor the whole, and encourage organisations and individual behaviours that are supportivenot competitive.The nature of transformative action is not about efficiency. It is metamorphic andparticipatory, where processes and outcomes are blurred and not predetermined. It issubversive of disciplines and sectors where these structures operate to exclude broadersocietal agendas.4. What Kind of World Do We Want to Live in? Urban and Social Systems for Healthand Fulfilment on All ScalesThis session explores the challenges of changing social and urban environments—including increasing immersion and dependence on digital environments, as a rapidlyemerging factor in “nature disconnection”, especially in younger generations. We alsoexamine the social changes that may be needed to promote healthier, equitable, thrivingsystems that support flourishing across scales of people, places and planet. This includesInt. J. Environ. Res. Public Health 2021, 18, 10654 15 of 101pathways to efforts to promote social cohesion and connection to nature through artisticventures and urban green initiatives. The topics are summarized in Figure 3, and recordingsare also available [12].Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 15 of 104 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 ex-amine 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 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 record-ings are also available [12]. Figure 3. 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. Figure 3. What kind of world do we want to live in? Overview of topics and speakers in the sessionon urban and social systems for health and fulfilment.4.1. Rethinking Social Change: Regenerative Sustainability, Reciprocity and JoyBlake Poland (Dalla Lana School of Public Health, University of Toronto, Toronto, ONM5T 3M7, Canada).Emerging threats to planetary health and health equity, including climate change,ecological degradation, resource depletion, energy insecurity, and widening socio-economicdisparities, are converging in ways that some now predict could bring down civilizationInt. J. Environ. Res. Public Health 2021, 18, 10654 16 of 101as we know it within the lifetimes of many alive today. Risk management, the dominantsystem response, is not up to the challenge, and indeed, by seeking to predict and controlthe negative outcomes of current systems and prevent or bounce back from adversity istilted in favour of maintenance of the status quo. Something more “radical” (as in gettingto the roots of the crisis) is required. In this presentation, three promising directions forreimagining sustainability are proposed, from a landscape of possibilities.First, decolonizing ourselves from the dominant western paradigm that naturalizesinequality, “meritocracy”, competition, domination, scarcity mentality, a story of separation,and that imagines sustainability as a greening of business as usual. Fortunately, there aremany other non-dominant knowledge traditions we can draw inspiration from to help ussee that things can be other than we currently imagine them, from critical and progressivetraditions at the margins in the Global North (degrowth, political ecology, ecofeminism,deep ecology) to Indigenous ways of knowing and Global South epistemologies. We arebrought to the question: what if the sustainability crisis is not a technical problem (as weare often led to believe) but rather a relationship problem, in the sense that we’ve fallenout of right relationship with ourselves, each other, and the more-than-human world?A second promising direction for reimagining sustainability follows: embracinganimism and a relational world view, where all life is seen as animate, sentient andpossessing agency and spirit, a world that is fully alive, in contrast to one that modernWestern 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-eyedrealism about the current state of affairs with a clear vision of “the more beautiful world ourhearts know is possible”, reflecting the power of vision and dreams to call a better futureinto being (not only railing against what we do not want). What if, to quote Rob Hopkinsfrom the Transition movement, “if it’s not fun, it’s not sustainable”? We are invited into thesweet spot at the intersection of what you love, what you are good at, and what serves theworld, as your unique contribution to realizing the momentous transition underway thatJoanna Macy calls The Great Turning.4.2. Addressing the “Social Dilemma”: Can We Realign Digital Technology with Humanity’sBest InterestsDavid H. Nelson (Independent Researcher, Woodstock, ON N4S 6Y9, Canada; inVIVOPlanetary 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 socialmedia use (e.g., Facebook, Twitter, Instagram, TikTok) and human health, particularlyin children. The global pandemic has been associated with massive increases in screentime—up by over 50% in children in North America. This has increased the urgency withwhich researchers must understand the consequences of screen time, and the ways in whichit might promote, or detract, from health at scales of person, place and planet. Here, thediscussion 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 compromisessleep. Behavioural solutions, those promoting judicious use of screen time, are offered.4.3. Managing the Digital Environment for Our Children: Physical, Mental and SocialImplications for a Post-COVID GenerationDesiree Silva (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 wasfirst developed in 2007. The use of devises at an early age are related to parental use. InAustralia, 9% of infants (<2 years) and 33% of preschool children (3–6 years old) own theirown mobile/tablet device and use it 2 h and 4 h/day respectively. This has led to increasingconcerns around how this may be influencing patterns of early childhood development inthis crucial period of life.Int. J. Environ. Res. Public Health 2021, 18, 10654 17 of 101In the early postnatal period, there are already concerns that increasing parental screentime is affecting eye contact and bonding. Similarly, there is also an increasing tendency touse mobile devises as “babysitters” to occupy, distract and quiet behaviour of babies andchildren for prolonged periods. This reduced personal social contact may be contributingto social and emotional immaturity—including increasing anecdotal observations of delayin 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 todetermine 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 digitalworld is also increases, as families struggle to deal with the associated adverse effects ofexcessive 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 ofexcessive electronic use on social and emotional development. Those families struggling tocontrol device experience guilt as this becomes increasingly challenging.This is one important focus in The ORIGINS project. This is a landmark birth cohortin Western Australia aimed at addressing many of these contemporary challenges. Thestudy commenced in 2017 and will follow 10,000 families for 5 years. Embedded in thiscohort platform, there are a number of specific studies, including the impact electronic useand interventions to address this—including strategies to increase nature connectedness infamilies. We are working with local groups, such as Nature Play WA to promote a newapproach which includes ways to reduce, replace and balance digital devices especially inchildren who have sleep and behaviour issues.We hope the results of this study will help shape policy on mobile technology use inyoung children especially in the post COVID-19 period.4.4. Nature as an Antidote to Digital Displacement: Increasing the Awareness of Nature-BasedSolutions for Human Health in Urban Settings Post COVIDMatilda 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 spaceshas rapidly developed. An increasing number of epidemiological studies demonstratesdirect and indirect health benefits by exposure to urban green and blue spaces. Whilethese studies have significantly contributed to confirming associations between natureexposure and various health outcomes, a number of challenges remain before evidence onmechanisms and causality can be established. These challenges range from uncertaintyabout optimal exposure measures to what physiological effects can be expected from naturecontact. Nevertheless, the side effects of “urban green interventions” are limited. By alsotaking co-benefits, such as increased biodiversity and climate change mitigation from urbannatural spaces, into account there seems to be little to lose from a policy perspective byadvocating 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 researchchallenges in on-going studies around urban nature and human health. It will also discussthe prevailing discourse around pathways and mechanisms. Finally, the goal is to initiate adebate around opportunities and risks with taking a “nothing-to-lose” approach to urbangreen initiatives across the world.4.5. The Future of Urban Systems: Saving Our Cities to Save Our Health in the Post-COVID EraMark J. Nieuwenhuijsen (Director of Urban Planning, Environment and Health, ISGlobal,08003 Barcelona, Spain).Int. J. Environ. Res. Public Health 2021, 18, 10654 18 of 101Over 50% of the world’s population is living in cities and this is expected to rise to70% over the next few decades. Cities are society’s predominant engine of innovationand wealth creation, but also main sources of pollution, and disease. Partly due to poorurban 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 tohigh air pollution and noise levels, heat island effects and lack of green space and physicalactivity that are all detrimental to health. For example, a recent health impact assessmentin Barcelona estimated that 20% of premature mortality was due to urban and transportrelated exposures.The COVID-19 has shown the importance of public space in cities and cities havestarted to transform their public spaces by for example increasing cycling lanes and creatinglow traffic or car free areas. Furthermore, more green space is being introduced as there is areal need. COVID-19 has been an accelerator in many ways. This talk will review the latestdevelopments on urban and transport planning pathways leading to low carbon, liveableand 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-termvisioning of healthy urban future is needed that bring health, sustainability and liveable atthe forefront of urban and transport planning. Systemic approaches to the current problemsand a shift away from our grey car centric cities towards cities with more public and activetransportation and green space are urgently needed. New urban models such as car-freecities, the 15 min city and the Superblocks are urgently needed. Collaboration betweene.g., urban and transport planners, environmentalists and public health professionals isessential to create carbon neutral, liveable and healthy cities.4.6. Inspiring Children to Imagine the Future: What They Can Teach Us through ArtAlanna 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 globalconversations 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” andfinding personal and/or shared hope at times of stress. I am an artist and art teacherworking in a public elementary school just outside of Baltimore, Maryland in the UnitedStates, and this was an opportunity for me to share an art project designed to help ourstudents 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 virtuallearning environment, and many students and families faced the challenges of socialisolation. Our school is highly diverse, with students’ families from all around the worldacross a wide socioeconomic range. Anxiety mounted as the pandemic continued andevents, such as the death of George Floyd, amplified social unrest across the USA andthe world. Artistic creativity was an important avenue for my students to process thesesignificant 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 theiremotions and aspirations. Drawing on the awe and wonder of the Earthrise photographtaken by the Apollo 8 astronauts, and how this had inspired new awareness and newpossibilities at the time, I encouraged them to draw from their imaginations to create apicture 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 theirexplanations—ranging from environmental and social justice concerns, to sharingtoys and playing with their sister. Even at the age of 8 years, many artists expresseddeep caring for nature. Along with frequent depictions of vibrant nature scenes, theyincluded 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 planetalso depicted hope and desire for change, with comments that we need to “changeInt. J. Environ. Res. Public Health 2021, 18, 10654 19 of 101how humans and animals live together and how animals are going extinct due tothe population taking over their homes and taking down forests”. Another emergenttheme 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 knockeddown you help them back up”. Importantly, the very process of reflection, creation andsharing also generated hope and positivity with comments such as “drawing makesme happy”.Significantly, both children and their families (many experiencing great hardship)expressed profound gratitude in the knowledge that their art and their thoughts would beshared with the international inVIVO community. It was meaningful and empowering forthem to feel connected to something bigger in this way.While anecdotal, this illustrates the personal and collective value of creativity andimagination in sharing inspirations and creating hope, and wonderful opportunities to givechildren a voice in important conversations—because it is ever true to say that children arethe future.Suggested reading:Alan C. Logan, et al. Project Earthrise: Inspiring Creativity, Kindness and Imaginationin Planetary Health. Challenges 2020, 11 (2).4.7. Imagining Our Future: Comparing Green and Sci-Fi Utopian Themes and Effects on SocialChange MotivationJulian Fernando (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 relatedareas. Early work has shown that thinking about one’s ideal society tends to predictgreater criticism of one’s existing society and great motivation to change it. Here, I discusstwo prominent contemporary utopian visions—a Green utopia and a Sci-Fi utopia—andsome 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 performpro-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 capacityof the Green utopia could be partly accounted for by an increased sense of self-efficacy (thefeeling that one can make a difference in bringing about that kind of society). These resultscompletement those of other research showing that people see future societies as becomingmore competent and technological, but less warm and moral. Thus, people may view theSci-Fi utopia as a fulfilment of the current societal trajectory (requiring no action), but theGreen utopia as requiring a diversion of the current society trajectory. My colleagues and Iare continuing our work to understand the motivational function of utopian thinking, inparticular, 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 PlanetCatherine 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 thisthrough the lens of original artworks that have been created and exhibited internationallyand 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 relationshipsbetween science and society. The Projects include, but are not limited to: The EphemeralMarvels Perfume Store, an olfactory installation of things we could lose because of climatechange; The Sewer Soaperie, soaps created from raw sewage that will further exacerbateInt. J. Environ. Res. Public Health 2021, 18, 10654 20 of 101urban flooding that is caused by stronger typhoons; Climate Change Couture, potentialgarments of the future under specific environmental impacts; Experiments in Nature, avideo performance series that depicts scientific experiments in the wild to interrogate therole of science in society; and Letters for Science, a participatory project that asks the publicto 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 sculpturalinstallation series that casts the ashes and remains from the Australian bushfire crisis intohuman 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 AttachmentRebecca Hood (Curtin University, Bentley, WA 6102, Australia).This Prenatal attachment (the relationship between a parent and their baby duringpregnancy) is of great importance, as evidence suggests it leads to secure attachment inearly childhood and to better child developmental outcomes in the future. Many potentialinfluences on prenatal attachment have previously been explored. However, one possibleinfluence on prenatal attachment yet to be considered is the use of mobile touch screendevices such as smartphones and tablet computers. The advancement of screen technologyin recent years has led to devices having a pervasive impact on expecting parents’ livesduring 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 avariety of purposes, and all described secure prenatal attachment. Many parents indicatedthey had not previously considered the influence of device use on their relationship withtheir baby. On reflection, parents described both negative and positive influences on theirrelationship with their baby. For example, some described feeling distracted while usingtheir device and feeling more anxious due to reading information online. Others describedfeeling closer to their baby due to reading about their baby’s development and playingmusic for their baby on their device while pregnant.These findings show how devices can be used by parents to feel more connected totheir baby during pregnancy while being aware of potential downsides, which may lead tobetter parent–child relationships after birth as well as better future child outcomes.4.10. “Desirable Green”: Informing Design Guidelines for Restorative Small Urban Green SpacesHildy Steinacker (Department of Landscape Architecture, University of Sheffield, SheffieldS10 2TN, UK).The positive mental health implications of exposure to green space and its potentialto reduce stress, i.e., to be restorative, has attracted much interest, but does immersionin a green environment systematically lead to a restorative experience or is the pathwaymore complex? What is perceived as “desirable green” could be an important factor thateither enables or hinders this restorative effect. This research project explores to whatdegree the restorative experience made possible in green spaces is mediated by perceivedattractiveness, or preference.The approach taken in this thesis is to view these aspects as outcomes of processesof socialization and culture. Although research on restoration does incorporate socio-demographic variables, to what degree these influence the restorative experience of naturehas 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 whereboth the landscape experience of the viewer and the landscape itself are expressions ofsocietal processes.At the inVIVO 2020 annual meeting, I presented findings from a questionnaire takenby around 450 participants representative of various sociodemographic groups. Thequestionnaire examines the green space characteristics and features considered by theInt. J. Environ. Res. Public Health 2021, 18, 10654 21 of 101participants 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 socialcategories statistically examined. The results provide precious insights into the degree towhich representations, expectations and preferences regarding green spaces vary betweenrespondents from different social categories, and the similarities and differences betweenthese groups. To examine whether the preferences of each group moderate their restorativeexperience, the emotional responses to experimental park designs will be visually tested inthe second stage of the research.4.11. Knowledge Translation in the Response to the COVID-19 and Climate ChangeCo-Emergencies of Our TimeCecilia Sierra-Heredia 1, Perla Araiza-Viramontes 1, Kerri Klein 2, Trevor Hancock 3,Mira Ziolo 4, Maya Gislason 1, Christopher Buse 5 and Tim Takaro 1 (1 Faculty of HealthSciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; 2 Shift Collaborative,Surrey, BC V4A 2H9, Canada; 3 University of Victoria, Victoria, BC V8P 5C2, Canada;4 University of British Columbia, West Mall Vancouver, BC V6T 1Z4, Canada; 5 Centre forEnvironmental 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 thesocial and economic devastation caused by climate change will be greater than that ofCOVID-19 without appropriate actions from multiple sectors (Fearnow, 2020). As partof the broader set of global ecological changes that constitute the Anthropocene, climatechange exacerbates existing health inequalities which are being further compounded bythe pandemic. However, climate change has also been described as “the greatest globalhealth opportunity of the 21st century”. It is important that public health professionals andstudents are involved in the design of mitigation and adaptation strategies in partnershipwith other organizations and sectors.The webinar series “Learning for Planetary Health: Lessons from a Pandemic” is acollection of session recordings and files from the SFU Planetary Health research group andother scholars and practitioners. In eleven sessions, the presenters covered a range of topicsregarding the relationship between COVID-19 pandemic, planetary health, climate changeand 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 improvehealth for all as we face the overarching threat of climate change. Knowledge Translation isthe process of sharing research findings to multiple stakeholders and practitioners in orderto 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-edsthat 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 byresearchers and presented in webinars to communicate climate action opportunities andstrategies emerging from the COVID-19 pandemic.4.12. A History of the Psychologies of the EnvironmentJames Dunk (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 urbancontexts, focusing on the built environment and the various risks that it posed to humanhealth. As the field came to encompass the physical environment, it retained the risk matrix.“Global” psychologies or psychologies of survival appeared from the 1980s, integratingmethodology and insights from diverse psychological schools to meet the perceived globalcrises represented by ecological and other crises at a global scale, while conservationpsychology, modelled on conservation biology and conservation medicine, addressedInt. J. Environ. Res. Public Health 2021, 18, 10654 22 of 101problematic aspects of the human–animal relationship with a view to stemming those still-developing crises. The paper will trace through lines across these approaches, includingthe constitution and scale of the “environment” which each addresses, and the relationshipbetween the human psyche and this environment which each approach theorises. It willconclude with a discussion of global mental health and planetary mental health in light ofthis psychological terrain.4.13. Change in Complex Systems: Lessons about Policy and Practice for Healthy,Sustainable HealthcareSarah Walpole (Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK).Healthcare, as other sectors, has a duty to reduce its environmental impacts; and anopportunity to do this as part of a positive transformation, benefiting both those workingin the sector and the public.Healthcare systems are complex, containing multiple sub-systems and comprisingmultiple, varied relationships with external actors, environments and systems. Throughher research on transition to more sustainable healthcare systems, Charlesworth (2016)highlighted six key elements to facilitate this: clear vision, innovation to redesign systemsand processes, staff and patient engagement, effective information management, goodperformance management and good leadership.This presentation considered the goals of healthcare systems and outlines a “wholesystem” 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 aroundthe world that are already modelling healthy and sustainable practices, and explores howdifferent healthcare system structures, financing and governance may facilitate or inhibitpositive change.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 stewardinga sustainable healthcare system. Measurable outcomes are important, but less measurableoutcomes may even be more important.A health system requires both shared goals and responsiveness and respect for diverseviews, perspectives and values. Being inclusive of diversity of experiences and perspectivescan enhance responsiveness (including to the needs of patients), adaptability, dynamismand resilience of the health system (Murray and Frenk, 2000), all of which are essentialduring transition.Suggested reading:• Charlesworth, K. et al. (2016) “Transformational change in healthcare: An examinationof four case studies”, AHR, 40 (2), pp. 163–167;• Murray, C. and Frenk, J. (2000) “A framework for assessing the performance of healthsystems”, B WHO, 78 (6), pp. 717–731.4.14. Strategies Caregivers Use to Support Adolescents Who Experience Climate GriefTaylor 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 understandthe 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 ofloss associated with the changing climate.The wide-ranging impacts of climate change on adults’ emotional wellbeing hasbeen an increasing focus of scholarly concern over the past decade. Children, however,remain an understudied population, although some anecdotal reports suggest that theyare especially prone to experiencing climate grief. As children grapple with how climatechange will affect their lives, it is important to understand how they process climate-relatedgrief and how their caregivers are supporting them to cope with future environmentalrealities. To fill a gap in the literature, this research explores climate grief through theInt. J. Environ. Res. Public Health 2021, 18, 10654 23 of 101lens of caregivers as well as their adolescent child. It also examines how caregivers aresupporting young people, and what, from the perspective of adolescents, is helping themto 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), whichuses a five-point Likert scale to assess human connections to the environment. This studywill test the hypothesis that children and caregivers with higher nature relatedness scoresexperience more climate anxiety, potentially due to a greater sense of Solastalgia.Improving understanding of the dimensions of climate grief and strategies to supportcoping provides an opportunity to inform responsive programming and early interventionsthat can positively impact life course trajectories for both children and their families.4.15. Designing a Carbon Neutral Health System through Sustainable Quality ImprovementKathleen Leedham-Green and Stefi Barna (Centre for Sustainable Healthcare, BanburyRoad, Oxford OX2 7JQ, UK)Healthcare, as all human activities, takes place within a social and environmentalcontext. Growing numbers of healthcare professionals express concern about the healthimplications of environmental challenges facing us, and national health bodies are callingfor radical reductions in health sector carbon and waste. Sustainability is one of the domainsof quality in healthcare. The sustainable quality improvement movement aims to createa sustainable health service whilst improving patient outcomes. Clinicians involved insustainable quality improvement projects report greater job satisfaction when they engagework on the “triple bottom line” (financial, environmental, social) to improve patientoutcomes, increase staff work satisfaction, and future proof the health service and thecommunities it supports. Sustainable quality improvement (SusQI) methods include healthsystem changes to promote health, prevent disease, increase patient agency, and developlean care pathways. This session examines how the perspective of sustainable value canenrich clinical teaching and practice while tackling real-life ethical issues in healthcaredelivery. Practical cases are used to illustrate the key principles of sustainable practiceand measure the triple bottom line, thus safeguarding the health system for the patients oftoday and of tomorrow.4.16. Implementation of an Air Quality Forecasting Operating System for Health Surveillance andSustainability in the Salvador Metropolitan Region, BrazilNelzair Vianna 1, Larissa Zanutto 2, Fanny Velay-Lasry 2, Samya Pinheiro 2 and AndreFraga 3 (1 Oswaldo Cruz Foundation, Rio de Janeiro 40296-710, Brazil; 2 Aria Tecnologies92100; 3 Secretary of Sustainability, Innovation and Resilience, Brazilian government, Riode Janeiro 40010-010, Brazil).Air pollution is a threat to public health in the 21st century. In Latin America, morethan 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 forecastingsystems 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 surveillanceand civil defence, allowing the mapping of areas of higher risk and vulnerability for thepopulation. Methodology: The SOPRAR project was built through an articulated intersec-toral mobilization, scientific institutions, private and public sector, The project includesthe configuration of emission, chemical, and transportation models to represent the localconditions. The system operates based on CHIMERE model runs (48 h forecast) forcedby weather forecast simulations (WRF) performed by the local civil defence, integratingan updated emissions inventory. Model results, pollutants concentration maps and airquality index will be available by WEB service. A tailored health risk indicator will bedeveloped to make the SOPRAR system. The project is committed with the technology andknow-how transfer to local actors. Results: The emission inventory was updated basedon available local data regarding traffic, road network, industries processes and land use.Int. J. Environ. Res. Public Health 2021, 18, 10654 24 of 101Total emissions in the Salvador Metropolitan Region corresponds to 3327.03 tons/year ofparticulate matter, 14,964.32 tons/year of sulphur dioxide, 75,572.28 tons/year of carbonmonoxide, 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 onurban environment air quality modelling and will provide support for the activation of airquality protection and communication service protocols for use in research, public policiesfor 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 adverseimpact on natural ecosystems (soil and water contamination, waste and emissions), localcommunities and growers, and human health. Speakers consider aspects of the modernfood environment, spanning from personal ecology to the social, economic and marketingforces that affect both food choices and access to healthy food. We consider the necessaryshift to regenerative agro-ecological systems, which restore soils, retain water, increasebiodiversity, cycle nutrients to produce more nutrient-rich foods, and fix carbon for climatesolutions (see Figure 4).5.1. Why Think Resilience: New Tools for Shaping ChangeLaura 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 climatechange—that have put us on the path to planetary collapse. The question is not IF, butHOW we change the way we eat. Many different solutions—how do we choose amongthem? Resilience thinking can help. Social–ecological resilience thinking offers new con-cepts, a new language and an effective framework for decision making that is uniquelysuited 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 thatinvestments that cultivate high response and transformation capacity in the food systemand in other critical resource systems are less expensive and more effective ways to sustaincommunity wellbeing over the long term. Resilience thinking identifies solutions thatcultivate the social–ecological behaviours associated with high response, recovery andtransformation capacity: networks of equitable relationship; regional self-reliance; and thelocal accumulation of community-based wealth, including natural, human, social, financial,and technological resources. Because these resilient behaviours are well aligned with thecore principles of the US sustainable agriculture and food movements, sustainable foodadvocates have sown the seeds of our resilient food future through more than 40 yearsof work to develop, for example: cooperative processing, distribution and marketingnetworks such as Shepherds Grains in the Pacific northwest, Co-op Partners Warehouse in theMidwest, and Hickory Nut Gap Meats in the Southeast; regional food systems assessmentssuch as A New England Food Vision; Maine Harvest, the first federal credit union in the USto focus investments on regional food system development; and The Agriculture ResilienceAct which supports investment in regionally led research and development to promoteclimate-resilient agriculture and food systems.Int. J. Environ. Res. Public Health 2021, 18, 10654 25 of 101Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 25 of 104 Figure 4. Food systems from the ground up: can food solutions also be climate solutions? Overview of topics and speakers in the session on food systems. Figure 4. Food systems from the ground up: can food solutions also be climate solutions? Overviewof topics and speakers in the session on food systems.Int. J. Environ. Res. Public Health 2021, 18, 10654 26 of 1015.2. From the Ground up: Soil Microbes, (Carbon Storage) and Our 3Rs from aGrass + Roots PerspectiveSarah Hargreaves (farmer and educator, Three Ridges Ecological Farm, Aylmer, ON N5H2R4 Canada).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 andpollinator health.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 plantsand move a diversity of animals on pasture. This diversity, in turn, stimulates a diversifyof 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 andstrong 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 SystemsSabine Gabrysch 1,2,3 (1 Potsdam Institute for Climate Impact Research (PIK), Member ofthe Leibniz Association, 14412 Potsdam, Germany; 2 Charité—Universitätsmedizin Berlin,10117 Berlin, Germany; 3 Heidelberg Institute of Global Health, Heidelberg University,69120 Heidelberg, Germany).A “planetary health” perspective is required for transformative food solutions thatare more beneficial to human health, other species and the environment. The current foodsystem is failing on multiple levels, and is hugely wasteful, with at least one quarter offood lost or wasted. Poor nutrition is the leading cause of disease globally—two billionpeople are undernourished or deficient in micronutrients, and two billion are overweight orobese—driving the growing “double burden” of disease. Agriculture also has devastatingimpacts 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 nitrogenfertilisers, pesticides and plastic waste, and (3) greenhouse gas emissions, including fromdeforestation, degrading soils, energy use, methane from livestock and nitrous oxide fromfertiliser, generating approximately one quarter of anthropogenic greenhouse gases, thuscontributing substantially to climate change.Our destructive model of progress is fundamentally driven by an obsession witheconomic 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 tobenefit multinational companies, including agribusiness and producers of ultra-processedfoods and beverages, largely at the expense of consumers, communities, local farmers, andthe environment (see Raj Patel’s Stuffed and Starved).Jared Diamond describes in “Collapse” that survival of societies depends on theircapacity for long-term planning, willingness to reconsider core values and beliefs, andwisdom to change trajectory. There is a pressing need to revisit our current values, andto 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 placegreater value on the health of people, communities and environments on all scales.We are currently faced with a “syndemic” of multiple global challenges with commonsystemic drivers. Understanding that these are interrelated means we do not need to solveeach separately. Indeed, we can learn from nature in terms of multi-solving strategies andshared 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 101retain water, increase biodiversity and produce nutrient-rich foods, with low greenhousegas emissions, even carbon negative. Shifting to a healthier and sustainable diet (with morevegetables and less meat and dairy) will release land, reduce emissions and be better foranimal and human health. Many such win–win–win strategies are already occurring at thelocal “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 thedominant 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 togetherto build vision into action for healthier people on a healthier planet.Suggested reading: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, VikingPress. New York, USA.Boyd A Swinburn et al. The Global Syndemic of Obesity, Undernutrition, and ClimateChange: 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 toCorporate Capture and OverconsumptionJean-Claude Moubarac (Department of Nutrition, Faculty of Medicine, University ofMontréal, Montreal, QC H3T 1J4, Canada).Transforming food systems such that they become healthy, just and sustainable is apolitical project that requires a common set of values and beliefs about food, nutrition andhealth. Food are commons goods and food practices should aim to nourish and protecthuman and planetary health, while benefiting local communities and livelihoods. However,there exists an inherent tension between public health objectives to protect and promotehealth, and commercial interests of corporations to produce and promote ultra-processedproducts that are highly profitable but unhealthy and destructive (known as “commercialdeterminants of health”). Indeed, these products are formulations of refined substancesand additives that are nutritionally poor, linked to severe adverse health outcomes andcause harm to the planet, but they are extremely profitable, and they are designed to favouroverconsumption. Food corporations that make ultra-processed products are, however,legally obliged to create growth and therefore cannot be held responsible for the healthconsequences associated with them. Indeed, in front of the law, corporations are given thestatus of “moral persons” with the rights and freedom to buy and sell food, regardless ofthe consequences on society. In this situation, changing food systems will require changingthe nature of corporations in order to favour the development of a private sector that isin harmony, not in conflict, with public health goals to promote and protect human andplanetary health.5.5. The Implications of Ultra-Processed Diets and Food Additives for the Gut MicrobiomeLaurence Macia (The Charles Perkins Centre, School of Medical Sciences, Faculty ofMedicine 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 innon-communicable diseases. While diet has a profound impact on gut microbiota compo-sition and function, the role of food additives such as titanium dioxide (TiO2), prevalentin processed food, is less established. We investigated the impact of food grade TiO2 ongut microbiota of mice when orally administered via drinking water. While TiO2 hadminimal impact on the composition of the microbiota in the small intestine and colon, wefound that TiO2 treatment could alter the release of bacterial metabolites in vivo and affectthe spatial distribution of commensal bacteria in vitro by promoting biofilm formation.We also found reduced expression of the colonic mucin 2 gene, a key component of theInt. J. Environ. Res. Public Health 2021, 18, 10654 28 of 101intestinal mucus layer, and increased expression of the beta defensin gene, indicating thatTiO2 significantly impacts gut homeostasis. These changes were associated with colonicinflammation, as shown by infiltration of CD8+ T cells, increased macrophages as wellas increased expression of inflammatory cytokines. These findings collectively show thatTiO2 is not inert, but rather impairs gut homeostasis which may in turn prime the host fordisease development.5.6. Multi-Dimensional Advantages of Beneficial Microbes for Food: From Nutrition to Prosperityand Empowerment of Women in Developing RegionsGregor Reid (Lawson Health Research Institute and Western University, London, ON N6A3K7, Canada).We are born into a microbial world having no say in the country or living standardswe enter into. In time, we learn from what is around us. For some, it is easy to forgetthat we are equal in terms of species if not the imprint we can make on the planet, butequality is a term with many features. Disease can strike everyone, except if a person ispoor, malnourished, homeless, uneducated and without access to good healthcare, theconsequences can be very different. While a single 1 g sachet containing a fermentativeStreptococcus thermophilus and a probiotic Lactobacillus rhamnosus strain cannot addressall these issues, it can create a surprisingly important dent. Shown to ferment milk, cereal,fruits and vegetables, the organisms can enhance immunity, counter pathogens, detoxifycertain pollutants and produce nutritious good tasting foods. Moreover, one sachet canproduce 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, helpedcreate hundreds of small businesses and improved school food programs. Now led byWestern Heads East and Maimuna Kanyamala in Tanzania and Yoba-for-life in Uganda andother countries, the opportunities to grow locally are continuing. Meanwhile, our lab hasexpanded the research to use probiotic strains to reduce honeybee colony collapse causedby pathogens and pesticides. As these pollinators are critical to the food chain, efforts areneeded to save them. In addition, we are assessing whether probiotic strains can reducedeath and failure to thrive in Chinook salmon. This application is challenging becauseof water temperature and the absence of a permanent gut microbiota. Nevertheless, fishare a critically important staple for many people around the world and while salmon arenot 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 tocounter. Feeding probiotics to farm fisheries is logistically easier than lakes and oceans, buthumans have never been deterred by challenges. If researchers in developed countries canpartner with researchers and communities in developing countries, the least it will teach usis that we are one species, and the colour of our blood is the same. We have much to learnfrom each other—this is not a one-way street. Beneficial microbes can be the tools throughwhich humanity and the ecosystem can grow and learn together. Let us encourage the nextgeneration of talented students to make this area fulfil its potential.5.7. Beneficial Microbes in Apiculture: A Multi-Purpose Solution to Improve Honeybee Health andReduce the Environmental Spread of Antimicrobial ResistanceBrendan Daisley, Andrew Pitek, John Chmiel, Shaeley Gibbons, Anna Chernyshova,Kait Al, Kyrillos Faragalla, Jeremy Burton, Graham Thompson and Gregor Reid (West-ern University, London, ON N6A 3K7, Canada).Antibiotic administration in apiculture is intended to prevent bacterial disease butinadvertently contributes to the global dissemination of antimicrobial resistance and canharm 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 atthe same time depletes key symbionts known to regulate immune function and nutrientInt. J. Environ. Res. Public Health 2021, 18, 10654 29 of 101metabolism, such as Frischella perrera and Lactobacillus Firm-5 strains. Functionally, thesemicrobial changes are associated with a ~50% decrease in capped brood (marker of hivenutritional status and productivity) and a ~30% reduction in antimicrobial capacity ofadult hemolymph (indicator of immune competence). To assess how probiotic lactobacillimight be used to counter these negative effects on hives and potentially reduce the needfor antibiotics, we fed three probiotic strains of lactobacilli (2 strains exogenous and 1 strainendogenous) 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 immunoselectiveregulation of core microbiota members, and (iii) maximize the intended benefit of oxytetra-cycline by suppressing larval pathogen loads to near-undetectable levels. We conclude thatmicrobial-based therapeutics may offer a simple but effective multi-purpose solution toreduce honeybee disease burden, environmental pollution by xenobiotics, and spread ofantimicrobial resistance.5.8. Biochar-Urine Nutrient Cycling for Health: A Carbon Intelligence ProjectJillian Waid 1,2,3 (1 Heidelberg Institute of Global Health, Heidelberg University, Hei-delberg, Germany; 2 Helen Keller International, Bangladesh Country Office; 3 ResearchDepartment 2, Potsdam Institute for Climate Impact Research (PIK), Member of the LeibnizAssociation, 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 SylhetDivision, Bangladesh. During formative research, low soil fertility was found a productionconstraint by the majority of farmers. The intervention sought to test and scale the use of alocally produced, low-cost, urine-enriched biochar-based fertilizer to increase yields. Thisfertilizer combines liquid organic nutrients and biomass transformed into biochar. Urineis a highly efficient fertilizer but underused because of odour. Biochar can be producedfrom crop waste in soil-pit kilns at the village level. It is a porous material that can soak upurine and transform it into an odourless solid fertilizer. This intervention was tested foracceptability and scaled through two projects (BUNCH 2016–2017, BUNCH2Scale 2017–2020) nested within the FAARM trial (FAARM website: https://bit.ly/2NJud9y accessedon 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 wasexamined 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 October2018, and sustainability assessment from November 2018 to August 2019).By July 2018, 94% of farmers in the intervention group had heard of urine–biocharfertilizer, 87% had attended training, and 81% had tried the new fertilizer. Reported benefitsincluded better yields, healthier plants, fewer pests, lower input costs, and better-tastingvegetables. During each growing season following project scale-down, well over one-thirdof farmers continued to use biochar-based fertilizer. In farmer field trials, where oneplot fertilized with usual practice was compared to another plot fertilized with nutrient-enriched biochar, biochar-based fertilizers increased yields from 28% to 68%, depending onthe crop type.Biochar–urine fertilizer was thus found to be an acceptable and effective technologyfor increasing home garden yields in the FAARM project area in Sylhet, with the potentialto scale this technology further within Bangladesh and similar settings. Biochar is a win foryields, soil fertility, and the planet. These fertilizers increase soil organic matter, biologicalactivity, and water-holding capacity, in contrast to commercial mineral fertilizers thatallow soluble nutrients to leach into groundwater. While the production of commercialmineral fertilizers is energy intensive and contributes to greenhouse gas emissions, biocharfunctions as a carbon sink.Int. J. Environ. Res. Public Health 2021, 18, 10654 30 of 101Further reading: Sutradhar, I., Jackson-deGraffenried, M., Akter, S. et al. Introducingurine-enriched biochar-based fertilizer for vegetable production: acceptability and results fromrural 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 onHealth Outcomes of a Probiotic Yoghurt Intervention among Schoolchildren from Three to Six YearsOld in Southwest UgandaNieke Westerick 1,2, Wilbert Sybesma 1 and Remco Kort 1,2,3 (1 Yoba for Life foundation,Amsterdam, The Netherlands; 2 ARTIS-Micropia, Amsterdam, The Netherlands; 3 Depart-ment of Molecular Cell Biology, VU University Amsterdam (VUA), De Boelelaan 1085, 1081HV Amsterdam, The Netherlands).Children in Southwestern Uganda have poor growth indicators and a high incidence ofcommon childhood diseases such as respiratory tract infection, skin disease and diarrhoea.In response to these challenges, the consumption of locally produced milk and probioticyoghurt containing Lactobacillus rhamnosus yoba 2012 is currently promoted at pre-primaryand primary schools in seven districts in Southwestern Uganda. Parents are encouragedto pay approximately USD 3 per school term of 3 months, for their child to take 125 mLof 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 probioticyoghurt consumption in this program versus milk was assessed in a real-life interruptedtime series study. A total of 1116 children from three to six years old (probiotic yoghurtn = 584, milk n = 532) were assessed on daily basis with regards to incidences skin diseaseand common cold during three weeks of baseline and eight weeks of intervention. Thestudy 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 weeksof intervention. In a second phase of the research, a double-blinded placebo-controlledinterrupted time series study was conducted to confirm the results of the first study, inwhich a total of 195 children from three to six years old (probiotic yoghurt n = 100, placebodairy product n = 95) participated. The study showed a reduction over time in the incidenceof common cold (p value = 0.0032) and showed a trend for a reduction in the incidence ofskin conditions (p value = 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 higherin the intervention group, hence despite the significant relative decrease in the incidence ofthe 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 ofLactobacillus rhamnosus Yoba to Enrich and Decontaminate Aflatoxins in Fermented FoodsAlex Paul Wacoo 1,2,3, Nieke Westerik 1,2, Wilbert Sybesma 1 and Remco Kort 1,2,4 (1 Yobafor Life Foundation, Hunzestraat 133-A, 1079 WB Amsterdam; 2 Department of Molec-ular Cell Physiology, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amster-dam; 3 Department of Medical Biochemistry, School of Biomedical Sciences, College ofHealth Sciences, Makerere University, Kampala, Uganda; 4 ARTIS-Micropia, Amsterdam,The Netherlands).Background and rationale: Food safety require urgent attention especially in devel-oping countries where regulation of local food is neglected. In the 2018–2019 financialyear, Uganda lost USD 52.4 million due to rejection of maize resulting from high aflatoxincontamination. There was no record of the rejected maize being destroyed, therefore itcould have been sold and consumed locally in Uganda. Exposure to aflatoxins is linkedto liver cancer contributing to approximately 25,200—155,000 of 550,000 to 600,000 newcancer cases yearly. A total of 83% of these deaths occur in Sub-Saharan Africa and EastAsia due to synergistic contribution between aflatoxins and highly endemic hepatitis Binfection. Since maize is a major food crop in East Africa, the development of technologiesInt. J. Environ. Res. Public Health 2021, 18, 10654 31 of 101that can reduce aflatoxins is highly relevant. Lactobacillus rhamnosus GG, under the genericname Lb. rhamnosus yoba 2012, successfully ferments milk to make yogurt, maize porridge(Uji), and Obushera, but the precise mechanism behind the reduction of aflatoxins duringfermentation has not yet been studied. The effect of administered L. rhamnosus yoba 2012in minimizing the dangerous effect of ingested aflatoxin is unknown.Objective: The objective of our research is to evaluate the prevalence of aflatoxinsin 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 aflatoxinsreduction during fermentation of maize porridge and to understand the mechanism ofaction. The impact of consuming probiotic fermented foods on the reduction of aflatoxiningested in contaminated food was assessed.Methodology: 60 maize flour samples from five major markets of Kampala and72 samples from households were analysed for aflatoxins contamination using a novelimmunosensor for point-of-care measurements that has been developed in our laboratory.Kwete spiked with 120 µg/Kg of total aflatoxin was produced by fermenting a suspensionof maize flour in water at 37 ◦C for a period of 24 h. The aflatoxin level in fermented Kwetewas monitored using HPLC-fluorescence measurements.Results: A total of 31.7% maize flour samples from the markets were contaminatedwith aflatoxins and 16.7% of the positive samples had concentration higher than 10 µg/Kgallowable level for East Africa. For household samples, 43% of the samples had aflatoxinswhich were higher than acceptable limits with the highest concentration registered being233 µg/Kg. During fermentation of contaminated maize, Lb. rhamnosus yoba 2012 increasedfrom log 6 to log 8 cfu/g in 24 h at 37 ◦C. Simultaneously, the aflatoxins levels in the porridgewere completely eliminated.Conclusions: The study demonstrated that fermentation with the Lb. rhamnosus yoba2012 starter culture offers a practical approach to reduce aflatoxins B1, B2, G1 and G2 inmaize porridge during a period of 24 h.5.11. Bacterial Community Diversity in Gundruk—The Naturally Fermented Food from NepalPrajwal Rajbhandari 1 and Remco Kort 2 (1 President and co-founder, Research Institutefor Bioscience and Biotechnology, Lalitpur 44600, Nepal; 2 Department of Molecular CellPhysiology, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam).Naturally fermented foods contain complex and diverse microbial communities, whichare a source of beneficial bacteria and vitamins such as B [12]. Different countries havetheir 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 andmade 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 madelocally in households annually but its nutritional information and its health benefits arepoorly described. Therefore, this study will isolate, identify and characterize naturallyoccurring bacterial compositions of Gundruk made by local communities in differentgeographical regions of Nepal. Along with that, the project aims to explore the variation inmicrobial communities, its dynamics throughout the production process and characterizethe metabolites produced during fermentation with potential health benefits.5.12. Microbial Characterization of Kefir from Raw Milk Fermented by a Commercial Culture or aSymbiotic Consortium of Bacteria and YeastLuuk van Ooijen 1, Ton Baars 2 and Remco Kort 1,3 (1 Department of Molecular CellBiology, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands; 2 Depart-ment of Immunopharmacology, Utrecht University, 3584 CL Utrecht, The Netherlands;3 ARTIS-Micropia, 1018 CZ Amsterdam, The Netherlands).The modern western lifestyle resulted in improvement of personal hygiene andthereby reduction of the prevalence of communicable diseases. Food preservation tech-niques further reduced the incidence of foodborne pathogens. These developments led toInt. J. Environ. Res. Public Health 2021, 18, 10654 32 of 101reduced environmental exposure of humans to microbes with adverse effects. Reducedmicrobial 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 incidenceof asthma and allergies. These properties could be explained trough immunomodulatoryproperties 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 includingSalmonella, Campylobacter and Listeria can be present. Preventive measurements in theform of proper milking and zoonosis detection techniques can limit the health risk forconsumers. Fermentation of raw milk could be the solution in consuming raw milk witha further reduced risk of exposure to harmful microorganisms. Kefir is a dairy beveragetraditionally fermented by a consortium of bacteria and yeasts. The high microbial loadof 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 willuse amplicon 16s and ITS sequencing of several stages of raw milk fermentation in orderto determine which bacteria and yeast are present. By using a genomic spike-in the ratiobetween yeast and bacteria could be quantified. Furthermore, comparisons will be madebetween the microbial diversity of raw milk kefir and pasteurized milk kefir based ona commercial culture or an in-house SCOBY. The outcome of this research will provideadditional insight for strategies to enhance dietary uptake of microorganisms in order todiversify and improve the human microbiome. This can potentially assist in tackling thenon-communicable diseases pandemic.5.13. Screening of β-Galactosidase Production from Lactic Acid Bacteria Isolated from DifferentLivestock of NepalManila Poudel, Shyam Suwal and Prajwal Rajbhandari (Research Institute for Bioscienceand Biotechnology, Lalitpur 44600, Nepal).The dairy industry is one of the most dynamic sectors of Nepal where productionof cheese and its market is in constant growth. As a starter for the production of dairyproducts, Gram-positive Lactic acid bacteria (LAB) are generally regarded as safe. Inaddition, some of the LAB can produce β-galactosidase (β-GAL) that are responsible forthe breakdown of lactose into its simpler forms and form galactooligosaccharides (GOS). Alarge quantity of cheese whey produced as a by-product from the dairy processing consistsof lactose (80–85% dry mass) which can be fermented by the β-GAL into GOS. GOS areprebiotic compounds that enhance the performance and function of gut microflora whichcould potentially improve human health. The main purpose of this study is to isolateindustrially useful lactic acid bacteria producing β-GAL enzyme from milk of variouslivestock found in varying altitude in Nepal. The milk samples were collected from variouslivestock (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 wereisolated on selective media (MRS agar for Lactobacillus spp. and M17 agar for Lactococcusspp.). A total of 85 bacteria isolated from samples were identified via morphological andbiochemical characterization. Among the isolates, 40 LAB strains were screened for β-GALproduction by using X-gal/IPTG assay which showed blue colonies.5.14. From Agricultural Health to Climate Change’s Health Threat among Farmers andTheir FamiliesVivien How, Raihanah Chokeli, Nurul Syazani, Yuswir and Zailina Hashim (UniversitiPutra Malaysia, Serdang, 43400 Seri Kembangan, Selangor, Malaysia).While chemicals have played a key role in agriculture, they also pose potentiallysignificant 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 familiesexplores the potential links between agricultural exposures and chronic diseases. Farmworkers performing hand labour tasks in pesticide-treated areas have increased exposureto direct spraying, aerial drift, or contact with pesticide residues in the crop and soil viaInt. J. Environ. Res. Public Health 2021, 18, 10654 33 of 101skin and inhalation. These environmental residues have cross-contaminated the farmchildren 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 touncontrolled 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 nearto this pesticide-treated farmland. Our work also found that heavy metals as impuritiesthat soil receives from agricultural practices bioaccumulated in the fish collected from thepaddy trench. The dietary health risks from the low-level accumulative consumption ofthese contaminated fish have found to increase with ages and body mass index amongfarming villagers. Exposure to extreme heat stress is yet another growing concern forfarming communities due to global climate change, particularly in tropical developingcountries. Our recent study also found that there is a disparity in the physiological healthstatus among conventional and agroecology farmers, where the former bears the increasedphysiological health risk burden under extreme climatic effects. For years, our workprovides the evidence-based agricultural health study. Today, it supports the action ofsustainable healthy agricultural practices that can lead to lasting change for both individualand environment.5.15. The Under-Appreciated Role of Tropical Forests in Nutrition and Food SecuritySarah Gergel 1, Bronwen Powell 2, Laura Rasmussen 3 and Frédéric Baudron 4 (1 Uni-versity of British Columbia, Vancouver, BC V6T 1Z4, Canada; 2 Pennsylvania State Uni-versity, State College, PA 16801, USA; 3 University of Copenhagen, 1165 København,Denmark; 4 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 sourceof nutrition is underappreciated. Here, we explore the role of landscape diversity (thecombined patterns of forests and fields) in supporting dietary diversity by examininglinkages 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 withhousehold diet surveys across a range of sites in Africa and Southeast Asia to uncoverassociations between primary forests, forest patches, as well as disturbed and edge habitatsin bolstering dietary diversity. This approach helps illuminate direct and indirect pathways(agro-ecological, energy, and market pathways) connecting forested landscapes to dietdiversity. Improved evaluation of the role of land cover complexity in food security andnutrition can help avoid overly simplistic views of food security and uncover nutritionalsynergies with forest conservation and restoration.5.16. Protein for a Healthy Future: How to Increase Protein Intake in an EnvironmentallySustainable Way in Older Adults in The NetherlandsAlessandra Grasso 1, Margreet R. Olthof 1, Corné van Dooren 2, Roline Broekema 3,Marjolein Visser 1 and Ingeborg A. Brouwer (1 Vrije Universiteit Amsterdam, 1081 HV;2 Voedingscentrum, 2594 AC; 3 Blonk Consultant, 2805 PJ, Amsterdam).Protein intake greater than the recommended amount is suggested to improve physicalfunctioning and wellbeing in older adults, yet it is likely to increase the climate footprintof the diet if environmental sustainability is not considered. Therefore, there is a needto delineate ways to increase protein intake in an environmentally friendly manner inolder adults. This study aimed to identify dietary changes needed to simultaneouslyincrease protein intake and reduce greenhouse gas emissions (GHGE) in the diet of Dutchcommunity-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/daywas developed isocalorically while maintaining or improving nutritional adequacy of thediet. 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 alignedInt. J. Environ. Res. Public Health 2021, 18, 10654 34 of 101with the FBDG without considering GHGE resulted in 5% increase in GHGE in men and9% 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 inpoultry and pork (mainly for women) and stepwise decrease in beef/lamb and processedmeat, and increases in whole grains, nuts, and meat/dairy alternatives and decreasesin discretionary products were needed. A high-protein diet aligned with FBDG can beachieved in concert with reductions in GHGE in Dutch older adults by consuming no morethan the recommended 500 g meat per week while replacing beef and lamb and processedmeat 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, CanadaChris Buse (University of British Columbia, Kelowna, BC VIV 1V7, Canada).Natural resource extraction and development activities interact with a host of landuses that can leave lasting consequences for environmental, community and humanhealth values. Novel research methods are required to account for past, present andfuture “cumulative impacts” of resource extraction and development across broadgeographic 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 generationresearch and policy action that can improve health equity and sustainability for allin the face of the grand ecological challenges of the 21st century. Leveraging insightsfrom environmental, social and health impact assessment, this presentation utilizesthe case study of British Columbia, Canada to introduce a suite of research methods toconceptualize a novel integrated assessment method merging quantitative and qualita-tive data to inform an understanding of the cumulative environmental, communityand health impacts of natural resource development. These include qualitative “data-driven story-telling” approaches with local stakeholders and Indigenous rightsholderscomprising 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 novelenvironmental health justice screening tool. By merging statistical representations withnarratives that articulate the lived experience of cumulative impacts, this presentationcomments on the current state of cumulative impacts assessment, and contemporarypolicy approaches to natural resource development in relation to the pursuit of healthequity. Implications for exploring cumulative impacts across multiple temporal andgeographical scales (e.g., watersheds, airsheds, multiple governing jurisdictions) andtheir implications for driving healthy public policy are discussed.5.18. Altered Eating in the Anthropocene and Brain “Injuries”: Is It Fundamentally AlteringOur Senses?Duika Burges Watson 1 and Vincent Deary 2 (1 Newcastle University, Newcastle uponTyne NE1 7RU, UK; 2 Northumbria University, Newcastle upon Tyne NE1 8ST, UK).Many people live with an altered sense of taste as a result of illness, life coursetransitions or environmental disruptions. For instance, the 2018 SHEFBIT cohort study ofaltered eating in traumatic brain injury suggests that 43.5% of people with severe injury and9.55% 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 (asopposed to completely lost) olfaction on taste, eating preferences and pleasure. Part of thereason for this lack of data appears to be a general lack of interest in olfactory function inrelation to health, eating and wellbeing. Yet smell largely governs our overall experience ofthe “flavour” of food and a diminished or altered sense of smell can have major impacts onflavour, food choice and wellbeing. In this presentation we argue that the modern foodenvironment has fundamentally altered our smell and taste through “injuring” the brainInt. J. Environ. Res. Public Health 2021, 18, 10654 35 of 101structures that subtend these senses. There is a high degree of neuroplasticity of the brainin relation to what tastes “good to eat”. Consequently, researchers have raised concernsthat a diet of ultra-processed food products, typically high in salt fat and sugar, is rewiringneural networks in a way that shapes preferences for foods that are neither good for healthnor for the environment. In short, a diminished sense of smell may be as much the result ofthe spread of ultra-processed foods and the rising dominance of transnational food as it isthe result of direct physical injury. Drawing on the work of the Altered Eating ResearchNetwork with traumatic brain injury and other illnesses, we reflect on the potential forolfactory training and multi-sensory awareness to “rewire”, repair and restore consumerspleasure in foods.6. Building Mutualism through Nature Connectedness: Inspiring Wellbeing, Meaning,Social and Environmental ResponsibilityHuman connection to nature is known to be a basic psychological need: emergingresearch shows relationships between nature connectedness as a psychological asset andpro-environmental and pro-social behaviour, as well as human wellness. This sessionexplored the value of nature connection in promoting creativity and mutualistic valuesystems (as summarised in Figure 5).6.1. Imagining New Ways of Living: At the Intersection of Art, Nature and HealthSara Warber (Clinical Professor Emerita, Family Medicine, University of Michigan, AnnArbor, 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 humansperpetuate destruction in denial of this truth. Expressive arts and creativity speak to us inways that can touch our hearts and motivate future action for planetary health. My overallgoal is to inspire others to imagine anew our human ways of living, such that we have atemplate for transformative action through multiple pathways, all supporting an expandedview 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 andto 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 reciprocalhealing, and finding our new map to the future.Going forward, my transdisciplinary team and I have identified ways in which art andother image-based forms of communication bring our awareness to the natural world andthe predicament of humans in relationship to environmental catastrophe. However, fewexisting two-dimensional works focus on the known salutogenic aspects of our relationshipwith nature, nor do they link the impending environmental catastrophe explicitly to itseffects on human health. Our plan is to build on this work by soliciting new works that willbring an experience of these reciprocal benefits and perils to ordinary people, encouragingand 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.orgaccessed on 1 August 2021.Int. J. Environ. Res. Public Health 2021, 18, 10654 36 of 101Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 36 of 104 6. Building Mutualism through Nature Connectedness: Inspiring Wellbeing, Mean-ing, 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 sessi n ex-plored the value of nature connection in promoting creativity and mutualistic value sys-tems (as summarised in Figure 5). Figure 5. Building mutualism through nature connectedness. Overview of topics and speakers in the session on nature and wellbeing on all scales. Figure 5. Building mutualism through nature connectedness. Overview of topics and speakers in thesession on nature and wellbeing on all scales.6.2. The Green Road Project a Therapeutic Nature Space Veterans Struggling with the UnseenInjuries of WarFred 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. Itwas designed to provide healing and stress relief to the 12,000 military personnel at NavalSupport Activity, Bethesda, MD (NSA/B), home of the Walter Reed National MilitaryMedical Center (WRB), especially for those with traumatic brain injury and post-traumaticInt. J. Environ. Res. Public Health 2021, 18, 10654 37 of 101stress disorder (TBI/PTSD). The Green Road serves as a source of holistic healing inTBI/PTSD, as a model for the use of green space in urban environments, and as a nationallaboratory for studying the health effects of nature.The Green Road consists of a half-mile long ADA-compliant path (along an existingnatural stream) and a central woodland healing garden. Along with access from the WalterReed hospital, the path allows users to avoid traffic and other stressors while moving aboutthe Base. The two-acre central garden sits in an eight-acre woodland ravine, surroundingthe stream. The pedestrian path traverses the garden, with branches leading to a variety offorest and stream encounters. The garden site was modified to give enhanced exposure totrees, water, stone, and wild animals (deer, aquatic life, and other fauna). A Communaland a Commemorative Pavilion were also constructed.Adjacency to the National Institutes of Health and the Uniformed Services Universityof the Health Sciences (USUHS) has facilitated research into the health benefits of theProject—including a recent comparison of the Green Road with a parallel experience ofwalking in an urban environment (Ameli R, et al., 2021). The Green Road was unanimouslyrated as positive (100%). The Green Road yielded mainly positive themes such as enjoymentof nature, relaxation, and feelings of privacy and safety. The Urban Road producedsignificantly more negative themes. Quantitative assessment showed that a walk on theGreen Road significantly decreased distress and increased mindfulness compared to a walkon the Urban Road. Further funded research focused on stress biometrics will be reportedin 2021–2022.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.Further reading:Rezvan Ameli, Perry Skeath, Preetha Abraham et al., 2021. A nature-based healthintervention at a military healthcare center: a randomized, controlled, cross-over study.PeerJ 9: e10519.6.3. Group Activities in Nature: Growing Resilience and Buffering AdversityMelissa Marselle (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 experiencingstress and mental ill health.This study investigates whether nature-based group walks could be a public healthintervention to foster resilience and protect against adversity. An observational researchdesign with propensity score-matched samples compared the mental health of individualswho partook in nature-based group walks once a week or more (frequent nature-basedGroup Walkers, n = 631) to a comparison group (n = 435). Results showed that nature-basedgroup 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 stressfullife event and not—than the comparison group. This suggests that nature-based groupwalks at least once per week may be a good treatment to lessen the impact of a stressfullife events on mental health. In another study, we investigated whether the type of naturalenvironment for a group walk matters for mental health. Compared to group walks inan urban environment, group walks in the countryside and urban green corridors wereassociated with significantly less stress and negative emotions—suggesting that contactwith these spaces can boost resilience. Our research shows how nature-based group walkscould 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 UKJake Robinson (Department of Landscape, The University of Sheffield, Sheffield S10 2TN, UK).Int. J. Environ. Res. Public Health 2021, 18, 10654 38 of 101Chronic, non-infectious diseases are on the rise and social isolation is emerging as amajor risk factor for mortality. Spending time in natural environments, immersed in thesights, 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 biogeniccompounds in these natural environments. Indeed, a plethora of studies now supportthe nature-health nexus and several mechanistic pathways have been proposed. A greenprescription is an emerging method of prescribing time spent interacting with nature, e.g.,a nature walk, conservation volunteering, or therapeutic horticulture. Green prescriptionsare typically provided by general practitioners and social care professionals in conjunctionwith environment-centric groups. Green prescribing is designed to be a holistic interventionwith the potential to help prevent (proactive) and alleviate (reactive) noncommunicablediseases and social isolation. However, little is known about the perceptions and awarenessof, and opportunities and constraints (e.g., social, spatial, ecological) associated withgreen prescribing in the UK. To explore these factors from the perspective of both greenprescribing providers and prescribers, we formulated and distributed online questionnairesand collected data from across the UK. A total of N = 261 respondents were included in theanalysis. The respondents consisted of general practitioners (n = 118) and nature-basedorganisations (n = 143). We also collected baseline data to provide an estimation of thespatial distribution of green prescribing activity in the UK. Using geographic informationsystems (GIS) we will conduct further analyses to explore the socio-spatial and ecologicalrelationships associated with green prescribing, for example, using the Index of MultipleDeprivation and various landscape metrics. At the time of writing this abstract, the analysisfor this study is only partially complete. Therefore, we discussed the preliminary findingsof this study during the inVIVO Planetary Health 2020 annual meeting.6.5. Can Nature Contact Build Character Strengths: Wider Implications forEnvironmental Education?Amparo Merino (Department of Management, Comillas Pontifical University Calle deAlberto Aguilera, 23, 28015 Madrid, Spain).The rupture between our self and nature is arguably one central reason behind thecurrent environmental crisis (Liefländer et al., 2013). In fact, a large body of evidence showsthat nature relatedness is an antecedent of pro-environmental concern and behaviour(Zelenski et al., 2015). Consequently, fostering interconnectedness with nature has becomea central goal of environmental education. Exposing students to natural sites has beencommon practice in environmental education to nurture this connection among students.However, activities in nature are not always feasible in classroom-based programs nor isit clear that these activities equally accrue nature relatedness among students. Therefore,there are calls for greater understanding of psychological factors that may impinge intogreater connectedness. Yet, only limitedly have studies examined the antecedents orcorrelates 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 drawfrom positive psychology in order to examine whether character strengths (i.e., dispositionsto thinking, feeling, and acting towards a moral goal) are antecedents of nature relatednessand which character strengths are more predictive of greater nature relatedness. Our resultsevidence that intellectual character strengths (i.e., appreciation of beauty, love of learning,and curiosity) are strongly associated with nature relatedness. In addition, they unveilthat nurturing the character strength of appreciation of beauty might be the most effectiveroute to increase nature relatedness among learners. These findings allow to suggestthat training this strength is a particularly productive route to higher levels of naturerelatedness; 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 ofindividuals, and through a wide range of resources, approaches and methods, either innature/outdoor-based or in classroom-based programs.Int. J. Environ. Res. Public Health 2021, 18, 10654 39 of 101The evidence provided about the prominence of appreciation of beauty in nurturingour interdependence with nature supports the idea that developing a sense of wholeness,relatedness and interconnectedness is necessary such that we can deconstruct the frames ofreference 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.Further reading:Lieflaänder, A.K., Fröhlich, G., Bogner, F.X., and Schultz, P.W. (2013). Promotingconnectedness with nature through environmental education. Environmental EducationResearch, 19 (3), 370–384.Merino, A.; Valor, C.; Redondo, R. (2020). Connectedness is in my character: therelationship between nature relatedness and character strengths, Environmental EducationResearch, 26: 12, 1707–1728.Mochizuki, Y. and Fadeeva, Z. (2010). Competences for sustainable development andsustainability: Significance and challenges for ESD. International Journal of Sustainabilityin 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 PotentialMargaret Hansen 1 and Reo Jones 2 (1 School of Nursing and Health Professions, Univer-sity of San Francisco, California, USA; 2 School of Nursing, Oregon Health and ScienceUniversity, 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, itmay 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 naturepromotes spiritual wellbeing. Hence, we performed a scoping review of the literature withregard to the evidence of the interrelationship of Shinrin-yoku/nature and spirituality withan aim to identify gaps in knowledge and assist with furthering empirical research.The PRISMA extension for Scoping Reviews (PRISMA-ScR) methodological approachwas 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 differentresearch methodologies and publications, nature may have a positive effect on humanspirituality and, therefore, enriching individuals’ wellbeing.Thus, Shinrin-yoku is an integrative practice that may enhance or actualize humanspirituality. More research is needed to determine the interrelationship of Shinrin-yokuand human spirituality in achieving one’s fullest possible self.Suggested reading:Margaret Mary Hansen and Reo Jones. The Interrelationship of Shinrin-Yoku andSpirituality: 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: AnExplanatory AnimationMarco van Es 1, Erin Kiemeney 2 and Remco Kort 3,4 (1 Bac2nature, Amsterdam; 2 Cre-ative Business, University of Applied Sciences, Weesperzijde 190, 1097 DZ Amsterdam, TheNetherlands; 3 ARTIS Micropia, 1018 CZ Amsterdam, The Netherlands; 4 Vrije Universiteit,De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands).Int. J. Environ. Res. Public Health 2021, 18, 10654 40 of 101Biodiversity is at the core of our health and happiness. Bac2Nature is an explanatoryanimation about our connection to nature and a call for modern recovery of biodiversityfor our health. The animation explains the importance of exposing our immune system tomicrobial diversity for the benefit of our physical and mental health. It connects the care forour planet to the care for our health. Our immune system is at the core of our health. It hasevolved in a highly diverse microbial environment. Therefore, the exposure to microbesis required for a proper development and functioning of the immune system. Since theindustrial revolution we have reduced this exposure throughout our lives by decreasingbiodiversity of our environment (urbanization), process our food and overuse antimicrobialcleaning agents and antibiotics. The consequence is a malfunctioning immune systemleading to an increased risk of several physical and mental chronic diseases. The animationwill explain that biodiversity connects our health to the health of our planet and inspiresthe public with this novel paradigm. It will show the reduction of microbial exposure inour modern society, and sparks the development of innovative solutions, leading to actionsto regain our health and happiness.6.8. Do Natural Environments Promote Childhood Mental Health and Development? A SystematicReview and Assessment of Different Exposure MeasurementsZoe Davis 1, Martin Guhn 1, Ingrid Jarvis 1, Michael Jerrett 2, Lorien Nesbitt 1, TimOberlander 1, Hind Sbihi 1, Jason Su 3 and Matilda van den Bosch 1 (1 The Universityof British Columbia, Vancouver campus, V6T 1Z4, Canada; 2 University of California, LosAngeles, CA 90095, USA; 3 University 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 areinconsistent and association strength unclear, which may reflect the heterogeneity in NE-measurements. We conducted a systematic review to evaluate the relationship betweenNE-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, 55articles were included. From these articles, we extracted data on NE-measurement andrelative association to childhood mental health and development indicators. Additionally,to evaluate evidence level, a systematic assessment of study quality and risk of biaswas conducted.Findings: The most common NE-measurement was normalized difference vegetationindex (NDVI) derived from Landsat (30m resolution). Other measurements included landuse/land cover (LULC) datasets, expert audits, and surveys. NE-exposure was typicallyassigned to participants in various buffer sizes around their residential address, and wefound 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 associationbetween NDVI or LULC and improved birth outcomes, general behaviour and socialfunctioning, and decreased ADHD/ADD symptoms. We found limited evidence for anassociation between LULC and academic achievement and insufficient evidence for anassociation between NE and mental disorders, memory function, and wellbeing.Conclusions: This review suggests that several NE-measurements must be evaluatedfurther and compared with each other. It also indicates that research efforts should becoordinated, using consistent NE-measurements to improve evidence level of associationsand effect sizes for different health outcomes. Strengthened evidence could contribute topolicies that benefit the mental health and development of children by promoting contactwith NEs.6.9. Childhood Experiences of Nature Influence Outdoor Preferences as AdultsShinya Numata (Department of Tourism Science Graduate School of Urban EnvironmentalSciences Tokyo Metropolitan University, Minami-Osawa 1-1, Hachiouji, Tokyo 192-0397, Japan).Int. J. Environ. Res. Public Health 2021, 18, 10654 41 of 101Individuals who frequently play in wild environments during childhood have morepositive perceptions towards nature, outdoor recreation activities, and potential futureoccupations in outdoor environments. However, many people may have fewer chancesto interact with nature due to the loss of available natural environments and changes inlifestyle, such as increasing indoor activity. Especially, the loss of childhood nature experi-ences could decrease people’s emotional connection to nature, including nature relatednessor likeability of living things. However, there is surprisingly limited information on hownegative emotions towards nature influence people’s contact with nature. In the presen-tation, I introduced a study: how negative perceptions evoked from outdoor activitiesinfluence preferences for later outdoor activities. The results showed that childhood natureexperiences decreased levels of disgust sensitivity and fear expectancy later in life. Disgustsensitivity influenced outdoor activity preferences, whereas fear expectancy did not. TheSEM results suggest that childhood nature experiences are a strong predictor of perceptionsof outdoor activities. Therefore, I concluded that increasing contact with nature duringchildhood 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 HealthBrent 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 reviewand investigate the potential clinical utility of altering light regimens in support of mentalhealth in humans. The mechanics of how light impacts mammalian health are establishedin a review of animal studies. Paired with epidemiological meta-analyses and experimentalhuman studies evidencing strong correlation between light exposure regimens, healthmarkers, and outcomes, recent evidence indicates a need for both further research andimmediate action. One of the most compelling research areas covers the arousing effects ofblue light exposure, occurring via human’s non-visual photo-receptive system. Cortisolrelease 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 worldwideincidents of depression. This relationship has been observed in experimental studies ofhuman exposure to blue light in the evenings correlating with disturbed circadian rhythms,depression, and anxiety. Epidemiological meta-analyses connect regular sun exposure withpositive cardiac health impacts as well as improvements in energy and mood, upending thecurrent clinical doctrine which recommends largely avoiding direct sunlight and replacingVitamin D with supplements. The extent of artificial indoor lighting and screen use hasdrastically altered humans’ light exposure. Sunlight’s spectrum changes throughout theday with the blue spectrum most prevalent early in the day shifting towards red in theevening. 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 andMental IllnessIngrid Jarvis, Sarah Gergel, Mieke Koehoorn and Matilda van den Bosch (University ofBritish 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) andforms of human-nature contact (access versus exposure) remain relatively unexplored.Methods: This study uses a cross-sectional design to analyse the relationship betweenself-reported health and both access and exposure to different types of natural environmentsin Metro Vancouver, Canada. Data was acquired from the 2013–2014 Canadian CommunityHealth Survey on self-reported general health, mental health, and mood and/or anxietyInt. J. Environ. Res. Public Health 2021, 18, 10654 42 of 101disorder (weighted n = 1,960,575). Natural environments were estimated using local landuse and land designation data and a high-resolution land cover dataset. Access was definedas living within 300 m of a public park (≥1 hectare) and exposure as the percentage ofdifferent land cover types within several buffer zones of residential postal codes. Separatelogistic regression models were used to estimate associations between access and exposureto natural environments and the respective health outcomes.Results: Exposure to water within 1000 m of residential postal codes was significantlyassociated 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 andgrass-herb vegetation types. Exposure to paved surfaces increased the odds of poor generaland mental health, while exposure to buildings was associated with higher odds of moodand/or anxiety disorder. Neither access to public greenspace nor aggregated greenspaceexposure were associated with self-reported health.Conclusions: Results suggest that type of natural environment should be consideredin future research studying the health-promoting aspects of natural environments and thatpositive health effects appear to be more consistent for daily life exposure than for accessto public greenspaces.6.12. Walking the Talk—Putting Healthy and Ecologically Mindful Living into PracticeSheelin 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 rangeof experiences and insights gained from my rural Australian background, my veterinarytraining and experience in the US intensive animal sector, and subsequent work experienceacross a variety of industries including the pharmaceutical, construction, financial andnatural health sectors, my husband’s prolonged illness and death due to brain cancer,widowhood and single parenthood, and more recently, further post graduate studies infood and sustainability, and the construction of a “healthy” sustainable house, lifestyleand community. In light of my life experience and variety of learnings, I have set out tocreate a living environment and lifestyle that incorporates as many aspects pertaining tosustainability and health as possible. I have built an optimally healthy, sustainable homein the Noosa UNESCO biosphere, that is adapted to the local environmental conditionsand context, is constructed for longevity, utilises minimal toxic inputs, and that is designedto conserve resources (energy, water and other inputs). Food production, water storageand conservation, energy production, thermal regulation, electromagnetic minimisationand a seamless nature interface are all essential elements of the house design. In additionto the built environment, I also adopt many other sustainable and healthy practices withthe aim of minimising as many toxic inputs and outputs as possible to create and modelan optimally healthy and sustainable lifestyle. A variety of additional aspects have beentaken into consideration, including but not limited to: the creation of circular systems,recycling and minimal wastage of resources, enhancement and rehabilitation of the broaderecological habitat, aspects of social sustainability including integration of surroundingcommunity and actively creating and strengthening local and broader community andenvironmental networks.6.13. Nature Nearby and Its Association with Physical Activity in Older Adults in Delhi, IndiaDanielle MacCarthy 1, Suresh Rohilla 2, Geraint Ellis 1 and Deepti Adlakha 1 (1 DavidKeir Building, Queen’s University Belfast, University Rd, Belfast BT7 1NN, NorthernIreland; 2 Centre for Science and Environment 41, Tughlakabad Institutional Area, NewDelhi 110062, India).Int. J. Environ. Res. Public Health 2021, 18, 10654 43 of 101In the context of the rapid urbanisation taking place in many developing cities aroundthe world, the impact on both people and nature can be profound. It has become urgentto understand the simultaneous benefit of both a greater ecological presence in urbanenvironments and its relationship for people and health. With rising NCD’s and growingageing societies, environments play a key role in facilitating health for this population,and in particular countering the effects of sedentary lifestyles. Less well understood arethe psychosocial mechanisms which underpin physical activity and its relationship toattachment to place and nature connectedness, and in particular how these operate withinthe developing world context.Based on surveys, (n = 228) we assessed people’s rates of nature dose, time spent innature 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 ofphysical activity as a whole, as well as measuring levels of place attachment and natureconnectedness for each respondent. Preliminary results confirm that a relationship betweengreener neighbourhoods and physical activity may be witnessed and that nature–doseresponse may be mediated by nature connectedness. At the time of writing this abstracthowever, the analysis for this study is only partially complete. I propose to discuss the fullfindings of this study during the inVIVO Planetary Health 2020 annual meeting.These findings could contribute to our understanding for the future planning of citiesand ageing in place discourse, with ramifications for health but also health budgets andwider ecological benefits. The importance of green cities is increasingly recognised for theirrole in preventative health as well as the wide-reaching benefits for cities with regards toclimate adaptation and the range of ecological services greenspaces provide.6.14. Therapeutic Landscapes in Brussels City for Human Health Promotion andDisease PreventionVitalija Povilaityte 1, Pierre Duez 2 and Katriina Kilpi 3 (1 Faculty of Medicine andPharmacy, University of Mons, 25 Chemin du Champ de Mars, B-7000 Mons, Belgium;2 Faculty of Medicine and Pharmacy, University of Mons, 25 Chemin du Champ de Mars,B-7000 Mons, Belgium; 3 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 qualityof 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 ofhuman behaviour. It has been suggested that a meaningful psychological relationship withthe natural world, i.e., nature connectedness can fulfil our need of belongings and canplay a very important role in building human resilience, which results in connection withoneself, nature and the larger community. Places that enable enjoying and meaningfullyinteracting with the natural world can offer such opportunities to connect with nature. Inour study, we assessed the potential of natural environments (e.g., urban gardens, parksand forest) to become a therapeutic landscape in Brussels city and their possible positivehealth outcomes for human health promotion and disease prevention. Our study showedthat constructing a therapeutic landscape becomes possible when using nature-basedinterventions and nature therapies as efficient practices associated with human health andhealing. The evidence of the efficacy of green exercise, garden therapy, eco-therapy andforest therapy are starting to build up, though further studies are required. Nature basedsolutions for health and wellbeing can produce supportive nature and social spaces thatcan function as restorative places for human health. Significant impacts of connectednesswith nature, one-self and social interactions transform the cultural and social urban fabricinto a therapeutic landscape with numerous benefits for human health. Aesthetic qualitiesand social networks offering a sense of security and inclusion, play a key role in every daygreen care spaces through the transformative power of making urban nature spots intotherapeutic landscapes.Int. J. Environ. Res. Public Health 2021, 18, 10654 44 of 1016.15. A Biography of Richard St. Barbe Baker’s 1950 New Earth Charter; An Ecological ManifestoCalling for Harmony between People and NatureCamilla Allen (Department of Landscape Architecture, The University of Sheffield, SheffieldS10 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 EarthCharter which set out the foundations of the society’s ecological philosophy. The societyhad been founded in Kenya as the Watu Wa Miti (People of the Trees) in 1922 when Bakerwas working as a colonial forester and which aimed to foster a culture of tree-plantingto counter deforestation. In 1924 Baker founded a Men of the Trees group in Britain andfurthering the aims of the society—to plant and protect trees across the world—becamehis life’s work. He was a prolific self-publicist and unofficial diplomat, whilst publishingnumerous 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 anatural balance between minerals, vegetation, animals and mankind”. This plea for knowl-edge, peace, and reconciliation preceded many of the twentieth century’s environmentalproclamations 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 takingprecedence, the paper presents two biographies: that of Baker and—within and beyondthat—of the New Earth Charter. It questions the intention and efficacy of the charter, aswell as its later reinterpretation as the Earth Charter as important artefacts within the storyof human nature relationships.6.16. Important Park Features for Encouraging Adolescents’ Park Visitation, Physical Activity andSocial Interaction: A Conjoint AnalysisElise Rivera 1, Jenny Veitch 2, Anna Timperio 1, Venurs Loh 1 and Benedicte Deforche 3(1 Institute for Physical Activity and Nutrition at Deakin University, 221 Burwood Highway,Burwood, VIC 3125, Australia; 2 Institute for Physical Activity and Nutrition at DeakinUniversity, 221 Burwood Highway, Burwood, VIC 3125, Australia; 3 Department of PublicHealth 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, sociallyinteract and connect with nature. Despite their benefits, park visitation and physical activitylevels 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 andbe active and social whilst visiting. This study examined the relative importance of parkfeatures for encouraging adolescents’ visitation, physical activity and social interactionin parks.Adolescents (13–18 years) were recruited in 2019–2020 from five secondary schoolslocated in socio-economically diverse areas of Melbourne, Australia. As part of an in-classactivity, participants completed an online survey, which included adaptive choice-basedconjoint (ACBC) tasks. This methodology enabled the relative importance of park featuresfor encouraging park visitation and active and social park use to be determined. Includedpark features (n = 13) for each ACBC task were based on findings from a previous studywith adolescents. For each feature, part-worth utility and relative importance scores wereestimated 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 openspace and a café; for physical activity, were sports courts, large grassy open space andoutdoor fitness equipment; and for social interaction, were a café, barbecue/picnic areasand sports courts. Gender differences were observed; sports features were more importantfor males, while slides and swings were more important for females across the outcomes.Int. J. Environ. Res. Public Health 2021, 18, 10654 45 of 101These results can inform stakeholders regarding which park features to prioritisefor optimal park development and refurbishment that maximises visitation and activeand social park use among adolescents. Findings highlight the importance of consideringspecific needs of adolescents when planning park (re)design.6.17. Urban Landscape Multifunctionality: Integrating Socio-Cultural Values to EnsureSustainable Urban FuturesElizabeth 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 asbiophysical functions, such as importance for biodiversity, habitat provision and recreation,and are considered important for human wellbeing. Densification of urban areas arethought to provide more efficient infrastructure, reducing traffic and related pollution. Inreality, more compact urban forms have a negative impact on the quality of life. Amongstother impacts, green, public, open spaces are lost, while demand for their importantfunctions increase due to an increased number of residents.Ensuring sufficient and good quality urban green space faces a number of challengesin compact cities and urban development areas. Improved knowledge of green spacequalities and how they fulfil the needs of residents is essential for socially sustainabledevelopment. However, trade-off analysis that integrates different forms of values andbenefits (such as biophysical, social and ecological) and appropriately considers relevantcultural ecosystem services continues to be a major challenge.Public participatory GIS (PPGIS) is an accepted way to identify citizens’ values andhas 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 densificationis being planned. We present a framework whereby insights obtained with PPGIS can becombined with ecological and physical spatial attributes of the landscape in an integratedanalysis of urban multifunctionality. Using PPGIS we define the needs of current residentsand 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 andthe benefits provided by the current landscape. We then analyse the mismatches betweensocial expectations and ecological functions in different development scenarios and assesshow different green space qualities could be utilised to alleviate trade-offs.7. Targeting Ecological Foundations: Rewilding Environmental Microbiomes:Implications for Human Health and Microbial EcologyIn recent decades, we have begun to see that microbes are the foundation of alllife, not only in evolutionary terms, but in every modern ecosystem. Virtually everyaspect 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. Withthis knowledge, we can work with nature to restore ecosystems from “the bottom up”.Moreover, microbial symbiosis exemplifies collaboration in nature. A simple unifyingprinciple that is much needed across every domain of human society today. This sessionexplored creative ways in which understanding and harnessing microbial ecology canprovide benefits for healthier systems on all scales (Figure 6).Int. J. Environ. Res. Public Health 2021, 18, 10654 46 of 101Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 47 of 104 Figure 6. Targeting Ecological Foundations: Rewilding Environmental Microbiomes. Overview of topics and speakers in the session on microbial ecology for health at all scales. Figure 6. Targeting Ecological Foundations: Rewilding Environmental Microbiomes. Overview oftopics and speakers in the session on microbial ecology for health at all scales.Int. J. Environ. Res. Public Health 2021, 18, 10654 47 of 1017.1. “Earth” Rise: Soil Ecosystems Connecting the Health of People, Place and Planet (CelebratingWorld Soil Day)Janet Jansson (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 theanimals 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 forgrowth of plants and animals. In addition, soil microbes are the funnel through which soilorganic carbon is cycled. Depending on the soil properties and soil microbial activity, soilorganic carbon is either retained in the soil, which is beneficial for soil fertility, or lost asCO2 to the atmosphere, which is deleterious for climate warming.Our research focuses on the impact of climate change on functions carried out by soilmicroorganisms that are essential for ecosystem functioning. This research spans differentecosystem types, from permafrost in the Arctic to native prairie soils. As the climate warmspermafrost is starting to thaw. Permafrost is a huge reservoir of terrestrial carbon andcontains as much carbon as the Earth’s atmosphere and vegetation combined. As thepermafrost is thawed this enormous carbon freezer starts to warm and microbial activityincreases as a result. Microbes can survive in frozen permafrost but have low activity andthus the soil organic carbon turns over very slowly. However, in thawed permafrost activemicroorganisms start to metabolize the organic carbon, churning out CO2 and methane.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 changesthere are shifts in temperature and precipitation patterns that result in either increasedprecipitation in northeast grasslands or decreased precipitation and drought in southwestgrasslands. 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 insoil moisture impact the microbial community composition, but also their functional genesand expression. For example, we found that genes and pathways for production of stressprotecting 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 theirenvironment. Whether these shifts will be permanent, or not, depend on the resilience ofthe 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 climatechange 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 Microbesin Topical PreparationsAki Sinkkonen (Head of Adele consortium *, Natural Resources Institute Finland, ItäinenPitkäkatu 4, 20520 Turku, Finland). * Adele research group members: Cerrone D, GrönroosM, 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 illnessesand 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 reasonfor the high incidence of immune-mediated diseases (Haahtela et al., 2021).In urban environments, typical playground sand contains magnitudes less microbesthan natural forest soils do. We recently realized how humans carry less microbes indoorsin urban compared to rural environment. We also found an association between diverseyard vegetation and gut microbial diversity (Vari et al., 2021). Finally, we performed abiodiversity intervention among daycare children (Roslund et al., 2020). In the interven-Int. J. Environ. Res. Public Health 2021, 18, 10654 48 of 101tion, diverse vegetation and environmental bacterial communities were associated withenhanced immune modulation (Roslund et al., 2020).Based on these associations and findings, we designed a diverse microbial inoculantthat was manufactured from commercially available, microbiologically diverse gardeningsoil 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 (Nurminenet al., 2018). Today, we are performing a randomized double-blind biodiversity interventionstudy among infants. In the trial, 2 m old infants receive either placebo or lotion and linencontaining high microbial biodiversity. Children participate the intervention until 12 mage, and they are followed for two additional years. Thus far, the results show that the trialis safe. The vision is that those who have no access or who are not interested in exposingthemselves to rich environmental microbial communities, will eventually have a change toreceive the benefits of diverse environmental microbiota indoors.Suggested reading: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 immediateincrease in diversity of skin microbiota. MicrobiologyOpen 8: e645. doi:10.1002/mbo3.645Haahtela T, Alenius H, Lehtimäki J, Sinkkonen A, Fyhrquist N, Hyöty H, RuokolainenL, Mäkelä M. 2021. Immunological resilience and biodiversity for prevention. Authoreapreprint. doi:10.22541/au.161670861.12608109/v1Nurminen N, Lin J, Grönroos M, Puhakka R, Kramna L, Vari HK, Viskari H, OikarinenS, 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-2017-0286Roslund M, Puhakka R, Grönroos M, Nurminen N, Oikarinen S, Gazali AM, Cinek O,Kramná L, Siter N, Vari HJ, Soininen L, Parajuli A, Rajaniemi J, Kinnunen T, Laitinen OH,Hyöty H, Sinkkonen A. 2020. Biodiversity intervention enhances immune regulation andhealth-associated commensal microbiota among daycare children. Science Advances 6 (42):eaba2578. DOI: 10.1126/sciadv.aba2578Vari 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 endocrinesignaling 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 roleof environmental microbiota in ecological restoration, particularly in the context of urbanecosystems, has received international attention. Diverse and functional microbial com-munities are essential for soil formation, nutrient cycling and decomposition, symbioticrelationships between flora and fauna, and are highly biodiverse in their own right. Giventhat environmental microbiota are also essential to human health, it raises a series of im-portant questions. How does human exposure to environmental microbiota change withecosystem restoration? What types of restoration interventions promote the restoration ofhealth-associated environmental microbiota? Can ecological restoration—specially restora-tion that targets the environmental microbiota—have positive effects on human health viaenvironmental microbiota?7.4. Transfer of Environmental Microbes to the Skin and Respiratory Tract of Humans after UrbanGreen Space ExposureCaitlin Selway 1, Jacob Mills 1, Philip Weinstein 1, Chris Skelly 2, Sudesh Yadav 3, An-drew Lowe 1, Martin Breed 4 and Laura Weyrich 5 (1 University of Adelaide, Adelaide,Int. J. Environ. Res. Public Health 2021, 18, 10654 49 of 101SA 5005, Australia; 2 Public Health Dorset, Prince’s St, Dorchester DT1 1TP, UK; 3 Jawa-harlal Nehru University, Delhi 110067, India; 4 Flinders University, Bedford Park, SA 5042,Australia; 5 The 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, changesin 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 innon-communicable diseases.In response, the Microbiome Rewilding Hypothesis proposes that adequate envi-ronmental microbial exposures could be achieved by restoring urban green spaces andcould potentially decrease the prevalence of non-communicable diseases. However, themicrobial interactions between humans and their surrounding environment and the pas-saging of microbes between both entities remains poorly understood, especially within anurban context.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 urbangreen space environments in three different cities across different continents (Adelaide,Australia; Bournemouth, United Kingdom; New Delhi, India). Using 16S ribosomal RNAmetabarcoding, we examined baseline controls (pre-exposure) of both skin (n = 16) andnasal (n = 16) swabs and tracked microbiota transfer from the environment to the humanbody after exposure events. Microbial richness and phylogenetic diversity increased afterurban 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 microbiotaafter exposure, while nasal samples became more similar to air samples. Nasal sampleswere 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-communicable diseases.7.5. Health-Associated Microbiome Is Altered in Urban Environments: Daycare BiodiversityInterventions Improve Children’s Microbiome and Immune RegulationMarja Roslund 1, Anirudra Parajuli 2, Riikka Puhakka 1, Anna-Lea Rantalainen 1, MiraGrönroos 1, Laura Soininen 1, Sami Oikarinen 3, Noora Nurminen 3, Olli H. Laitinen 3,Heikki Hyöty 3 and Aki Sinkkonen 4 (1 University of Helsinki, FI-15140 Helsinki, Finland;2 Karolinska Institutet, SE-17177 Solna, Sweden; 3 Tampere University, FI-33014 Tampere,Finland; 4 Natural 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, thereis a lack of natural green spaces with diverse microbiota. At the same time, the pollutionlevels in urban areas alter microbial communities. We asked what happens to the humancommensal microbiota when living under pollution stress and how does this affect ourhealth? 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 immuneresponse and endocrine signalling pathways. First, we studied PAH induced microbiotashifts in urban environments, and estimated associations between PAHs, microbiota andendocrine signalling. Secondly, we compared environmental and commensal microbialcommunities in typical urban versus biodiverse environments. The study participantsincluded elderly people living in urban and rural environments, and small children livingin urban environment.Int. J. Environ. Res. Public Health 2021, 18, 10654 50 of 101Pollution studies showed that PAHs levels are associated with both environmental andcommensal microbiota. Microbiota alterations in the gut were associated with endocrinesignalling, which can affect hormonally mediated processes. Since commensal microbesare able to affect PAH metabolism and detoxification, future research should find out ifcertain microbial taxa can improve human health by reducing the negative health outcomesinduced by PAHs. The results support the altered environmental microbiome hypothesis;both biodiversity loss and pollution contribute to altered microbiomes in the environmentand in the human body.7.6. Urban Rewilding by Green Printing: Ecological Restoration of Microbial Diversity onCity WallsRemco Kort 1, Joris Laarman 1, Tim Geurtjens 1, Olivier de Gruijter 1, Jasper Buikx 2and Remco Kort 2,3 (1 Joris Laarman Studio, Ottho Heldringstraat 3, 1066 AZ Amsterdam;2 Artis-Micropia, Plantage Kerklaan 38-40, 1018 CZ Amsterdam; 3 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 incities and has a profound effect on the aesthetics of a city. In addition, there is a clear healthbenefit, 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 urbanenvironments is partly resulting from diminished exposure to microbes, which educate ourimmune system leading to the suppression of inappropriate inflammation responses. Suchdiseases include allergies, asthma, and neurodevelopmental disorders, including anxietyand depression. Here we propose to contribute to the ecological restoration of microbialdiversity by transforming grey concrete city facades into living green walls. In order torealize our ambition, we plan to develop a robot, which is able to reach the entire surfaceof the wall by vertical movements. The robot is able to apply water, substrate, algae, fungiand bacteria on the wall, allowing the creation of a living, colourful and dynamic piece ofmicrobial art. The purpose of our project is twofold. On one hand we aim to contribute toan improved living environment in the city, on the other we would like to create awarenessfor the importance of a diverse microbial environment for our own health, which maycontribute to a change in mindset leading to restoration of natural ecosystems.7.7. Fear and the City: How Exposure to Environmental Microbes Enhances Fear ExtinctionChristopher 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 economicburden to individuals, their families, and society. Chronic low-grade inflammation hasbeen identified as a risk factor for these stress-related psychiatric disorders and, indeed,machine learning approaches have identified biological signatures of inflammation asamong the highest-ranking features predicting subsequent development of a diagnosis ofPTSD (Schultebraucks et al., 2020).The “Old Friends” hypothesis posits that a lack of exposure to diverse microbialenvironments in modern Western societies is resulting in impaired immunoregulation and,consequently, inappropriate inflammation. The “Old Friends” hypothesis may be relevantto risk of developing stress-related psychiatric disorders. We have shown that individualsraised in an urban environment without daily exposure to pets respond to the Trier SocialStress Test (TSST) with an exaggerated stress-induced inflammatory response, relative toindividuals 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 inflammatoryconditions, such as allergic asthma, and stress-related psychiatric disorders, in whichInt. J. Environ. Res. Public Health 2021, 18, 10654 51 of 101inflammation 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 previouslybeen 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 thatimmunization with M. vaccae NCTC 11659 induces a number of behavioural responsesto stress consistent with prevention of a PTSD-like syndrome. These effects of M. vaccaeNCTC 11659 include: (1) decreases in stress-induced anxiety-like defensive behaviouralresponses; (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 inthe 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 topromote stress resilience and prevent endophenotypes relevant to stress-related psychi-atric disorders.Suggested Reading:• Schultebraucks K, Qian M, Abu-Amara D et al. Pre-deployment risk factors for PTSDin active-duty personnel deployed to Afghanistan: a machine-learning approach foranalyzing multivariate predictors. Mol Psychiatry 2020; https://doi.org/10.1038/s41380-020-0789-2.• Böbel TS, Hackl SB, Langgartner D et al. Less immune activation following social stressin 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 bykilled Mycobacterium vaccae-induced allergen-specific regulatory T-cells. Nat Med2002; 8: 625–629.7.8. Urbanized Early Life Microbiota Increases the Risk of Asthma and Atopic TraitsJenni Lehtimäki 1, Jonathan Thorsen 2 and Jakob Stokholm 2 (1 Finnish EnvironmentInstitute, 00790 Helsinki, Finland; 2 Clinical Research Unit COPSAC, Ledreborg Alle 34,2820 Gentofte, Denmark).Urban populations have higher prevalence of asthma and atopic diseases than ruralpopulations. Accumulating evidence suggests that differing microbial exposures betweenurban and rural areas can be underlined reason for this difference. However, most of thisevidence comes from research focusing on the effect of farming related microbes, especiallyconsidering indoor microbiota.We studied differences in the infant microbiota and indoor microbiota infants areexposed to in rural and urban children. We utilized birth cohort data from Denmark (COP-SAC2010) including 700 prospectively followed children. Asthma, allergic rhinitis, eczemaand sensitization are defined by COPSAC paediatricians at six years of age followingcommon criteria. Cohort included hardly any children from farms.We found that children born in urban areas had higher risk of asthma and atopictraits at six years of age than rural children. Both airway and gut microbiota differedbetween urban and rural children, but differences were more pronounced in airways.Indoor microbiota was clearly dissimilar between rural and urban areas. Urbanization ofall these microbial communities increased the risk of later developing asthma, and asso-ciations with allergic rhinitis, eczema and sensitization were also discovered. Urbanizedairway microbiota also produced major shifts in the immune marker concentrations on thelung epithelium.With comprehensive data, we show that urban associated microbial communities ininfants can mediate increased risk of asthma and atopic traits in urban areas. The potentialmechanism for this is disturbed immune development.Int. J. Environ. Res. Public Health 2021, 18, 10654 52 of 1017.9. What Is a Healthy Skin Microbiome? Leveraging Ancestral Microbiomes for Guidance inRestoration of a Healthy Western Skin MicrobiotaJulia Durack 1, Yvette Piceno 1, Brian Fanelli 2, David Good 3 and Larry Weiss 1 (1 Sym-biome, Indiana St, San Francisco, CA 94107, USA; 2 CosmosID, Rockville, MD 20850, USA;3 The Good Project 13 Appian Way Cambridge, MA 02138, USA).Skin microbiota, similar to all other niche-specific human microbial assemblages, areshaped by environmental exposures influenced by lifestyle choices. Growing evidenceimplicates skin microbiome perturbation in a number of dermatological conditions im-pacting western society, but how much do we really know about what defines a healthyskin microbiome? To answer this question, we examined the human skin microbiomeof individuals from a semi-nomadic hunter–gatherer tribe in the Amazon. Metagenomicsequencing provided insights to the composition and function of a healthy ancestral hu-man microbiome before we were impacted by the urban-industrialized lifestyles of themodern world.7.10. Urban Green Space Aerobiomes: Exposure to Airborne Bacteria Depends upon VerticalStratification and Vegetation ComplexityJake Robinson 1,2,3, Christian Cando-Dumancela 2,3, Craig Liddicoat 2,3,4, Philip We-instein 3,4, Ross Cameron 1 and Martin F. Breed 2,3 (1 Department of Landscape, TheUniversity of Sheffield, Sheffield S10 2TN, UK; 2 College of Science and Engineering,Flinders University, Bedford Park 5042, Australia; 3 The Healthy Urban Microbiome Ini-tiative (HUMI), Adelaide 5005, Australia; 4 School of Public Health and the EnvironmentInstitute, 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. Vegetationand soil are both known to be important sources of airborne microbiota, i.e., constituentsof the aerobiome. A limited number of studies have attempted to characterise the spa-tiotemporal dynamics of the aerobiome; however, no known studies have investigatedthese dynamics from a vertical perspective. Support for its existence can be drawn fromstudies of pollution and allergenic pollen where vertical stratification occurs at variousscales. The existence of aerobiome vertical stratification could have important implicationsfor 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 differentland cover types are still poorly understood. In this study we developed and combined aninnovative columnar sampling method (using passive petri dish sampling stations), remotesensing techniques, and high-throughput sequencing of the bacterial 16S rRNA gene toassess whether significant vertical stratification of the aerobiome occurs. We also assessedwhether there were differences in the aerobiome between land cover types in the AdelaidePark 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 determinedusing a combination of remote sensing approaches (such as habitat classification indicesand random point algorithms), and ground-based site assessments. We also installeddataloggers to record microclimate data.Results presented provide evidence of vertical stratification in both alpha and beta(compositional) diversity of airborne bacterial communities, with diversity decreasingroughly with height. We also found significant vertical stratification in potentially pathogenicand beneficial bacterial taxa.Although additional research is needed, these preliminary findings point to potentiallydifferent 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 urbangreen space aerobiomes and their implications for public health and urban planning.Int. J. Environ. Res. Public Health 2021, 18, 10654 53 of 101Further Reading: Jake Robinson, Christian Cando-Dumancela, Craig Liddicoat, PhilipWeinstein, Ross Cameron, and Martin Breed. (2020). Vertical Stratification in Urban GreenSpace Aerobiomes. Environmental Health Perspectives. 128. 10.1289/EHP7807.7.11. Using the Human Skin Microbiota to Measure Nature Exposure in a Longitudinal StudyDanica-Lea Larcombe 1, Eddie Van Etten 1, Alan C. Logan 2, Susan L. Prescott 2,3 andPierre Horwitz 1 (1 Edith Cowan University, Joondalup, WA 6027, Australia; 2 The Institutefor Integrative Health, Baltimore, MD 21231, USA; 3 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 tostabilise the indoor environment. As high-rise apartment dwellers are at a disadvantage inbeing further away from environmental biodiversity (and reducing the transfer of microbesonto their skin from soil and plants) the question was asked “do soil and plants causechanges in skin microbial diversity and species richness over time”?This study investigated relationships between high rise apartments, environmentalbiodiversity and the biodiversity of the human skin microbiota. Fifty-nine eligible partic-ipants living in Perth, Western Australia randomly received either three real or artificialindoor plants and were tested for communities of skin bacteria (16S DNA Sequencing) overa 12-month period. Skin microbiota (16S DNA) results from a pilot sample of ten real andfake plant recipients were analysed for respondent’s microbial diversity before and afterthe study.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 significantinteraction between time and treatment was found, with participants receiving real plantshaving 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 ofthe Kocuria environmental genus for real plant respondents.The intervention appears to have resulted in an increase in OTU richness, and ashumans (as a holobiont) are a microcosm of the ecological environment it makes sense thattheir microbiome would also reflect this habitat that includes bacteria normally residing insoil and plant roots.7.12. Investigating the Effect of Chlorinated Drinking Water on the Assembly of the InfantGut MicrobiomeKimberley Parkin 1, David Martino 1 and Claus Christophersen 2 (1 Telethon Kids Insti-tute, Nedlands, WA 6009, Australia; 2 Curtin University, Bentley, WA 6102, Australia).The gut microbiome has been particularly interesting in recent years due to its links tohealth and disease. In infants, the gut microbiome is highly plastic, and easily influencedby environmental factors. The development of a healthy gut microbiome is essential for astable, diverse, and species-rich gut microbiome as an adult, and improper development ofthe gut microbiome in this sensitive period can lead to gut dysbiosis. Chlorine is one ofthe most effective ways to deliver safe drinkable water to the public free from microbialcontamination because it produces a residual disinfectant that persists in the distributionsystem. Due to the antimicrobial effects of chlorine in tap water, this raises the questionif persistent exposure to low levels of chlorinated tap water may have a mild antibioticeffect 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 gutdysbiosis. This project will investigate whether chlorine effects the natural spatial andtemporal organisation of the gut microbiome in infancy and early childhood.We hypothesise that persistent exposure to low levels of residual chlorine in earlychildhood may alter stereotypical colonisation of the infant gut microbiome, by reducingInt. J. Environ. Res. Public Health 2021, 18, 10654 54 of 101richness and diversity. We will use a randomised control trial study design to install waterfilters in participant’s homes that remove residual chlorine from tap water.We will compare longitudinal changes in the infant gut microbiome from 6 months ofage to 18 months of age via faecal samples between the intervention (unchlorinated water)and control (chlorinated water) groups. We will use metagenomics technology to identifynovel links between the two groups and early childhood health outcomes, such as asthmaand allergies.7.13. Algae as Allies: Learning Algal Patterns to Better Understand Ecosystem HealthYogi Hendlin 1, Sergio Mungai 1, Johanna Weggelaar 2 and Nathalia Derossi 1 (1 Eras-mus University College, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands;2 Het Nieuwe Instituut, Museumpark 25, 3015 CB Rotterdam, The Netherlands).Algae are the most prominent generators of oxygen and absorbers of CO2 on planetearth. The various forms of algae such as unicellular heterokont algae, diatoms, are alsoone of the most diverse groups of protists and in addition to fixing carbon and producingoxygen, they generate through photosynthesis basic lipids key to planetary food webs.This presentation surveys human-algae relations through non-instrumental means. Ratherthan focusing on using algae for fuel production, the dominant technological-scientificdiscussion of algal applications currently, we ask what do algae need from humans in orderto sustain their life-giving ecosystem services?One of the most underappreciated organisms, discourses around algae currentlyfocus on control, such as geoengineering schemes using iron filing dumping to precipitateplankton algal blooms to draw out masses of oxygen. Such manipulative actions carryunintended counteractions that ignore the complex relationships algae have with sea pH,salinity, water turbidity, and other organisms. Algal quorum sensing allows them abilities tosimultaneously be separate organisms, superorganisms, and interspecies conglomerationsof organisms. We stand to learn as much or more, we claim, from their communicative andcooperative capacities, as we do from exploiting their metabolic processes.Looking at Gregory Bateson’s concept of “mindedness” in all living organisms, weinquire into the various ways in which algae mind their habitats, in both senses of theterm. How they take care of and create their habitats and circulate resources and energythrough directed and passive action is key to understanding how (especially marine)ecosystems sustain and renew themselves. By learning from algae, we suggest that humanprocesses that impinge on algal processes can and must be attenuated through biomimetictechnologies and cyclical rather than continuous extraction schedules.7.14. Insights into the Circadian Rhythms on Parasitic Infections and Planetary HealthMona El-Sherbini (Department of Parasitology, Cairo University, Gisa 12613, Egypt).Planetary health explores the constant interaction between natural and human forcesand the resultant state of harmony that arises as an outcome. Of especially increasingimportance are the circadian rhythm and night and day cycles governed by the planetearth’s rotation; such automated rhythm appears to play a significant role in system-widebiotics in the atlas of biodiverse species.We take a look at how modern-day life may have affected human–parasite interactionsby studying the effect of circadian rhythms on human immunity and parasite adaptations.Timing matters in all cells of the immune system, orchestration of circadian oscillatorsas cytokines and chemokines that drive rhythms in synthesis and regulations of variousimmune responses, influence time-of-day susceptibility to pathogens. For example, theonset of Leishmania infection during late day led to a larger lesion compared to late nightinfection. Conversely, rhythms in Leishmania parasite load were notably observed in night-time collected blood samples. Clinical and experimental observations have highlightedcircadian rhythms of parasites as either intrinsic, generated by endogenous clocks asindicated in Trypanosoma brucei infection or conferred by a rhythmically active vectoras in the case of Plasmodium species and microfilariae of Wucheraria bancrofti infections.Int. J. Environ. Res. Public Health 2021, 18, 10654 55 of 101Rhythmic pattern in the course of infection potentially encodes and predicts circadianenvironment system and coordinates the parasite’s metabolism, life cycle and transmissionwith the host’s circadian rhythm.Therefore, appreciating how external ecosystems interface with internal ecosystems todifferentially influence physiology, we can consider circadian biology at the core of humanphysiology as to anticipate the time of parasitic infection and optimize cellular defence.Hence, better knowledge about host-parasite dynamics may help with new preventivecare and personalized treatment strategies in hopes of reducing morbidity and mortalityassociated with parasitic infections and to achieve harmony between our body clocks andchallenges 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, DominicSchmidt 1 and Christopher A. Lowry 1 (1 University of Colorado Boulder, Boulder, CO80309, USA; 2 University of California at San Diego, La Jolla, CA 92093, USA).Regulation of the immune system by biodiversity from the natural environment mayplay an ecosystem service essential to physical and emotional health, in part, througheffects 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 withM. vaccae is an effective countermeasure in a “two hit” stress exposure model of chronicallydisrupted circadian rhythms (CDR) followed by acute social defeat (SD). On day 28, micereceived implants of telemetric recording devices for monitoring 24 h rhythms of locomotoractivity. Mice were subsequently treated with a heat-killed preparation of M. vaccae (0.1 mgadministered 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) conditionsor 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 day54. All mice were exposed to object location memory testing 24 h following SD. The gutmetabolome was assessed in faecal samples collected on days 1, 48, and 62 and the hostplasma 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,including, 1-heptadecanoyl-sn-glycero-3-phosphocholine.Together, these data support previous literature demonstrating that increased plasmaconcentrations of lysophospholipids may be biomarkers of exposures to mycobacterialstrains such as M. vaccae. Additionally, lysophosphatidylcholines emerge as interestingcandidates for mediating some of the physiological and behavioural responses that havebeen described following immunization with M. vaccae.7.16. Do Soil Microbes Influence Stress-Coping Behaviours and Cognitive Performance in anAnimal Model?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 mayplay an ecosystem service essential to health. Mycobacterium vaccae NCTC 11659 (M. vaccae),a soil-derived bacterium with anti-inflammatory and immunoregulatory properties, isa potentially useful countermeasure against negative outcomes to stressors. Here weused male C57BL/6NCrl mice to determine if repeated immunization with M. vaccae is anInt. J. Environ. Res. Public Health 2021, 18, 10654 56 of 101effective countermeasure in a “two hit” stress exposure model consisting of chronicallydisrupted circadian rhythms (CDR) followed by acute social defeat (SD). On day 28, micereceived implants of telemetric recording devices for monitoring 24 h rhythms of locomotoractivity. Mice were subsequently treated with a heat-killed preparation of M. vaccae (0.1 mgadministered 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) conditionsor 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 onday 54. All mice were exposed to object location memory (OLM) testing 24 h followingSD. Immunization with M. vaccae induced a shift toward a more proactive behaviouralcoping response to SD as measured by increases in scouting and avoiding an approachingmale CD-1 male aggressor and decreases in submissive upright defensive postures. In theOLM 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 geneexpression in the dorsal raphe nucleus (DR). Together, these data support the hypothesisthat immunization with M. vaccae induces a shift toward a more proactive response to stressexposure and promotes stress resilience through microbiome-gut-brain axis signalling.7.17. Effects of Soil Microbe Mycobacterium vaccae on Faecal Microbiomes: Investigating Effects inan Animal ModelEvan Schaefer 1, Sandra Appiah 1, Christine Foxx 1, Jared Heinze 1, Antonio Gonzalez2, 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 Turek3 and Christopher A. Lowry 1 (1 University of Colorado Boulder, Boulder, CO 80309, USA;2 University of California at San Diego, La Jolla, CA 92093, USA; 3 Northwestern University,Evanston, IL 60208, USA).Regulation of the immune system by biodiversity from the natural environment mayplay an ecosystem service essential to physical and emotional health, in part through effectson microbiome-gut-brain axis signalling. Mycobacterium vaccae NCTC 11659 (M. vaccae),a soil-derived bacterium with anti-inflammatory and immunoregulatory properties, is apotentially useful countermeasure against negative outcomes to stressors.Here we used male C57BL/6NCrl mice to determine if repeated immunization withM. vaccae is an effective countermeasure in a “two hit” stress exposure model of chronicallydisrupted circadian rhythms (CDR) followed by acute social defeat (SD). On day 28, micereceived implants of telemetric recording devices for monitoring 24 h rhythms of locomotoractivity. Mice were subsequently treated with a heat-killed preparation of M. vaccae (0.1 mgadministered 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) conditionsor 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 day54. All mice were exposed to object location memory testing 24 h following SD. The gutmicrobiome was assessed in faecal samples collected on days 1, 48, and 62 using 16S rRNAgene sequencing.Immunization with M. vaccae stabilized the gut microbiome, attenuating CDR-inducedreductions 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 demonstratedthat 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 aneffective countermeasure against chronic circadian disruption.Int. J. Environ. Res. Public Health 2021, 18, 10654 57 of 1017.18. Effects of M. vaccae, a Bacterium with Anti-Inflammatory and Immunoregulatory Properties,on Circadian Rhythms of Locomotor Activity in Mice Experiencing Circadian DisruptionM. C. Flux 1, Kyle Kent 1, Jared Heinze 1, Philip Siebler 1, Ahmed Elsayed 1, David Dug-gan 1, Dominic Schmidt 1, Martha Vitaterna 2, Fred Turek 2, Monika Fleshner 1, PieterDorrestein 3, Rob Knight 3, Kenneth White 1 and Christopher A. Lowry 1 (1 Universityof Colorado Boulder, Boulder, CO 80309, USA; 2 Northwestern University, Evanston, IL60208, USA; 3 University of California at San Diego, La Jolla, CA 92093, USA).Modern urban lifestyles are frequently associated with chronic disruption of circadianrhythms (CDR). CDR, in turn, has been associated with a persistent exaggeration ofinflammatory responses to immune stimulation, which may have negative health outcomes.The soil-derived bacterium Mycobacterium vaccae NCTC 11659 (M. vaccae), a bacteriumwith immunoregulatory properties, has been shown to provide protection against negativestress-related outcomes.In this study, we explored whether these stress-protective effects extend to stressassociated with CDR. Adult C57BL/6NCrl mice (N = 112) were equipped with telemetricrecording devices on day 28 to continuously monitor locomotor activity throughout theexperiment. Mice were immunized with a heat-killed preparation of M. vaccae (0.1 mgsubcutaneously on days 21, 14, 7, and 27) or borate-buffered saline vehicle. On days 0–56,mice underwent an eight-week CDR paradigm or stable normal 12:12 light:dark (NLD)conditions. Actigraphy data recorded during 8 weeks of CDR/NLD were transformedinto weekly periodograms, as calculated via the χ2 method. Dominant periods for eachperiodogram were identified and modelled as a function of M. vaccae and circadian treat-ment conditions, experimental week, the interaction of circadian treatment and week, andrandom effects of animal modelled on the intercept.While there was a significant effect of circadian treatment (F(1,572.0) = 291.97, p < 0.001),week (F(1,585.8) = 14.62, p < 0.001), and the interaction of week and circadian treatment(F(1,586.0) = 9.41, p = 0.002), there was no significant effect of M. vaccae treatment ondominant period (F(1,79.4) = 0.002, p = n.s.). Overall, dominant periods in the CDR groupwere higher than the NLD group (CDR mean = 25.6 h, SEM = 0.043; NLD mean = 23.9 h,SEM = 0.007). Simple slope analysis revealed that dominant period increased over thecourse of the experiment in the CDR group (slope = 0.058, p < 0.001) but not the NLD group(slope = 0.006, p = n.s.).These findings suggest that period length was altered by circadian treatment and that thischange grew over the course of the experiment but was not altered by M. vaccae treatment.8. Personal Ecology in a Rapidly Changing Exposome—What Next!? Health andFulfilment in a Changing Physical, Emotional, Social and Political EnvironmentThe “exposome” is the total environmental exposures affecting all living systemsand their genomes. This occurs in an interdependent, bidirectional manner across thecontinuum from personal ecology to the wider ecology of physical environments in whichall life resides, including the social, economic and political ecology that influences thehealth of these systems. Personal health therefore depends on addressing both the adverseexposures eroding health, and promote positive exposures for resiliency, which extend frombiological influences to psychological assets and value systems that determine policies andpractices. This session explores these interrelationships and opportunities for meaningfulchange (Figure 7).Int. J. Environ. Res. Public Health 2021, 18, 10654 58 of 101Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 59 of 104 continuum from personal ecology to the wider ecology of physical environments in which all life resides, including the social, economic and political ecology that influences the health of these systems. Personal health therefore depends on addressing both the adverse exposures eroding health, and promote positive exposures for resiliency, which extend from biological influences to psychological assets and value systems that determine poli-cies and practices. This session explores these interrelationships and opportunities for meaningful change (Figure 7). Figure 7. Health and fulfilment in a changing physical, emotional, social and political environ-ment. Overview of topics and speakers in the session on personal ecology in a rapidly changing exposome. Figure 7. Health and fulfilment in a changing physical, emotional, social and political environment.Overview of topics and speakers in the session on personal ecology in a rapidly changing exposome.8.1. KEYNOTE: Reimagining Humanity: Promoting Self-Awareness, Connectivity andMutualistic value Systems for Healing Person, Place and PlanetDeepak Chopra (Clinical Professor of Family Medicine and Public Health at the Universityof California, San Diego; founder of The Chopra Foundation, La Costa, CA 92009, USA).No abstract available: a recording of Dr Deepak Chopra’s inspirational KeynoteLecture is available for viewing through our online proceedings [12].Int. J. Environ. Res. Public Health 2021, 18, 10654 59 of 1018.2. Making Planetary Health Personal: Promoting the Understanding That It Goes Both Ways!Jeffrey Bland (President, Personalized Lifestyle Medicine Institute, Bainbridge Island,Seattle, WA 98110, USA).The viral infection known as SARS-CoV-2 and the worldwide COVID-19 pandemichave been a frame-shifting event for all humans living on planet Earth. One of the keythings we have learned is that not all people exposed to the SARS-CoV-2 virus have equalrisk to the COVID-19 disease. The presence of certain reducible risk factors associatedwith chronic disease—specifically obesity, diabetes, hypertension, and dyslipidemia—areconsidered to be significant factors that increase the pathogenicity of the virus. Becausethese risk factors are common in the modern world, we essentially were already experi-encing a pandemic of chronic disease when the SARS-CoV-2 virus began to spread. Thiswidespread state of compromised health is what to led to the concerning progression toCOVID-19 disease and the serious pandemic we have witnessed over the past year—inessence, COVID-19 is a pandemic within a pandemic.Researchers have determined that risk to COVID-19 is associated not only withbiological factors, but also social issues, such as isolation, compromised access to goodnutrition, poverty, loneliness, and poor physical environment, which can include exposureto toxins, as well as stressful social and community context. What is the connection? All ofthese factors contribute to altered immune status, which can lead to increased vulnerabilityto viral infection and disease severity.Is there a root cause that links disturbances of immune system function to the comor-bidities that have become a hallmark of the COVID-19 pandemic? I propose that it relatesto disturbances in the planetary immune system—that essential network that connectsmicrobes, plants, animals, and humans. Each living thing has its own immune system,and we are all interconnected through 24/7 communication networks. When disturbancesoccur at the planetary level in the systems that maintain homeodynamic balance of themacrocycle, they work their way downstream into perturbations in the regulatory systemsthat control the defence, repair, and regeneration processes of every microbe, plant, andanimal. In a sense, there is a planetary immune system that connects all systems together,both living and non-living.This concept I am describing is based on a field of study called macroimmunology.It is now well recognized that the function of plant immune systems is connected toboth biotic and abiotic factors. Environmental pollution, global warming, and climatechange modify the function of a plant’s innate immune system through changes in geneticexpression of stress-responsive genes. The immune systems of plants consist of the typeand amounts of various phytochemicals within them, and these substances can impacthuman immune systems when they are consumed as food. Diets of highly processed foodsthat are devoid of immune-active phytochemicals can result in compromised immunesystem reserve. The fact that low quality dietary habits have become commonplace hasled to the increasing prevalence of the immune-stressed phenotypes of obesity, diabetes,and inflammatory disorders. Stressed immune systems have been linked to inflammaging,which is a metabolic condition associated with all of the reducible comorbidities that havebeen found to be significant to COVID-19. Dr. Francis Collins, Director the NationalInstitutes of Health in the United States, has stated the following: “Exploring how diet andnutritional status modify the immune response could help explain some of the variabilityin the COVID-19 morbidity and mortality, even in individuals without diet-related disease”(see Rodgers et al. in suggested reading).The takeaway is this: the planet, microbes, plants, animals, and humans are allinterconnected through the integrity of their shared immune systems. Planetary healthshould therefore be aligned with a pledge to unite health professionals in the age of theAnthropocene in supporting the connection among planetary abiotic and biotic systemsand making a commitment to establishing the functional integrity of the immune systemsof all people.Suggested Reading:Int. J. Environ. Res. Public Health 2021, 18, 10654 60 of 101Sheldon TA, Wright J. Twin epidemics of covid-19 and non-communicable disease.BMJ. 2020 Jun 30; 369: m2618.Belanger MJ, Hill MA, Angelidi AM et al. Covid-19 and Disparities in Nutrition andObesity. N Engl J Med. 2020 Sep 10; 383 (11): e69.Franceschi C, Bonafè M, Valensin S, et al. Inflamm-aging. An evolutionary perspectiveon immunosenescence. Ann N Y Acad Sci. 2000 Jun;908: 244–54.Rodgers GP, Collins FS. Precision Nutrition-the Answer to “What to Eat to StayHealthy”. JAMA. 2020 Aug 25; 324 (8): 735–736.8.3. Increases in Depression during the COVID-19 Pandemic: Socio-Economic Gradient of MentalHealth ImpactCatherine Ettman (Boston University School of Public Health, Boston, MA 02118, USA).While the COVID-19 pandemic has upended daily life for all people, the economicand mental health consequences of the moment have not been borne equally. This presen-tation reported on some of the first findings published in the US on depression severityexperienced during the pandemic relative to before COVID-19, and emerging trends forincreasing inequities. This talk explores leading edge data on mental health, assets, andwhat we can learn from this moment to build back a better world post-pandemic.Further Reading:Ettman et al. Prevalence of Depression Symptoms in US Adults Before and Duringthe COVID-19 Pandemic. JAMA Network Open. 2020; 3 (9): e20196868.4. Happiness as Fairness: The Relationship between National Life Satisfaction and Social Justicein EU CountriesSalvatore Di Martino 1 and Isaac Prilleltensky 2 (1 Division of Psychology, Faculty ofManagement Law and Social Science, University of Bradford, Bradford BD7 1DP, UK;2 Vice Provost for Institutional Culture, Erwin and Barbara Mautner Chair in CommunityWellbeing, University of Miami, Coral Gables, FL 33124, USA).In recent years, we have witnessed an ever-growing release of books, TED talks,websites, and scientific articles that promote strategies to achieve long-lasting happiness.Some are based on the idea of self-help, self-improvement, and life coaching, some drawfrom ancient and modern philosophical teaching, some promote spiritual practices suchas Buddhism, others rely on modern scientific findings—from neuroscience to positivepsychology—and some a combination of all these.What most of these approaches have in common, is the idea that happiness is some-thing we can achieve if we put our mind and efforts into it, because ultimately happinessis a choice, and individuals are the only ones responsible for their own actions. This alsomeans that what matters most to enjoy a happy life is less about the objective world outsideof us, and more about the way we look at the world. It is our attitude towards life thatmust change if we want to be happy.This kind of approach also finds confirmation in the mainstream wellbeing scholar-ship, which has often treated happiness as a personal matter, an individual state of mindthat comes more from within than from without. Some scholars, for instance, attach an ex-tremely low weight to external circumstances in determining life satisfaction, believing thatwhat it counts most is people’s right predisposition towards life. This attitude has resultedin a strong focus on the individual determinants of life satisfaction and an overlook of theenvironmental, social, and political factors that play a significant role in either fosteringor hindering people’s happiness. Conversely, we argue that, when it comes to happiness,we cannot shy away from considering conditions of social justice. When we talk aboutsocial justice, we refer to the equal distribution of resources and life-fulfilling opportunities(distributive justice), fair and transparent decision-making (procedural justice), and therightful allocation of rewards and punishments (retributive justice) in society.To demonstrate the thesis that social justice is beneficial to people’s happiness, wepresented results from a study that compared the EU Social Justice Index (a measureInt. J. Environ. Res. Public Health 2021, 18, 10654 61 of 101of social justice developed by the Bertelsmann Stiftung), with levels of life satisfactiontaken from several waves of the Eurobarometer, across 28 EU countries. Our analysesalso included relevant predictors of national happiness including Gross Domestic Product(GDP), social capital, level of individualism versus collectivism, and being or not a post-communist country. Our findings offer strong evidence that social justice has an impact onpeople’s happiness, much more than GDP. In fact, those countries that score lower on theEU Social Justice Index tend to show lower levels of life satisfaction, and vice versa.These findings are relevant to raise awareness within the wellbeing scholarship andbeyond of the importance of promoting conditions of social justice for the betterment ofsocieties and the happiness of their people.8.5. The COVID-19 Pandemic and Perinatal Mental Health in SwedenEmma Bränn 1, Emma Fransson 1, Mary Kimmel 2, Fotios C. Papadopoulos 3 and Alk-istis Skalkidou 1 (1 Uppsala University Women’s and Children’s Health, Akademiskasjukhuset, 751 85 Uppsala, Sweden; 2 Department of Psychiatry, School of Medicine, Uni-versity of North Carolina, Campus Box #7160, Chapel Hill, NC 27599, USA; 3 Departmentof Neuroscience, Psychiatry, Uppsala University, 751 85 Uppsala, Sweden).The COVID-19 pandemic has thus far claimed the lives of more than 1 million peopleworldwide. Today, more than 36 million people have been infected and among thempregnant women and new parents. For this group, the pandemic could take on additionaldimensions including worry for the pregnancy and the infant, which implies additionalrisk for developing mental ill-health during the already critical perinatal period. Perinataldepression is an overlooked and underdiagnosed condition affecting 12% of the pregnantpopulation. The need for early detection and intervention have become evident and thepandemic generates further obstacles to an already vulnerable population.Therefore, the aim of this study was to investigate the impact of the COVID-19 pan-demic on the mental health of pregnant women in Sweden using the research mobileapplication, Mom2B (mom2b.se). Data on COVID-19 related symptoms, testing, diagnosisand how much the pandemic has affected everyday life, as well as symptoms of depressionand anxiety administrated by the Edinburgh postnatal depression scale (EPDS and EPDS-A), were assessed in 1340 pregnant women since the end of 2019. No direct associationbetween a possible COVID-19 diagnosis and depression was observed. However, the per-centage of women scoring higher than the validated cut-off (≥13 points) increased duringthe months with high death tolls and restrictions in maternity care due to the pandemic inSweden, from ~16% in November–January to ~23% in April-June. Furthermore, increasedanxiety was observed among women reporting everyday life to be moderately to highlyaffected by the pandemic.Our results indicate pregnant women’s mental health being significantly affectedduring months with the greatest pandemic related impact in Sweden, despite the absenceof lockdown measures. As mental ill-health during pregnancy is a major contributor topostpartum depression, these results need to be taken into consideration when planningfor future societal resource distribution.8.6. Framing the Discussion of Microorganisms as a Facet of Social Equity in Human HealthSuzanne Ishaq (University of Maine, College Ave, Orono, ME 04469, USA).What do “microbes” have to do with social equity? Microorganisms are integral toour health, that of our natural environment, and even the “health” of the environmentswe build. The loss, gain, and retention of microorganisms—their flow between humansand the environment—can greatly impact our health. It is well known that inequalitiesin access to perinatal care, healthy foods, quality housing, and the natural environmentcan create and arise from social inequality. Do we have a right to microbes? In the age ofhost-associated microbiomes, diet and gut health, urbanization and the indoor generation,and human influence on microbial communities, perhaps we need to re-imagine publicpolicy which takes microorganisms into account.Int. J. Environ. Res. Public Health 2021, 18, 10654 62 of 101In a four-week course in the summer of 2019, I introduced 15 undergraduates fromthe University of Oregon Clark Honors College to microorganisms and the myriad ways inwhich we need them. We talked about how access to nutritious foods (and especially fibre),pre- and postnatal health care, or greenspace and city parks, could influence an individual’smicrobial exposures over a lifetime. Inequalities in that access—such as only putting parksin wealthier neighbourhoods—creates social inequity in resource distribution, but it alsocreates inequity in microbial exposure and the effect on health. By the end of the that fourweeks, the students, several guest researchers, and I condensed these discussions into asingle essay.Importantly, nearly all the students were from diverse humanities fields. The courseitself became a model on the feasibility of connecting science to the humanities. Similarly,this presentation explores the idea of microbes and social equity, and sparks discussion onour role as scientists in public policy, with the goal of connecting researchers to generateactionable items on how we can use our understanding of microbial ecology to informpublic policy.8.7. Resilience through Nutrition: Buffering Stress and Adversity through Personal EcologyPedro Carrera Bastos (Department of Clinical Sciences, Lund University, Malmö, Sweden).Psychological and physical resilience can be affected by many factors, which althoughapparently unrelated can act through common mechanism—inflammation. Nevertheless,it should be mentioned that acute inflammation is actually an evolutionarily conservedprocess whose goal is to protect the host from infections and other insults and also topromote tissue repair, restoring homeostasis. Inflammation is thus a crucial physiologicalresponse characterized by the recruitment of various immune and non-immune cells. Sincethese activated cells will have increased energy requirements, as well as specific nutrientneeds, there will be competition for those resources between the immune system and otherorgans and systems (such as the muscle, the adipose tissue and the central nervous system,among others). Therefore, various metabolic, and neuroendocrine changes must occurto supply more nutrients to the activated immune system at the expense of other organs,while at the same time limiting nutrient (such as iron) access to infectious organisms. Theseadaptations, which include insulin resistance, dyslipidaemia, increased blood pressure,nutritional perturbations, bone and muscle losses, anorexia, fatigue, decreased libidoand fertility, depression-like symptoms, and sleep disturbances cannot be chronic or riskcompromising survival and reproduction. As such, a healthy acute inflammatory responseis time-limited and resolves once the trigger ceases.Nevertheless, variety of lifestyle and environmental factors, such as smoking, pollu-tion, psychological stress, sleep disturbance and circadian disruption, physical inactivity,and western-type hypercaloric diets (which are high in sugar, refined grains, alcohol, salt,trans fatty acids, oxidized lipids, and advanced glycation end-products, and low in variousmicronutrients, fibre, prebiotics, omega-3 fatty acids and phytochemicals), coupled withexcessive adipose tissue, increased intestinal permeability and dysbiosis can persistentlyactivate numerous inflammatory pathways, leading to a state of low-grade chronic in-flammation (LGCI). In turn, LGCI can compromise resilience directly or indirectly, sinceit might cause hypertension, type 2 diabetes, non-alcoholic fatty liver disease, coronaryheart disease, stroke, osteoporosis, sarcopenia, various types of cancer, endocrine disorders,depression, and neurodegenerative diseases. Moreover, it contributes to the exacerba-tion and perpetuation of osteoarthritis and chronic kidney disease, disturbs the status ofvarious micronutrients, and compromises the adaptive immune function, precluding an ad-equate response to infectious agents and vaccines and the establishment of immunologicaltolerance to self-antigens (thereby increasing the risk for autoimmune diseases).Therefore, lifestyle and nutritional interventions that prevent, decrease, and resolveinflammation are of paramount importance, especially under the current stressful context(e.g., the coronavirus pandemic).Int. J. Environ. Res. Public Health 2021, 18, 10654 63 of 1018.8. Gut Microbiome in Children from Indigenous and Urban Communities in México: SelectivePressures of Western Diet and LifestylesIsaac G-Santoyo (National Autonomous University of México, University City, Coyoacán,Mexico City 04510, Mexico).We are holobionts, which means that we are a biological unit formed by our cellsplus associated microbes. In this relation, the human gut microbiome (GM) needs tobe considered an essential component that defines host health. Lifestyle practices thatwe have experienced recently may impact the ecosystem dynamics of our GM. Thesepractices can result in selective pressures for the GM that has co-evolved with us sinceour origins as species. For instance, measures to kill or limit exposure to pathogenicmicrobes, such as the excessive use of antibiotics, combined with other factors such asultra-processed foods containing preservatives and additives. These selective pressures aresignificant for Childhood since it is a sensitive period for establishing and developing thismicrobial ecosystem. In this study, we sequenced the 16S rRNA gene from faecal samplesof children between 5 and 10 years old in two Mexican communities with contrastinglifestyles; inhabitants of Mexico City, the most industrialized in Mexico, and an indigenouspre-Hispanic population of the ethnic group named Mep’haa. Births in these communitiesare through natural delivery, and children are breastfed to the age of two. There is almostno access to allopathic medications, and there is no health service, or water purificationsystem. Food is based on beans, lentils and corn. Wild edible plants are also collected,and some fruits and vegetables are cultivated in garden plots. Meat is consumed almostentirely during special occasions and is not part of the daily diet.The main differences found were in bacteria associated with different diets, highanimal protein, refined sugars, and high fibre food. Besides, the GM of Me’phaa childrenshowed higher total diversity and the exclusive presence of 11 phyla. In contrast, thechildren from México City showed less diversity and the exclusive presence of 1 phylumassociated with the degradation of sugar compounds. Hence, there was a clear GMseparation between these populations sharing only a quarter of the total species. Thehigher diversity and dissimilarity found in Me´phaa children could induce GM stabilityafter disturbance periods because it is possible to have different bacteria groups withsimilar functions, resulting in a Functional Redundancy. These results provided furtherknowledge about how changes in sociocultural practices have been selective pressuresfor the GM, and how these changes are associated with pathophysiological states usuallypresent in westernization lifestyles.8.9. Restoring Our Inner Wisdom: Microbes Modulate Oxytocin Compassion andProsocial BehaviourSusan Erdman (Massachusetts Institute of Technology, Cambridge, MA 02139, USA).Our inner wisdom helps us navigate traumatic life events during social and environ-mental upheavals. Mounting scientific evidence implicates a gut–immune–brain axis in oursense of self, raising the possibility that our microbial passengers and hormone oxytocinoffer both resiliency and a sense of connectedness to sustain life during challenging times.Earlier work in animal models revealed that exposure to a commensal human milk mi-crobe, Lactobacillus reuteri, served to elevate endogenous levels of oxytocin, a neuropeptidehormone otherwise associated with reproduction and feelings of sociability, trust, andempathy. We postulate that our holobiont, including symbiotic microbiota, together withhormone oxytocin stimulate nurturing near birth with a cascade of individual, familial,and societal outcomes of wellbeing. Additionally, oxytocin emerges as a candidate key tounlocking our navigational inner wisdom. In this paradigm, oxytocin-mediated neuronalengagement forms the basis of our spirituality, gut feelings and intuitions. Through ourancestral experiences, microbes and microRNAs build a vast universal wisdom in neuro-logical archives to help us navigate through difficult emotional and spatial journeys to findour way back to the safety of community. In this way, distant forebear holobionts gift uswith resiliency and inner wisdoms that take care of us all.Int. J. Environ. Res. Public Health 2021, 18, 10654 64 of 1018.10. Transcending Chaos: Spirituality and Coping in the Aftermath of DisasterSusan Young (Lincoln University, Lincoln 7647, Christchurch, New Zealand).When an “I thought I was going to die quake” occurs amidst four additional majorearthquakes and 15,000 aftershocks during a sixteen-month period, it challenges people’sability to cope and recover. Residents of Canterbury, New Zealand endured this extended,chaotic state in 2010/11; and continue to deal with lingering effects on their devastatedcentral city, Christchurch. Stress and coping theory suggests that finding meaning insuch situations can help people recover, and that religion and spirituality often play arole in post-disaster resilience. This research focuses on spirituality in its most generalform and explored how it may have contributed to people’s coping and recovery afterthe earthquakes. Sixteen people were interviewed and their storied accounts thematicallyanalysed to understand each individual’s meaning construction and coping/recoveryprocess and identify connective themes and patterns amongst their experiences. Fourcore elements of acceptance, clarity and choice, connection, and transcendence emergedfrom the thematic analysis to conceptualize a model of transcendent coping. This researchcontributes to the growing interest in spirituality as an important facet of human naturethat can support wellbeing in the face of ongoing stress. Harnessing this innate wisdomand strength is easily done by thinking about what each of us does, in our own way, tobring us peace.When dealing with stress or even during good times, living well could involve tappinginto these transcendent moments more often which ultimately results in more kindness—for ourselves and others.8.11. Unintended Consequences from the COVID-19 ResponseJacinta Ryan 1, Jeffrey Craig 2 and Wayne Leifert 3 (1 RMIT University, La Trobe St,Melbourne, VIC 3000, Australia; 2 Deakin University, Burwood, VIC 3125, Australia;3 CSIRO, University of Adelaide, Adelaide, SA 5000, Australia).As significant resources are committed in the race for a pharmacological solutionto the COVID-19 emergency, questions need to be asked as to the potential risks a treat-ment or preventative could pose to the individual and the community due to unintendedconsequences.What do we know? We know is that pharmaceuticals can be toxic to biologicalsystems, resulting in disease. This toxic effect can be through damage to DNA, otherwiseknown as a “genotoxic effect”. This has been linked to major chronic diseases (e.g., cancer,cardiovascular, neurodegenerative diseases) as well as generational changes contributingto disease in offspring. OECD Guidelines for Testing of Chemicals require genotoxicitytesting for potential new and existing pharmaceuticals. This currently does not apply topharmaceuticals classed as biologics (e.g., whole vaccines).What are we getting to know? New insights into the genome’s 4D landscape areemerging raising new concerns relating to potential genotoxic risks created by the in-troduction of pharmaceuticals. As our growing understanding of the complexity of thegenome architecture unfolds, the mechanism by which pharmaceuticals can create risk tothe biological system through genome damage are increasingly being revealed.Why the need for caution? If what we know provides cause for concern, what weare getting to know should create even greater concern as it relates to pharmacologicalresponses to the COVID-19 crisis. It is essential that, in our haste to find a solution tothe immediate threat created by COVID-19, the solution does not establish the cellularconditions that could create long term and generational disease risk for other serious healthconditions. It is essential that we ensure potential interventions are appropriately under-stood and evaluated as not to create immediate and long-term unintended consequencesnot only in otherwise healthy individuals but also to their offspring.Int. J. Environ. Res. Public Health 2021, 18, 10654 65 of 1018.12. Canadian Public Health Measures for SARS-CoV-2 Targeting Children during the EarlyDays of the COVID-19 PandemicRachel Livergant 1, Julie Polisena 2, Omolara Sanni 1, Brittany Matenchuk 1, SanaAmjad 1, Liz Dennet 1, Igor Zoric 1, Nisrine Haddad 3, Andra Morrison 2, Wilson Ku-mana 3,4,, Isaac Bogoch 5, Vivian Welch 6 and Maria Ospina 7 (1 School of Public Health,University of Alberta, Edmonton, Alberta, Canada; 2 Canadian Agency for Drugs andTechnologies in Health, Ottawa, Ontario, Canada; 3 School of Epidemiology and PublicHealth, University of Ottawa, Ottawa, Ontario, Canada; 4 Clinical Epidemiology Program,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; 5 Divisions of General In-ternal Medicine and Infectious Diseases and Department of Medicine, University HealthNetwork, Toronto, Ontario, Canada; 6 Centre for Global Health, Bruyere Research Institute,Ottawa, Ontario, Canada; 7 Faculty of Medicine and Dentistry, University of Alberta,Edmonton, Alberta, Canada).Introduction: On March 11, 2020, the World Health Organization declared a globalpandemic in response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the causative agent of the novel coronavirus disease 2019 (COVID-19).Accordingly, health officials in Canada issued public health measures at the federal andprovincial/territorial (PT) level to contain and mitigate SARS-CoV-2 transmission in thepopulation and prepare the health. Children were identified as a critical group duringthe pandemic, due to their propensity to act as asymptomatic carriers and transporters ofthe virus.Objective: This scoping review describes public health measures implemented at thestart of the global COVID-19 pandemic in Canada, with an emphasis on the extent to whichissued public health measures targeted children.Methods: We conducted a comprehensive search strategy of federal and P/T websiteson COVID-19 public health preparedness strategies that were released between 30 January30 and 30 April 2020. Specific measures targeting children under the age of 18 wereidentified and examined. A mixed-methods approach for analysis of results was conducted,using both quantitative and qualitative methods.Results: Of the 722 public health measures implemented during the study period,8.7% (63) targeted children. Prince Edward Island and Quebec issued the most measures(8) while Yukon, Nunavut, Northwest Territories, British Columbia and Manitoba issuedthe least (three each). The majority of measures focused on school and university closures(28, 44%), with daycare closures the next most common measure (14, 22%). Most of thepublic health measures targeting children were mandatory orders issued by governments(53, 84%). Non-mandatory measures focused on social supports for children and parents,including daycare provisions for essential workers and recommendations to keep childrenhome from school after travelling in the first few weeks of the pandemic. Most of the publichealth measures were issued in March 2020 (45, 71%), while none were issued in Januaryand only one measure was introduced in February. Eleven (17%) public health measuresaimed at mitigating the psychological, social and/or educational stressors of the pandemicon children.Conclusion: This scoping review provides insights on the effects of public healthmeasures issued by the Canada federal and P/T government in the first 90 days of thepandemic on children. Several of these measures directly impacted children’s educationand care, however, an analysis on the evolution and impact of these measures meritsfurther investigation.8.13. TSUNAMI: An Environment Wide Association Study of Diabetes Burden in IndiaPuja Chebrolu 1, Anjali Radkar 2, Atul Kumar Sahai 3, Morteza Khafaie 4, Pooja Arora5, Shraddha Surana 5, Susmitha Joseph 3 and Chittaranjan Yajnik 6 (1 Weill CornellMedicine, 1300 York Ave, New York, NY 10065, USA; 2 Gokhale Institute of Politics andEconomics, Pune, Maharashtra 411004, India; 3 Indian Institute of Tropical Meteorology,Panchawati, Pashan, Pune, Maharashtra 411008, India; 4 Ahvaz Jundishapur University ofInt. J. Environ. Res. Public Health 2021, 18, 10654 66 of 101Medical Sciences Khuzestan Province, Ahvaz 61357, Iran; 5 ThoughtWorks Technologies,Gurgaon 122002, India; 6 Diabetes Unit, King Edward Memorial Hospital and ResearchCenter, Pune, Maharashtra 411011, India).Background: Type 2 diabetes (T2D) has complex aetiology, including genetics, in-trauterine epigenetic programming and life course environmental exposures. Traditionalrisk factors (diet and physical activity) explain only a part of the susceptibility. Substantialproportions of Indian diabetic patients are non-obese and are physically active. Environ-mental factors may play a significant role but are poorly studied. An Environment-WideAssociation Study (EWAS) such as that performed in the US by Patel et al. (PLoS ONE2010) may provide direction for future studies. We aim to conduct an India-wide EWAS ofT2D using data on air, water and soil pollution, weather patterns and population health-developmental indices.Methods: We will use conventional statistics and machine learning methods andvisualizations to correlate rise in T2D prevalence to changing environmental exposuresfrom 1990 to 2016. Data will be obtained from multiple public sources. Diabetes prevalencewill be obtained from the GBD India and INDIAB studies conducted between 1990 and2016. Other data sources are: the Indian National Family Health Survey, air pollution datafrom the Indian Central Pollution Control Board (PM 2.5 and 10, NO2, and SO2 levels)by state from 2000 to 2016, POP exposure estimated using a composite measure of levelsof individual POPs in groundwater and milk from 1970 to 2000, water pollution dataincluding heavy metal contamination of groundwater between 1970 and 2000, and weatherdata including mean rainfall and average temperature from 2000 to 2016. Given the longexposure time to cause disease, POPs and heavy metals (and other exposures) will beassessed 20 years prior to available T2D data.Expected Findings: Outcomes will include the association of environmental factorswith rise in T2D prevalence between 1990 and 2016. This will provide vital data forgeneration of novel hypotheses to study the association of these factors with T2D risk.8.14. A Live Probiotic Sunscreen to Protect against Skin NeoplasiaTina Varkevisser (Vrije Universiteit, 1081 HV Amsterdam, The Netherlands).The skin microbiome has been studied for its role in protecting the host against in-vading pathogens, educating our immune system, and breaking down natural productson the skin. Staphylococcus epidermidis is a prominent bacteria found on our skin, andrecent findings have elucidated its role in skin cancer protection. A commensal strainof S. epidermidis produces the compound 6-N-hydroxyaminopurine (6-HAP) which wasshown to selectively inhibit DNA polymerase function of skin tumour cells, leaving pri-mary keratinocytes unharmed. Topical treatment with this strain of S. epidermidis in micehas shown a significant reduction in the incidence of UV-induced tumours. Moreover,intravenous injection of 6-HAP in mice was able to inhibit the growth of B16F10 melanomawithout systemic adverse drug reaction. With this knowledge, this project aims to developa safe and effective sunscreen containing a live commensal strain of S. epidermidis to reducethe risk of UV-induced skin cancer. We hypothesise that the topical application of thisproduct will potentially reduce the incidence of skin cancer through the dual benefit of the6-HAP produced by S. epidermidis and sun protection factor.8.15. Metabolic Diversity amongst Lactobacillus Crispatus Isolates for Probiotic PurposesRosanne Hertzberger, Heleen Eising and RemcoKort (Vrije Universiteit, 1081 HV Ams-terdam, The Netherlands).The microbiome of the human vagina has low diversity compared to other mammalsand to other bodily niches: most women are dominated by a small group of Lactobacillusspecies. Absence of these bacteria is regarded as a dysbiotic state with increased diversity,an elevated pH, exfoliation of the vaginal epithelium and degradation of glycogen, which isthe most abundant vaginal carbohydrate. Besides abnormal discharge, vaginal dysbiosis (orInt. J. Environ. Res. Public Health 2021, 18, 10654 67 of 101“bacterial vaginosis”) is associated with adverse sexual and reproductive health outcomes.Especially women who are colonized by Lactobacillus crispatus are less likely to acquiresexually transmitted disease and when pregnant are at lower risk of preterm labour.Amidst the global epidemic of antibiotic resistance, bacterial vaginosis is still com-monly treated with metronidazol. Here we propose to transfer from an antibiotic approachtowards a “women for women”—probiotic approach. We have isolated 19 strains ofLactobacillus crispatus from various reproductive-age women and studied their metabolicdiversity. Thirteen out of nineteen were capable of utilizing glycogen for acidification. Thesix non-glycogen consuming strains all carried a deletion in the N-terminal signal peptidesequence of a putative cell surface associated type 1 pullulanase. This enzyme showedhigh similarity to the extracellular cell wall attached pullulanase previously found in ahuman gut isolate of Lactobacillus acidophilus.In the future, we aim to utilize this collection of metabolically diverse strains in aprobiotic mixture to facilitate women to share vaginal microbial health amongst each other.8.16. The Brain–Gut Axis Organoid Model, Creation of an Organoid–Organoid Connection of theIntestine and BrainJob Schlösser 1 and Remco Kort 2 (1 University of Amsterdam, 1000 GG Amsterdam, TheNetherlands; 2 Vrije Universiteit, 1081 HV Amsterdam, The Netherlands).The bidirectional brain–gut axis demonstrates itself as a prominent controversialmystery within the scientific community. Various associations are made between neu-ropathology/mental health and the gut microbiome. However, current experimental toolslack the capability of direct and robust conclusions for the brain–gut axis functioning. Byintroducing the possibility to connect the human brain organoid (HBO) and the humanintestinal organoid (HIO), this study could provide new insights in the scientific investiga-tion of the brain–gut axis. This brain–gut axis organoid will be connected via the vascularsystem, nervous system and autologous immune cells. Starting from various progenitor cellcombinations, to strategical finetuning by state-of-the-art biomimetic methods. Moreover,the vascular system will be connected to a blood/vascular controlling apparatus providingthe brain–gut axis organoid a steady state (including essential lung and heart functioningabilities) and quantitative abilities. This newly formed organoid connection will createvarious experimental approaches and applications to intervene with the organization ofthe brain–gut connection. Although its experimental ambitious nature, recent researchprovided sufficient possibilities to fulfil this brain–gut axis organoid, thereby contributingto future insight in the interesting field of the brain–gut axis research.8.17. Hyphae-Active: Mycelia-Inspired Participatory Service Design for Healthier People andPlaces—Inspired by Nature’s InternetApril Rose Presto (Center for Interventions toward Development and Empowermentthrough Allied Services, (I.D.E.A.S.), Inc./1231, University of the Philippines, 1101 QuezonCity Manila, Philippines).Participatory service design is recognized as beneficial in learning about and engagingwith clients. Individual narratives, much like a hyphae, make up a vibrant networkof places, objects, and experiences—data that can be utilized to create programs thatenhance quality of life of people and families with neurodiversities (i.e., family memberwith medical conditions such as ADHD, ASD, or other developmental challenges). Byco-designing the process with clients, relationships are established and ecosystems inwhich the relationships take place are better understood. This mycelia-inspired journeydocuments the experience of a clinical facility in the creation of a food journey map linkingfood practices, environment, and food systems to aid in the assessment and interventionphases of the occupational therapy process.Eating and meal preparation are seen as meaningful occupations that sustain familylife. Understanding our clients with neurodiverse abilities and their families’ interactionwith food not only provided information about sensory–motor challenges in eating—theInt. J. Environ. Res. Public Health 2021, 18, 10654 68 of 101typical reason for referral to occupational therapy services—but also revealed insightsabout food habits (e.g., where it is sourced, who prepares it, temporal dimensions, etc.)and environments (e.g., home, restaurants, parks, groceries etc.) where microbiomescan interact. Good nutrition and nature contacts have a positive influence on learningand behaviour and can therefore be incorporated as nature services in the occupationaltherapy process.This service design aims to go deep and beyond grassroots interaction and reflect onthe connections within a mycelium internet. From client to clinician to other membersof the medical team (such as speech-language therapists, physicians, nutritionists, etc) tofood systems and environments, each connection is established to inform and nurture eachother’s role in the ecosystem of health and wellbeing—not only of individuals and familiesbut of communities and our planet.8.18. Strategies to Reduce Antibiotic Usage by Targeting Bacterial Quorum Sensing: The Q-PatchAnnika Dokter (Vrije Universiteit, 1081 HV Amsterdam, The Netherlands).Chronic wounds containing biofilm have a major impact on today’s society, both interms of morbidity and economic costs. Current treatment is suboptimal and lengthy useof systemic antibiotics is common, leading to resistance and unwanted side effects such asdysbiosis of the microbiome. New ways to prevent and treat biofilm formation in chronicwounds are urgently needed. A possible target is quorum sensing, a communicationsystem between bacteria that orchestrates biofilm formation. The development of a plasterimpregnated with the quorum sensing inhibitor thionine T310 can bring an effective, easy-to- use treatment for patients suffering from chronic wounds and thereby lower the useof antibiotics.9. Across the Ages—Transgenerational and Life-Course Opportunities to ImproveHealth: Developmental Origins—Part 1The long-term health of all societies depends on the health of the next generations,and the importance of taking a transgenerational and life-course approach to improvinghealth of individuals and societies, beginning with the first moments of life—as this iswhen physical, mental and emotional health is established—and when personal, socialand environmental attitudes and behaviours begin to form. This session explored theimportance of early environmental ecology in determining lifelong health—includingmicrobial diversity, nutrition, nature, social interactions during “critical windows” ofdevelopment (Figure 8).9.1. Across the Generations: A Traditional Perspective from the Longest Surviving Cultureon EarthSandra Eades (Curtin University Kent St, Bentley, WA 6102, Australia).No abstract available.9.2. From Mother to Child: How, When and Why We Need to Optimise theDeveloping MicrobiomeMaria-Carmen Collado (Institute of Agrochemistry and Food Technology-National Re-search Council (IATA-CSIC), 46980 Valencia, Spain).Int. J. Environ. Res. Public Health 2021, 18, 10654 69 of 101Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 70 of 104 The long-term health of all societies depends on the health of the next generations, and the importance of taking a transgenerational and life-course approach to improving health of individuals and societies, beginning with the first moments of life—as this is when physical, mental and emotional health is established—and when personal, social and environmental attitudes and behaviours begin to form. This session explored the im-portance of early environmental ecology in determining lifelong health—including mi-crobial diversity, nutrition, nature, social interactions during “critical windows” of devel-opment (Figure 8). Figure 8. Transgenerational and Life-course Opportunities to Improve Health: Overview of topicsand speakers in the session on developmental ecology (Part 1).Advances in the understanding of the host–microbes interactions suggest maternalmicrobiota plays a crucial role in infant health. Microbial colonization is essential for theimmune system development and function. Intestinal microbes also affect other physiologicprocesses related to nutrition, metabolism, and intestinal homeostasis. Accumulatingevidence suggests that the human microbial contact begins in utero and is then modulatedby perinatal factors including mode of delivery and infant diet. Maternal microbiotatherefore form the first and unique microbial inoculums, with microbial diversity increasesand converges towards an adult-like microbiota by the end of the first years of life.Int. J. Environ. Res. Public Health 2021, 18, 10654 70 of 101Alterations in this early microbial colonization (including delayed colonization, al-tered microbiota profiles and lower microbial diversity), are strong risk factors for thedevelopment of some diseases during life. Such alterations are mainly linked to C-sectionbirth, antibiotic use and lack of breastfeeding practices. With a strong link between micro-biota and risk of non-communicable diseases (NCDs), this imposes an increasing globalburden that requires urgent action. It also underscores that conception, gestation andlactation are critical periods for human development where microbiota would play a rolefor future health.There are several interventions targeted to modulate the microbiota. These includedietary counselling and also, probiotics, prebiotics and even antibiotics. To date, there hasonly been limited research to assess whether diet leads to changes in the microbiota andhost interaction during gestation and thus, affect the specific strain microbial transferenceto the neonate both at birth and during lactation. At the same time, there is significantinterest in research aimed at establishing the identity of specific microorganisms, microbialmolecules and metabolites that contribute to the host’s physiology and health.Taken together, these observations indicate that adequate nutritional and microbialenvironments during the perinatal period are key in promoting and supporting humanhealth. Further research is required to determine how specific microbes, along with lifestyle,contribute to the maintenance of microbial and physiological equilibrium. This may revealnew opportunities to reduce the risk of non-communicable diseases by modulating themicrobiota in early life. It therefore remains urgent to identify “how, when and why” weneed to optimise the developing microbiome.9.3. From Father to Child: Transgenerational Effects of Toxic Environmental Exposures inArtic PopulationsJanice Bailey 1,2 (1 Scientific Director, Fonds de Recherche du Québec en Nature et Tech-nologies (FRQNT); 2 Professor, Department of Animal Sciences, Université Laval, Québec,QC G1V 0A6, Canada).According to the World Bank (2016), the global fertility rate, defined as the number ofbirths per woman, has declined markedly since the 1960s. This reduced fertility is oftenattributed to social issues related to family planning, such the successful use of effectivecontraception, couples making a financially based decision to have no or few children, or ashorter biological window of fertility when women choose to delay starting a family.That environmental influences also play a role should not be ignored, and a LancetCommission (2017) concluded that pollution is the largest environmental cause of diseaseand premature death in the world today. While it is well recognized that the maternalenvironment and lifestyle are important determinants of her children’s health, the influenceof the father’s environment on his reproductive parameters and those of his subsequentgenerations has been overlooked. Indeed, according to a global study, sperm productionhas declined 60% since 1970, which could be a factor in declining fertility. Rapid biologicalshifts are usually considered to be environmental in nature and recent disturbing findingsindicate that the effects of environmental exposures can be transmitted to future generationsvia fathers and his paternal lineage.The overarching hypothesis of my team’s research is that exposure to environmentalcontaminants interferes with male fertility and the development and health of his futuregenerations. To test the hypothesis, we created a multi-generation, outbred rat modelduring which the founder males are transiently exposed to an environmentally relevantmixture of persistent organic pollutants (POPs) contaminates the Arctic food chain andapproximate levels in northern people. Our results demonstrate that sperm quality andpregnancy outcomes, including early embryo gene expression, are reduced across three,unexposed generations following a single developmental window of paternal exposure.We also showed that the sperm epigenome, specifically the profile of miRNAs and DNAmethylation, is perturbed across three generations, providing insight into the molecularunderpinnings of these phenotypes.Int. J. Environ. Res. Public Health 2021, 18, 10654 71 of 101In conclusion, our research has demonstrated that (1) the environment influences malefertility across multiple, unexposed generations, and (2) the sperm epigenome exhibitsmarks of environmental insults. Taken together, our studies suggest that declining fertilitycould be related to POPs exposure of their previous generations through their fathers. Thepaternal environment affects the development of his descendants and must be consideredfor pregnancy outcomes and offspring health.9.4. Early Life Exposome and Industrial Chemical EmissionsCharlene Nielsen 1, Osornio Vargas 1 and Carl Amrhein 2 (1 University of Alberta, Ed-monton, AB T6G 1C9, Canada; 2 Aga Khan University, Nairobi 74800, Kenya).Industrial chemical emissions—because they are not routinely monitored—are anoften-overlooked aspect of the early life exposome. Geographical Information Systems(GIS) helped us to map pollution sources, assign potential exposure, and analyse patterns ofprenatal-related morbidities co-located with emissions from industrial facilities. Air pollu-tion, irrespective of source, has a recognized association with adverse birth outcomes, suchas low birth weight, small for gestational age, and preterm birth. We integrated the spatiallocations and estimations of Environment and Climate Change Canada’s National Pollu-tant Release Inventory (NPRI) database into: (1) the identification of industrial chemicalemissions co-located with adverse birth outcomes across Canada; (2) the development of amaternal ambient health hazard index for Alberta; and (3) the spatiotemporal modelling ofhot spots in major Canadian metropolitan areas. We calculated spatial proxies of exposuresto over two hundred industrial chemicals released to air and up to eighteen land-basedhazards. For spatiotemporal analysis we estimated monthly dispersion of emissions byincorporating proximal weather station data. We assigned the modelled values to thesix-character postal codes of the maternal residence at birth. Using correlation and logisticregression with pertinent covariates, we compared the resulting patterns. Over twenty ofthe chemicals revealed by our research are recognized or suspected developmental toxi-cants. We hope our research will contribute to effecting change in public perceptions andinfluence opinions leading to environmental health policies that will reduce the exposureof children to modifiable environmental hazards.9.5. A Nudge from Evolution: Sex and Birth Order Influence How Mothers Eat andOffspring GrowRalph Nanan 1, Sammuel Schäfer 2, Rosie Ribeiro 1, David Raubenheimer 1, BatoolNadim 1 and Anthony Liu 1 (1 The University of Sydney, Camperdown, NSW 2006,Australia; 2 Linköping University, Linköping, Sweden).From an evolutionary perspective, reproductive success is proportionate to the numberof offspring reared and their probability to reproduce. This implies that beyond thetransmission of heritable characteristics to successive generations, biological fitness as ameasure of offspring quality contributes to overall reproductive success. Early nutritionalinvestment has been shown to influence the most important early determinants of offspringbiological fitness, namely survival and growth. Higher birth weight leads to decreasedinfant morbidity and mortality. Furthermore, growth propensity appears to be an importantdeterminant of lifetime reproductive fitness. This has been well described in animal modelsand might to some extent pertain to humans. We have explored relationships betweenoffspring sex and birth order and maternal energy and macronutrient intake as well asthe effects on the offspring weight development. Our results indicate that both genderand birth order drive distinct patterns of maternal total energy, macronutrient intakeand influence offspring growth. To prevent metabolic pathologies over the lifespan thesefindings warrant further investigations towards targeted nutritional interventions duringand after pregnancy, stratified for gender and birth order.Int. J. Environ. Res. Public Health 2021, 18, 10654 72 of 1019.6. The Burden of Maternal Depression in Pregnancy: Implications for Psycho-Emotional andPhysical Development of Next GenerationsAlkistis Skalkidou, Emma Bränn, Theodora Kunovac Kallak and Emma Fransson (Up-psala University Women’s and Children’s Health, Akademiska sjukhuset, 751 85 Upp-sala, Sweden).Maternal peripartum depression (PPD) is associated not only with future maternalmorbidity but also with sub-optimal child development and poor mental health. Despitethe growing evidence of such an association, the mechanisms are still not fully understood.Within the population-based, prospective Biology, Affect, Stress, Imaging and Cognition(BASIC) cohort in Sweden, including 6472 pregnancies; mothers are followed from ges-tational week 17 throughout the first year after childbirth with web-questionnaires andbiological sampling of blood, tissues, microbiota etc. We have investigated the biopsy-chosocial etiological processes involved in PPD and the associations of maternal depressivesymptom trajectories with child development in the follow up cohort U-BIRTH, in whichchildren are followed-up at 18 months, as well as at 6 and 11 years of age, regardingpsycho-emotional and physical development.In one study of 1093 children at 18 months, different time onset of maternal depressionin the perinatal period showed distinct associations with child behavioural problems.While the effects of postpartum onset or persistent depression were mediated by maternalbonding to the infant, the effects of antenatal depression were an independent predictorof child behavioural problems. In another study, we investigated possible epigeneticmechanisms through DNA methylation using cord blood of 256 children born to motherswith or without antenatal depressive symptoms. In general, few epigenetic differenceswere identified, but analyses stratified for child sex showed that boys of depressed mothers,who also expressed higher internalized behavioural problems at 18 months, had lowerDNA methylation at the MTH2 gene, which has been associated with brain development.The cohorts have thus far generated 45 publications. Future studies will furtherinvestigate biological processes involved in PPD, through study of metabolomics andmicrobiome, the possibility of prediction of high-risk mothers, as well as the long-termhealth of children to mothers with peripartum depression.9.7. Ecology of the Microbial Mother-Newborn DyadNelly Amenyogbe 1, Dennis Adu Gyasi 2, Yeetey Enuameh 2, Kwaku Poku Asante 2,Kaali Seyram 2, David Dosoo 2, Pinaki Panigrahi 3, Tobias Kollmann 1, WilliamMohn 4and Seth Owuso-Agyei 2 (1 Telethon Kids Institute, Nedlands, WA 6009, Australia; 2 Kin-tampo Health Research Centre, Kintampo—North Municipality, Ghana, West Africa;3 Georgetown University, Washington, DC 20057, USA; 4 University of British Columbia,Vancouver, BC V6T 1Z3, Canada).From before birth, mothers begin nurturing their children and preparing them for abrave new world. The inheritance of specific microbes, or the microbiome, has garneredattention as a key avenue for mothers to shape the development of their children. Women’smicrobiomes are also reshaped during pregnancy in a body site-dependent manner. Thenature of these changes together with their consequences for her and her child’s healthare only beginning to be realized. Here, we describe the ecology of both bacterial andfungal stool and breastmilk microbiomes of mothers, and the stool microbiomes of theirchildren in the first post-partum month using molecular approaches. We observed massivedifferences in the bacterial stool microbiomes of women sampled in the first, compared towomen sampled in the fourth post-partum week, including a lesser relative abundancePrevotella and greater abundance of Escherichia in the first, compared to fourth post-partum week. Differences of this scale were not observed for fungi. Further, while sharedbacteria between mother’s breastmilk and child’s stool were readily identified, sharedfungal species were sparse. Given the known ability of commensal fungi to influenceimmune development, the distinct pattern of their inheritance compared to that of bacteriais likely important to fully understand. Moreso, understanding the relationship betweenInt. J. Environ. Res. Public Health 2021, 18, 10654 73 of 101the surprisingly massive shifts in women’s bacterial microbiome around the time of birthto her and her child’s health must become a research priority.9.8. Life in Our Gut: The Impact of Birth Mode, Diet and Social Interactions in Shaping theMicrobiome during Early LifeJohn Penders (Department of Medical Microbiology, Maastricht UMC+ [University Medi-cal Centre], 6202 AZ Maastricht, The Netherlands).During infancy and early childhood, our intestinal microbiome establishes from thefirst inoculum to a complex and diverse ecosystem under the influence of a large numberof perinatal environmental and maternal factors. Dispersal of maternal microbes is clearlylimited in case of Caesarean section delivery, but also lack of social interactions with peers(e.g., with siblings or infants at daycare centres) or contact with pets have been shown toinfluence microbiome assembly during this critical age window. Diet plays an importantrole in shaping the infant microbiome both by dispersal of foodborne microorganisms(e.g., microbes in breast milk) but also by environmental selection (e.g., human milkoligosaccharides selecting for Bifidobacterium).Perturbations in early life microbiome development as a result of our modern lifestylehas been linked to the increase in various non-communicable diseases including allergiesand asthma, diabetes, inflammatory bowel diseases and overweight and obesity. Theseperturbations and the accompanying loss of keystone bacterial species (old friends) inthe intestinal tract of the current generation of children and adolescents are driven bythe increased use of antimicrobial agents, rising rates of C-section deliveries, decreasein breastfeeding, western diets (rich in animal fat and protein and low in dietary fibres),decreased family sizes, increased stress levels and our reduced contact with biodiversity ingeneral and environmental microbes in particular.The current COVID-19 pandemic has however resulted in an unprecedented abruptshift in microbial exposures and stressors. Many countries across the world have experi-enced lock downs with playgroups, day cares and schools being closed, social interactionshave been minimized and we refrain from physical contact beyond household members.Moreover, frequent hand washing is being strongly advocated and sales of disinfectantshave risen more than 10-fold. Besides the aimed reduction of SARS-CoV-2 transmission,these measures have also resulted in reduced microbial transmission in general exemplifiedby the substantial decline in other respiratory as well as gastrointestinal viruses in manycountries. The extent to which the current pandemic also affects the assembly of the com-mensal intestinal microbiome during infancy remains to be explored. On one hand, lackof social interactions might result in dispersal limitation of commensal microorganisms,but on the other hand, this might also result in reduced dispersal of antimicrobial resistantand opportunistic pathogenic bacteria. Additionally, the crowded forests, parcs and othergreen spaces during lockdowns might point to more exposure and connection to natureand thereby dispersal of environmental bacteria. Altogether, these challenging times alsoprovide us with unique opportunities to study these forces on the development of theintestinal microbiome during early life.9.9. Reduced Microbial Richness in Breast Milk Associates with Increased Risk of Immune DiseaseMajda Dzidic 1,2,3, Alex Mira 2, Alejandro Artacho 2, Thomas R Abrahamsson 4, MariaCarmen Collado 1,*,Ψ and Maria C Jenmalm 3,Ψ (1 Institute of Agrochemistry and FoodTechnology (IATA-CSIC), Department of Biotechnology, Unit of Lactic Acid Bacteria andProbiotics, 46980 Valencia, Spain; 2 Department of Health and Genomics, Center for Ad-vanced Research in Public Health, FISABIO, 46980 Valencia, Spain; and CIBER-ESP, Madrid;Spain; 3 Department of Biomedical and Clinical Sciences, Division of Inflammation and In-fection, Linköping University, 581 83 Linköping, Sweden; 4 Department of Biomedical andClinical Sciences and Department of Pediatrics, Linköping University, 581 83 Linköping,Sweden; Ψ Shared senior authors).Int. J. Environ. Res. Public Health 2021, 18, 10654 74 of 101Background: Diverse microbial exposures play a crucial role for appropriate immunematuration during childhood. One important source of microbes for the infant is thebreastmilk microbiota, transferred together with maternal IgA antibodies. In childrendeveloping allergies, we previously noted aberrant IgA responses to the gut microbiotaalready at 1 month of age, when the IgA antibodies are predominantly maternally derivedin breastfed infants.We aimed to determine the microbial composition and IgA-coating of bacteria inbreastmilk in relation to allergy development in children participating in an interventiontrial with pre- and postnatal Lactobacillus reuteri supplementation.Methods: We characterized the bacterial recognition patterns by IgA in breastmilksamples collected one-month postpartum from 40 mothers whose children did or didnot develop symptoms of allergy and asthma during the first seven years of life, using acombination of flow cytometric cell sorting and 16S rRNA gene sequencing.Results: Children developing allergy received milk with a significantly lower bacterialrichness, when compared to the milk fed to children that remained healthy, while theproportions of IgA-coated bacteria, the total bacterial load and the patterns of IgA-coatingwere similar in the two groups. Probiotic treatment influenced the breastmilk microbiotacomposition.Conclusion: Reduced microbial richness in breast milk associates with increased riskof infant allergy development.9.10. Human Breast Milk Bacterial Dysbiosis Is Associated with Lactose Fermentation and PoorBreastfeeding OutcomesAnna Ojo 1, Stefano Cacciatore 2, Shantelle Claassen-Weitz 3, Kilaza Mwaikono 4, HeatherZar 5, Dan Stein 6, Luiz Zerbini 7, MarkNicol 8 and Elloise du Toit 3 (1 University of CapeTown Medical School, Anzio Road, Observatory 7925, South Africa; 2 International Centrefor Genetic Engineering and Biotechnology (ICGEB), University of Cape Town, 7700 CapeTown, South Africa; 3 Division of Medical Microbiology, Department of Pathology, Faculty ofHealth Sciences, Observatory 7925, University of Cape Town, Cape Town 7700, South Africa;4 Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, P.O.Box 2958, Dar es Salaam 11000, Tanzani; 5 Department of Pediatrics and Child Health, Red CrossWar Memorial Children’s Hospital, Rondebosch, Cape Town 7700, South Africa; 6 SA MRCUnit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute,Observatory 7925, University of Cape Town, Cape Town 7700, South Africa; 7 InternationalCentre for Genetic Engineering and Biotechnology (ICGEB), University of Cape Town, 7700Cape Town, South Africa; 8 School of Biomedical Sciences, Division of Infection and Immunity,The University of Western Australia, M504, Perth, WA 6009, Australia).Human breast milk (HBM) is universally regarded as the optimal source of nutritionfor the growing infant, however the impact of variation in the components of HBM onbreastfeeding outcomes is not fully understood. In particular, the interaction betweenthe HBM metabolome and microbiota has not been well studied. Here, we show thata dysbiotic HBM microbiota is associated with evidence of fermentation of lactose, lowlactose concentration and poor breastfeeding outcomes. We identified a subset of SouthAfrican lactating mothers with markedly reduced HBM lactose concentration. Motherswith low-lactose HBM breastfed exclusively for shorter periods and their infants grewless well during the period of exclusive breastfeeding. Metabolomic profiling of low-lactose HBM revealed an increase in metabolites associated with mixed acid fermentation,characteristic of microbial carbohydrate metabolism, and depletion of metabolites in thetricarboxylic acid cycle. We therefore explored the bacterial composition of HBM using 16SrRNA amplicon sequencing and showed marked differences in composition in low lactosesamples, which were characterized by higher median relative abundance of Staphylococcusspecies, lower abundance of Streptococcus species and increased bacterial load. Ourfindings suggest that an aberrant HBM microbiota may result in fermentation of lactoseand poor lactational outcomes. Since the HBM microbiota is potentially modifiable, if theseInt. J. Environ. Res. Public Health 2021, 18, 10654 75 of 101findings are reproduced in other populations, they may identify opportunities to interveneto avert poor lactational outcomes.9.11. A Prospective Study of Persistent Organic Pollutants and Body Mass Index Trajectoriesamong Black WomenXiaoxia (Sasha) Han 1, Donna Baird 2, Quaker Harmon 2, Amelia Wesselink 3, Lauren Wise3, Olivia Orta 3, Birgit Claus-Henn 3, Andreas Sjodin 4 and Ganesa Wegienka 1 (1 HenryFord Health System, Detroit, MI 48202, USA; 2 National Institute of Environmental HealthSciences, Durham, NC 27709, USA; 3 Boston University School of Public Health, Boston, MA02118, USA; 4 Centers for Disease Control and Prevention, Atlanta, GA 30333, USA).This abstract not available; however, a recording of this presentation is available aspart of the on-line proceedings.9.12. Gut Microbiota Signature Based on Sex and the Presence of Siblings in 2-Year-OldJapanese ChildrenBahrul Fikri 1, Yumiko Nakanishi 2, Midori Yamamoto 3, Naoko Tachibana 2, AyumiIto 2, Ryohei Shibata 2, Tamotsu Kato 2, Taiji Nakano 1, Fumiya Yamaide 1, KenichiSakurai 3, Chisato Mori 3,4, Naoki Shimojo 1 and Hiroshi Ohno 2 (1 Department of Pedi-atrics, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan; 2 Laboratoryfor Intestinal Ecosystem, RIKEN Center for Integrative Medical Sciences, Yokohama City,Kanagawa 230-0045, Japan; 3 Center for Preventive Medical Sciences, Chiba University,Chiba 263-8522, Japan; 4 Department of Bioenvironmental Medicine, Graduate School ofMedicine, Chiba University, Chiba 260-8670, Japan).Background: Gut microbiota has been demonstrated to be associated with age andcould be associated with the health and development of diseases such as allergy. However,less is still known about the profile of gut microbiota based on sex and the presence ofsiblings in early childhood. Here we studied the profile of gut microbiota based on sex andthe presence of siblings in 2-year-old Japanese children.Methods: This study is an adjunct study of the Japan Environment and Children’sStudy (JECS). Faecal microbiome data were collected at 2 years of age in the Chiba regionalcentre. The Faecal microbiome was profiled by 16s rRNA gene sequencing. Microbiomeanalysis was performed using Quantitative Insight Into Microbial Ecology (QIIME) andPhyloseq in R package. Statistical analysis was performed by JMP13; p value was adjustedfor multiple comparisons.Results: Complete data were available for 267 children; there were 126 males and 141females; 153 out of 267 had at least one elder sibling. In microbial diversity analysis, the generaBifidobacterium was significantly lower abundance in male. In contrast, the genera Coprococcus,Lachnospira, and Sutterella were significantly higher abundance in males (Wilcoxon rank-sum test, p < 0.05). Meanwhile, in relation to the presence of elder siblings, we found thatParabacteroides was significantly overrepresented in children who had elder siblings comparedto those who did not. Conversely, Dorea and Trabusiella were significantly underrepresented inchildren with elder siblings (Wilcoxon rank-sum test, p < 0.05).Conclusions: The genera Bifidobacterium, Coprococcus, Lachnospira, and Sutterellacould be the sex-associated gut microbiota in 2-year-old children. Parabacteroides, Dorea, andTrabulsiella could be gut microbiota determined in children who have elder siblings. Thesefindings may be important for the pathomechanism of inflammatory diseases in children.9.13. The Role of Early Life Gut Microbiota Maturation in Allergy Predisposition: Higher Risk ofSensitization among Asian–Canadian ChildrenHein M. Tun (HKU-Pasteur Research Pole, School of Public Health, LKS Faculty ofMedicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China).Increasing evidence supports the role of early life gut microbiota in developing atopicdiseases, but ecological changes to gut microbiota during infancy in relation to food sensiti-zation remain unclear. In this observational study, using 16S rRNA amplicon sequencing,Int. J. Environ. Res. Public Health 2021, 18, 10654 76 of 101we characterized the composition of 2844 faecal microbiota in 1422 Canadian full-terminfants. Atopic sensitization outcomes were measured by skin prick tests at age 1 yearand 3 years. The association between gut microbiota trajectories, based on longitudi-nal shifts in community clusters, and atopic sensitization outcomes at age 1 and 3 yearswas determined.Four identified developmental trajectories of gut microbiota were shaped by birthmode and varying by ethnicity. The trajectory with persistently low Bacteroides abundancethroughout infancy increased the risk of sensitization to food allergens, particularly peanutat age 3 years by three-fold (adjusted OR, 2.82; 95% CI, 1.13–7.01); a much higher likelihoodfor peanut sensitization was found if infants with this trajectory were born to Asian mothers(adjusted OR, 7.87; 95% CI, 2.75–22.55). Importantly, this trajectory of depleted Bacteroidesabundance mediated the association between Asian ethnicity and food sensitization. Ourstudy is the first to show a mediation role for infant gut microbiota in ethnicity-associateddevelopment of food sensitization.Further reading (details now published):Tun HM, Peng Y, Chen B, et al. Ethnicity associations with food sensitization aremediated by gut microbiota development in the first year of life. Gastroenterology. 2021Mar 16:S0016-5085(21)00523-0. Epub ahead of print. PMID: 33741316.9.14. Ancestral Paternal Exposure to Arctic Pollutants Impairs Placental and FoetalDevelopmental Outcomes without Protective Effect from Folic Acid SupplementationPhanie L. Charest 1, Maryse Lessard 1, Pauline Herst 1, Pauline Navarro 1, MathieuDalvai 1, Marie-OdileBenoit-Biancamano 2 and Janice Bailey 1 (1 Université Laval, Ruede l’Université, Québec, QC G1V 0A6, Canada; 2 Université de Montréal, Montréal, QC J2S2M2, Canada).Inuit people have more adverse pregnancy outcomes and shorter life expectancies.Because of their traditional diet, they are highly contaminated by Persistent OrganicPollutants (POPs), known to induce negative health effects. We hypothesize that folicacid (FA) supplementation attenuates developmental disorders in foetuses and placentasassociated with prenatal paternal exposure to POPs over multiple generations.We used a four-generation rat model, in which F0 founder females were divided intofour treatment groups (n = 8) and gavaged with corn oil or an environmentally relevantArctic POPs mixture before mating and until parturition. F0 females were fed either a base-FA diet (2 mg/kg), or a supplemented-FA diet (FAS; 6 mg/kg). Twelve F1 males/treatmentwere mated to untreated females to produce F2 rats, etc. until F4. Histopathologicalexamination of the foetuses and placentas were performed at Gestational Day 19.5. Thecut-off value for significance is p ≤ 0.05.The foetal:placental weight ratio (FW:PW) was reduced by POPs*FAS interaction inF1–F2. In contrast, FW:PW was increased due to POPs in F3 and by both POPs and FAS inF4. Similarly, the length of the limb long bones was reduced due to POPs in F1–F2, whereasit was increased in F4. Placental histomorphometry was impaired by POPs and FAS inF1–F2, although no differences were present in F3–F4. These results suggest inadequateplacental efficiency and possible compensatory mechanisms.Prenatal paternal POPs exposure impairs development over multiple generations.FAS, however, may not represent an ideal solution to counteract the consequences of POPs.Multigenerational transmission of the paternal environment is apparent and may occur viaplacental disruption. Achieving our objectives will broaden current understanding of thetoxicological impacts of the environment on human health and the developmental originsof disease.Int. J. Environ. Res. Public Health 2021, 18, 10654 77 of 10110. Healthier Beginnings: Early Life Interventions. Making Change Early in Life(Developmental Origins—Part 2)Chronic inflammatory diseases, collectively known as non-communicable diseases(NCDs), now pose the greatest threat to human health globally. Many of these conditionshave their origins in early life, and there is a pressing need to understand how the modernenvironment is contributing to this unsustainable health burden. There are mountingconcerns that this new generation will have a shorter life expectancy than their parents,particularly in disadvantaged populations. Early interventions will ultimately be the onlyway of curtailing this and are an essential aspect of improving global health. This sessionexplores different aspects of improving early life ecology (Figure 9).10.1. Can Rewilding the Microbiome Ameliorate the Effects of Early Life Stress andTransgenerational Vulnerability?Bridget Callaghan (Brain and Body Lab, University of California-Los Angeles, Los Angeles,CA 90095, USA).No abstract available.10.2. Born to Be Wise: Impact of Modifiable Early Life Environmental Exposures on the Health andDevelopment of ChildrenMatilda van den Bosch 1, Brauer Michael 1, Rick Burnett 2, Hugh Davies 1, Zoe Davis 1,Martin Guhn 1, Ingrid Jarvis 1, Lorien Nesbitt 1, Tim Oberlander1, Hind Sbihi 1, JasonSu 2 and Michael Jerrett 3 (1 The University of British Columbia, Vancouver, BC V6T 1Z4,Canada; 2 Health Canada, Vancouver, BC K1A 0K9, Canada, University of California,Berkeley, CA 94720, USA; 3 University of California, Los Angeles, CA 90095, USA).Deficiencies in childhood development is a major global issue and inequalities arelarge. The influence of environmental exposures on childhood development is currentlyinsufficiently explored. The Born to be Wise project analyses the impact of modifiable earlylife environmental exposures on different dimensions of childhood development.Our cohort contains approximately 34,000 children who have completed an earlydevelopment test at the age of five. Land use regression models of air pollution andspatially defined noise models will be linked to geocoded data on early developmentto investigate harmful effects. The potentially beneficial effect on early development ofearly life exposure to natural environments, will also be explored. The project will analyseoverall and age specific impact, including variability depending on cumulative exposureby assigning time-weighted exposure estimates and by studying subsamples who havechanged residence and exposure. Potentially moderating effects of natural environmentson air pollution or noise exposures will be studied by mediation analyses. A matchedcase-control design will be applied to study moderating effects of natural environmentson the association between low socioeconomic status and early development. The mainstatistical approach will be mixed effects models, adjusting for multilevel random effects ofnested data. All models will be adjusted for a priori selected confounders.The Born to be Wise project is relevant to a key set of contemporary challenges relatedto rapidly changing living environments and harmful exposures that may influence earlychildhood development. In many areas, these exposures are ubiquitous, thus affectinglarge populations with the potential for major impacts on population health. Results fromthe project will provide empirical evidence on the impact of environmental exposureson early development and may ultimately inform effective policies and interventionsto support healthy urban planning for vulnerable populations, particularly children insocioeconomically deprived areas.Int. J. Environ. Res. Public Health 2021, 18, 10654 78 of 101Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 79 of 104 Figure 9. Healthier Beginnings: Early Life interventions: Overview of topics and speakers in the session on developmental ecology (Part 2). 10.1. Can Rewilding the Microbiome Ameliorate the Effects of Early Life Stress and Transgenera-tional Vulnerability? Bridget Callaghan (Brain and Body Lab, University of California-Los Angeles, Los An-geles, CA 90095, USA). No abstract available. Figure 9. Healthier Begin ings: Early Life interventions: Overvie of topics and speakers in thesession on developmental ecology (Part 2).10.3. ActEARLY: How Can We Keep Our Young People Happy, Health and Physically Active?A Multi-Method, Multi-Disciplinary Community Priority Setting Exercise in the City of Bradford,United KingdomRosie McEachan, Aamnah Rahman and Chris Cartwright (Bradford Institute for HealthResearch, Bradford Teaching Hospitals NHS Foundation Trust, UK).Int. J. Environ. Res. Public Health 2021, 18, 10654 79 of 101Economic, physical, built, cultural, learning, social and service environments havea profound effect on lifelong health. However, policy thinking about health research isdominated by the “biomedical model” which promotes medicalisation and an emphasis ondiagnosis and treatment at the expense of prevention. Prevention research has tended tofocus on “downstream” interventions that rely on individual behaviour change, frequentlyincreasing inequalities. Preventive strategies often focus on isolated leverage points andare scattered across different settings. Born in Bradford is part of a new ActEarly researchconsortium aims to create City Collaboratory testbeds to support the identification, imple-mentation and evaluation of upstream interventions within a whole system city setting toimprove children’s health.Community co-production is vital to ensure that preventive strategies are acceptableand feasible to implement which in turn will increase their effectiveness. A multi-methodpriority setting exercise led by a community steering group was conducted with communi-ties in 2019 to inform the focus of the consortium. Adapting a James Lind Alliance approachto research priority setting we conducted a survey with 1000 community members and over20 community events asking people what they felt was important to keep children “happyand healthy”. We found that people identified healthy eating, physical activity and healthylifestyles as priorities for keeping children healthy most often; whilst they identified mentalhealth, socialising and nurturing environments most often as priorities for keeping childrenhappy. Communities’ priorities reflected both individual determinants (e.g., education andattitudes) and structural determinants (e.g., access, environment) of health as important.The findings are being used to co-design prevention strategies to improve the health andhappiness of families in Bradford and London (Tower Hamlets), UK. For more informationsee: https://actearly.org.uk/ accessed on 1 August 2021.10.4. How Changes in the Anthropocene May Influence the Role of Breast Milk as Child’s BestPersonalised Medicine?Valerie Verhasselt (University of Western Australia, and Telethon Kids Institute, Nedlands,WA 6009, Australia).Breast milk contains thousands of bioactive compounds, which have the potentialto influence infant immune health. The composition of breast milk is highly dependenton maternal environment, and we propose to consider breast milk as a mini-exposomededicated to preparing the child to his future exposome. We suggest this key functionof breast milk is hampered by new practices of breastfeeding and by extreme changes ofbreast milk composition in the Anthropocene. Here, we will review some evidence of thisworking hypothesis.The personalized medicine afforded by breastfeeding is best illustrated by the immunedefences that are provided to the breastfed newborn. A mother exposed to respiratory orenteric pathogens will produce antibodies that will protect her from infection. Importantly,those antibodies will also be secreted in breastmilk through the gut–respiratory–breast axisand provide passive immunity to the newborn against pathogens that are specific to theenvironment where the newborn is raised. Our recent data also highlight that pathogens’antigen shedding in maternal milk may be a way to naturally vaccinate the offspring. Inthe era of globalization, newborns are now receiving human milk from milk bank wherebreast milk was collected at distant places and may not have the appropriate compositionfor the child.A striking observation is that breast milk is not protecting from allergic disease, andthis is not expected for the child’s physiological food that is endowed with multipleimmune modulatory properties. To understand this conundrum, we hypothesis thatextreme change in maternal exposome may have affected the anti-allergenic properties ofbreast milk. Supporting this hypothesis, our data both in rodents and in human cohortsshowed that the presence of house dust mite allergen in human milk (found in about 50%of milk samples) was associated with increased risk of allergy in offspring. House dust mitehave been living on our planet for million years and have probably always been present inInt. J. Environ. Res. Public Health 2021, 18, 10654 80 of 101maternal milk. To address the hypothesis that maternal exposome has changed the milkcomposition and its capacity to inhibit allergic priming in offspring, we are now exploringthe influence of maternal diet on milk anti-allergenic properties. Within the ORIGINS birthcohort, we aim to reveal whether maternal intake of prebiotics can restore such a profile.Knowing that more than 80% of the children will be receiving human milk, thereis a critical need to provide mothers with recommendations that increase the chance ofchild healthy development. The understanding of how the multiple breast milk bioactiveswill influence immune outcomes in offspring is fundamental to instruct evidence-basedmaternal interventions that will contribute to increase child health through breastfeeding.10.5. Breastfeeding and Planetary Diets: Why Breast Milk Substitutes Should Have the SameAspirations for People, Place and PlanetDaniel Munblit (Imperial College London, St Mary’s Hospital, Praed St, London W2 1NY, UK).No abstract available.10.6. The Benefits of Spending Time in Nature for Infant Gut Health—Overcoming the IncreasingUse of Disinfectants in the Post-COVID EraAnita Kozyrskyj (Department of Pediatrics, Faculty of Medicine & Dentistry, Alberta,Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada).Natural environments (e.g., native vegetation) and biodiversity, through the influenceof environmental microbes, may be beneficial for human commensal gut microbiota,especially for its development during infancy. The nature on gut health story in Dr.Kozyrskyj’s presentation was told in two parts with evidence from the CHILD CohortStudy: (i) depletion of environmental microbes and hence, infant gut microbiota in thehome through greater use of disinfectant cleaning products, and (ii) proximity to naturalenvironments in urban centres as an intervention to restore depleted gut microbes inyoung infants.Main findings from the first study showed that increasing frequency of home dis-infectant use successively increased the chance of an infant having high levels of Lach-nospiraceae in their gut microbiota at 3–4 months of age and becoming overweight at age 3.Taking the statistical analysis one step further by conducting a mediation test, higher levelsof the Lachnospiraceae bacteria were found to be responsible for the association betweendisinfectant use and child overweight.The second study was based on data linkage between the unique Urban Primary Landand Vegetation Inventory (uPLVI) for the city of Edmonton and 355 infants in the CHILDbirth cohort, infant exposure to natural environments (yes/no) was determined within500 m of their home residence. Gut microbiota composition and diversity at age 4 monthswas assessed in infant faecal samples. Adjusted for covariates, we observed a reduced oddsof high microbial alpha-diversity in the gut of infants exposed to any natural environment(Simpson index = 0.63 (0.41, 0.98)). In stratified analyses, these associations remained onlyamong infants not breastfed or living with household pets.When doubly stratifying by these variables, the reduced likelihood of high alpha-diversity was present only among infants who were not breastfed and lived with householdpets (9% of the study population, Simpson diversity index = 0.11 (0.02, 0.66)). Differencesin beta-diversity was also seen (p = 0.04) with proximity to a nature space in not breastfedand pets-exposed infants. No associations were observed among infants who were fullyformula-fed but without pets at home. When families and their pets had close access to anatural environment, Verrucomicrobiales colonization was reduced in the gut microbiota offormula-fed infants, the abundance of Clostridiales was depleted, whereas the abundanceof Enterobacteriales was enriched.Our double-stratified results indicate that proximity to a natural environment pluspet ownership has the capacity to alter the gut microbiota of formula-fed infants.Int. J. Environ. Res. Public Health 2021, 18, 10654 81 of 10110.7. Improved Eating Habits and Active Playtime though Connecting Preschool Children toNature: Preliminary Results of a Randomized Controlled TrialTanja Sobko (University of Hong Kong, Pok Fu Lam, Hong Kong, China).The urgency to develop and test novel and more diverse lifestyle intervention pro-grams for pre-school children is obvious. We feel our study breaks new ground in terms ofdemonstrating the additional benefits accrued by strategically integrating short, simple,creative, and interactive natural world engagements for young children and their care-givers participating in lifestyle intervention programs aimed at promoting healthier eatingand nature practices. The Connectedness to Nature (CN) component of the researched Play& Grow programme shows to amplify the effects of some of the standardised nutritioneducation of the intervention. We further explored new direct links regarding feedingand eating habits and show that the Play & Grow intervention positively increased care-givers and children CN, which improved children eating behaviours. This indicates ahigher autonomy in children’s eating behaviours if they are exposed to nature. Further,the methodology described could help researchers/practitioners to better understand howconnectedness to nature affects child health when it comes to feeding, eating and wellbe-ing. We therefore believe that our paper would be of particular interest in the context ofhealth behaviours, health promotion in early childhood and early environmental education.Future research should include and further test the CN module in promotion of healthylifestyles in pre-schoolers, especially its possible long-term effect.Suggested Reading: T. Sobko, G. Brown and W.H.G Cheng. Does Connectedness toNature improve the eating behaviours of pre-schoolers? Emerging evidence from the Play& Grow randomised controlled trial in Hong Kong. Appetite.2020 Nov 1;154:104781.10.8. Impact of COVID-19 on Families: Comparison of Birth Cohorts in Australia and the UnitedKingdom (Collaboration between ORIGINS and Born in Bradford)Bridget Lockyer 1, Lisa Gibson 2,3,4, Josie Dickerson 1, Charlotte Endacott 1, Sally Bridges 1,Rosemary McEachan 1, Kate Pickett 7, Sarah Whalan 2, Natasha Bear 8, Desiree Silva 2,3,4,5,Susan Prescott 2,3,4,5 and Jacqueline Davis 2,3,5 (1 Bradford Institute for Health Research,Bradford Teaching Hospitals NHS Foundation Trust, UK; 2 Telethon Kids Institute, 15 HospitalAvenue, Nedlands, WA 6009, Australia; 3 The University of Western Australia, Perth, Australia;4 Joondalup Health Campus, Perth, Australia; 5 Edith Cowan University, Perth, Australia; 6Curtin University, Perth, Australia; 7 Department of Health Science, University of York, UK; 8Institute for Health Research, Notre Dame University, Perth, WA 6160, Australia).Few studies have documented the impact of the COVID-19 pandemic on the emotionalwellbeing, needs and concerns of the general population. Free text questions were adminis-tered to participants in the ORIGINS (Australia) and Born in Bradford (UK) cohort studiesto collect qualitative information on worries, concerns and enjoyable experiences duringthe pandemic. A total of 903 (400 for ORIGINS and 503 for BIB) participants completed thetwo surveys during April 2020. Despite varying in geography, levels of socio-economicdisadvantage and the situational context during the pandemic, respondents from bothcohorts reported similar worries and challenges during the lockdown period includingemployment/finances, health anxiety, mental health and social isolation, caring for chil-dren and child development. Families across the globe experienced both positive andnegative immediate impacts of COVID-19. Population-based data can be used to informthe development of support services, public health campaigns and universal interventionsto assist families in future health crises.10.9. Urban Children’s Wellbeing Factors and Qualities of Being and Doing in Natural SpaceMisako Nagata 1 and Patricia Liehr 2 (1 Department of Health Science and Nursing,Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-City, Tokyo,113-0033, Japan; 2 Christine E. Lynn College of Nursing, Florida Atlantic University, 777Glades Road, Boca Raton, FL 33431, USA).Int. J. Environ. Res. Public Health 2021, 18, 10654 82 of 101In the presentation, I discuss my mixed methods research study about urban chil-dren’s wellbeing through nature immersion—being and doing in natural space—from theperspective of Nursing. This research came from my lifelong inquiry: everyday phenomenaaround us can be observed in order or pattern, and this would be the conditions of naturallaw. Certain phenomena can occur if certain conditions meet. Then, healing could occurwhen nature around us meets with certain conditions for healing. Florence Nightingale(1820–1910) said that what nursing has to do was to arrange the environments of thepatient in the best condition for nature to act upon him. Given a hint from her statement, Ideveloped a concept called Nature Immersion. Nature Immersion is defined as connect-ing with earthy materials to generate healing force from within embodied as personalemergence. Healing emerges when nature meets the person with certain conditions. Thisassumption launched the research on wellbeing conditions for urban children who weredistant from nature.Battery Urban Farm, which is located at the south tip of Manhattan, New York, issurrounded with green and blue space with a community garden. The farm was chosen toexplore parental reports of wellbeing conditions of urban children. Both the quantitativedata (N = 174) and the qualitative data (N = 15) were collected. The research led a newmodel for the conditions of urban children’s wellbeing. There were space–time factorsand parental appreciation of their children’s being and doing in urban nature. The re-sults indicated the wellbeing conditions were those with nature–child immersion: higherparental appreciation, higher frequency of visits, short-lived but expansive nature exposure,learning and caring hubs, and integration that creates oasis. Environmental conditionsaltogether, compared to parental socioeconomic status, had a significant impact (p < 0.001).From the results, it may have meant about what Nightingale said, “Health is not onlyto be well, but to be able to use every power we have to use”. Her statement is linkedto a sort of natural law where health, healing, and wellbeing are expressed as emergentprocesses of rejuvenating, remembering, and reconnecting the whole system of oneself—body, mind, spirit, culture, and environment. This natural law is not fixated but flexible, foras urban children choose to be and do in nature, they are connecting their whole system,creating potential for wellbeing.10.10. The Influence of Early Vitamin D Supplementation and UV Light Exposure on AllergicDisease Outcome in Infancy: A Double-Blinded Randomized Controlled TrialKristina Rueter 1,2, Anderson P. Jones 3, Aris Siafarikas 1,2,3,4, Paola Chivers 4,5, SusanL. Prescott 1,2,6 and Debra J. Palmer 1,3 (1 School of Medicine, The University of WesternAustralia, 35 Stirling Highway, Crawley, WA, 6009, Australia; 2 Perth Children’s Hospital,15 Hospital Avenue, Nedlands, WA 6009, Australia; 3 Telethon Kids Institute, University ofWestern Australia, 15 Hospital Avenue, Nedlands, WA 6009, Australia; 4 School of Medicaland Health Science, Edith Cowan University, Perth, WA 6027, Australia; 5 Institute forHealth Research, The University of Notre Dame Australia, Perth, WA 6160, Australia; 6 TheORIGINS Project, Telethon Kids Institute and Division of Paediatrics, University of WesternAustralia, 15 Hospital Avenue, Nedlands, WA 6009, Australia).Background/Aims: The epidemic of allergic disease is a public health crisis partic-ularly in children in developed countries. Changing human behaviour has led to lesssunlight exposure and associated predisposition to vitamin D deficiency. Vitamin D isknown to have immunomodulatory functions and low levels of vitamin D have beenlinked to allergies in children. However, randomised controlled trials (RCTs) on the effectof vitamin D supplementation during infancy as an allergy prevention strategy are lacking.Method: We investigated the influence of oral vitamin D supplementation for the first6 months of life in high-risk infants (n = 195). Uniquely, sunlight exposure was measuredby a UV-dosimeter. Infant blood samples were taken to determine relationships betweenoral vitamin D supplementation and ultraviolet (UV) light exposure with blood 25(OH)Dconcentration and immune cell function responses to allergens. At 6 months, 1 and 2.5 yearsof age infants were examined for allergic disease outcomes.Int. J. Environ. Res. Public Health 2021, 18, 10654 83 of 101Results: At 1 year of age results showed no difference in eczema (p = 0.17), eczema severity(p = 1.0), wheeze (p = 0.13) and food allergy (p = 0.98) incidence or sensitisation (p = 0.24)between the vitamin D supplemented and placebo groups. This finding was consistent withour 6 months outcomes (eczema (p = 0.68), eczema severity (0.82); wheeze (p = 0.79)). However,infants with eczema in the first 6 months had significantly less UV light exposure from 0 to3 months than children without eczema (p = 0.023). UV light exposure was also inverselycorrelated with IL-2, GMCSF and eotaxin production to Toll-like receptor ligands.Conclusions: Initial findings of this RCT reveal that early vitamin D supplementationhad no influence on allergic disease outcome in infancy. However, UV light exposurein the first 3 months was independently associated with immunomodulatory effects andappeared to reduce the risk of eczema. Further follow up data are in preparation and willbe presented at the conference.10.11. Exploring the Experience and Engagement of Perinatal Women in Online EmotionalWellbeing TrainingJacqueline Davis 1,2, Susan Prescott 1,2, Amy Finlay-Jones 1, Jeneva Ohan 2 and De-siree Silva 1,2,3 (1 Telethon Kids Instiute, Nedlands, WA 6009, Australia; 2 Universityof Western Australia, Nedlands, WA 6009, Australia; 3 Joondalup Health Campus,Joondalu, WA 6027, Australia).Background: The perinatal (antenatal and postnatal) period can be a time of increasedpsychological distress. Up to 9% of women experience depression during pregnancy andup to 16% suffer from postnatal depression. Maternal psychological distress (stress, anxietyand depression) in the early postpartum period can disrupt mothers’ wellbeing, functionalability, interpersonal relationships, including those with the infant. Subjective wellbeing iscrucial for positive mental health and wellbeing. Positive mental health could be a bufferduring times of psychological distress, such as that experienced in the perinatal periodwhich effects the mother and potentially the developing child. Cost-effective interventionsthat support lasting positive mental health, while also preventing symptoms of negativemental health, are of critical importance for public health. While there are evidence-basedinterventions that can be applied during the perinatal period, there is little known aboutenduring engagement and sustained practices.Aim: This PhD project’s aim is to understand the engagement and experience ofwomen undertaking perinatal minimal contact wellbeing interventions that build positive,sustained emotional assets.Methods: A series of studies will be undertaken within the ORIGINS Project, anexisting longitudinal pregnancy cohort study in Western Australia. These include a pilotRandomised Controlled Trial (RCT), “Mums Minds Matter” that will explore women’s expe-rience and engagement of online mindfulness and self-compassion training using a mixedmethods design. Women will be followed up at various timepoints, post-intervention. Asecond study will assess willingness to engage by type of available online wellbeing pro-gram. Third, “Community Wellbeing during COVID-19” will explore pregnant women’semotional wellbeing information and support needs during the pandemic period. Addi-tionally, a systematic review will explore the extant literature on engagement and retentionin digital mental health and wellbeing programs by perinatal women.Status: Ethics approval has been provided, pending confirmation of the third study.Data collection is underway.10.12. Modulation of the Immune System in Feto-Maternal Tissues by Prebiotics Supplementationduring Pregnancy: A Future Strategy for Allergy PreventionCarole Brosseau (French National Institute for Agriculture, Food, and Environment [IN-RAE], Centre de Recherche Angers-Nantes 44000, France).Allergies are multifactorial diseases related to the dysfunction of the microbiota, ep-ithelial barriers and the immune system leading to a failure in the establishment of immunetolerance. Pregnancy represents an optimal window of intervention in the regulation of theInt. J. Environ. Res. Public Health 2021, 18, 10654 84 of 101allergic process by modulating the immune and microbial systems of the foetus. Prebioticscan modulate the immune system, the microbiota and the intestinal barrier.A preclinical study carried out in our laboratory shows that prebiotics supplementa-tion during pregnancy and lactation reduces the development of food allergy in offspring.The aim of this study was to understand the immunological processes of prebiotics admin-istered during pregnancy only on foetal and maternal tissues. Pregnant mice received astandard diet or a diet enriched with prebiotics (GOS/inulin). After 18 days of gestation,the frequency of the different lymphoid and myeloid cell populations was determined inthe different gestational (decidua, placenta, uterus), maternal (spleen) and foetal (intestine,blood) tissues. The effect of prebiotics on the frequency of hematopoietic stem cells frommother and foetus femur was also determined.Supplementation with prebiotics during gestation increases significantly the frequencyof IL-10-secreting regulatory B lymphocytes in the placenta compared to mice on a standarddiet. They are also found in the intestine and bone marrow of the foetus. The rate ofregulatory T cells is also significantly increased in the placenta of mice supplemented withprebiotics compared to control. Prebiotics have no effect on the frequency of dendritic cellsnor on the homeostasis of hematopoietic stem cells.In conclusion, prebiotic supplementation during pregnancy leads to the establishmentof a tolerogenic environment which could protect the foetus against future allergies.10.13. Impact of Prebiotics Supplementation during Pregnancy on Food Allergy Developmentin OffspringAmandine Selle, Carole Brosseau, Angéline Duval and Marie Bodinier (French NationalInstitute for Agriculture, Food, and Environment (INRAE), Centre de Recherche Angers-Nantes 44000, France).Allergies are multifactorial diseases related to the dysfunction of three biological ac-tors: the microbiota, the epithelial barriers and the immune system. These alterations leadto a defect in the establishment of immune tolerance. Compelling evidence for the earlyrole of gut microbiota dysbiosis and barrier integrity with allergies is emerging. In thiscontext, pregnancy represents an optimal window of intervention in the regulation of theallergic process through a modulation of the immune and microbial systems, which makesit a promising avenue for the prevention of allergy. Prebiotics are able to act on the immunesystem, the microbiota and the intestinal barrier. The aim of our study is to assess theeffect of prebiotic supplementation during pregnancy on the development of food allergyin offspring. To do this, mice received a diet enriched in prebiotics (GOS/inulin) duringpregnancy. Then, food allergy to wheat was induced in their offspring by two intraperi-toneally sensitization and one oral challenge with the allergen (gliadins). Subsequently, weanalysed clinical symptoms and immunological and physiological biomarkers of allergy.In the context of prebiotic supplementation, we observed in offspring: 1) a tendency todecrease allergic symptoms; 2) no decrease of allergic markers (TH2, IgE); 3) a tendency toincrease tolerance biomarkers; 4) a decrease in the degradation of the intestinal barrier inthe presence of food allergies. These results show that prebiotics could induce tolerogenicenvironment on the offspring when they are used during pregnancy, but this strategy isnot enough to reduce the allergy.10.14. Short Chain Fatty Acids Augment Differentiation and Function of Human InducedRegulatory T CellsMingjing Hu 1, Bilal Alashkar Alhamwe 2, Brigitte Santner-Nanan 1, Sarah Miethe 2,Hani Harb 3, Harald Renz 2, Daniel P. Potaczek 2 and Ralph Nanan 1 (1 Charles PerkinsCentre Nepean, Sydney Medical School Nepean, The University of Sydney, Sydney, NSW2747, Australia; 2 Institute of Laboratory Medicine, Member of the German Center for LungResearch (DZL), and the Universities of Giessen and Marburg Lung Center (UGMLC),Philipps-University Marburg, Germany; 3 Division of Immunology, Boston Children’sHospital, Harvard Medical School, Boston, MA 02115, USA).Int. J. Environ. Res. Public Health 2021, 18, 10654 85 of 101Regulatory T cells (Tregs) control immune system activity and inhibit inflammation.While in mice short-chain fatty acids (SCFAs) are known to be essential regulators ofnaturally occurring and in vitro induced Tregs (iTregs), data on their contribution to thedevelopment of human iTregs are sparse, with no report of the successful SCFA-augmentedin vitro generation of fully functional human iTregs. Likewise, markers undoubtedly defin-ing human iTregs are missing. Here, we aimed to generate fully functional human iTregsin vitro using protocols involving SCFAs and to characterize the underlying mechanism.Besides, our target was to identify the potential phenotypic markers best characterizinghuman iTregs. Naïve non-Treg CD4+ cells were isolated from peripheral blood of 16 healthyadults and cord blood of 12 healthy term newborns. Cells were subjected to differentiationtowards iTregs using a transforming growth factor β (TGF-β)-based protocol, with orwithout SCAFAs, acetate, butyrate, or propionate. Thereafter, they were subjected, withor without preceding restimulation, to flow cytometric phenotyping or suppression as-say. During differentiation, cells were collected for chromatin-immunoprecipitation-basedanalysis of histone acetylation. Enrichment of the TGF-β-based protocol with butyrate orpropionate potentiated the in vitro differentiation of human naïve CD4+ non-Tregs towardsiTregs and augmented the suppressive capacity of the latter. These were at least partlyunderlain by the effects of SCFAs on histone acetylation levels in differentiating cells. GITR,ICOS, CD39, PD-1, and PD-L1 proved to be potential markers of human iTregs. Our resultsmight boost further development of Treg-based therapies against autoimmune and chronicinflammatory disorders.10.15. Does Dairy Fat Alter the Gut Microbiome of Australian Children? A RandomisedControlled TrialClaus Christophersen 1,2, Kane E. Deering 2, Analise Nicholl 2, Amanda Devine 2, RoseLines 2, Johnny Lo 2, Mary C. Boyce 2 and Therese A. O’Sullivan 2 (1 Curtin University,Bentley, WA 6102, Australia; 2 Edith Cowan University, Joondalup, WA 6027, Australia).There is a paucity of knowledge on the effect of dairy fat on the gut microbiota inyoung children. This study, therefore, examines the impact of whole-fat dairy intake,compared to reduced-fat dairy intake, on the paediatric gut microbiome.Forty-nine healthy Australian children who were regular consumers of whole-fatdairy were recruited for a 12-week double-blind randomised clinical trial (ANZCTR:12616001642471). Participants were distributed using block randomisation into eithera whole-fat dairy group (WFDG) or reduced-fat dairy group (RFDG). Participants wereprovided with ad libitum dairy products based on their habitual intake. Three-day weighedfood records, physical measurements, blood and stool samples were collected at baselineand post-intervention.Forty-nine participants (mean (SD) age = 5.26 (0.88) years, female n = 23) were ran-domised (WFDG = 25; RFDG = 24); 46 children completed the intervention. The two groupsconsumed similar amounts of dairy, however, participants in the WFDG consumed signif-icantly more fat (grams) (pFalseDiscoveryRate < 0.001) and saturated fat (pFDR < 0.001)per day. All participants met the adherence guideline (1 serving) of dairy (300 mg cal-cium) per day with an overall median serve of 2.01. The microbial analysis revealedthat there was no overall significant change in richness, -diversity (Shannon diversity)or -diversity in either group at the phylum or genus level. While there was a significantincrease in the relative abundance of Actinobacteria (pFDR = 0.012) and Subdoligranulum(pFDR = 0.048) in children allocated to the RFDG group. In the WFDG, relative abundanceof Bacteroides increased significantly (pFDR = 0.036) and Massiliomicrobiota decreasedsignificantly (pFDR = 0.005). The relationship between the faecal microbiota, metabolitesand the consumed diet is still being investigated.Modifying dairy fat intake in young Australian children may alter the relative abundanceof specific bacteria; however, it is unlikely to significantly change alpha- or beta-diversity.Int. J. Environ. Res. Public Health 2021, 18, 10654 86 of 10111. From the Grassroots: Change through Communities and NetworksMeaningful change increasingly depends on grassroots strategies that improve thehealth of people and places—and ultimately our planet. These strategies empower com-munities, engender optimism, and encourage collaboration among different sectors ofgovernment, industry, science, and the public and increase opportunities for people toengage in change personally and collectively. This session explores the importance ofempowering and connecting communities—that people everywhere can have more effectthan they realize by telling their stories of change, no matter how small they seem, toempower others—for a contagion of positive change (Figure 10). Connecting all thesemany stories of change is how we build large scale change. This requires imagination,creativity, courage and inspiration—and shared stories to help create just that!Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 88 of 104 11. From the Grassroots: Change through Communities and Networks Meaningful change increasingly depends on grassroots strategies that improve the health of people and places—and ultimately our planet. These strategies empower com-munities, engender optimism, and encourage collaboration among different sectors of government, industry, science, and the public and increase opportunities for people to engage in change personally and collectively. This session explores the importance of em-powering and connecting communities—that people everywhere can have more effect than they realize by telling their stories of change, no matter how small they seem, to empower others—for a contagion of positive change (Figure 10). Connecting all these many stories of change is how we build large scale change. This requires imagination, creativity, courage and inspiration—and shared stories to help create just that! Figure 10. Making change through communities and networks: Overview of topics and speakers in the session on grassroots engagement. Figure 10. Making change through communities and networks: Overview of topics and speakers inthe session on grassroots engagement.Int. J. Environ. Res. Public Health 2021, 18, 10654 87 of 10111.1. Special Guest: Inspiring Hope through Stories of Grassroots Action: Using Impact-DrivenFilm to Accelerate Change. A Message from the Redford CenterJill Tidman (Executive Director. The Redford Center, The Presidio, San Francisco, CA94129, USA).This is a message of hope from The Redford Center and includes three short filmstelling stories of change in number of communities, including a message from co-founderRobert Redford, Uniontown Votes, Hunger for Change and Closing the Gap. This recording(including the films) is available through our online proceedings [12].11.2. Galvanising Action towards Justice in a Greener and Healthier Future—Addressing HealthDisparities Created by COVID-19 in DetroitNicholas J. Schroeck (University of Detroit Mercy School of Law, 651 East Jefferson Ave.,Detroit, MI 48226, USA).This presentation examines drinking water regulations under the United States SafeDrinking Water Act pertaining to bacteria and the type of public notice required when adisease outbreak related to public water supply occurs. Then, the focus shifts to lessonslearned from the failure to provide public notice of the Legionnaires’ disease outbreak inFlint and Genesee County, Michigan during the Flint water crisis. Additionally, I analysethe recent proposed changes to the federal Safe Drinking Water Act, Lead & Copper Rule.I provide a brief overview of the Lead & Copper Rule and the Environmental ProtectionAgency’s proposed changes to the Rule. Finally, I identify remaining gaps in the Lead &Copper Rule, particularly in relation to environmental justice communities, and compareand contrast the Safe Drinking Water Act with regulations in other countries.11.3. Co-Creating Multi-System Human and Planetary Resilience with Nature: Using Ecology,Campaigns and Activism for TransformationRobert Verkerk (Science Unit, Alliance for Natural Health International, Chilworth, Surrey,Chilworth, Surrey GU4 8NS, UK).Planetary, ecosystem and human resilience are degrading rapidly because ecosystemservices utilised by humans are exceeding their natural capacity for sustainability. In-creasing recognition of the linkage between the challenges facing human health and thosefacing the environment offer unique opportunities for the resolution of both crises. Suchsolutions require a widescale recognition of the ecological interactions both within andoutside the human body within the context of a systems approach. This contrasts withthe siloed, reductionist approach that has been central to rapid technological developmentin industrialised countries that has also been, directly or indirectly, central to the loss ofintegrity and resilience of human and natural systems.Any transition towards sustainable health systems requires the development of proac-tive, eco-centric health systems that are focused on creating, maintaining or regeneratingadaptive capacity, health and resilience throughout the lifespan of individuals in communi-ties. Such an approach needs to extend well beyond the scope of existing, largely top-downpublic health support. Successful implementation of such a proactive, salutogenesis-based systems would greatly reduce net disease burdens on existing, largely reactive,disease-centric, “health care” systems, while also reducing net costs and productivity lossesincurred by society.Two essential prerequisites are: (a) a universal language of communication betweencitizens, health professionals, health authorities, businesses, educational establishmentsand other organisations and institutions; and (b) a multi-disciplinary scientific frameworkthat extends beyond the current and limited scope of the medical sciences. Extensiveconsultation with experts, health professionals from diverse backgrounds, communitiesand industry has concluded with a consensus view that the language should be basedaround physiological, psychological and social function, while systems ecology providesthe appropriate multi-disciplinary framework. Based on this approach, a two-tiered,Int. J. Environ. Res. Public Health 2021, 18, 10654 88 of 101bottom-up model for community-based, sustainable health systems has been created bythe Alliance for Natural Health International.The first tier of the model allows for self-assessment, guided assessment or biomedicalassessment of resilience of individuals via 12 domains of an individual’s “ecologicalterrain”. Within communities, individuals are guided by health and fitness professionals(“health guides”) in ways that optimise function while minimising stressors that limit theadaptive and transformative capacity across all domains. Both citizens and their healthguides would subscribe to shared values, goals and priorities, including use of the commonlanguage around system function. The second tier of the model includes 10 hallmarks forhealth system sustainability that must be fulfilled to ensure compliance by health guidesand citizens alike. The model lends itself to extensive digitisation and would contributesubstantially to the democratisation of health and care systems.Real-world testing of the community-based sustainable heath system model is nowurgently required, particularly in the wake of COVID-19 which has further widenedhealth inequalities and emphasised the importance of high quality, measurable, self-carein communities. Such seismic changes to the predominantly reactive nature of exist-ing healthcare systems will not be triggered without compelling pressure and powerfulactivism by influential individuals, communities, organisations and forward-thinking,purpose-driven companies.11.4. Life Knowledge for Preventing Lifestyle Diseases: Experiential Culinary and LifestyleLearning for Medical StudentsChris D’Adamo (Department of Family and Community Medicine, Center for IntegrativeMedicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; TheInstitute for Integrative Health, 1407 Fleet Street, Baltimore, MD 21231, USA).Nutrition education for medical students has generally been limited in both curricu-lum time and relevance to patient care. This paucity of nutrition training carries throughinto residency and ultimately clinical practice. Thus, physicians are often left with limitedknowledge and tools to help patients eat healthier diets known to reduce the risk of chronicdisease. “Culinary medicine” education has become increasingly popular in medicalschools across the United States to help fill this important gap in training. Medical studentselecting to participate in experiential culinary medicine education have demonstratedimprovements in nutrition knowledge, skills, and attitudes for both personal and patientcare. While promising, most culinary medicine education is currently only offered on anelective basis to relatively small cohorts of medical students.Following a series of successful elective pilot sessions, culinary medicine trainingwas incorporated into the core medical student curriculum and was provided to all first-year medical students at the University of Maryland School of Medicine in the 2019–2020 academic year. The training was held at the community-based teaching kitchenof the Institute for Integrative Health in Baltimore, Maryland. The three-hour trainingincluded a combination of: (1) evidence-based nutrition lecture supporting a unifying“nutrient density” approach to numerous popular dietary approaches (Mediterranean, low-carbohydrate, low-fat, palaeolithic, plant-based) while offering practical strategies to helpovercome personal and patient barriers to healthy eating, (2) cooking simple recipes basedupon tenets of the lecture, and (3) eating the meal together and discussing the applicationsof the training to personal and patient care. A mixed-methods outcomes analysis wasconducted and statistically significant improvements were noted in mean scores of allnutrition knowledge, skills, attitudes and patient counselling outcomes that were assessed.Themes of being better prepared to address barriers to healthy eating in patient care,familiarity with multiple evidence-based popular diets to help offer choices to patients inhow to eat healthier, and ability to make practical healthy eating behaviour changes in themedical students’ own lives were noted in qualitative analysis.In light of the success of the culinary medicine training for medical students, aninterprofessional culinary medicine course has been developed and is currently beingInt. J. Environ. Res. Public Health 2021, 18, 10654 89 of 101offered at the Institute for Integrative Health to medical, nursing, dentistry, social work,pharmacy, and law students at the University of Maryland, Baltimore graduate campus.The course has been similarly well received and plans for expansion of this experientialtraining are underway.11.5. Mission Thrive Community-Based Programs: Empowering Youth, Families, andCommunities to Make Lifestyle Changes That Support Their Health and WellbeingBrian Berman 1,2, Brandin Bowden 1 and Christopher R. D’Adamo 1,2 (1 The Institute forIntegrative Health, 1407 Fleet Street, Baltimore, MD 21231, USA; 2 Department of Familyand Community Medicine, Center for Integrative Medicine, University of Maryland Schoolof Medicine, Baltimore, MD 21201, USA).This was a video presentation based on the work of the Mission Thrive Summer(MTS) program, that was developed to address the physical inactivity, poor nutrition, andchronic stress, which threaten the health of African American youth in urban environments.The program was targeting in the summer period when conditions often worsen withdiminished access to healthy foods and safe venues for physical activity. MTS was anintegrative health intervention developed as a public-private partnership—based at anurban farm and adjacent school in a low-income community in Baltimore, Maryland.The intervention included farming, nutrition education, cooking, physical activity, yoga,mindfulness, and employment. Mixed-methods outcomes evaluation was conducted.Quantitative measures included accelerometery and self-reported health behaviours, usingthe Child and Adolescent Mindfulness Measure, Perceived Stress Scale, Physical ActivityQuestionnaire for Adolescents (PAQA), CDC Youth Risk Behavior Survey, and Block KidsFood Screener (BKFS). Participants experienced statistically significant improvements inself-reported physical activity (PAQA) and dietary habits (BKFS). Surveys did not detectchanges in stress or mindfulness. Qualitative data demonstrated new knowledge and skills,increased self-efficacy, health behaviour change, and program enjoyment. These findingsshow that MTS was feasible among African American high school students in Baltimore.Mixed-methods outcomes evaluation provided preliminary evidence of health behaviourchange during the summer and at follow-up.Further reading: B. Pierce et al. A Summer Health Program for African-AmericanHigh School Students in Baltimore, Maryland: Community Partnership for IntegrativeHealth. Explore (NY). 2017; 13 (3): 186–197.11.6. Mindfulness at Patterson Partnership: Impact of a school-wide mindfulness program onattitudes, behaviour and performanceBrandin Bowden 1, Brian Berman 1,2 and Christopher R. D’Adamo 1,2 (1 The Institute forIntegrative Health, 1407 Fleet Street, Baltimore, MD 21231, USA; 2 Department of Familyand Community Medicine, Center for Integrative Medicine, University of Maryland Schoolof Medicine, Baltimore, MD 21201, USA).The Mindfulness at Patterson Partnership (MAPP), an initiative of the Institute forIntegrative Health, evaluated the Holistic Life Foundation’s Mindful Moment programat Patterson High School in Baltimore, Maryland. The 15 min mindfulness practice in-cluded seated yoga, breathwork and silent reflection. The University of Maryland Schoolof Medicine’s Center for Integrative Medicine helped identify a combination of school-wide and student-level outcomes to explore the research question: “Is implementing amindfulness program in an entire urban high school feasible and effective”. The researchteam concluded this primarily intercom-based delivery of a school-wide mindfulnessintervention feasible, with limited effectiveness.The feedback and lessons learned during MAPP highlighted some of the nuancesof collecting outcomes in a real-world setting. The Institute’s Building Bridges DefiningMetrics Forum convened a variety of stakeholders to amplify similar lessons and inspire col-laborative solutions. These rich discussions informed a set of guiding principles for creatingand evaluating community-based programs that impact youth health in Baltimore City.Int. J. Environ. Res. Public Health 2021, 18, 10654 90 of 101Further reading: Building Bridges, Defining Metrics: Envisioning an integrativeapproach to community-based programs to improve the health of urban and disadvantagedyouth. Forum Report, 3–4 February 2016, Baltimore: found at: https://tiih.org/files/9614/6921/8738/tiih_2016BBDMreport_final_lowres.pdf accessed on 1 August 2021.11.7. Taking the Planetary Health Pledge: University of Minnesota School of Nursing Leadsby ExampleTeddie M. Potter and the students and staff at Minnesota School of Nursing providea video message “taking the pledge” (School of Nursing University of Minnesota 308Harvard St. SE 6-189B Weaver Densford Hall Minneapolis, MN 55455, USA).The 2020 planetary health pledge published in the Lancet was recited:“I solemnly pledge to dedicate my life to the service of humanity, and to the protectionof natural systems on which human health depends. The health of people, their communi-ties, and the planet will be my first consideration and I will maintain the utmost respect forhuman life, as well as reverence for the diversity of life on Earth”.“I will practise my profession with conscience and dignity and in accordance withgood practice, taking into account planetary health values and principles. To do noharm, I will respect the autonomy and dignity of all persons in adopting an approachto maintaining and creating health which focuses on prevention of harm to people andplanet. I will respect and honour the trust that is placed in me and leverage this trustto promote knowledge, values, and behaviours that support the health of humans andthe planet. I will actively strive to understand the impact that direct, unconscious, andstructural bias may have on my patients, communities, and the planet, and for cultural self-awareness in my duty to serve. I will advocate for equity and justice by actively addressingenvironmental, social, and structural determinants of health while protecting the naturalsystems that underpin a viable planet for future generations. I will acknowledge andrespect diverse sources of knowledge and knowing regarding individual, community, andplanetary health such as from Indigenous traditional knowledge systems while challengingattempts at spreading disinformation that can undermine planetary health. I will share andexpand my knowledge for the benefit of society and the planet; I will also actively promotetransdisciplinary, inclusive action to achieve individual, community, and planetary health.I will attend to my own health, wellbeing, and abilities in order to provide care and servethe community to the highest standards. I will strive to be a role model for my patientsand society by embodying planetary health principles in my own life, acknowledging thatthis requires maintaining the vitality of our common home. I will not use my knowledgeto violate human rights and civil liberties, even under threat; recognising that the humanright to health necessitates maintaining planetary health”.“I make these promises solemnly, freely, and upon my honour. By taking this pledge,I am committing to a vision of personal, community, and planetary health that will enablethe diversity of life on our planet to thrive now and in the future”.Full reference: K. Wabniz et al. A pledge for planetary health to unite health profes-sionals in the Anthropocene. The Lancet 2020; 396 (10261): 1471–1473.11.8. Engaging Healthcare Professionals in the Planetary Health Narrative: Development andRational for a Planetary Health PledgeKathy Wabnitz (Department of Public Health and Primary Care, The Primary Care Unit,University of Cambridge CB2 0SR, UK).In 1948, the Declaration of Geneva was passed by the recently founded World MedicalAssociation, aiming to promote ethical principles underpinning medical practice world-wide. It was grounded in the thinking and practice of the Greek physician Hippocratesand aims to serve as a universally valid set of principles to which doctors should adhere.Reciting the Declaration with her fellow graduates at the Medical Faculty of Tübingen,Germany in 2018, was a significant moment for Katharina Wabnitz, the lead author of arecently published commentary in The Lancet: “A pledge for planetary health to uniteInt. J. Environ. Res. Public Health 2021, 18, 10654 91 of 101health professionals in the Anthropocene”. This experience sparked the idea of formulatinga new pledge, which is broader in scope and audience and engages not only doctors but allhealth professionals in protecting the health of people and planet. It includes principlessuch as intergenerational justice and a new interpretation of what it means to Do no harmin the Anthropocene. Health professionals are among the most trusted members of society.They can play a crucial role in igniting and becoming agents themselves of individualand systemic transformative changes. These changes include a shift from the currentpredominant focus on acute care to promoting and protecting the health of people andthe state of natural systems that underpin the latter through a life-course and intergenera-tional approach to health and a focus on primary prevention. The authors of this pledgeemphasize its suggestive character, published to be used in graduation ceremonies andother events but also to spark further discussion and development of adapted versions tofit local and institutional purposes. We hope that this contribution will be a powerful toolto spark individual and collective action for planetary health.Further reading: K. Wabnitz et al. A pledge for planetary health to unite healthprofessionals in the Anthropocene. The Lancet 2020; 396(10261):1471–147311.9. Narrative Medicine and Planetary Health: Promoting Physician Wellness in the Shadow ofa PandemicMona El-Sherbini (Department of Parasitology, Cairo University, Gisa 12613, Egypt).In the face of mental health challenges secondary to the global pandemic of COVID-19and the larger malaise narratives that operates around them. It is important for physiciansto pay attention to their baseline stress levels, their emotions, and the effect their workis having on them. A magnitude of sharp career demands, strains in the work settings,with barriers to help-seeking such as time constrains and concerns about confidentiality,inevitably may aggravate mental health consequences such as depression, anxiety and post-traumatic stress disorder among physicians and frontline healthcare providers, impactingthe wellbeing and productivity of billions.Early interventions may mitigate the mental health impact on its providers. The coretenets of “Narrative medicine” have emerged to recognize vulnerability (in the self andothers), cultivate emotional equilibrium and foster self-awareness, placing the humansubject at the centre, as a harmonic system continuously interacting with himself and hisenvironment. Planetary Health coordinates interdependent sustainable vitality of all natu-ral and human ecosystems. In synchronizing Planetary Health principles with Narrativepractices in the form of mindfulness and reflection, we may have an opportunity in makingphysician mental wellbeing revitalized with just a few seconds focus micro-practices orstrategies to manage the emotional aspects of stress and leverage positive psychology.Physicians are encouraged to find their own methods for cultivating mindfulness in theirdaily lives, applying mindfulness micro-practices as to STOP (Stop, Take a breath, Observe,Proceed) before seeing new patients or starting new activity, at bedtime or before gettingup. Through physician’s self- regulated attention and capacity for living in resonancewith the outside world, becoming conscious of thoughts, feelings and possible prejudices.Linking narrative medicine to planetary health approaches may help physicians achievemindset equilibrium for concomitant personal and professional growth as crucial aspectsin sustaining the quality of care and wellbeing.11.10. A Case Study on Impacts of Student Organizations Focused on Planetary HealthTaylor Hirschberg and Christopher Lowry (University of Colorado-Boulder, Boulder, CO80309, USA).As stated in the Canmore Declaration, “Planetary health is vital to and inextricablyinterlinked with high-level wellness...and humankind must advocate for planetary health”.There is a need for dialogue in pre-health care educational settings on the relationshipsbetween planetary health and human health. Consequently, we are developing a studentorganization at the University of Colorado Boulder to address this topic. This ethnographicInt. J. Environ. Res. Public Health 2021, 18, 10654 92 of 101case study is being used to develop an understanding of changes in student developmentand quality of life after joining. In Spring of 2020, a student organization was created tobring awareness, inter-institutional collaboration, and advocacy. A pedagogical approachaligned with social events and community service will be the initial structure of the organi-zation with the intent to broaden the understanding of planetary health and to promoteself-identification of what planetary health means to its members. We will administerthree surveys at baseline and again at the end of each semester for a one-year period.First, to assess the impact of the initial programming on student perspectives of planetaryhealth, an online qualitative survey will be given to members. This survey will determineif the student: (1) felt engaged and connected to other students; (2) modified patterns ofbehaviour around protection of the environment; (3) explored new career opportunities;(4) changed previously held understanding of planetary health; and (5) responded withincreased interest in the field of planetary health. We will use the Connectedness to NatureScale (CNS) to determine if engagement in the program affected connectedness to nature,which has been shown to impact quality of life. Furthermore, to test the hypothesis that asense of nature connectedness may impact the quality of life of the participants, we willuse the 36-item short form survey (SF-36), a validated survey that assess physical, mental,and overall health.11.11. 240 s of Lockdown: A Short Film, Giving a “Lightning” Perspective on the Opportunities ofthe COVID-19 Pandemic for the Greater Good of Our World and PlanetAbdelrahman Ahmed El-Badr (Cairo University, Gisa 12613, Egypt).“The consequences of a pandemic could be modulated by the positive narrative wemake of it”. Building upon this notion, the featured 4 min film with a birds-eye viewbeyond individual physical lockdown or isolation to deeper narratives portraying thequalitative similarities and demarcations between today’s COVID-19 pandemic and the1918 Spanish Flu pandemic, highlighting and conceptualizing “Wisdom of Pandemics” asopportunities during adversity for the greater good of our world and planet.Throughout history, grand narratives have weaved together humanities and naturalsciences shaping the future of civilizations. Thus, offering insights into the origins andimpacts of pandemics on human experience and the ability to give voices to the complexmalaise we must heal, changing the way we live on Earth: from ecology to social coexistencefrom a holistic approach.The 1918 pandemic emerged during World War One with great social, economic andmega-planetary upheaval. COVID-19 pandemic and global warming were mentioned as afew examples of the fragility and unsustainability of human activities and ecosystems.Overwhelmed by the observable details, we may have turned a blind eye to thepositive human relationships represented by the courage, faith and solidarity of healthcareworkers, and the hints of planetary revival seen in the return of wildlife to places wherethey were long lost.In conclusion, planet Earth will “go on with or without us”, and we must delve deeperinto the hidden ecological webs in addition to the physical measures taken during thepandemic, with humanity in our line of sight.11.12. Influence of Community Governance on Planetary Health in FijiSarah Nelson Joel Negin, Aaron Jenkins and Seye Abimbola (University of Sydney,Camperdown, NSW 2006, Australia).Background: Fijian village committees play an important role in managing ecologicalecosystem, human health and planetary broader societal outcomes within communities, andthe wider catchment. The actions and practices of individual communities and their committeesimpact the health of the humans and their ecosystems. Understanding these actions andpractices provides understanding how communities manage their natural resources.Methods: A mixed method approach was used. A quantitative survey was conductedon rules, structure and governance of community committees for planetary health. Descrip-Int. J. Environ. Res. Public Health 2021, 18, 10654 93 of 101tive analysis was conducted. Semi-structured interviews and focus group discussions wereconducted in communities to understand structure and management of water resourcesfrom leadership and water committees. Thematic analysis was conducted using NVIVO.Results: Community governance and committee practices, varied amongst commit-tees: some committees had written rules, and organisational practices whereas othershad unwritten rules with ad hoc practices. Without meetings, issues are not raised anddiscussed, and planetary health practices are unable to change. Regular meetings andgreater community involvement in decision-making practices were wanted by communitymembers. Women’s roles were found to vary among committees and the community mem-bers felt a stronger role was required by women. Committee and community behaviourswere found to impact the state of ecosystem, especially the state water.Conclusion: Current community governance and committee practices do not alwaysconsider planetary health and are typically considered in a reactive nature. Stronger gover-nance and practices were wanted by the community. Creating appropriate understandingof community planetary health actions, can help create a healthier ecosystem, reducingdisease, improving farming techniques, land use practices and improving water quality.11.13. The Watershed Interventions for Systems Health in Fiji Project: A Model for AdaptiveManagement of Catchment-to-Reef Social-Ecological SystemsAaron Jenkins 1,2, Stacy Jupiter 3, Pierre Horwitz 2, Jacqueline Thomas 1, Rachel Devi 1,Samuela Lagataki 3, Sangeeta Manghubai 3 and Joel Negin 1 (1 Wildlife ConservationSociety; 2 University of Sydney, Camperdown, NSW 2006; 3 Edith Cowan University,Bentley, WA 6027, Australia).Research from Fiji during the past decade has linked watershed modification to thespread of waterborne bacterial disease, such as typhoid, in human populations, as wellas degradation in downstream freshwater and coral reef communities. Since declines indownstream human health and ecological condition and share several of the same ultimatedrivers (e.g., forest loss, amount of area of high erosion risk, density of creek crossings),well-designed and coordinated watershed interventions should enable achievement ofmultiple objectives across sectors at reduced expense.The Watershed Interventions for Systems Health in Fiji (WISH Fiji) project providesa model case for transdisciplinary cooperation to: evaluate initial catchment conditions;co-design management interventions with Fijian landowners and industry; and monitordownstream responses in indicators of public health and ecosystem wellbeing throughiterative cycles of adaptive management. We present on the WISH Fiji project design,initial diagnostic analysis of catchment and reef condition, and the participatory processof co-designing management interventions to address factors affecting whole-of-systemhealth at nested scales. Data informing management choice selection include indicators of:human behavioural characteristics; water and sanitation infrastructure condition; waterand soil contamination; catchment land use; coral reef condition; fisheries catch; andcommunity governance.This proof-of-concept initiative, which showcases collaboration from academia, gov-ernment, civil society, and public and private philanthropy, has the potential to scalenationally through: (1) predictive models that can identify targeted areas for investment toimprove water quality and reduce disease burden; and (2) innovative platforms of blendedfinance. We share lessons to enable proliferation of integrated watershed management thatmoves beyond project-based implementation to mainstreamed practice for enduring coralreef and human health and wellbeing.11.14. Making Planetary Health Part of Professional Health Care: Blurring the Boundariesbetween Patient, Professional, Personal, Body, and Healthcare Practice as a Way of LifeFilip Maric (Environmental Physiotherapy Association (EPA); University of Trondhein,Høgskoleringen 1, 7491 Trondheim, Norway)Int. J. Environ. Res. Public Health 2021, 18, 10654 94 of 101Coming to planetary health as a physiotherapist, I explore the potential of an alterna-tive understanding of physiotherapy, both to ground my own planetary healthcare practice,and as a contribution to this burgeoning healthcare movement. This alternative conceptionof physiotherapy draws on two sources of inspiration:First is the notion of a “Way of Life” that can be traced through ancient traditionsacross the Globe, including Buddhism, Daoism, Greek and Roman philosophy, and others.The strengths of this notion are the way in which it highlights the synergistic embodimentof practice and philosophy and, therefore, places the focus on the question of how welive, before the question of what we do professionally. The embodied synergy betweenphilosophy and practice and the ensuing shift in focus supports the undoing of the bound-ary between personal and professional practice and, importantly, also between healthcarerecipient and healthcare professional. The undoing of these boundaries is critical at atime that requires broad collaboration across all sectors of society and “the work of the7.5 billion people currently alive” (Lancet Countdown 2019 Report), and thus a time whenprivate, professional and collective health and action can no longer be thought about and“treated” separately.The second source of inspiration is a radical, etymological play on “physiotherapy” as aservice for all and everything that grows. I trace my arrival at this terminological dis/juncturewith my profession through a critique of its hitherto understanding of self and other by drawingon the ethics of 20th century philosopher Emmanuel Levinas. Particularly the resultant view ofsubjectivity further underscores the way in which physiotherapy is an embodied practice thatprecedes and undermines the personal–patient–professional boundaries, but therewith alsocommon notions of climate/health activism and interventionism.12. Taking It Forward: Elements and Actions for Meaningful Change?The Project Earthrise agenda is about changing the stories that have created manyfailing systems, by promoting integrated approaches in the broadest possible sense—recognising connectivity across all scales, from deep biology to the spiritual purpose thatinspires us towards discovery—both self-discovery and the way that we can improveopportunities and experience for all people, and the health of our places and planet, alwaysremembering the far-reaching transgenerational implications. This session (Figure 11)explored the potential directions of these evolving narratives, and the next steps.12.1. Taking the Leap of FaithCornel West (Professor of the Practice of Public Philosophy, Harvard Divinity School,Cambridge, MA 02138, USA; Professor Emeritus at Princeton University, Princeton, NJ08544, USA).No abstract available: a recording of Dr. Cornel West’s inspirational words is availablefor viewing through our online proceedings [12].12.2. Inspiring Social and Cultural Change: The Importance of ImaginationBlake Poland (Dalla Lana School of Public Health, University of Toronto, Toronto, ONM5T 3M7, Canada)The contemporary sustainability crisis is arguably, at its core, a crisis of (limited)imagination. As Fredric Jameson famously put it, “it has become easier to imagine the endof the world than the end of capitalism”. TINA (there is no alternative) reigns supreme.Oscar Wilde reminds us that a map of the world that does not include Utopia is not wortheven glancing at. Surely Martin Luther King would concur.Int. J. Environ. Res. Public Health 2021, 18, 10654 95 of 101Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 97 of 104 Figure 11. Elements and Actions for Meaningful Change: Overview of topics and speakers in the session considering the “next steps” for Project Earthrise. 12.1. Taking the Leap of Faith Cornel West (Professor of the Practice of Public Philosophy, Harvard Divinity School, Cambridge, MA 02138, USA; Professor Emeritus at Princeton University, Princeton, NJ 08544, USA). No abstract available: a recording of Dr. Cornel West’s inspirational words is availa-ble for viewing through our online proceedings [12]. 12.2. Inspiring Social and Cultural Change: The Importance of Imagination Blake Poland (Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada) Figure 11. le ents and Actions for Meaningful Change: Overview of topics and speakers in thesession considering the “next steps” for Project Earthrise.It is indeed time to dream a better dream than the so-called “American Dream” that leftmany behind and many trung out on Prozac. In add tion to stopping further destruction,we are invite to be known by what we stand for, and not just what we stand against. Wemust animate ourselves with dreams worth reaching for. By Paul Hawken’s reckoning,thousands if not hundreds of thousands of groups are doing just that.Sometimes named as “prefigurative”, social movements have been experimentingwith modes of organization, social relationships, and behaviours that make real a de-sired future in the current moment and context. The Transition movement is but oneof these. This “positive turn” is evident all around us, including in academia, spanningwork on appreciative inquiry, empowerment evaluation, capability theory, positive de-viance, resilience, hope studies, Buddhist notions of “basic goodness”, quantum socialInt. J. Environ. Res. Public Health 2021, 18, 10654 96 of 101theory, Indigenous cultural renewal and resurgence, gay (and LGBTQi) pride, fat-positive,nonviolent communication, and more.These movements reflect the understanding that energy flows where attention goes,and that a deficit orientation and constant diet of negativity and fighting against is wearingand sometimes counterproductive, and that something magical happens when we collec-tively focus on peace, our universal humanity, and what Charles Eisenstein refers to as “themore beautiful world our hearts know is possible”. What if, in so doing, we call what wemost fervently desire into being through a kind of morphic resonance, in much the sameway as quantum science shows how electrons phase-shift from wave to particle by themere act of being observed? A whole new kind of “sacred activism”, to borrow AndrewHarvey’s term, becomes possible; one that could inspire and unleash untold collectiveenergies for “The Great Turning” (from an industrial growth paradigm to a life-centredapproach predicated on a capacity to listen to and work with nature, flourishing throughinterdependence, “inter-being”, and sacred reciprocity).Dreams are encoded in the stories we tell ourselves about who we are and where weare headed, individually and collectively. Daring to dream of a better future means tellingdifferent stories that enliven and animate us to match the size of the challenges we facewith the boldness of our vision for a better world and our faith in the power of a collectivechange of heart and united collective action that can change worlds in the face of even themost recalcitrant vested interests.12.3. Creating New Narratives for Systemic Solutions: Co-Creating a Story to EnlivenConnectivity between Individuals, Communities and the PlanetJamie Harvie (Institute for a Sustainable Future, Duluth, MN 55802, USA).For the last three to four centuries humanity has experimented with a mechanisticmental model of the world. The model assumes certainty and is dependent on a belief in ahierarchy of human value and a hierarchy of all life. Yet, we dwell on a planet, fully alive,self-healing, hurtling through the cosmos with all life, sensing, probing and communicating.There is much more we do not see than what we do see. The world as a machine is at oddswith the reality of the complexity of life. This incongruity results in planetary inflammation,racial inequality, species collapse, ecological grief, and more.We are in the midst of a great transition in which humanity is reawakening to theinterconnectedness of all life, of non-duality. We are being called to step into the unknown,the mystery and to the original story, ancient, first told by our shared ancestors thatcomes from the universe itself. Through models and approaches, this story is being writtenaround us using language of resilience, mutuality, interconnectedness, holism, co-operation,reciprocity, shared ownership, self -organization, agency and the commons.Our collective job is to call these new examples out, invest in them, share them, andseek others out. We have to be curious, and we have to listen to our language such thatwe do not reinforce old patterns. Are we advancing power over or power within? It willrequire us to go to and trust our hearts and our sensing. To acknowledge that as economistsunderstand and complexity science explains, we are not rational beings, not predictablemachines. That we feel. We need elders, to call on ancestors and need ritual to help usmove through birth, adolescence, life and death. This is not a call for a technological fixbut rather a shift in mindset and a reconnection to one’s heart, to one another, to spirit.12.4. Touchpoints for Action: Interwoven Global Conversations and Threads Connecting DifferentGlobal EffortsMargot W. Parkes (University of Northern British Columbia, Prince George, BC V2N4Z9,Canada; University of Otago, Dunedin 9016, Aotearoa/New Zealand).Learning how to be “better together” is an essential element of our collective effortsto address a healthy, just and ecologically viable future on our shared planetary home.Drawing on insights from eco-social elders, and recent decades of (re)learning aboutinterrelated efforts, this presentation reflects on how we respond to connections, confluenceInt. J. Environ. Res. Public Health 2021, 18, 10654 97 of 101and convergence among complementary global efforts, and the opportunity to turn theseinto “touchpoints for action”. Emphasis is given to the interweaving global conversationsthat have been emerging across overlapping fields such as ecohealth, one health, planetaryhealth and other allied efforts. Identifying the threads connecting these different effortsis enhanced by an ecological and systems orientation, that encourages reflection andawareness of what we are connecting, and important related questions of why? where?when? how? for and with whom? who benefits? from these connections. We are challengedto ask so what? in relation to respectfully enhancing collective co-benefits, for equity andecosystems? As we look toward “next generation” options for cultivating connectionsand conversations, this ecological orientation also asks what we need to do to designfor “emergence”?Emergence arises from the ways in which the parts of a system influence one another,expressing consequences and leading to outcomes that would not have occurred if thecomponents had not been interacting. With many different global efforts, there is a risk ofdispersal and competition, rather than intentionally designing for co-benefits and “emer-gence” that address the imperatives of people, place and planet. “Both/and” thinkingencourages us to value both attention to different parts, and connections among theseparts. Indigenous leadership approaches also offer guidance, as exemplified by the word“Rangatira”, which in Ma¯ori means “chief” and is also closely linked to “raranga”, the act ofweaving. Leadership that weaves people together to achieve their common goal, requiresa shift in emphasis from power and authority, towards humility (meeting challenges byworking together) and courage (bringing people together to achieve that). This act ofweaving demands specific intention, bringing together threads of collective effort for morerobust conversations, learning and actions for the benefit of our shared planetary home anda thriving future that realises the potential arising when we focus on being better together.12.5. Putting It Back Together to Move ForwardGeorge A. Kaplan (Professor Emerita, University of Michigan, Ann Arbor, MI, USA; TheInstitute for Integrative Health, Baltimore, MD 21231, USA).Understanding what determines the health of individuals and populations is no easytask because it is a complex, sticky problem. The “slicing and dicing” approach with variousactors competing about what matters the most does not really work for complex problems,which more often than not, involve multiple determinants ranging from the cellular tothe societal level, at different scales of space and time, all interacting with each other. Agood example is the COVID-19 pandemic, where many dozens of factors are associatedwith the development of the virus, susceptibility to infection, and its consequences. We seethe same complex pattern for the determinants of obesity, inequalities in health, diabetes,maternal morbidity and mortality, healthy child development—indeed, wherever we look.We need a new approach that looks at the totality of causes of population health andhealth inequalities in an integrative way, not one that simply dissects and supports silos ofknowledge and practice. Looking backwards at Galileo’s Observatory (ca. 1609) and hisattempt to look at the celestial bodies could provide a way forward towards a new kind ofObservatory—a Responsive Integrative Health Observatory focused on the earth and itsinhabitants. Imagine an organized and integrated approach to data from schools, healthagencies, social media, environmental monitors, city planning, public agencies, police,medical care, pharmacies, the arts, etc., all being viewed in a coordinated way by suchan Observatory, and providing inputs to citizens, NGOs, government agencies, funders,communities, researchers, and others! Such an observatory could help us put the puzzlepieces of what determines population health and health inequalities back together.12.6. From “Me” to “We”—How to Promote Wellness and Fairness for People, Places andthe PlanetIsaac Prilleltensky (Erwin and Barbara Mautner Chair in Community Wellbeing, Univer-sity of Miami, Coral Gables, FL 33124, USA).Int. J. Environ. Res. Public Health 2021, 18, 10654 98 of 101In order to promote health and wellness for people, places, and the planet, there is anurgent need to transform our culture. We live in a “Me Culture” in which the dominantassumption is that “I have the right to feel valued such that I may be happy”. This is aninadequate conception of a healthy society. To create a healthier planet for everyone, wemust embrace a “We Culture”, according to which “We all have the right and responsibilityto feel valued and add value, such that we may all experience wellness and fairness”. In a“We Culture” we balance rights with responsibilities, feeling valued with adding value,care for self and others, and a focus on wellness with a focus on fairness. A “We Culture”has the potential to correct many of the ills that currently assail our societies; amongthem, narcissism, inequality, xenophobia, depression, occupational disengagement andecological entitlement. There is evidence that cultures oriented towards fairness achievehigher levels of life expectancy, literacy, knowledge of math, trust and social mobility. Atthe same time, these “We” cultures experience lower levels of infant mortality, homicides,imprisonment, teenage births, obesity, and mental illness. In order to move society forward,we must embrace a “We Culture” and promote its tenets in our relationships, at work, inthe community, in politics, and in our relationship to non-human animals and the planet.Furthermore, we must abandon paradigms of health that are reactive, based on deficits,and that blame individuals for their misfortune. Instead, we must advance approaches thatbuild on people’s strengths, prevention, empowerment, and community change.12.7. Towards More Mindful Societies—Political Discourse That Tackles Societal Challenges at theLevel of the Human Heart and MindJamie Bristow (The Mindfulness Initiative, Secretariat to the Mindfulness All-Party Parlia-mentary Group, Sheffield S1 2JP, UK).This discussion explored how mindfulness might help us meet the existential crises ofthe 21st Century. It seems that humanity is currently unable to handle the consequencesof its own progress. From the transgression of planetary boundaries to the collapse ofshared values and public trust, it is becoming that greater sophistication and maturity arerequired in order for us to collectively handle the increased complexity of the world wehave created.In this context, mindfulness training is emerging as one of the most promising ap-proaches for building important inner capacities and shifting mindsets. In addition tosupporting elements associated with climate action, such as increased nature connectionand pro-environmental attitudes, mindfulness works more broadly to help us reclaimand reorient attention towards what matters, reflect more wisely, and act from a place ofcollective purpose.In this session, we shared the work of the Mindfulness Initiative in politics and publicpolicy and explored a three-fold model for understanding how mindfulness supportshuman agency, our ability to act intentionally, as proposed in our recent discussion paperMindfulness: Developing Agency in Urgent Times (details below).Suggested Reading:Bristow J. Bell R, Nixon D, Mindfulness: Developing Agency in Urgent Times. 2020,The Mindfullness Initiative, Sheffield, United Kingdom.Bristow J. Mindfulness in politics and public policy. Curr Opin Psychol. 2019Aug;28:87–91. doi: 10.1016/j.copsyc.2018.11.003. Epub 2018 Nov 22. PMID: 30529976.12.8. Are We Being Good Ancestors—For Our Grand Our Granddaughters’ Granddaughters?Brian Berman 1,2 (1 The Institute for Integrative Health, 1407 Fleet Street, Baltimore, MD21231, USA; 2 Department of Family and Community Medicine, Center for IntegrativeMedicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA).The Seventh Generation Principle of the Native American Iroquois people asks—arethe decisions we are making today resulting in a sustainable world seven generationsinto the future? In the midst of the extraordinary challenges of our current times—aglobal coronavirus pandemic layered on top of a worldwide tsunami of life-threateningInt. J. Environ. Res. Public Health 2021, 18, 10654 99 of 101chronic diseases, we have to reflect on this and ask: “Are we being good ancestors for ourgranddaughters’ granddaughters”?Across the globe, if health was a core value, we would all recognize there is no healthwithout clean air, clean water, access to nutrition-rich foods, and the ability to live in safeneighbourhoods, with adequate housing and access to quality education. The policies ofevery department of our governments and every practice of the corporate world, fromfarming and agriculture to the food industry, from transportation to urban planners wouldbe built on this value. Furthermore, within the healthcare sector, models of care wouldshift from a predominant focus on treatment of disease to greater emphasis on preventionand health promotion. We would remove profit as the driving force for delivery models,and in the US, we would join other developed countries in providing healthcare for all.COVID-19, and its disproportionate impact on the poor and on communities of colour;severe environmental disasters, including wildfires and devastating floods; and socialunrest due to deep underlying inequities are exposing the profound cracks in our society.We are at an important decision point. As the Chinese character for crisis Wei Jiimplies—the top part of the character meaning fear and chaos, and the bottom half,opportunity—we can let the current crisis paralyze us with fear or we can use our innatesense of infinite possibility and our incredible capacity for creativity, to actually imagineand then manifest the kind of world we DO want for our grandchildren’s grandchildren.We have a choice. We can choose to ignore science, let our leaders feed into our fear,and allow greed to be the captains of our political and economic ships, or, we can throw outthe old rule book, listen to our inner voice, our higher selves, and race to beat the clock ofdestruction by imagining a new reality based on our values of love, compassion, empathy. . . and our belief in justice and equity.12.9. Depolarizing the Cultural Divide: A Path for Social HealingKirk Schneider (President of the Existential–Humanistic Institute San Francisco, CA 94102,USA; Adjunct Faculty, Columbia University, New York, NY 10027; and Saybrook Universityand Teachers College, Pasadena, CA 91103 USA).America and the world need healing dialogues—especially now. In the wake of thecoronavirus and George Floyd killing, many of the issues dividing the US as a nation—race,politics, class, gender, climate change, globalism, and religion—have only been magnified,and although the US Surgeon general has called for an end to bickering and partisanship, itis unclear to what extent this will take effect. What is clear, however, is that safe, mindfullystructured dialogues are imperative if we are to salvage our republic and the democraticprinciples on which it is built.In this talk, I discuss my work to promote safe, mindfully structured dialogues inhomes, offices, classrooms, and community centres. It is an attempt to “give away” thetime-tested skills with which I have a range of intimate experience, to both laypersons andprofessionals; people who yearn to socially heal. The talk begins with personal observationsabout our polarized state, both within the United States (and by implication) the world.It follows up with a reflection on how the sense of awe toward life—issuing in part fromAmerica’s founding spirit—can serve as a counter to this polarized state. It concludes withpractical strategies centred on what I call the “Experiential Democracy Dialogue”. Thesestrategies translate awe-based sensibilities, including humility and wonder toward life,to a rediscovery of one another, a rediscovery of our potential to shape and revitalize ourtimes. The talk finally, draws from my recent book The Depolarizing of America: A Guidebookfor Social Healing, as well as other writings elaborating “awe-based consciousness”.12.10. Taking It Forward—Project EarthriseSusan Prescott (School of Medicine, University of Western Australia, the ORIGINS Projectsat Telethon Kids Institute and Perth Children’s Hospital, Perth, WA, Australia; Departmentof Family and Community Medicine, Center for Integrative Medicine, University of Mary-Int. J. Environ. Res. Public Health 2021, 18, 10654 100 of 101land School of Medicine, Baltimore; and The Institute for Integrative Health, Baltimore,MD 21231, USA)The broad-ranging Project Earthrise agenda underscores the importance of ecologicalapproaches to health on all scales—spanning from the foundational microbial ecosystemsthat underpin health of all ecosystems to the social, economic, and cultural value systemsthat drive the many risk factors for human disease and environmental destruction. Itemphasises the need for integrated multilateral, multi-solving strategies that seek to under-stand and improve the complex relationships between human health and planetary health.This includes the socio-eco-biological interactions in our living environment (includingurbanization, food systems, education, social inequity, climate change, biodiversity loss,and microbial ecology) that impact physical, mental and spiritual wellbeing, togetherwith the wider community and societal factors that govern these. This creates many newopportunities for both personal and community actions towards grassroots positive change.It builds on the value of connectivity and efforts to promote and restore the many physical,psychological, social and environmental factors that promote resilience in every sense—recognising that even small changes signal important long-term shifts in health behaviourand in wider values. Our ongoing agenda, will promote change narratives through diverseactivities that encourage greater awareness, inspire creativity, cultivate connectivity andclarify path and purpose—aimed at imagining what kind of world we want to live in, andhow to make it a reality.13. ConclusionsProject Earthrise is about sharing far more than our data, it is about sharing our passion,our spirit, and our desire for change. In the opening session, Trevor Hancock reminds usthat “we are all made of star stuff ”—an ultimate reminder of our connectivity to all things.It is a perspective that inspires our awe, our wonder, our love, our hope—respect foreach other and all of life. These are the recurring themes through every session of ourconference—as we are reminded of the importance of recognizing connections between thematerial realms we are familiar with, and the great mysteries of the spiritual realms, whichare no less real because we do not understand them—realizing that these are not in factseparate. These sacred wisdoms have been preserved in traditional cultures, but they arenow beginning to resurface in all societies—perhaps another measure of our connectivityand shared collective consciousness.We must courageously go to the deep roots of where change needs to begin—not justthe foundational ecosystems but the foundational value systems which govern all that weare and all that we do—our attitudes, our choices and our actions. These are the deeperconversations that are often neglected or deliberately avoided in many agendas. We mustrecognize that we can only solve the many interdependent challenges of our world today ifwe address the spiritual decay (the moral “decrepitude”, to quote Cornel West), from thedeep roots, because everything flows from there.We seek to normalize mutualistic approaches, and to place a higher value on cre-ativity, imagination, and self-development in solving challenges at all scales. We aim topromote connectivity, where the wide-ranging work of all individuals is relevant, con-nected and contributing to the wider context—encouraging and inspiring purpose andmeaningful progress.Through the ongoing activities, discussions, and events of Project Earthrise, we hope toprovide an ongoing forum to develop our strengths and our assets, to engage with othersto ask meaningful questions for purposeful actions, and to create a positive, healthy, andinspiring community that creates opportunities for all who wish to be part of it. At theheart of all of these activities, we will continue to take every opportunity to return to thefundamental question of “What kind of world do we want to live in?” as we consider what weneed to make this a reality.Int. J. Environ. Res. Public Health 2021, 18, 10654 101 of 101Author Contributions: Conceptualization and planning, S.L.P., R.K., A.C.L., S.H.B., and B.B.; reviewand selection of abstracts, S.L.P., A.K., and G.W.; writing—original draft preparation and collatingabstracts, S.L.P.; important contribution to the conference narrative and ideology, reviewing finalmanuscript, D.H.N., S.G., T.H., C.A.L., N.R., B.P., J.R., J.-C.M., S.W., J.J., A.S., J.P., S.E., R.N., M.v.d.B.,K.S., N.J.S., T.S., J.H., G.A.K., R.M., L.L., I.P., and Y.C.; project administration, S.H.B. and B.B. Allauthors have read and agreed to the published version of the manuscript.Funding: This event was supported by the Institute for Integrative Health, Baltimore, Maryland, andthe University of Western Australia.Acknowledgments: We acknowledge the support of CorpComm events management, Melbourne,Victoria, Australia for their assistant in hosting the virtual event.Conflicts of Interest: C.A.L. serves on the Scientific Advisory Board of Immodulon Therapeutics,Ltd., C.A.L is Cofounder and Chief Scientific Officer of Mycobacteria Therapeutics Corporation,C.A.L serves as an unpaid scientific consultant to Aurum Switzerland AG, and C.A.L is a memberof the faculty of the Integrative Psychiatry Institute, Boulder, Colorado. Other authors declare noconflict of interest.References1. Logan, A.C.; Berman, S.H.; Scott, R.B.; Berman, B.M.; Prescott, S.L. Catalyst Twenty-Twenty: Post-Traumatic Growth at Scales ofPerson, Place and Planet. Challenges 2021, 12, 9. [CrossRef]2. Whitmee, S.; Haines, A.; Beyrer, C.; Boltz, F.; Capon, A.G.; de Souza Dias, B.F.; Ezeh, A.; Frumkin, H.; Gong, P.; Head, P.; et al.Safeguarding human health in the Anthropocene epoch: Report of the Rockefeller Foundation-Lancet Commission on planetaryhealth. Lancet 2015, 386, 1973–2028. [CrossRef]3. Prescott, S.L.; Logan, A.C.; Albrecht, G.; Campbell, D.E.; Crane, J.; Cunsolo, A.; Holloway, J.W.; Kozyrskyj, A.; Lowry, C.A.;Penders, J.; et al. The Canmore Declaration: Statement of Principles for Planetary Health. Challenges 2018, 9, 31. [CrossRef]4. Prescott, S.L.; Hancock, T.; Bland, J.; van den Bosch, M.; Jansson, J.K.; Johnson, C.C.; Kondo, M.; Katz, D.; Kort, R.; Kozyrskyj, A.;et al. Eighth Annual Conference of inVIVO Planetary Health: From Challenges to Opportunities. Int. J. Environ. Res. Public Health2019, 16, 4302. [CrossRef] [PubMed]5. Logan, A.C.; Berman, S.H.; Berman, B.M.; Prescott, S.L. Project Earthrise: Inspiring Creativity, Kindness and Imagination inPlanetary Health. Challenges 2020, 11, 19. [CrossRef]6. Clash, J. Astronaut Bill Anders Recalls Famous ‘Earthrise’ Photo He Took from Moon. Available online: http://www.forbes.com/sites/jimclash/2015/04/17/bill-anders-recalls-famous-earthrise-photo-he-took-from-moon/#7b2d29cf7223 (accessed on 16November 2016).7. Brand, S. The Last Whole Earth Catalog; Pertola Institute Publishing: Menlo Park, CA, USA, 1971; p. 3.8. Ella Bahaire Decisive Moments: The Photographs That Made History. How Photography Became a Force to Be Reckoned with inthe 1960s. Available online: https://www.youtube.com/watch?v=rp8zeLNGeYw (accessed on 25 May 2020).9. Cotton, S. (Ed.) Earth Day—The Beginning; Arno Press: New York, NY, USA, 1970.10. Associated Press. Coordinator of Earth Day Not Radical in Appearance. The Oshkosh Northwestern, Wednesday 22 April 1970,p. 21.11. Donovan, R.J. Afterglow Lights Problems: Moon Voyage Turns Men’s Thoughts inward. Los Angeles Times, Sunday 29 December1968, p. 4.12. In Vivo Planetary Health Project Earthrise: At the 9th Annual Meeting of In Vivo Planetary Health. Available online: https://www.invivoplanet.com/2020-meeting.html (accessed on 5 May 2021).
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Project Earthrise: Proceedings of the Ninth Annual Conference of inVIVO Planetary Health
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