2.1. Cumulative Thinking, Resource Development, and Health
The combined environment, community, and health impacts of resource development remain poorly understood due to their scope, scale, and systemic nature [
21]. This is consistent with the long-standing tendency to address interrelated health, ecological, and social concerns in isolation [
18]. Recurring calls to bridge and work across traditional disciplinary territories, sectoral mandates, and jurisdictional boundaries are a common response to the ‘wicked’ features of health and resource development, with their associated interrelationships, dependences, and overlapping organizational mandates. Extending from foundational work by Churchman in 1967 and Rittel and Weber in 1974, “wicked problems” describe issues which are not typically amenable to a simple cure or complete resolution, and that tend not to be solved by ‘taming’ manageable sub-problems [
18,
22,
23].
One response to these dilemmas in the context of resource development has been the development and application of a conceptual framework that focuses on cumulative impacts, as detailed by Gillingham et al. [
21] in relation to the “cumulative environmental, community, and health impacts of multiple natural resource developments”. A central conceptual foundation of this work is cumulative thinking [
24,
25] described as:
“… a commitment to conceptualizing the full range of spatial and temporal scales as well as impacts that occur as a result of human-caused changes to coupled social–ecological systems. A cumulative thinking perspective demands recognition that impacts are not just environmental, they are not just large development projects, and they are not all easily identified and quantified. Furthermore, past experience tells us to expect interactions”
Cumulative impacts arise when multiple forms of resource development occur simultaneously on the same land base. The co-existence of these developments can then interact with both pre-existing effects, and the longer-term impacts of historical decisions and past land uses [
21,
26]. We experience cumulative impacts on a daily basis, and they leave lasting legacies for people, communities, and ecosystems.
Gillingham et al. [
21] describe the ways in which cumulative thinking creates an “integration imperative” in the context of resource development, warranting approaches that are more attentive to the relationships among ecological, community, and health impacts. This orientation is consistent with an array of international efforts emphasising the many ways social and ecological factors influence health, cumulatively, over time and space [
27]. Recognition of the ways that the health of other species (plants, animals, wildlife, ecosystems) have far-reaching implications for human health include the international attention to ‘One Health” [
28], “Wetlands and Health” [
29], and “Parks and Health” [
30,
31]. Ongoing attention to ecohealth—or ecosystems approaches to health—are characterized by systems approaches that promote the health of people, animals, and ecosystems in the context of social and ecological interactions [
5,
32,
33,
34,
35,
36,
37,
38]. These efforts are supported by an expanding range of integrative approaches that underscore the relevance of cumulative impacts on health across time and space, such as the Lancet Commission on Planetary Health [
39] and the 2015 “State of Knowledge report on Biodiversity and Health” co-produced by World Health Organization [
40]. Cumulative thinking applied to the health impacts of resource development also recognizes that ecosystems and biodiversity are not only sources of hazardous exposures, but also make positive contributions to health relating to our relationship to the land, livelihoods, lifestyles, culture, and identity [
29,
37,
41].
The precedents above, combined with the complex dynamics of resource development, have drawn attention to the “cumulative determinants of health impact” [
13], linking cumulative thinking with “upstream” factors, including the social and ecological determinants of health [
2,
42].
Figure 1 depicts the potential for resource development activities to interact as upstream drivers of change in a region of concern, leading to an array of proposed or actual changes in the landscape.
The cascade depicted in
Figure 1 highlights relationships among short-, medium-, and long-term effects and impacts, with implications for community, environment, and the social and environmental determinants of health [
13]. Although the feedback and flows depicted in the cascade are mostly one-way, multiple other feedbacks exist over time and space, whereby downstream impacts and flows (among health, community, environmental factors), can be seen to cycle back to impact upstream drivers of change.
The range and scope of possible ‘upstream’ drivers of change that trigger this cascade are extensive. Climate change can be seen to overlay and compound most drivers of landscape change [
43]. Halseth et al. note that some natural resource management decisions, such as the allocation of mineral rights or land leases, set in motion a series of pre-determined activities that lead towards a particular type of development debate and trajectory [
9]. Across sectors, there are also some noteworthy overlaps and disconnects among “upstream”-related metaphors. The oil and gas industry, for example, is described in relation to “upstream industry” which finds and produces crude oil and gas, “midstream industry” which processes, stores, markets, and transports oil and gas commodities, and “downstream industry” including oil refineries, petrochemical plants, and distribution chains [
44], making an interesting contrast to public health references to upstream determinants of health.
The flows depicted in the cascade (
Figure 1) prompt consideration of interactions among impacts on environments and communities via ecological injustices and social inequities. Ecological injustice can manifest through, for example, upstream assessment policies that lead to direct impacts on habitats and specific species [
45,
46]. Yet, accounting for environment and ecology can compound social and cultural tensions, as suggested by critiques of ecological justice narratives in relation to Indigenous ontologies [
47,
48,
49]. The interactions in
Figure 1 also suggest potential for cascades of interacting inequities where, for example, the same upstream industry could impact on the mental health and wellbeing of those witnessing changes to their communities and environments [
50,
51,
52,
53,
54], on the livelihoods of workers or families of workers [
11,
55,
56], and other nuances of lived experience within impacted communities [
10,
50,
57].
The cascade also has planetary implications across scales and generations. Cumulative impacts from multiple resource developments within the same landscape are also driven by global processes spanning climate change, corporate power dynamics, urbanization, and other megatrends, with an array of overlapping environmental, community, and health consequences [
2,
11,
27,
58,
59]. Attention to temporal and spatial dimensions of impacts draws attention to both short-term acute crises and longer-term health implications of global ecological change [
60]. Noting that the impacts of resource development manifest across the life span and generations raises questions about intergenerational equity. These considerations are especially pressing for those whose jurisdictional mandate is to protect and promote health and wellbeing over the long-term and across multiple generations [
10,
61] and demands attention to the complexity of interactions, outcomes, and intersectoral effort over time and space [
32].
2.2. Canadian Responses to Planetary Dilemmas: Assessments, Observatories, Intersectoral Prevention
In addition to the “push” of cumulative thinking applied to health and resource development, a range of contextual “pull” factors influenced the timing, opportunities, and motivations to engage in this project. The emphasis in this section is on several converging influences in the Canadian context, that have not only contributed to the “wicked”, cross-jurisdictional nature of the resource development and health issues, but that have also demanded research responses that are emblematic of the challenges of crossing knowledge boundaries to address complex issues [
62,
63].
Calls for attention to cumulative impacts in Canada are consistent with a range of critiques of the Canadian environmental assessment (EA) process [
24,
58,
64]. This includes urgent calls for increased and more robust inclusion of Indigenous decision making in impact assessment processes [
12,
65,
66,
67], and ongoing critiques of the ability of formal health impact assessment to express an integrated understanding of social and ecological determinants of health [
68,
69,
70]. These concerns also align with critiques of cumulative effects assessments as a component of environmental impact assessment [
58,
59,
64,
71] through to overt concerns about the failure of the EA process to address the intrinsic value of other species [
45]. Indeed, critiques of addressing the cumulative dynamics within EA underscore limits of Canadian federal and provincial legislation [
24]. They also exemplify the scope of the challenge when seeking to fully grasp the inter-jurisdictional complexity and local-to-global scope of these issues. Cumulative thinking confronts us, not only with the difficulties of engaging with local dynamics and lived experiences [
57,
72] but also the far-reaching impacts of the Canadian extractive industries beyond Canadian borders, raising important questions about the political ecologies of health [
73] and the commercial and corporate power dynamics involved [
7].
The “policy failures” exemplified by Canadian EA are not unexpected when dealing with wicked problems [
18,
22], and can be usefully seen in relation to disconnected but complementary calls for more integrative responses to overlapping health, social, and ecological concerns. Nationally-focused examples include the Canadian Nature Survey [
74] and the Canadian Public Health Association’s paper on Ecological Determinants of Health [
60]. The demand to connect across mandates and sectors is reinforced by overt calls from Canadian Provinces to more effectively link ecological and social determinants of health in the context of resource development, as exemplified by the report by the Office of the Chief Medical Officer of Health in New Brunswick in relation to the health impacts of Shale Gas [
10]. At the level of regional health authorities, new efforts can be seen to listen and respond to a range of social, ecological, and health concerns, exemplified by efforts in northern BC by Northern Health and First Nations Health Authority [
75,
76].
Public health observatories have been proposed as one way to better integrate and respond to complex, interacting issues, as a means to “address the challenges of understanding the multiple factors that influence health, and the dispersed and uncoordinated nature of data” [
77] and by networking relevant experts, data, and information to support decision-making and public health practice [
78]. The ongoing proposal and emergence of public health observatories in Canada, across national, provincial, and regional contexts reflects the ongoing appeal of this idea (see for example: [
79,
80,
81]). Yet, classic public health observatories face two notable challenges when addressing the cumulative impacts of resource development. First, current monitoring, evaluation, and analytical tools tend to deal with environmental, community, and health concerns in isolation, and are poorly equipped to integrate data and information, creating missed opportunities to “see” in an integrative way, or to benefit from the full range of knowledge and experience relevant to the cumulative impacts of resource development [
10,
11,
13]. A second dilemma is the need for increased capacity for intersectoral actions and responses, which requires working and learning together both “vertically” (through levels of socioecological or political systems) and “horizontally” (across the same levels of a system) including across species boundaries [
18,
82,
83,
84,
85].
Alongside these developments, between 2012 and 2015 the Canadian Institutes for Health Research identified concerns about Canada’s attention to environmental and health issues, and the funding allocated to address them, noting:
“Trends demonstrate that Canada ranks low amongst peer countries on the environment and risks falling further behind. The 2013 Conference Board of Canada Report Card on the Environment showed that Canada ranked 15th (among 17 peer countries) on fourteen indicators including air quality; water quality and quantity; biodiversity and conservation; climate change and natural resource management”.
In partial response to these concerns, a time-bounded Environments and Health “Signature Initiative” was launched [
15]. Intersectoral prevention research was identified as a core research component with the goal to “advance our understanding of how to prevent and mitigate environmental threats and promote healthful environments within Canada and globally” [
15]. All research components were also oriented toward three “nexus areas” of agrifoods (food production, food security, food safety, nutrition, and the microbiome), resource development (production and/or extraction of natural resources), and urban form (design of communities and cities). The subsequent call to fund nine intersectoral prevention research teams [
14] has fueled terminological, methodological, and practical debate about the nature of intersectoral prevention research. The program’s funding criteria underscored the ambitious nature of this work by requiring team grants to be co-led by researchers and ‘knowledge-users’, to involve knowledge-users outside of the health sector, and to be both cross-jurisdictional and interdisciplinary.
The ECHO Network is a response to these overlapping conceptual and contextual circumstance, and will be introduced in the section below. Importantly, while many of the features of the issues described above could be considered “Canadian”, the ECHO Network also needs to be seen as nested within its planetary context—tightly connected to, and informed by, specific nuances of global, national, regional, and local activities, which will be introduced further in the next section. Despite the obvious relevance of cumulative impacts of resource development internationally, and ECHO research partnerships in Oceania, it is important to note that the heart of the project lies in regional cases within Canada (discussed below). This highlights fundamental tensions within the planetary health context—although the ECHO Network is nested in a global context, our lens is one rooted in a country with a relatively well-established legal and regulatory regime, albeit with limitations and particularities of the contemporary Canadian settler colonial context. In other words, the approach and framework of the ECHO Network described below, are both deeply rooted in a particular, developed settler colonial context. Noting that the ECHO Network does not seek to be applicable across the political world, we also recognize the important differences and nuances that may arise from countries with entirely different legal and regulatory circumstances, legacies of colonialism within very different governance systems, and regionally specific capacity and resource issues that may differ across lower-, middle-, and high-income countries. These differences and nuances resonate with Escobar’s notion of “healing the web of life”, where he suggests that health, like ecology, is fundamental to pursuing the goal of “a better,
and different, world” [
19] p.3.