Participatory research on community knowledge and policy pathways for EcoHealth

Background: Earth’s life-supporting ecosystems are fundamental to human and planetary health, providing vital services such as clean water, food production, and climate regulation. However, ecosystem degradation is intensifying health inequities related to the social and ecological determinants of health. Addressing these complex socio-ecological challenges demands a rethinking of how ecosystems are valued and integrated into human society, particularly regarding population health and wellbeing. Cross-sectoral, multi-stakeholder approaches are required that include meaningful community participation. Communities offer unique local knowledge that can enhance ecosystem management and health outcomes, while exclusion risks policies disconnected from local realities, perpetuating injustice. Health Promotion offers a well-established disciplinary foundation for operationalising place-based socio-ecological action, recognising the ecological determinants of health alongside social determinants in shaping health outcomes. The healthy settings approach provides a framework for community participation in co-creating sustainable, health enhancing environments, grounded in principles of equity, participation and intersectoral collaboration. EcoHealth expands this vision by explicitly integrating socio-ecological systems thinking, knowledge pluralism and transdisciplinary collaboration, bridging gaps between health promotion and sustainable ecosystem management practices at the local scale. Aims: This study aims to explore how community knowledge and values can be integrated into cross-sectoral policy and practice to strengthen socio-ecological governance for health and sustainability. Additionally, the study seeks to contribute to the development of practical community informed tools that can support action on the interconnected challenges of climate change, biodiversity loss, and health inequities. Methods: Using a multi-phase, mixed-method qualitative design, the study engaged members of a rural community (n=148) through participatory research and conducted semi-structured interviews with 20 national-level policymakers. Phase 1 employed community participatory workshops to engage 121 community residents, ranging from age 10 to 89 years, in exploring community knowledge and connections between ecosystems, health, and sustainability. Outdoor nature walks and seven community discussion workshops employed participatory methods involving ‘nature in place’ stations, community mapping, timelines, Habitat maps, EcoHealth templates and ranking exercises. Reflective discussions and critical dialogue supported reflection and analysis of the interdependence between community health, ecosystem services and the natural environment. Phase 2 involved community verification workshops (n=27 participants) to authenticate and validate the findings from the community discussion workshops and evaluate use of the participatory methods. Co-facilitated with community facilitators, the workshops employed scenario forecasting and participative ranking methods. Phase 3 involved semi-structured interviews with 20 senior policymakers to explore perspectives on how community knowledge can be incorporated into intersectoral governance, policy, and decision-making processes. Results: Phase1findings revealed deep community knowledge of the ecological determinants of health, recognising all four ecosystem services categories, with cultural and regulating services most emphasised. Four key themes emerged from a thematic analysis of the data: nature-based health and wellbeing impacts; indirect health and wellbeing impacts; raising awareness and understanding of nature’s benefits; and community action on protection, restoration and management of nature and local habitats. Healthy habitats were described as biodiverse, ecologically rich and accessible. Phase 2 validation workshops confirmed these findings, emphasising the importance of distinguishing direct and indirect nature-health benefits. Participants highlighted the need to integrate ecological determinants into planning, and valued tools like guided walks, community mapping, and an EcoHealth template for fostering environmental learning and engagement. Phase 3 interviews with policymakers, highlighted the importance of community engagement, policy coherence, multisector collaboration, and practical supports, as being key to advancing inclusive, place-based EcoHealth planning. Participants stressed the critical role of community voices in socio- ecological decisions, but identified barriers such as institutional silos, lack of cross-sectoral frameworks, and misalignment between community and policy processes. Eleven subthemes were identified essential for embedding co-production and advancing more equitable, sustainable socio-ecological governance. Conclusions: The findings from across the three study phases underscore the importance of community engagement, knowledge mobilization, multisector collaboration, policy coherence, and supportive tools and infrastructure in enabling transformative, place-based EcoHealth governance. The findings offer guidance for researchers, practitioners, and policymakers seeking to operationalise integrated responses to socio-ecological challenges. Future research is needed on adapting and scaling co-produced tools, such as EcoHealth community toolkits, to integrate community voices and knowledge in decision-making essential for healthier, just, and sustainable futures. This study offers critical insights for informing practice and policy in enhancing participatory planning and advancing sustainable health promoting environments.

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University of Galway

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CC BY-NC-ND

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University of Galway Theses (PhD Theses)