Articles & Technical/Policy reports by Monika dos Santos
Atmosphere, 2024
There is a 50% possibility that global temperatures will have risen by more than 5 ◦C by the year... more There is a 50% possibility that global temperatures will have risen by more than 5 ◦C by the year 2100. As demands on Earth’s systems grow more unsustainable, human security is clearly at stake. This narrative review provides an overview and synthesis of findings in relation to climate change, air pollution, and human health within the Global South context, focusing on case study geographic locations in South Africa and Brazil. Two case study regions—the Kruger to Canyons Biosphere region of South Africa and the Amazon region of Brazil—were the subjects of PubMed literature searches. Technical reports, policy briefs, and grey literature were also narratively synthesized. The burning of wood for fuel, as witnessed in Agincourt, and forest fires, such as those seen in the Amazon rainforest, release air pollutants such as methane and black carbon, which are strong short-lived climate pollutants (SLCPs) which fuel climate change and adversely affect human health. SLCPs have a brief lifetime in the atmosphere, but they frequently have a far larger potential for global warming than carbon dioxide (CO2). Most air pollution in geographic case study areas, that are home to human settlements, is due to the burning of wood and other biomasses that are pollutants. These areas are seen to be important for climate and health responses, and if constructive action is taken to switch to other modes of electricity generation (such as solar power) and the prevention of deforestation, the worst of the impacts may still be mitigated in these regions. Authorities should also establish a monitoring strategy for air quality, as well as enforce air quality regulations that safeguard public health.
Connecting Climate Minds (CCM) is a Wellcome-funded initiative which aims to cultivate a collabor... more Connecting Climate Minds (CCM) is a Wellcome-funded initiative which aims to cultivate a collaborative, transdisciplinary climate change and mental health field with a clear and aligned vision. Over the last year, CCM has convened experts across disciplines, sectors and countries to develop regional and global research and action agendas. These agendas set out 1) research priorities to understand and address the needs of people experiencing the mental health burden of the climate crisis, and 2) priorities to enable this research and translate evidence into action in policy and practice. This report summarises the research and action agenda for climate change and mental health in sub-Saharan Africa (SSA); the full agenda has been published separately and is available.
Wellcome , 2024
Climate change is increasingly recognised as a threat to mental health, compounding risks for poo... more Climate change is increasingly recognised as a threat to mental health, compounding risks for poor mental health outcomes and destabilising the conditions needed for good mental health. While research at the intersection of climate change and mental health has proliferated in recent years, the field remains disconnected, uneven and siloed, slowing urgent progress to address the mental health impacts of climate change.
Connecting Climate Minds (CCM) is a Wellcome-funded initiative which aims to cultivate a collaborative, transdisciplinary climate change and mental health field with a clear and aligned vision. Over the last year, we have convened experts across disciplines, sectors and countries to develop regional and global research and action agendas. These agendas set out 1) research priorities to understand and address the
needs of people experiencing the mental health burden of the climate crisis, and 2) priorities to enable this research and translate evidence into action in policy and practice. This report presents the research and action agenda for climate change and mental health in sub-Saharan Africa (SSA).
SSA is ecologically diverse with several ecosystems that are highly vulnerable, including communities that are at particular risk to the harmful and threatening effects of climate change. Serious climatic events can result in psychological distress, including traumatic stress, which can develop into chronic psychopathologies and psychiatric patterns over time.
Nature Communications, 2024
The Russian invasion of Ukraine on February 24, 2022, has had devastating effects on the Ukrainia... more The Russian invasion of Ukraine on February 24, 2022, has had devastating effects on the Ukrainian population and the global economy, environment, and political order. However, little is known about the psychological states surrounding the outbreak of war, particularly the mental well-being of individuals outside Ukraine. Here, we present a longitudinal experience-sampling study of a convenience sample from 17 European countries (total participants = 1,341, total assessments = 44,894, countries with >100 participants = 5) that allows us to track well-being levels across countries during the weeks surrounding the outbreak of war. Our data show a significant decline in well-being on the day of the Russian invasion. Recovery over the following weeks was associated with an individual's personality but was not statistically significantly associated with their age, gender, subjective social status, and political orientation. In general, well-being was lower on days when the war was more salient on social media. Our results demonstrate the need to consider the psychological implications of the Russo-Ukrainian war next to its humanitarian, economic, and ecological consequences.
Sustainabilty and Climate Change, 2023
Holism is viewed as a vera causa. It is regarded to be an operative or driving force, or true cau... more Holism is viewed as a vera causa. It is regarded to be an operative or driving force, or true cause, of a natural phenomenon by an agency whose existence can be independently evidenced. Holism can thus be regarded to be as existent as other known natural forces such as gravity. What holism stands for then, in all its endless forms, is a real factor in nature, and is not merely an abstract or artificial construct. Could holism potentially be a theory of everything that is being overlooked by present-day physicists, scientists, and philosophers? A single or monastic concept of the universe, which is the ultimate ideal of all scientific and philosophical explanations, becomes a reality with the fundamental concept of holism and its encompassing fields of force. This commentary explores holism’s place in contemporary science and thought. Holism and its extended concepts relating to physics have still not yet been falsified.
A global experience-sampling method study of well-being during times of crisis: The CoCo project, 2023
We present a global experience-sampling method (ESM) study aimed at describing, predicting, and u... more We present a global experience-sampling method (ESM) study aimed at describing, predicting, and understanding individual differences in well-being during times of crisis such as the COVID-19 pandemic. This international ESM study is a collaborative effort of over 60 interdisciplinary researchers from around the world in the “Coping with Corona” (CoCo) project. The study comprises trait-, state-, and daily-level data of 7490 participants from over 20 coun- tries (total ESM measurements = 207,263; total daily meas- urements = 73,295) collected between October 2021 and August 2022. We provide a brief overview of the theoret- ical background and aims of the study, present the applied methods (including a description of the study design, data collection procedures, data cleaning, and final sample), and discuss exemplary research questions to which these data can be applied. We end by inviting collaborations on the CoCo dataset.
Sustainability and Climate Change, 2022
One focal endeavor of our time is to safeguard civilization and the planet in its entirety from t... more One focal endeavor of our time is to safeguard civilization and the planet in its entirety from the threats of global climate change. By recounting the story of Toughie, the last of the Rabbs fringe-limbed treefrogs, this article seeks to advance the argument that both an ecological revolution and an ecosophical shift in humankind's approach are urgently required. Drawing on holism and evolutionary psychology, humankind's inclination toward self-destruction in terms of brain structure and philosophies, and its encompassing cyclic political-historical dynamics, are also examined. Collective evolution and intelligence may mean that novel approaches to advancing climate change mitigation and adaptation strategies should be adopted. Collective intelligence could provide an avenue for crowdsourcing ideas on potential solutions in addressing various challenges in vulnerable spaces.
International Review of Psychiatry, 2022
Africa is ecologically sensitive, with vulnerable communities which are at particular risk of the... more Africa is ecologically sensitive, with vulnerable communities which are at particular risk of the associations and impacts of climate change. Serious climatic events can result in traumatic stress, developing into chronic psychopathological and psychiatric patterns. Nonetheless, there remains a lack of psychiatric studies on mental disorders associated with climate change within the African context. There is a need in Africa for robust complex adaptive integrated research concerning climate change impacts and associations on and with mental health and healthcare systems, policy and practice, so that relevant interventions may be implemented and strengthened.
Brazilian Journal of African Studies, 2022
African Journal of Primary Health Care & Family Medicine, 2022
Background: Climate change presents an unprecedented and urgent threat to human health and surviv... more Background: Climate change presents an unprecedented and urgent threat to human health and survival. South Africa’s health response will require a strong and effective intersectoral organisational effort.
Aim: Exploratory interview outcomes are used to advance practice and policy recommendations, as well as for broad input in the development of a draft national framework for a health risk and vulnerability assessment (RVA) for national departments.
Setting: Nationally in South Africa.
Method: Twenty key expert interviews were conducted with South African experts in the field of
climate change and health. Interview data was analysed by means of thematic content analysis.
Results: Findings suggest that previously poor communities are most at risk to the impacts of climate change on health, as well as those with underlying medical conditions. Climate change may also serve as a catalyst for improving the healthcare system overall and should serve as the conduit to do so. A draft climate change and health RVA should take into account existing frameworks and should be implemented by local government. It is also critical that the health and health system impacts from climate change are well understood, especially in light of the plans to implement the (South African) National Health Insurance (NHI) scheme.
Conclusion: Practice and policy initiatives should be holistic in nature. Consideration should be given to forming a South African National Department of Climate Change, or a similar coordinating body between the various national departments in South Africa, as health intercepts with all other domains within the climate change field.
Keywords: climate change; health; South Africa; climate change and health expert interviews; sustainable development; healthcare systems strengthening.
South African Journal of Science , 2022
• Critical climate change and health action needs to be considered globally post the COVID-19 pan... more • Critical climate change and health action needs to be considered globally post the COVID-19 pandemic.
Africa Insight, 2020
As climate change continues to impact the earth, the world will become less stable ecologically a... more As climate change continues to impact the earth, the world will become less stable ecologically and populations will become increasingly vulnerable. Despite greater material output, people in emerging economies, in particular, will become more vulnerable than they are today, unless innovative approaches are considered. Approaches in developing climate change adaptation and mitigation strategies should draw on fourth industrial revolution technologies. Collective intelligence provides an avenue for crowdsourcing ideas on potential solutions, whereas computer simulations and artificial intelligence can also advance sustainable development in vulnerable spaces. It is further suggested that big data should inform financial progress and sustainability at country level. Cities experiencing similar vulnerabilities should also be urged to share best practices among them. Furthermore, a fundamental change in society's collective ecosophical metaphors should be sought.
Climatic Change, 2019
In recent decades, greater acknowledgement has been given to climate change as a cultural phenome... more In recent decades, greater acknowledgement has been given to climate change as a cultural phenomenon. This paper takes a cultural lens to the topic of climate change, in which climate-relevant understandings are grounded in wider cultural, political and material contexts. We approach climate-relevant accounts at the level of the everyday, understood as a theoretically problematic and politically contested space This is in contrast to simply being the backdrop to mundane, repetitive actions contributing to environmental degradation and the site of mitiga-tive actions. Taking discourse as a form of practice in which fragments of cultural knowledge are drawn on to construct our environmental problems, we investigate citizens' accounts of climate-relevant issues in three culturally diverse emerging economies: Brazil, South Africa and China. These settings are important because greenhouse gas (GHG) emissions are predicted to significantly increase in these countries in the future. We conducted semi-structured interviews with a range of citizens in each country using a narrative approach to contextualise climate-relevant issues as part of people's lifestyle narratives. Participants overwhelmingly framed their accounts in the context of locally-salient issues, and few accounts explicitly referred to the phenomenon of climate change. Instead, elements of climate changes were conflated with other environmental issues and related to a wide range of cultural assumptions that influenced understandings and implied particular ways of responding to environmental problems. We conclude that climate change scholars should address locally relevant understandings and develop dialogues that can wider meanings that construct climate-relevant issues in vernacular ways at the local level. Climatic Change
Sustainability, 2019
As low-income communities are most vulnerable to climate-associated health concerns,
access to he... more As low-income communities are most vulnerable to climate-associated health concerns,
access to healthcare will increase in importance as a key priority in South Africa. This study explores
healthcare sustainability in the Agincourt sub-district, Kruger to Canyons Biosphere Region in
Mpumalanga, South Africa. A rapid assessment and response methodology (RAR) was implemented,
which includes the examination of previous studies conducted in the sub-district, the mapping of
healthcare facilities in the area, and the implementation of a facility infrastructure and workforce
capacity investigation by means of key informant (KI) interviews at eight healthcare facilities.
Findings indicate that the greatest need across the facilities relate to access to medical doctors
and pharmacists. None of the facilities factored climate associations with health into their clinical care
strategies. The necessity to train healthcare facility staff on aspects related to climate change, health,
and sustainability is highlighted. Environmental health practitioners should also be incorporated
in grassroots community climate adaptation strategies. Outcomes further indicate the need for the
advancement of integrated healthcare and climate adaptation strategies that focus on strengthening
healthcare systems, which may include novel technological approaches such as telemedicine. Policy
makers need to be proactive and pre-emptive in finding and improving processes and models to
render healthcare services prepared for climate change.
Background: An increasingly recognised prevention approach for substance use entails a reduction ... more Background: An increasingly recognised prevention approach for substance use entails a reduction in risk factors, and the enhancement of promotive, or protective factors in individuals and the environment surrounding them during their growth and development. Methods: This exploratory study evaluated the effect of potential risk and protective factors associated with family management relating to adolescent substance use in South Africa. Exploratory analysis and cumulative odds ordinal logistic regression modelling was performed on the data, while controlling for the influence of demographic and socioeconomic characteristics on adolescent substance use.
According to the Stern Review (2007) there is a 50% risk of global temperatures rising by more th... more According to the Stern Review (2007) there is a 50% risk of global temperatures rising by more than 5°C by the year 2100. As the Earth's systems are under increasing unsustainable pressures, human security is clearly at stake. Cities are regarded to be increasingly important sites for climate responses, and something can still be solved if humankind acts quickly. It is proposed that city adaptation and mitigation strategies should draw on collective intelligence and an innovative holism multi-systemic approach to the encompassing problem of climate change by breaking it up into smaller, manageable problems and crowdsourcing a way out by means of online argumentation systems, computer simulations, and collective decision making tools. As 'first responders', cities with similar location or vulnerability characteristics should also be encouraged to transfer best practices between each other. Furthermore, this theoretical exposition argues that whilst adaptation and mitigation strategies are crucial, at the very crux of it, humankind needs a fundamental change of metaphors: from seeing the world as a machine to understanding it as a holistic network.
In South Africa, where it is estimated that more people have HIV than anywhere else in the world,... more In South Africa, where it is estimated that more people have HIV than anywhere else in the world, HIV/AIDS and psychological disorder co-morbidity have been shown both to exacerbate the late diagnosis and treatment of psychological disorders and to affect adherence to ARVs. Targeted, affordable and evidence-based strategies to reach these populations are essential. Against this backdrop, a pilot project and situational assessment aimed at determining the context of psychological care and HIV treatment services in South Africa was undertaken.
The situational analysis consisted of individual interviews, a patient survey, and a retrospective medical record data review. Training and mentorship were conducted from 2011 to 2013 by the Foundation for Professional
Development (FPD) in five anti-retroviral therapy (ART) clinics in the Tshwane-Metsweding area. Data were both descriptively and inferentially analysed. Outcomes indicate that the general structure of HIV services is well organised and well run in the sampled clinics. However, mental healthcare and HIV services need to be integrated further. There is also a need to develop and pilot-test appropriate materials and models for the delivery of mental healthcare within the parameters of affordability, acceptability and availability further, and to advocate the advancement of mental health and HIV treatment and policy integration.
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Articles & Technical/Policy reports by Monika dos Santos
Connecting Climate Minds (CCM) is a Wellcome-funded initiative which aims to cultivate a collaborative, transdisciplinary climate change and mental health field with a clear and aligned vision. Over the last year, we have convened experts across disciplines, sectors and countries to develop regional and global research and action agendas. These agendas set out 1) research priorities to understand and address the
needs of people experiencing the mental health burden of the climate crisis, and 2) priorities to enable this research and translate evidence into action in policy and practice. This report presents the research and action agenda for climate change and mental health in sub-Saharan Africa (SSA).
SSA is ecologically diverse with several ecosystems that are highly vulnerable, including communities that are at particular risk to the harmful and threatening effects of climate change. Serious climatic events can result in psychological distress, including traumatic stress, which can develop into chronic psychopathologies and psychiatric patterns over time.
Aim: Exploratory interview outcomes are used to advance practice and policy recommendations, as well as for broad input in the development of a draft national framework for a health risk and vulnerability assessment (RVA) for national departments.
Setting: Nationally in South Africa.
Method: Twenty key expert interviews were conducted with South African experts in the field of
climate change and health. Interview data was analysed by means of thematic content analysis.
Results: Findings suggest that previously poor communities are most at risk to the impacts of climate change on health, as well as those with underlying medical conditions. Climate change may also serve as a catalyst for improving the healthcare system overall and should serve as the conduit to do so. A draft climate change and health RVA should take into account existing frameworks and should be implemented by local government. It is also critical that the health and health system impacts from climate change are well understood, especially in light of the plans to implement the (South African) National Health Insurance (NHI) scheme.
Conclusion: Practice and policy initiatives should be holistic in nature. Consideration should be given to forming a South African National Department of Climate Change, or a similar coordinating body between the various national departments in South Africa, as health intercepts with all other domains within the climate change field.
Keywords: climate change; health; South Africa; climate change and health expert interviews; sustainable development; healthcare systems strengthening.
access to healthcare will increase in importance as a key priority in South Africa. This study explores
healthcare sustainability in the Agincourt sub-district, Kruger to Canyons Biosphere Region in
Mpumalanga, South Africa. A rapid assessment and response methodology (RAR) was implemented,
which includes the examination of previous studies conducted in the sub-district, the mapping of
healthcare facilities in the area, and the implementation of a facility infrastructure and workforce
capacity investigation by means of key informant (KI) interviews at eight healthcare facilities.
Findings indicate that the greatest need across the facilities relate to access to medical doctors
and pharmacists. None of the facilities factored climate associations with health into their clinical care
strategies. The necessity to train healthcare facility staff on aspects related to climate change, health,
and sustainability is highlighted. Environmental health practitioners should also be incorporated
in grassroots community climate adaptation strategies. Outcomes further indicate the need for the
advancement of integrated healthcare and climate adaptation strategies that focus on strengthening
healthcare systems, which may include novel technological approaches such as telemedicine. Policy
makers need to be proactive and pre-emptive in finding and improving processes and models to
render healthcare services prepared for climate change.
The situational analysis consisted of individual interviews, a patient survey, and a retrospective medical record data review. Training and mentorship were conducted from 2011 to 2013 by the Foundation for Professional
Development (FPD) in five anti-retroviral therapy (ART) clinics in the Tshwane-Metsweding area. Data were both descriptively and inferentially analysed. Outcomes indicate that the general structure of HIV services is well organised and well run in the sampled clinics. However, mental healthcare and HIV services need to be integrated further. There is also a need to develop and pilot-test appropriate materials and models for the delivery of mental healthcare within the parameters of affordability, acceptability and availability further, and to advocate the advancement of mental health and HIV treatment and policy integration.
Connecting Climate Minds (CCM) is a Wellcome-funded initiative which aims to cultivate a collaborative, transdisciplinary climate change and mental health field with a clear and aligned vision. Over the last year, we have convened experts across disciplines, sectors and countries to develop regional and global research and action agendas. These agendas set out 1) research priorities to understand and address the
needs of people experiencing the mental health burden of the climate crisis, and 2) priorities to enable this research and translate evidence into action in policy and practice. This report presents the research and action agenda for climate change and mental health in sub-Saharan Africa (SSA).
SSA is ecologically diverse with several ecosystems that are highly vulnerable, including communities that are at particular risk to the harmful and threatening effects of climate change. Serious climatic events can result in psychological distress, including traumatic stress, which can develop into chronic psychopathologies and psychiatric patterns over time.
Aim: Exploratory interview outcomes are used to advance practice and policy recommendations, as well as for broad input in the development of a draft national framework for a health risk and vulnerability assessment (RVA) for national departments.
Setting: Nationally in South Africa.
Method: Twenty key expert interviews were conducted with South African experts in the field of
climate change and health. Interview data was analysed by means of thematic content analysis.
Results: Findings suggest that previously poor communities are most at risk to the impacts of climate change on health, as well as those with underlying medical conditions. Climate change may also serve as a catalyst for improving the healthcare system overall and should serve as the conduit to do so. A draft climate change and health RVA should take into account existing frameworks and should be implemented by local government. It is also critical that the health and health system impacts from climate change are well understood, especially in light of the plans to implement the (South African) National Health Insurance (NHI) scheme.
Conclusion: Practice and policy initiatives should be holistic in nature. Consideration should be given to forming a South African National Department of Climate Change, or a similar coordinating body between the various national departments in South Africa, as health intercepts with all other domains within the climate change field.
Keywords: climate change; health; South Africa; climate change and health expert interviews; sustainable development; healthcare systems strengthening.
access to healthcare will increase in importance as a key priority in South Africa. This study explores
healthcare sustainability in the Agincourt sub-district, Kruger to Canyons Biosphere Region in
Mpumalanga, South Africa. A rapid assessment and response methodology (RAR) was implemented,
which includes the examination of previous studies conducted in the sub-district, the mapping of
healthcare facilities in the area, and the implementation of a facility infrastructure and workforce
capacity investigation by means of key informant (KI) interviews at eight healthcare facilities.
Findings indicate that the greatest need across the facilities relate to access to medical doctors
and pharmacists. None of the facilities factored climate associations with health into their clinical care
strategies. The necessity to train healthcare facility staff on aspects related to climate change, health,
and sustainability is highlighted. Environmental health practitioners should also be incorporated
in grassroots community climate adaptation strategies. Outcomes further indicate the need for the
advancement of integrated healthcare and climate adaptation strategies that focus on strengthening
healthcare systems, which may include novel technological approaches such as telemedicine. Policy
makers need to be proactive and pre-emptive in finding and improving processes and models to
render healthcare services prepared for climate change.
The situational analysis consisted of individual interviews, a patient survey, and a retrospective medical record data review. Training and mentorship were conducted from 2011 to 2013 by the Foundation for Professional
Development (FPD) in five anti-retroviral therapy (ART) clinics in the Tshwane-Metsweding area. Data were both descriptively and inferentially analysed. Outcomes indicate that the general structure of HIV services is well organised and well run in the sampled clinics. However, mental healthcare and HIV services need to be integrated further. There is also a need to develop and pilot-test appropriate materials and models for the delivery of mental healthcare within the parameters of affordability, acceptability and availability further, and to advocate the advancement of mental health and HIV treatment and policy integration.
Methods: We conducted a cross-sectional survey among 450 PWID (362 males and 88 females) from five South African cities in 2013, using outreach and peer referral to recruit participants. We carried out rapid HIV tests on participants’ saliva and assessed drug-using and sexual practices by means of a questionnaire.
Results: We found that 26% of females and 13% of males reported to always share injecting equipment, while 49% of all participants had used contaminated injecting equipment the last time they injected. Only 6% of participants usually used bleach to clean their injecting equipment. We found that half of participants reported using a condom the last time they had sex. A quarter of participants reported symptoms of a sexually transmitted infection (STI) in the previous 12 months and 22% had ever worked as a sex worker (51% of females). HIV prevalence among participants was 14% (18% among females and 13% among males). In multivariate analysis HIV was significantly associated with being 25 years and older (adjusted odds ratio (aOR) 2.1, 95% confidence interval (CI) 1.0–4.6, p = 0.06), belonging to a racial group other than white (aOR 4.2, 95% CI 1.9–9.4, p < 0.001), coming from Gauteng province (aOR 2.3, 95% CI 1.1–5.5, p = 0.023), having ever worked as a sex worker (aOR 3.4, 95% CI 1.7–7.2, p = 0.001) and the presence of STI symptoms in the last 12 months (aOR 2.4, 95% CI 1.1–4.4, p = 0.019).
Conclusions: This study highlights the need for increased access to sterile injecting equipment, education around safer injecting practices and access to sexual and reproductive health services for PWID in South Africa. Programmes for PWID should also address the specific needs of female PWID, PWID who sell sex and PWID from previously disadvantaged communities.