Juxtaposition 12.1

Volume 12 Issue 1 | 2019

CONTRIBUTORS Michelle Amri Michelle is a PhD candidate in Social and Behavioural Health Sciences at the Dalla Lana School of Public Health at the University of Toronto with a Collaborative Specialization in Global Health. Her research is focused on global policy discourse around urban health and equity. She is funded by the Ontario Graduate Scholarship (2018–2019) and has previously worked as a Consultant for the World Health Organization’s Regional Office for the Western Pacific in Manila, Philippines, and the Lao Country Office in Vientiane, Lao PDR. Christina Angelakis Christina is a graduate from the department of human biology at the University of Toronto with a major in Global Health and a double minor in French and Biology. Passionate about research in global health equity, planetary health and health promotion, Christina has been awarded the Queen Elizabeth II Diamond Jubilee Scholarship and is working in Nairobi, Kenya on a public awareness and health information campaign.

Arshdeep Aulakh* Kimberly Dias* Gabriella Ekmekjian* Nina Finkhouse I am heading into my final semester at U of T with a major in Human Biology: Global Health and a double minor in Immunology and Environmental Science. My writing interests include anything related to health and the environment, especially air pollution and toxic chemicals!

Tahmid Hasib Khan Tahmid finished his undergraduate degree very recently with a major in Global Health and minors in Statistics and Anthropology. His interests lie in the intersection of the fields of analytic health, climate change action and bottom-up policy making.

Vanessa Kishimoto Vanessa is a fourth year undergraduate student double majoring in global health and biology. She is particularly interested in health equity and the effects of climate change on global health.

Madeline Helmer Pelgrim* Xijia Jessica Peng* Esther Somanader* Jonowin Terrance Jonowin is a third year undergraduate student at the University of Toronto. His present research interests are particularly in the intersections between health disparities and mental health.

Sarah Crawley: Artist for the cover page and all illustrations. *Biographies for the authors of The Globe at Gunpoint: An Analysis of Conflict and Climate Change-Induced Migration are included at the end of their article.

Sponsors and Supporters:

2

Juxtaposition Global Health Magazine 21 Sussex Ave. Rm 610 Toronto ON, M5S 1J6

TEAM Editors-in-Chief: Aceel Hawa Elizabeth Loftus Editorial Team: Miriam Ahmed Gawel Fakeha Jamil Jocelyn Catenacci Allison Daniel Celina Liu Stefan Litvinjenko Kimberly Skead Fatima Chohan Shafna Kallil Maria Medeleanu Michelle Amri Nina Finkhouse Christine Ung Natasha Altin Vanessa Kishimoto Tahmid Hasib Khan Jonowin Terrance Communications: Tahmid Hasib Khan Sanaya Rau Events: Zoe Zhang Juxtapod: Benjamin Levy Bryn Badour Zarlasht Jamal Toronto Thinks Chair: Elizabeth Loftus

TABLE OF CONTENTS LETTER FROM THE EDITORS

4

DISCOURSES IN MIGRATION AND IMPLICATIONS FOR HEALTH

6

THE ROHINGYA: VICTIMS OF A MAN-MADE BORDER

9

REFUGEE HEALTH CARE

13

SHORT-TERM INTERNATIONAL VOLUNTEERING

16

AIR POLLUTION AND RESPONSIBILITY

19

THE GLOBE AT GUNPOINT: AN ANALYSIS OF CONFLICT- AND CLIMATE CHANGE-INDUCED MIGRATION

21

TORONTO THINKS 2019 FIRST PLACE AND PARTICIPANTS’ CHOICE: IT’S TIME TO GO BANANAS: REDUCING FEMALE UNEMPLOYMENT IN RURAL RWANDA AND UGANDA BEST UNDERGRADUATE: GROWING CASSAVA: EMPLOYING AND EMPOWERING YOUNG WOMEN IN RURAL RWANDA AND UGANDA

25

28

3

LETTER FROM THE EDITORS Welcome to the 12th volume of Juxtaposition, the University of Toronto’s premiere global health magazine. We seek to highlight social, political, legal, economic, and medical issues that are affecting the health of populations worldwide, with a particular emphasis on topics that impact those most marginalized. We aim to publish articles with contrasting perspectives, raised by a variety of disciplines and presented in a thought-provoking manner. What makes us so unique lies within the breadth and diversity of our contributor base.

This year, Juxtaposition produced several online outputs, co-hosted events with student and professional groups on campus, and worked tirelessly towards the ultimate culmination in the form of our annual print edition. Our online reporting this year touched upon several noteworthy topics, ranging from the nefarious impacts of the climate crisis and deforestation on communities, all the way to global mental health and technology’s burgeoning influence on the public health sphere as we know it.

Moreover, the seventh annual Toronto Thinks Global Health Case Competition was a tremendous success. This year’s case focused on reducing youth unemployment to promote health in rural Rwanda and Uganda, and the pitches for both the first place and participant’s choice team, as well as the best undergraduate team can be found in this issue.

Thanks to the case writing team, the volunteer planning committee, and the Office of Global Public Health Education & Training, #TOThinks2019 saw over 200 students, faculty, and experts.

Following the far-reaching scope of article contributions and our fruitful editorial team meeting discussions, we are pleased to present our current print edition and its theme: Borders. In volume 12.1, you will find perspectives on the health impacts of discourses on migration; the implications of climate change and conflict on migration; and many more.

A warm and special thank you to those of you who have supported Juxtaposition in the past and continue to celebrate and enrich our presence. To our executive and editorial teams, our community partners, our professional mentors, and our readers: thank you. We sincerely hope you take pleasure in reading this year’s print edition.

Aceel Hawa Editor-in-Chief 2018-2019

Elizabeth Loftus Editor-in-Chief 2018-2019

Keep in Touch juxtamagazine.org | @juxtamagazine | facebook.com/juxtamagazine 4

DISCOURSES IN MIGRATION MICHELLE AMRI, CHRISTINA ANGELAKIS Migration is not new,1 nor is it disappearing anytime soon.2 Since the year 2000, international migration has increased from 155 million people to 244 million in 2015.3 While 3.3% of the world’s population undergoes forms of global migration, the number of internal migrants is even higher, with 740 million individuals migrating within their country of origin.3 Taking a historical view, arguably, the “age of mass migration” occurred from mid-nineteenth century until WWI, where approximately 59 million individuals migrated from Europe to North America.1 Following this predominantly transatlantic migration, migration became more global in na-

gration discourse reinforces negative connotations and further alienates migrants. Illustrating all migrants as ‘illegal residents’ invokes sentiments of threat and urgency aimed at stopping ‘them’ from invading ‘our’ country.8 Refugees and asylum seekers are often discussed as ‘charity cases’, being seen as lacking agency and skills and acceptance into a host country as an act of goodwill rather than obligation by international law.8 Specific to public health, migrants are thought to be a threat to the health of the host society, as they are often depicted as carriers of disease that must be screened before entry.8 Through these discourses, migrants are marginalized and silenced.8

ture after 1945 and expanded in the 1980s.1 Since this time, mobility has become easier, making international migration a “central dynamic within globalization”.1 Despite the advantages afforded by migration to those who undergo the process and to the host country, immigration and ethnic diversity remain politically salient issues.1 Looking to the news, immigration issues are glaring.

From Trump’s wall in the United States of America, to the recent arrival of Rahaf Al-Qunun in Canada,4 migration remains a pressing topic. This political saliency of migration has steered some scholars to note that we currently live in an “age of migration”1, which is argued to be “one of the most pressing issues of the 21st century”.2 However, our discussion of this issue creates divisions in society.1 On the one hand, some claim that immigrants are failing to integrate, reducing social cohesion and threatening security,1 while others are protesting against unjust treatment of migrants, such as the separation of immigrant children from their parents at the U.S.-Mexico border.5 Evidently, the views we take are shaped by many factors, one of which comes as a result of discourses. Discourses are thought to produce broader cultural and social structures, which are reproduced as social practices.6 Prominently, media coverage and rhetoric in host countries tend to depict migrants as ill and a burden on the healthcare system.7 Similarly, public, media, political, and legal discourses around forced migrants (many of which face conflict, political unrest, and economic difficulties) construct forced migrants as being different, or as an ‘other’ in Western society.8 This process of ‘othering’ sets apart forced migrants from mainstream communities by stigmatizing an(other).8 For example, metaphors of water (flows of forced migrants) and natural disasters (arriving in waves) are often used to discuss migrants.8 The use of destructive language within mi-

6

However, these discourses are not rooted in truth. In fact, there is a general misconception of how unhealthy migrants are. While migrants are depicted to be a burden on the healthcare system, evidence suggests they are in fact healthier than host populations.7 A globally diverse study of 15.2 million international migrants demonstrated that both male and female migrants had a health advantage across ten disease categories (with the notable exception of infectious diseases and external causes), in comparison to the general population.7,9 The “healthy migrant hypothesis” posits that migrants are a healthy population, but their health advantage may decrease with more time spent in the host country.7,10 Younger, healthier individuals face an increased likelihood of migration compared to sick individuals.11 While the “healthy migrant hypothesis” gives the illusion that ultimately, these migrants become a burden on the healthcare system of the host country with their decreased health over time, this is actually not true. The salm-

on bias stipulates that when migrants are in poor health and before death, rather than seeking care in their host country, migrants tend to return to their origin destinations, therefore not ‘straining’ the healthcare system as is frequently perceived.7 Furthermore, discourses can be internalized, as they shape and form our understandings.8 In other words, how we discuss migrants shapes our perceptions and has direct implications on migrants’ health, given that health and migration are “inextricably linked”.2 Upon arrival in the host country, migrants face an increased burden of disease.11 Insecure conditions when combined with social isolation can negatively impact mental and physical health, through an increased prevalence of depression and anxiety.11 The depiction of migrants as inferior individuals, not worthy of ‘our jobs’, forces them to accept precarious working and living conditions creating a negative self-image that can be internalized by migrants.12 This reduction in merit leads to the development of low self-worth and unhealthy coping mechanisms such as excessive alcohol consumption, smoking, and drug use.13 As opposed to targeting the source of these issues, policy reforms shaped by hateful discourses disregard the social determinants of health affecting migrants, shifting blame on the individuals undergoing migration, perpetuating a vicious cycle of discrimination and abuse.8 The intolerable portrayal of migration in the media shapes a biased and fearful public, who in return will elect governments that reinforce strict measures of ‘protection’ against those considered a threat, overlooking the internal threat to health, inequity.8 Similarly, through the ‘othering’ process, migrants are grouped together as a common threat. This inhibits a greater contextualized understanding of the different types of migrants – as there is a “differentiation of migration”, meaning most countries experience a variety of different types of migrants at once.1 Arguably, this could potentially limit the ability to address unique health issues faced by different types of migrants – as refugees possess a mortality advantage, whereas asylum seekers do not.9 Distinction between migrant groups and their unique risks, (infectious diseases, workplace accidents, etc.) combined with culturally inclusive healthcare resources is crucial in ensuring an adequate standard of health, through screening and prevention.14 With the “globalization of migration”, in other words, the tendency for an increasing number of countries to be affected by international migration,1 the importance of tackling the negative discourses around migrants becomes stark.

The way in which individuals talk about migration has a direct implication on the health and well-being of a country.

The ‘othering’ of migrants depicts them as a threat to ‘our health resources’ deterring their access to health resources through stigmatization.8 This creates a negative feedback system, whereby the divide further undermines the health of migrants, eventually placing an even bigger burden of disease and financial strain on the public health system.8

Given that migration and the health of migrants are connected in complex ways,7,10 one potential solution is to tackle the misconceptions around the health of migrants and reframe public discourses on migration and health.9 Another potential solution is to give a voice back to migrants who have been ‘othered’, to allow for conversations around migration to adapt to consider humanity.2 It is only through a concerted effort that our misconceptions can be overcome and we can work together to prioritize migrants and their health for a more unified world.

References

1. Castles, S., Haas, H. d. & Miller, M. J. The Age of Migration. (Guilford Press, 2013).

2. Clark, J. & Horton, R. Opening up to migration and health. The Lancet 392, 2523-2525, doi:10.1016/S0140-6736(18)32935-0 (2018).

3. International Organization for Migration. World Migration Report 2018. (Geneva, Switzerland, 2018). at <https://publications.iom.int/ system/files/pdf/wmr_2018_en.pdf>.

4. Kalvapalle, R. ‘A very brave new Canadian’: Woman who fled Saudi Arabia arrives in Toronto. Global News (2019). at <https://globalnews. ca/news/4841266/saudi-woman-abusive-family-toronto/> 5. The Associated Press. Separation of parents, kids at U.S.-Mexico border: How the Trump administration got here. CBC (2018). at <https://www.cbc.ca/news/world/border-children-parents-separation-trump-1.4710055> 6. Foucault, M. Power/knowledge: Selected Interviews and Other Writings. 1972-1977 (1980).

7. Borhade, A. & Dey, S. Do migrants have a mortality advantage? The Lancet 392, 2517-2518, doi:10.1016/S0140-6736(18)33052-6 (2018).

8. Grove, N. J. & Zwi, A. B. Our health and theirs: Forced migration, othering, and public health. Social Science & Medicine 62, 1931-1942, doi:10.1016/j.socscimed.2005.08.061 (2006).

9. Aldridge, R. W. et al. Global patterns of mortality in international migrants: a systematic review and meta-analysis. The Lancet 392, 2553-2566, doi:10.1016/S0140-6736(18)32781-8 (2018).

10. Lu, Y. Test of the ‘healthy migrant hypothesis’: A longitudinal analysis of health selectivity of internal migration in Indonesia. Social Science & Medicine 67, 1331-1339, doi:10.1016/j.socscimed.2008.06.017 (2008).

11. Abbas, M. et al. Migrant and refugee populations: a public health and policy perspective on a continuing global crisis. Antimicrobial resistance and infection control 7, 113-113, doi:10.1186/s13756-0180403-4 (2018).

12. Bhugra, D. Migration, distress and cultural identity. British Medical Bulletin 69, 129-141, doi:10.1093/bmb/ldh007 (2004).

13. Alaniz, M. L. Migration, Acculturation, Displacement: Migratory Workers and “Substance Abuse”. Substance Use & Misuse 37, 12531257, doi:10.1081/JA-120004182 (2002).

14. Rechel, B., Mladovsky, P., Ingleby, D., Mackenbach, J. P. & McKee, M. Migration and health in an increasingly diverse Europe. The Lancet 381, 1235-1245, doi:https://doi.org/10.1016/S0140-6736(12)62086-8 (2013).

7

THE ROHINGYA: VICTIMS OF A MAN-MADE BORDER TAHMID HASIB KHAN While there is a growing coverage of the Rohingya refugee crisis in South Asia, we must dig deeper into the issue to comprehend the gravity of the situation. Scrolling through social media may lead to one finding a resemblance of this situation to Kony 20121, or the Sri Lankan civil war2 where one powerful group cracked down on civilians. But how deep has this crisis become and how does it compare to the other refugee crises we have witnessed so far?

Let us explore the causal root of this problem and its impending catastrophic health implications.

The Rohingya have been characterized as a landless ethnic minority3 who are currently fleeing Myanmar (formerly known as Burma), having been under heavy persecution from the government. Muslims form a minority in the overall demographics of the country ranging between 4-20%4 of the population as reported by the Government of Myanmar and Islamic Leaders of the country. According to a Lancet article

by Mahmood et al. (2016)4, the Rohingya are residents of the Rakhine State - known as Arakan State before 1989 - which shares a border with Bangladesh along the coast of the Bay of Bengal4. The Rakhine state is a hot pot of cultures as the historically permease borders allowed the interaction of tribes of the Chittagong Hill Tracts (Bangladesh) such as the Chakma People, the Bengalis of Bengal as well as the then-thriving populations of Mizoram, Manipur and Assam5 regions which are now part of India. There was an increase in Muslim migration into the region after the British conquest in 18264. Due to the opening of the Suez Canal4 and rise in the value of staples, there was an influx of agricultural workers who were identified as Indians at the time; and the close proximity of Arakan to Burma’s economic capital Yangon, incentivised the movement.

With the British Empire leaving the region and Myanmar gaining independence in 19484, there were some major geopolitical shifts in the country. The very last census conducted by the Brit-

ish in Burma in 1931 showed that there were 15 indigenous races and 135 sub-races, which excluded the Rohingya. Animosity in the population dates back to the post Second World War period when the Muslims supported the British and some of the Buddhist populations were supporting the Japanese who also

had a strong influence in the region. Mr. M. A. Gaffar was an elected member of the 1947 Constituent Assembly and continued in his office, representing the Buthidaung constituency till Burmese independence6. He then took the oath of allegiance to the Union of Burma on 4th January 1948 as a member of the new parliament of the Union of Burma. On 20th November 1948, Gaffar presented a Memorandum of Appeal6 to the Principal Secretary of the Government of the Union of Burma asking for recognition of the Arakanese Indians as one of the "official nations" (ethnic groups) of Burma under the name ‘Rohingya’6. They were still not officially recognized, although some Rohingyas were provided national registration.

This is where the debate arises on the nativity of the Rohingya people. Their two main claims at this time are the memorandum proposed in 1948 and a 1799 report4 by the Scottish physician Francis Buchanan, which states that Arakan was also

9

known as Rovingaw’ among Mohammedans6 (historical term for ethnic Muslims), who have been long settled in Arakan, and who call themselves ‘Rooinga’, or natives of Arakan. The majority of the Burmese people, including the government, hold the position that the Rohingya have no official claim to Arakan and often consider them to be Bengalis. The political differences have accumulated to the point where a sovereign Burmese population does not want them in their lands. After the coup d’etat of 19627, the country has been under military control and tensions have only risen. Through the Citizenship Act in 19827, the Rohingya were officially excluded from the 135 recognized ethnic groups. A leading news outlet from the Asia Pacific, ‘The Diplomat’ reports that an official census carried out by the Myanmar government few years back has excluded the Rohingya8, cementing their position of zero tolerance. All of this begs the question: of whether this is a systematic persecution of all minorities or a pathway towards ethnic cleansing? The recognition of other minorities and certain Muslim populations may make one wonder, why the Rohingyas?

With the Rohingyas being declared illegal foreigners, the government was able to justify its crackdown. There were two waves of departure4, one in 1978 and one in 1991-1992. A total of 460,000 Rohingyas4 have fled to Bangladesh in this period having faced persecution. However, the world began to take notice in 2012 when violence broke out with word spreading that four Muslim men had raped and killed a Buddhist woman in Rakhine9. Buddhist nationalist forces, with the help of the authorities, were able to crackdown on Rohingya villages. The Human Rights Watch had declared this an attempt of ethnic cleansing9.

While misplacement and persecution continued, the brutality on the civilians erupted in 20164 when a militant group called the Arakan Rohingya Salvation Army retaliated. The government launched a military scale crackdown as reprisal and the plight of these landless people has been the same ever since.

In the UN, the Office for the Coordination of Humanitarian Affairs oversees the refugee camps in Cox's Bazar, Bangladesh. The humanitarian response is coordinated by the Inter-Sector Coordination Group (ISCG), which is in part led by UNHCR. In the recent ISCG report10 from 31st January 2019, we find a startling figure from several camps in Cox’s Bazar, Bangladesh’s southernmost district. In the mere seven camps listed, we see a total of 158,440 listed refugees. A press release from the Norwegian Refugee Council from August 201811 highlights that 900,000 people from Myanmar are currently seeking shelter in Bangladesh, labelling Cox’s Bazar as the world’s largest refugee settlement. If we take the lower estimates from the Burmese government, the Muslim population in Myanmar is currently around two million. With Arakan having the highest density from this group, we can now safely say that more than half of the total Rohingya population has been driven out of Myanmar. With the rest of them being forced to leave, the camps are only going to get more crowded.

10

The problems these people face in the camps cannot be accommodated within the confines of this article. Many of their basic human rights such access to water, food and shelter becomes a luxury. As you can imagine, the health impacts are far reaching. The Rohingya arrive in to these camps after a treacherous journey, malnourished, traumatised and possibly carrying diseases. Without proper authorization, they are not allowed to leave the camps, culminating into a nightmarish quarantine. With irregularities in data collection, it becomes hard to paint an overall picture of the health status in these camps. However, Mahmood et al. (2016)4 do a very good job of highlighting some figures for us. Stunting, or low height for age, is related to chronic malnutrition and is prevalent in 60% of Rohingya children in the refugee camps. Recent figures show a ratio of 1:37 latrine4 to individuals in these camps, whereas the current suggestion is one latrine per 20 individuals as outlined by the Minimum Standards in Humanitarian Response to minimise waterborne diseases. A recent publication from the Journal of Global Health by Islam and Nuzhath (2018) reports that Rohingya children have ten times higher rate3 of diarrhoeal disease compared to other children across Bangladesh with similar trends existing across Rohingya camps in southeast and south Asia. There has also been measles and diphtheria outbreaks3. The population inside these camps have also reported respiratory problems and skin diseases among the new arrivals since 25th August - with 10,846 and 3,422 cases respectively3. Although both Myanmar and Bangladesh have low prevalence of HIV among the South Asian countries, there have been 21 cases3 of HIV patients reported among the refugees until Oct. 8, 2017. Additionally, prostitution and sexual violence have greatly increased the risk of transmission of HIV3.

The UNHCR estimates that there are 10 million people who are classified as stateless worldwide13. This makes the 1·5 million Rohingya across southeast Asia account for more than one out of every seven stateless individuals. The active role taken by the Burmese Government in restricting Rohingya reproductive rights and in the high morbidity and mortality of the Rohingya people could arguably be made to account as a charge of genocide, or at the very least as ethnic cleansing. UNHCR12 reports that Syria has the highest number of non-local displacements, i.e. international refugees in the world right now. As of June 2018, there are 6.3 million Syrian refugees, followed by Afghanistan with 2.6 million and South Sudan with 2.4 million12. While the Rohingya rank fourth on the list, their situation is made horridly unique by the fact that they are the only people whose displacement did not come from armed conflict. While Bangladesh, Malaysia, Thailand and others lend their helping hand, the world leaders must ponder upon a crisis that is strangely unfamiliar.

References 1. Invisible Children. KONY 2012. YouTube (2012). at www.youtube. com/watch?v=Y4MnpzG5SqcChildren 2. Candela, M. & Aldama, Z. The Scars of Sri Lanka's Civil War. Al Jazeera (2016). at https://www.aljazeera.com/indepth/inpictures/2015/12/scars-sri-lanka-civil-war-151221062101569.html

3. Islam, M. M. & Nuzhath, T. Health risks of Rohingya refugee population in Bangladesh: A call for global attention. Journal of Global Health 8, 02039, doi:10.18411/a-2017-023 (2018).

4. Mahmood, S., Wroe, E., Fuller, A., Leaning, J. The Rohingya people of Myanmar: Health, human rights, and identity. The Lancet 389, 1841–1850, https://doi.org/10.1016/S0140-6736(16)00646-2, (2016).

5. Shekhar, S. Indian and Myanmar Army Crush Arakan, Naga Terrorists in Secret Joint Op. My Nation (2019). at https://www.mynation. com/security/indian-and-myanmar-army-crush-arakan-and-naga-terrorists-in-secret-joint-op-poenvg 6. Nemoto, K. The Rohingya Issue: A Thorny Obstacle Between Burma (Myanmar) and Bangladesh (1991). at http://www.burmalibrary.org/ docs14/Kei_Nemoto-Rohingya.pdf 7. BBC News. Myanmar Profile – Timeline. BBC News (2018). at https://www.bbc.com/news/world-asia-pacific-12992883 8. Heijmans, P. Myanmar's Controversial Census. The Diplomat (2014).

At https://thediplomat.com/2014/09/myanmars-controversial-census/ 9. Parnini, S. N. The crisis of the Rohingya as a Muslim minority in Myanmar and bilateral relations with Bangladesh. Journal of Muslim Minority Affairs 33, 281-297, doi:10.1080/13602004.2013.826453 (2013).

10. World Health Organization Bangladesh. Rohingya Crisis Bi-Weekly Situation Report #2 (2019). at http://www.searo.who.int/bangladesh/ bi-weeklysitrep02cxbban.pdf?ua=1 11. Kolstad, K. Cox's Bazar: The World's Largest Refugee Settlement.

Norwegian Refugee Council (2018). https://www.nrc.no/news/2018/ august/coxs-bazar-the-worlds-largest-refugee-settlement/ 12. United Nations High Commissioner for Refugees. Global Trends – Forced Displacement. (2018). at https://www.unhcr.org/5b27be547.pdf

11

HEALTH CARE FOR REFUGEES JONOWIN TERRANCE When we hear the word “refugee” in today’s day and age, we often think about it in the context of crisis and humanitarianism. In particular, we often think about refugees as vulnerable victims in need of our help – in need of refuge. Moreover, while we live in Canada, we are often so bombarded with news from the United States, where the word refugee – especially since the presidency of Donald Trump – has come to be understood as something to be feared, something so foreign and invasive that it needs to be stopped.

In the news, we hear about the number of refugees seeking asylum in Canada, which countries the refugees are coming from, and what we as a country can and should do about it. But we often do not hear about what we should do about the health of the refugees we welcome into our country. We may all believe that we should provide basic healthcare to refugees, but we often do not think about the policy implications of doing so, which are all the more important.

A quick search on the Internet for news stories on refugees to Canada and the United States brings up two different issues.

For example, among the most popular search items, one recent article by Global News published in November 2018 was titled “Refugee claims to Canada on track to hit highest levels in nearly 30 years.”1 In contrast, a recent article by BBC News published in September 2018 was titled, “US slashes number of refugees to 30,000.”2 These two articles tell two different stories, but they are essentially a depiction of each country’s policy approach to the topic of refugees. This is a result of how the media outlets in each country have chosen to frame refugees – as a humanitarian issue that must be addressed or as a crisis caused by an invasion of foreigners that requires a crackdown – which in turn shapes which healthcare policies are advocated for and how healthcare policy

is ultimately developed around these issues. In Canada, the Interim Federal Health Program (IFHP) is the primary vehicle of funding for refugee healthcare. As Holtzer et al.3 mention in their article on refugee healthcare policy, there have been many abuses toward the IFHP, which have subsequently led to a piling of debt as well as general concern about the wasting of Canadian taxpayer dollars. How do we strike the right balance between caring for the interests of Canadian taxpayers and also ensuring that our policies are designed to adequately address the healthcare needs of refugees?

One of the things that is causing refugee healthcare costs to increase is the legal and ethical responsibility that healthcare providers have to treat any and all patients in emergency situations, regardless of their healthcare coverage.

These costs must be absorbed by the healthcare provider or the provinces.3 This is simply unsustainable, not just because of general inflation, but because of medical inflation – which is even more costly. One innovative way to address refugee healthcare in Canada is matching federal funding dollars, whereby the federal government needs to match each provinces’ expenditures on healthcare for refugees. This solution not only prevents provinces and healthcare providers from accumulating debt, but it also provides them peace of mind that the federal government has certain [matching] funds earmarked for refugee healthcare and, therefore, providers and provinces do not have to divert resources from elsewhere to direct to refugee healthcare. However, a main disadvantage of this approach is that it may lead provinces and providers to spend more wastefully because they are not bearing the full costs of the care. The co-pay is not meant to be a huge

13

barrier, but just enough that people do not abuse the system.

Therefore, another innovative way we can use to address the healthcare needs of refugees is a per capita allotment system whereby the government simply provides healthcare coverage to a fixed number of refugees. This would provide more predictability for healthcare providers and provinces so they can control spending and avoid the possibility of accumulating any debts. While this level of predictability is very valuable for healthcare providers and provinces, it may, at the same time, provide them with an incentive to cut the services they provide, which will ultimately hurt refugee patients. Moreover, many may argue that this kind of system is inequitable, as some refugees are inevitably left out uncared for. However, we can address this by implementing a triage system on top, whereby the very sick and those with the most urgent care needs get priority over healthier people who are in need of preventative services.

Another innovative method of addressing refugee healthcare in Canada is to implement a reform of the current program â&#x20AC;&#x201C; the IFHP. This program is intended to be temporary, until refugees gain more permanent access. But there have been many abuses against the program that have been reported. While this may be controversial, I believe one way to curb the abuses are to implement a co-pay system on top, whereby beneficiaries of the IFHP are required to pay a small co-pay for each of the services they use. Since the beneficiary is expected to pay some of their own money, it is expected to reduce moral hazard â&#x20AC;&#x201C; in other words, people will think twice before deciding whether they really need healthcare.

In conclusion, there may exist several innovative ways of addressing refugee healthcare in Canada. However, even with the few I have discussed above, the advantages of each method come with disadvantages of their own. Currently there is no solution that is perfect and all-encompassing, but I believe that anything that is slightly more effective and impactful than the status quo is something worth pursuing. As a country, Canada fundamentally believes in treating refugees with welcome arms and ensuring that they successfully adapt in our country. This does not preclude caring for their healthcare needs, as we cannot ensure that they will adapt successfully if they are also not in good health. Therefore, we cannot, and should not, welcome refugees without ensuring that we first have an appropriately healthcare program that will care for them effectively and adequately.

References 1. Paperny, A. Refugee claims to Canada on track to hit highest levels in nearly 30 years. Global News. https://globalnews.ca/news/4671586/ canada-refugee-claims-2018-highest-levels/. (2018).

2. BBC. US slashes number of refugees to 30,000. BBC News. https:// www.bbc.com/news/world-us-canada-45555357. (2018).

3. Holtzer, E., Moore-Dean, A., Srikanthan, A., & Kuluski, K. Reforming Refugee Healthcare in Canada: Exploring the Use of Policy Tools.

Healthcare Policy. 12(4), 46, (2017).

14

SHORT-TERM INTERNATIONAL VOLUNTEERING VANESSA KISHIMOTO Short-term international volunteering has become more prominent since the 21st century following the creation of the Millennium Development Goals. Masked as voluntourism or missionaries, short-term international volunteering trips often involve individuals, normally students, from the global north traveling overseas to impoverished countries with the purpose of volunteering to, put it loosely, “solve poverty” and alleviate its effects, while participating in some form of tourism. Admittedly, it can be tantalizing to spend a summer with Free the Children or International Volunteer HQ teaching English, visiting orphanages or participating in medical interventions in a whole new country to explore, especially for students who are looking to build their resume. There are many benefits and consequences as a result of voluntourism and ethical considerations which must be made.

Benefits of International Volunteering Opportunities to travel abroad and volunteer can improve personal development and provide a sense of self-actualization and fulfillment. They can also increase awareness of extremely localized issues and increase awareness and improve international understanding.1 With the rise of globalization in an increasingly connected world, cross-cultural experiences and education outside of a classroom can foster so-

16

cial activism and a better understanding of global issues.

Consequences of International Volunteering Short-term international volunteering puts forth the notion that consequences of poverty can simply be remedied by well-meaning people.2 It often overlooks many of the underlying social, political and economic factors which contribute to issues concerning global poverty. These missions can reinforce the “White Saviour” stereotype and reiterates the assumption that the Global South needs to be saved by the dominant and all-powerful Global North. The constancy of these trips provides an incentive for local and national governments to accept the free aid and refrain from investing in healthcare or educational infrastructure. These brief trips merely provide a band-aid solution to problems which should be addressed through a sustainable, long-term solution. The short timeframe of these trips can also cause complications specifically on medical trips which volunteers are unable to provide continuous care for patients, await lab results or deal with any complications and overall, cannot be held accountable for their actions.2 Host communities often become dependent on volunteer organizations and trips. This can become extremely problematic in cases of cultural insensitivity and when Western values are being imposed. In these most intense and severe cases, voluntourism is viewed as neo-colonialism3 which imposes Western values and practices through providing healthcare and education services in countries which already have a history of being colonized.

In many cases of voluntourism trips, groups often bring supplies, including clothing, medical equipment and school supplies, to donate to the host community. In many cases of donations and charity, the needs of the community are not assessed beforehand. TOMS Shoes received criticism for their “One for One” campaign which matches “every pair of shoes pur-

chased with a pair of new shoes for a child in need”.4 While this seems like a worthwhile cause, it misses the fundamental reason of not having shoes -- poverty. Campaigns similar to “One for One”, such as the infamous (RED) campaign, have received criticism in the past for eliciting compassionate consumerism in customers which is based on the idea that a small percentage of their purchase is going towards a charitable cause. Similar to short-term international volunteering, these campaigns oversimplify the complexities of global issues and overlook sociopolitical factors which continue to allow poverty to endure. Contrastingly, volunteers can simply be an afterthought to the resources they provide. A study5 conducted on the perceptions of a short-term volunteer program in the Dominican Republic revealed material resources to be the main interest instead of the services provided by volunteers. These trips do not provide sustainability to the host communities they work in.

4.TOMS® : One for One. Available at: https://www.toms.ca/one-forone/. (Accessed: 12th May 2019) 5.Loiseau, B. et al. Perceptions of the Role of Short-Term Volunteerism in International Development: Views from Volunteers, Local Hosts, and Community Members. J Trop Med 2016, (2016).

6.Loewenberg, S. Medical missionaries deliver faith and health care in Africa. The Lancet 373, 795–796 (2009).

Missionaries and Neo-colonialism Analogous to voluntourism trips are missionary trips which perform acts of humanitarian service while preaching religion with the intention of converting communities to their faith. These trips predate voluntourism yet criticism regarding missionaries have largely been absent from scientific literature, perhaps due to the fact that it revolves around the sensitive topic of religion.

Missionaries are particularly prevalent across Africa, a continent which is still recuperating from the effects of colonialism.

Although these missionaries provide medical aid and services, benefiting the communities they work in, their control over these communities is neo-colonialism guised as medical aid.

Conclusion Another issue with short-term international volunteering, specifically missionaries and voluntourism, is the lack of oversight and realistically, there is no way to measure their efficacy6. Currently, there is no system for accountability regarding the potential harmful consequences of these trips.

These organizations are reaping all the benefits, receiving notoriety for their work without suffering any consequences.

If the primary goal of short-term international volunteering is to promote sustainability for communities, they must foster education and build public health infrastructure instead of giving them our leftover donations and calling it “global aid”.

As the saying goes, “give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime”.

References 1.Garrison, H. A. A Critical Analysis of Volunteer Tourism and the Implications for Developing Communities. 72 2.Bauer, I. More harm than good? The questionable ethics of medical volunteering and international student placements. Trop Dis Travel Med Vaccines 3, (2017).

3.McLennan, S. Medical voluntourism in Honduras: ‘Helping’ the poor? Progress in Development Studies 14, 163–179 (2014).

17

AIR POLLUTION AND RESPONSIBILITY NINA FINKHOUSE If you follow the news, you may have noticed that many countries, one in particular at the moment, are very concerned with protecting their borders. Their reasoning is to protect their citizens from outside danger, to keep communities safe from potential threats, to protect the economy, etc. Though this rhetoric presents a different issue altogether, this article will focus on a different problem. Many scientists believe the ongoing threat of air pollution will become one of the largest dangers to human health in the near future. Last year, the World Health Organization held its first conference1 on the topic of air pollution and health, highlighting the scope of the issue (92% of people breathe unhealthy air), and the most common dangerous types of air pollution and health issues that result.

beyond where they originate. PM2.5 is the smallest category of particulate matter, representing ultrafine particles. Not only the most dangerous form of particulate matter pollution because they can penetrate so deeply into the human body, but because they also are easiest transported through the air due to their small size. Research studies demonstrate how global wind patterns spread pollutants like smog and PM2.5. Dust storms spread3 giant clouds of pollution from industries in China, and winds disperse the pollutants over Southeast Asia, severely damaging human and plant health. This pollution can cross the Pacific Ocean, brought by strong eastbound winds. With tools like IQAirâ&#x20AC;&#x2122;s interactive map,4 you can watch PM2.5 travel through the global wind systems.

Global wind patterns pick up the pollution and bring it with them, spreading carcinogens and toxic compounds throughout the globe, far from where the chemicals were emitted.

Any country with large-scale industry produces dangerous amounts of pollution in the form of small particulate matter known as PM2.5 (less than 2.5 Âľm) and smog, also known as ground-level ozone.

These are produced from different forms of urbanization and industrialization: coal-burning factories, diesel-burning engines (often high levels of automobile use), and industrial activities in general. Standards on industry and how much they can emit generally go unenforced. Urbanization and industrialization levels in many countries are on the up and show few signs of stopping.

In India, policies limiting emissions from cities are ineffective as collaboration and cooperation between jurisdictions is slim.2

Global wind patterns spread smog and PM2.5 pollutants far

The smog problem on the west coast of North America has been well known for a long time. Though the high levels of traffic and automobile use in the area contribute greatly to the problem, part of it is due to weather and wind patterns that push pollution all the way across the Pacific.5 A NOAA research study5 measured levels of pollutants in American national parks like Yellowstone and Yosemite found that 65% of the smog in the national parks was due to Asian air pollution. Smog levels typically peak during the warmer summer months.5 Basically, nowhere is untouched from the dangers of pollution, especially if levels continue to increase in many countries. The study found that smog levels resulting from Asian air pollution on the east coast of America were low, but peak6 during summer heat waves.

The health issues resulting from exposure to air pollution like PM2.5 and smog have been well established in the scientific

19

community for years. Child asthma levels have risen steadily7 as levels of industrialization have too risen steadily. Even in cities considered to have relatively low levels of air pollution, levels of respiratory disease and deaths increase yearly.8 Smog triggers asthma and respiratory issues, especially in children and the immunocompromised. High levels of smog, like the ones seen daily in cities in China, can compromise and create serious health issues for even the healthiest of individuals.9 PM2.5 is linked to deadly respiratory and cardiovascular issues.10 The smaller the pollutant, the more stressful it is to the cells and the further it can penetrate into the body and destroy healthy cells and tissues.11 Recently, studies have revealed the potential connection between PM2.5 and neurodegenerative diseases like Alzheimer’s and dementia. PM2.5 pollutants may be able to penetrate the delicate blood-brain barrier and degrade critical neural tissue.11 The WHO reports that up to 1/3 of deaths from the leading NCDs (stroke, lung cancer, heart attacks and chronic obstructive pulmonary disease) are due to air pollution.1 Types of PM2.5 pollutants are carcinogens, possibly associated with the increased lung cancer levels observed in many cities.12 Diseases like cancer and dementia do not strike overnight, they develop over an extended period of time and often involve chronic exposure to certain environmental triggers. As they can take years to develop, those exposed to carcinogens or high levels of air pollution during childhood may not develop the resulting diseases until much later on in life. This makes it harder for society to realize and recognize what is going on and what is causing the problem in terms of environmental exposures like air pollution. The effect of exposure is not seen directly or overnight.

Though air pollution is a global problem, it disproportionately affects those living in lower income countries. The WHO reported that 90% of deaths related to air pollution occur in lower and middle income countries like Africa and Asia.13 This presents a moral dilemma on the global scale: first, who bears responsibility for the harm the pollutants, and second, how do we mitigate this?

Do we place blame on the multinational corporations pumping pollutants into the air or the governments, for actively allowing them to do so unabetted? How can high-income countries tell lower-income countries they have to stop growing their economies through industrial activities that heavily pollute? Global warming projections forsee worsening air quality14 through several pathways, so political action would ideally be swift.

Solving this problem will require international cooperation and standards to slow the speed of emissions and get them under control. As citizens, we rely on our governments and policymakers for this issue. Many powerful lawmakers and politicians have one foot in the government and the other in an industry so they do little to support the curbing emissions as they want industrial companies to profit. We need global action and collaboration to tighten and enforce regulations on how the amount that industrial companies can pollute into the air and water. This problem, like all the issues of global warming, will come to affect everyone’s lives if nothing changes.

20

References 1. WHO’s First Global Conference on Air Pollution and Health. www. who.int/ 2. Irfan, U. Why India’s air pollution is so horrendous. Vox (2018).

3. Friedman, S. How Air Pollution Moves Between Countries. How Air Pollution Moves Between Countries 4. Normile Nov, D. Watch air pollution flow across the planet in real time. Science(2017).

5. Rice, D. Air pollution in Asia is wafting into the USA, increasing smog in West. USA Today (2017).

6. Lin, M., Horowitz, L. W., Payton, R., Fiore, A. M. & Tonnesen, G. US surface ozone trends and extremes from 1980 to 2014: quantifying the roles of rising Asian emissions, domestic controls, wildfires, and climate. Atmospheric Chemistry and Physics 17, 2943–2970 (2017).

7. Akinbami, L. J., Simon, A. E. & Rossen, L. M. Changing Trends in Asthma Prevalence Among Children. Pediatrics 137, (2015).

8. Mozes, A. Respiratory Disease Death Rates Have Soared – WebMD. WebMD (2017).

9. Yang, L. E., Hoffmann, P. & Scheffran, J. Health impacts of smog pollution: the human dimensions of exposure. The Lancet Planetary Health 1, (2017).

10. World Health Organization: Regional Office for Europe. Health effects of particulate matter: Policy implications for countries in eastern Europe, Caucasus and central Asia. (2013).

11. Underwood Jan, E. et al. Brain pollution: Evidence builds that dirty air causes Alzheimer’s, dementia. Science (2018).

12. Li, R., Zhou, R. & Zhang, J. Function of PM2.5 in the pathogenesis of lung cancer and chronic airway inflammatory diseases (Review).

Oncology Letters(2018). doi:10.3892/ol.2018.8355 13. CCAC secretariat. World Health Organization releases new global air pollution data. Climate & Clean Air Coalition (2018).

14. Damato, G., Cecchi, L., Damato, M. & Annesi-Maesano, I. Climate change and respiratory diseases. European Respiratory Review 23, 161–169 (2014).

THE GLOBE AT GUNPOINT: AN ANALYSIS OF CONFLICT- AND CLIMATE CHANGE-INDUCED MIGRATION MADELINE H. PELGRIM, ARSHDEEP AULAKH, GABRIELLA EKMEKJIAN, KIMBERLY T. DIAS, ESTHER SOMANADER, XIJIA JESSICA PENG In todayâ&#x20AC;&#x2122;s globalized world, anthropogenic climate change will impact all aspects of human life through its significant influence on the frequency and intensity of extreme climatic events like droughts, floods, extreme rain and wind.1 These drastic changes in climate and weather patterns will contribute to an increase in the number of migrants.1 This influx of climate change-induced migrants may aggravate the drivers of conflict in receiving states, such as poverty, food scarcity, and inequalities, and thus increase the risk for conflict.1 This has the potential to result in poor health outcomes, including premature death, disability, psychological trauma, and malnutrition.1 An improved understanding of the relationship between climate change, migration, conflict, and health can lead to improved policies regarding the health outcomes of vulnerable populations who could chose to migrate or stay like the Sahelâ&#x20AC;&#x2122;s pastoralist or the Syrian population . It is vital to address these concepts separately from regular migration flows driven by education, profession or social ties. Since climate change not only threatens human and state security but can play a significant role in prolonging and/or inciting conflict, which can lead to increased climate change-induced migration. This course of events will also have major repercussions on climate-sensitive industries and will test the capabilities of urban infrastructure and social and health support systems in both rural and urban areas.2 Thus, climate change-induced migration and social conflict should be examined as related phenomena that critically endanger the health and security of citizens and states.

Context: Exploring Existing Frameworks To explore this relationship, researchers have previously proposed various frameworks to conceptualize the connections between broad families of drivers like political, social, and economic factors which directly impact migration.3 Environmental change has been included as an independent driver, with an emphasis on migration following climate shocks, such as natural disasters.3 Furthermore, environmental change is not only a direct driver of migration, but also indirectly influences the economic, socio-political, and demographic conditions of a state, which in turn impacts the preconditions for climate change-induced migration.3 These indirect impacts have made it challenging to empirically study the link between climate change and conflicts.

Researchers attempting to study the impact of climate change on migration, conflict, and human health have taken a simple approach of focusing on the choices presented to individual migrants. This emphasis on the agency of an individual migrant challenges the notion that climate change-induced migration is something that is forced upon potential migrants.3, 4 Similarly, an overemphasis on individual agency rather than systemic factors can lead to a failure to address the root causes of challenges faced by migrants. This is because any negative impacts of their migration can be seen as self-induced. Despite the need for caution, it is still valuable to understand why migrants leave. Where climate change has a drastic impact, there are three choices for migrants: to exit, where migrants leave the affected area; to voice, where a mitigation solution is created in response to the problem; and towards loyalty, where people stay in the affected area and do nothing.4 These proposed choices each have an impactful outcome in their own right, including the outcome of conflict. However, this choice framework is limited or strengthened by the specific social, political or economic context in which people find themselves.

Defining Conflict In the complex relationship between climate change, conflict, and migration, the term conflict is contested and often used to exclusively refer to violent conflict, with emphasis on interstate wars and armed encounters.4 Social conflict, however, represents a more comprehensive measure of unrest, referring to anything ranging from protests to interstate war.5 This more comprehensive definition expands to encapsulate various types of conflicts as they are escalating, and which can catch unrest that does not always escalate to armed insurgency but is nonetheless damaging to the community.

Using the Social Conflict in Africa Database, researchers were able to examine over 6,000 social conflicts across the continent to advance their understanding of the trends between climate change and conflict.5 This aggregate data, spread over 20 years, was then compared to regional rainfall data and there were significant increases in occurrences of conflict in years of extreme rainfall, both high and low.5 The demonstrated curvilinear relationship suggests that years of extreme weather, like those predicted to increase as climate

21

change progresses, see elevations in social conflict rates of more than 100%.5, 6 As climate change leads to a rise in extreme weather events, including flooding and droughts, human safety, security, and health will be increasingly at risk.6 Important to consider, not all research on climate change measures that change in the same way. Measuring climate change is challenging as it impacts many metrics, and researchers are forced to choose a metric that they feel will be the most impactful to their region. In Africa, climate change will add pressure to water availability and accessibility - a resource that is already strained.6 Due to this unique relationship with water, examining changing rainfall is often examined as a metric for climate change.5 While well justified, the examination of this narrow metric challenges the ability to make direct comparisons with other research. That being said, this broad scale study provides an empirical and theoretical basis to narrow the focus on more specific case studies, building off the understanding that climate change and conflict are intricately linked.

A Unique Population: Mobile Pastoralists in the Sahel The Sahel region and its inhabitants have an interwoven and intricate relationship with the environment, their livelihoods, and their health. This region encompasses the nations of Chad, Mauretania, Burkina Faso, Mali and Ethiopia, where 20-30 million people live as mobile pastoralists .4, 7 Mobile pastoralists consist of livestock owners who live a highly nomadic lifestyle in order to access available pastures, water, and other wildlife to sustain their livestock.7 These land resources adapt to seasonal environmental changes, and thus mobile pastoralists internally migrate throughout the year to access resources where they are available.7 Their highly mobile livelihoods are largely reliant on the seasonal climate conditions, but with the addition of climate change as a variable, their way of life is profoundly threatened and may be rendered unstable.7 Studying this population is important as it can help guide policymakers to adopt site-specific policies to address the barriers and facilitators related to climate inducted migration and the health of mobile pastoralists.

Climate change has the power to increase the variability of the rainfall patterns, which in turn impacts the abundance or degradation of pastures, water sites, and wildlife.6 This presents an increased need for flexibility for mobile pastoralistsâ&#x20AC;&#x2122; migration routes and campsites.7 Likewise, the large number of individuals searching for limited viable resources also face increased land pressures. If climate change progresses at its current rate, it may lead to competition over limited resources.7 Such competition could increase the risk of food insecurity, prolonged displacement, and, lack of permanent shelter from the elements.

In a changing climate where conditions are getting more extreme, mobile pastoralists are increasingly vulnerable during the high humidity of the rainy season, and the overwhelming heat and dust of the dry season.7 However, as a direct result

22

of their mobility, pastoralists lack many of the benefits offered by their stateâ&#x20AC;&#x2122;s social services, including education and health outreach programs.2 These impacts only increase the value and pressures over the use of viable land and land-based resources for pastoral activities.8 These fragile relationships with the land carry the ability to alter the sociopolitical stability in these communities.8 Another intriguing aspect of policy research is how adaptation policies are chosen or the factors that impact the choice of these pastoralists adaptation (in place) to climate change.2 Self adaptive strategies could include spontaneous changes in short-term farming or pasturing activities. These adaptations to the livelihoods of pastoralists address climate variability rather than climate change, as they act in a more immediate and pressing manner. 2 Conversely climate change may politically or economically marginalize the pastoralist population in the Sahel region by imposing constraints and threatening how pastoralists conduct their routine activities or make choices in regards to their livelihoods and governance.8 Some academic researchers suggest that spikes in violence or conflict over access and use of resources might be a result of traditional self-governing lifestyles of pastoralists, and is only exacerbated by governments with scarce resources, rather than solely climate change.8 This challenges the idea that unique groups such as the Sahel region pastoralists are most vulnerable to climate change-induced migration and conflict, due to their stateâ&#x20AC;&#x2122;s pre-existing political and economic vulnerabilities to climate change.8 This counter idea places the onus for conflict onto groups of pastoralists and reduces it to be a byproduct of local politics.8 Opposing parties argue for more centralized control of the mobile pastoralists and their livelihood by the state government, in order to control these conflicts.8 However, this itself can be counterproductive in places with hostility or simply disinterested governments.8 Conflicting Policy: The Syrian Conflict Syria provides an example of a country in which existing governmental policies have intensified the effects of climate change, rapidly driving the country into civil conflict.9 Policies implemented by the Syrian government of Hafez al Assad in 2007, aimed to increase agricultural production through the implementation of a quota system, land redistribution, and several irrigation projects.9 However, these policies endangered the water security of the Syrian population by exploiting the already limited water resources and ignored the need to strive for sustainability.9, 10 A critical consequence of these policies was the severe strain on groundwater availability. As a result, over two-thirds of Syrian farmers and pastoralists had to rely on the groundwater supply that originated from rivers shared by neighbouring countries. These rivers primarily included the Euphrates and Tigris Rivers which bordered Syria, Turkey, and Iraq. However, due to the existing ethnic conflict between Turkey and Syria, the construction of the Ataturk Dam was funded by the Turkish government to redirect wa-

ter flow upstream, solely providing water to Turkey. 9, 10 This had destructive effects on Syria as over 60% of their declining groundwater supply originates from neighbouring countries.9, 10

From ideology to power

This severe reduction of groundwater supply led to multiyear droughts, defined as 3+ years of consecutive below-normal rainfall, and led to the collapse of the entire Syrian agricultural sector.9 This not only had a devastating impact on vegetation and pastoralist livelihoods, but dislocated rural farming families to urban Syrian areas.9 Over 1.5 million people migrated to peripheral areas within urban cities, which were already burdened by rapid population growth. As a result, there were increases in illegal settlements, crime, overcrowding, and unemployment. 9, 10 These factors are often cited as contributing to unrest, corruption, and the destabilization of state infrastructure.9, 10 In addition, these outcomes have an immense impact on the health of migrants in the form of nutrition-related diseases, increases in the spread of infectious diseases including respiratory infections, meningitis, and psychological distress.9, 10 In Syria, climate change induced migration was expressed internally and was further amplified through problematic governmental policies, which established the foundation for civil conflict over the landâ&#x20AC;&#x2122;s limited resources.

Correlation versus Causation There is no denying the relationship between climate change, migration, and conflict, but there is a lack of evidence that demonstrates the causal relationship between these variables. Most existing research is correlational, a weaker form of evidence that does not lay out a strong plan of action for combatting the problems faced. By removing variables from the three interrelated factors of climate change, migration, and conflict the correlation between them becomes clear.

Past researchers have examined of the thirty-eight cases of climate change-induced migration, nineteen of which did not result in violent conflict, with fourteen out of the nineteen being intrastate migration.4 By focusing on the nineteen cases that did not result in conflict, the relationship between climate change and migration can be explored in isolation.

These case studies and the authorâ&#x20AC;&#x2122;s comments demonstrate that climate change-induced migration does not always lead to violent conflict. This lack of a guaranteed cause and effect shows that climate change-induced migration is not causally related to conflict and that the two are merely correlated.4

Further research has explored the relationship between climate change and conflict in the absence of migration. For pastoralists in Somalia, armed conflict hinders their traditional movements even in the situation of severe drought.11 It is important to note that for the variable of migration to be removed in this situation, another variable must be added in choice. The pastoralists in Somalia would be described as a trapped population.11 A trapped population means that, unlike the traditional three choices, migration for that group

is simply not an option.4, 11 For pastoralists in Somalia, living within the chain of climate change, migration, and violent conflict, climate change and violent conflict can occur within a population without migration being a component.

What Next? An Overview of Recommended Action In terms of creating a cohesive action plan for climate change, and distributing funding for improved infrastructure, this ought to be facilitated by national governments of all states. However, decisions to develop site-specific solutions for communities must be informed by local stakeholders in the forms of local levels of government and community leaders. Already being done within the Sahel region, it is beneficial for local governments to consult local members of the community as equal stakeholders, as well as non-governmental organizations (NGOs) that have worked extensively within that community.7 The use of multiple stakeholders can offer practical experience in determining which particular issues regarding climate change are worrisome, and thus, which activities and infrastructure would succeed if they were to be invested in by state governments.12 This can also avoid paternalistic and highly Westernized policy solutions to the impacts of climate change like those offered by which are likely not appropriate in all local contexts.4 As was seen in the case studies of the Sahel region and Syria, future research must be site-specific in order to inform our understanding of the contexts in which climate change might increase the risk of conflict by focusing on the local interplay of multiple drivers. Furthermore, a common theme in current research is the promotion of Westernized solutions, such as developing alternate sources of income apart from the agricultural or fishing sector.4 However, it would be ignorant to suggest that individuals who work in such industries, like the pastoralists in the Sahel region and Syria, could easily change their careers and find other livelihoods. Researchers should take careful steps to ensure that they are not biased towards Westernized solutions that promote one lifestyle over another as a solution to mitigating climate change-induced migration.

Implications for the Future If the situation is left as is, those countries that are already susceptible to conflict, as a result of political instability, for example, or which have high population density, are at a higher risk of experiencing an increase in conflict as climate change worsens.13 Although citizens in higher-income countries are better able to protect themselves from severe natural disasters as well as from political instabilities, researchers suggest that they too could experience increases in the incidence of violent crimes as temperatures increase, especially within socially disadvantaged neighbourhoods.14 In addition, as conflict increases as a result of climate change-induced migration, there could be significant negative physical and mental health effects on those in the receiving state, as well as those migrating. These health impacts include increased mortality and injuries, malnutrition, and psychological trauma (e.g. post-traumatic stress

23

disorder).15 However, if policymakers can react effectively and contextually to the issue of climate change early on, this will likely have the effect of mitigating poor health outcomes.4

Conclusion The repercussions of climate change and human interference with climate raise countless geopolitical questions, have implications for livelihoods of unique populations and necessitate a strategic response to ensure sustainable development. The Sahel’s pastoralist population faces local and state risks for climate induced migration, livelihood loss and environment related conflicts (e.g. access to resources) .7 Efforts to mitigate their vulnerability to climate change are interfered with by their high mobility and political marginalization by the state.7, 8 As outlined through the above cases, the issue of climate change-induced migration is at the heart of international politics and has the potential to cause significant and highly uncertain impacts on societies. These may include increases in conflict and climate-induced migration, which undermine human and state security. The impacts of climate change are relating to increasing the overall risks of conflict and political instability both directly and indirectly, and early action is required to mitigate the human cost. In all, climate change induced migration and social conflict are intricately related phenomena that pose a danger to the health and security of people around the world.

Author Biographies: Madeline Helmer Pelgrim will be graduating from the University of Toronto in June of 2019, with an Honours Bachelors of Science in Psychology and Biology. In her time at U of T Madeline was heavily involved with the Students’ Alzheimer’s Alliance (SAAUT) and was a campus tour guide. Arshdeep Aulakh is currently pursuing an undergraduate degree in Health Studies and Criminology and Sociolegal Studies.

She is particularly passionate about legal advocacy, harm reduction and healthcare for underserved populations like Indigenous people and visible minorities. Gabriella Ekmekjian is a third-year undergraduate student at the University of Toronto St. George campus with membership in Trinity College. She is pursuing a HBA with a double major in Criminology & Sociolegal Studies and Health Studies. Following her undergraduate studies, she hopes to attend law school.

During the upcoming 2019-2020 academic year she will be serving as the Communications Director for the Health Studies Students’ Union. Kimberly Dias is a fourth year undergraduate student at the University of Toronto, completing a double major in Ethics, Society & Law and Health Studies.

She is particularly interested in the intersection between climate change and conflict, and the repercussions this has for the global community. Esther Somanader is a fourth year undergraduate student at the University of Toronto, completing a major in Health and Disease with a double minor

24

in Math and French. She has been actively involved in the U of T chapter of Pencils of Promise and in Power to Change. Xijia Jessica Peng will be graduating with a Honours Bachelors of Science from the University of Toronto in June 2019. She has been actively involved with the First In The Family peer mentorship program and the UofT Centre for Community Partnerships.

References 1. Abel, G., Brottrager, M., Crespo Cuaresma, J., & Muttarak, R. Climate, conflict and forced migration. Global Environ. Chang. 54, 239-249 (2019).

2. Zampaligré, N., Dossa, L., & Schlecht, E. Climate change and variability: Perception and adaptation strategies of pastoralists and agro-pastoralists across different zones of Burkina Faso. Reg. Environ. Chang. 14, 769-783 (2014).

3. Black, R., et al. The effect of environmental change on human migration. Global Environ. Chang. 21, S3-S11 (2011).

4. Reuveny, R. Climate change-induced migration and violent conflict.

Political Geogr. 26, 656-673 (2007).

5. Hendrix, C. S., & Salehyan, I. Climate change, rainfall, and social conflict in Africa. J. Peace Res. 49, 35–50 (2012).

6. World Water Assessment Programme. The United Nations World Water Development Report 3: Water in a Changing World (United Nations Education, Scientific, and Cultural Orgnaization, 2009).

7. Montavon, A., et al. Health of mobile pastoralists in the Sahel – assessment of 15 years of research and development. Trop. Med. Int. Health, 18, 1044-1052 (2013).

8. Raleigh, C. Political marginalization, climate change, and conflict in African Sahel states. Int. Stud. Rev. 12, 69-86 (2010).

9. Kelley, C., Mohtadi, S., Cane, M., Seager, R., & Kushnir, Y. Climate change in the fertile crescent and implications of the recent Syrian drought. Proc. Natl. Sci. 112, 3241-3246 (2015).

10. Gleick, P. Water, drought, climate change, and conflict in Syria.

Weather Clim. Soc. 6, 331-340 (2014).

11. The Government office for Science. Foresight: Migration and Global Environmental Change Final Project Report https://assets.publishing. service.gov.uk/government/uploads/system/uploads/attachment_data/ file/287717/11-1116-migration-and-global-environmental-change.pdf (2011).

12. Lewis, K. & Buontempo, C. Climate impacts in the Sahel and West Africa: The role of climate science in policy making. (Organisation for Economic Co-operation and Development, 2016).

13. Plante, C., Allen, J., & Anderson, C. Effects of Rapid Climate Change on Violence and Conflict. Oxford Research Encyclopedia of Climate Science. doi: 10.1093/acrefore/9780190228620.013.344 (2017).

14. Mares, D. Climate change and levels of violence in socially disadvantaged neighborhood groups. J. Urban Health, 90, 768–783 (2013).

15. McMichael, C., Barnett, J., & McMichael, A. An ill wind? Climate change, migration, and health. Environ. Health Perspect. 120, 646 – 645 (2012).

ITâ&#x20AC;&#x2122;S TIME TO GO BANANAS: REDUCING FEMALE UNEMPLOYMENT IN RURAL RWANDA AND UGANDA TARA FAGHANI HAMADANI, NOUSIN HUSSAIN, RIM MOUHAFFEL, SOPHIA ZEKIROS, SHEWIT BUZUAYNE, CRISTINA BENEA Unemployment in Rwanda and Uganda Unemployment remains a serious barrier to Rwanda and Ugandaâ&#x20AC;&#x2122;s economic and social development. The unemployment rate is particularly high for women, as approximately 42% of women in rural Rwanda and 47% of women in Uganda are unemployed.1,2 Elevated unemployment rates among women are attributable to a variety of barriers to employment faced both in Rwanda and across Sub-Saharan African countries. Women are more likely to work in the informal economy where lower wages and unstable income is prevalent, and experience decreased access to labour market participation and barriers such as child rearing responsibilities at a young age, lack of education, and instances of violence.3,4 These factors may be indicative of an increased employment gap for young, rural women, and furthermore, contributes to increasingly disparate health gaps.5 The Period Dilemma When it comes to explicitly targeting employment needs in women, it is crucial to target significant obstacles that prevent women from participating in the labour market. A particularly pertinent barrier is menstruation management and hygiene, which proposes a unique dilemma for young girls and women across Sub-Saharan Africa.5 Indeed, the cultural toll of shedding, which consist of stigma of menstruation, poor menstrual hygiene products, and misinformation of biological functions of menstruation paired with poor menstrual management sees girls missing up to 50 days of school/work per year.6 In fact, up to one third of Ugandan school girls report missing school owing to a lack of menstrual products, thus hindering their access to education and, ultimately, access to upward economic mobility.7 Studies have found that schools that provide sanitary napkins are able to improve retention by 20%.8 Beyond an educational setting, lack of adequate access to menstrual hygiene products and the subsequent missed school/work results in a potential loss in GDP of US $115 million per year in Rwanda.8 Results have found that 20% of the employees in Rwanda missed work for up to 30 days a year because of the lack of sanitary supplies.8,9 As such, menstrual hygiene creates a clear gender economic divide. There is a clear need to develop and employ sustainable population-based approaches to not only address this economic divide, but also systemically address gender inequality re-enforced through menstruation through autonomous job creation.

Potential of Agriculture Smallholder agriculture accounts for around 70% of the labour force in low-income countries in Sub-Saharan Africa.10,11 Though evidence-based policies around agriculture focus on men, women play a critical role in agriculture both in Rwanda and Uganda.12,13 Considering low technological penetration in rural regions, innovative approaches to leverage the agricultural industry serve as the most viable solution for unemployment as it incorporates existing cultural norms and practices with an opportunity to advance job creation opportunities.11 A Banana Powered Solution Bananas provide a powerful solution to overcome significant systemic barriers to employment faced by women living in Rwanda and Uganda. Rwanda and Uganda are banana-havens both in terms of production and consumption. For example, 23% of the arable land in Rwanda is dedicated to banana cultivation and the per capita consumption in Uganda and Rwanda exceeds 200 kg of bananas with the vast majority of consumption occurring in rural areas.14,15 This familiarity and history with banana is consistent with evidence which suggests that incorporating traditional knowledge with scientific expertise can advance strategies for climate change adaptation, economic growth and health.16,17 Thus, it follows that banana by-products can serve as a robust, under-utilized renewable food biomass with diverse uses.

Introducing the SheGO Pad! Sustainable Health Enterprises (SHE) has developed an innovative and biodegradable menstrual pad made from banana leaf fibers: a common waste product of banana production and consumption. The approximate cost for these pads is 67 cents for a pack of 10 pads which is approximately 75% less than major international brands and 35% cheaper than other locally produced sanitary napkins.18 Further, banana-leaf fiber pads are proven to be twice as absorbent as standard commercial pads.

Value Chain Integration The purpose of this project is to create long-term, sustainable employment which can only be realized through the implementation of a robust Value Chain Integration (VCI) process (see figure 1). The value chain integration process will involve upscaling and expanding the activities of SHE, which will be our key partner and collaborator. The VCI strat-

25

Figure 1 egy will inform the coordination, design, development, production and delivery the sanitary napkins to rural and urban areas across Rwanda and Uganda. This process will facilitate economic growth through the employment of local women throughout the VCI process and increase the access of safe and affordable sanitary napkins.19 Additionally, the upscaling efforts of the project will pay close attention to the gendered barriers of childcare and family planning by offering affordable and reliant childcare for the participating women.

factories where these pads will be made will be safe, clean and nurturing work environment which should result in a decrease in occupational health risks and job-related health stressors.

References 1. The National Institute of Statistics of Rwanda. Labour Force Survey Report. http://www.statistics.gov.rw/publication/labour-force-survey-report-february-2018 (2018).

2. Uganda Bureau of Statistics. National Labour Force Survey 2016/17.

Kampala. https://www.ubos.org/wpcontent/uploads/publica-

Impact and Benefit There are many benefits of this project with potential for wide spread impact. Firstly, it would utilize existing agricultural practices and produce in rural Rwanda and Uganda, thus ensuring that production practices remain environmentally friendly and sustainable. By partnering with SHE and expanding their models of sanitary pad production, women in rural Rwanda and Uganda will have the opportunity to participate in a labour market that has historically been hostile towards their needs and circumstances.3,7 Second, the production of sanitary pads will encourage women and girls to transition away from difficult-to-clean cloth material to a sterile, biodegradable material which will result in lower rates of infections and complication.18 Third, owing to the provision of menstrual hygiene and education programming, school attendance would be improved.6 As education is associated with improved overall health, we anticipate that improvement in public health would be an added indirect benefit of our intervention.8 Fourth, this project will increase access to reliable, constant, well-paying jobs with emphasis placed on vocational training which will result in reductions in chronic disease outcomes associated with precarious work.7 Lastly, the

26

tions/10_2018Report_national_labour_force_survey_2016_17.pdf (2018).

3. Chakravarty, S., Das, S., & Vaillant, J. Gender and Youth Employment in Sub-Saharan Africa: A Review of Constraints and Effective Interventions. http://econ.worldbank.org (2017).

4. International Labour Office. Uganda SWTS Country Brief. www.ilo.org/ w4y (2017).

5. United Nations Development Programme. Human Development Reports. http://hdr.undp.org/en (2018).

6. Elledge, M., Muralidharan, A., Parker, A., Ravndal, K., Siddiqui, M., Toolaram, A., & Woodward, K. Menstrual Hygiene Management and Waste Disposal in Low- and Middle-Income Countriesâ&#x20AC;&#x201D;A Review of the Literature. International journal of environmental research and public health, 15(11), 2562 (2018).

7. The Innovation Policy Platform. Changing the Lives of Women and Girls through Affordable Feminine Hygiene Products. https://www.innovationpolicyplatform.org/system/files/6_Health%20Female%20Hygiene%20 Case_Jun21.pdf (2017).

8. Hitimana N. She28: The intersection between innovation, health, WASH & economic development for girls and women in Rwanda. https://www.unicef.org/wash/schools/files/2.4_Camacho.pdf?fbclid=IwAR1nznCN-PK1H8HuitUJh4LDK9oru_wRkFI9Yz8DGdx5NBRekqYlPjoKA-

Po (2014).

9. UNICEF. WASH in schools empowers girlsâ&#x20AC;&#x2122; education: Proceedings of the menstrual hygiene management in schools virtual conference 2012. https://www.unicef.org/wash/schools/files/WASH_in_Schools_Empowers_ Girls_Education_Proceedings_of_Virtual_MHM_conference.pdf (2012).

10. Alliance for a Green Revolution in Africa (AGRA). Africa Agriculture Status Report: The Business of Smallholder Agriculture in Sub-Saharan Africa (Issue 5). Nairobi. https://agra.org/wp-content/uploads/2017/09/ Final-AASR-2017-Aug-28.pdf (2017).

11. International Labour Organization and United Nations. Shared Harvests: Agriculture, Trade, and Employment. Geneva. https://www. ilo.org/wcmsp5/groups/public/ed_emp/documents/genericdocument/ wcms_212868.pdf (2013).

12. Filmer, D., & Fox, L. Youth Employment in Sub-Saharan Africa. Washington, DC. http://documents.worldbank.org/curated/ en/424011468192529027/pdf/840830v20REVIS0ll0Report0ER0English.pdf (2014).

13. Food and Agriculture Organization of the United Nations. The State of Food and Agriculture 2018. Migration, agriculture and rural development. http://www.fao.org/3/I9549EN/i9549en.pdf (2018).

14. Mukantwali, C., Shingiro, J. B., & Dusengemungu, L. Banana production, post harvest and marketing in Rwanda. Traditional banana juice extraction method in Eastern province in Rwanda (2008).

15. Nsabimana, A., Gaidashova, S. V., Nantale, G., Karamura, D., & Van Staden, J. Banana cultivar distribution in Rwanda. African Crop Science Journal, 16(1) (2008).

16. Padam, B. S., Tin, H. S., Chye, F. Y., & Abdullah, M. I. Banana by-products: an under-utilized renewable food biomass with great potential.

Journal of food science and technology, 51(12), 3527-45 (2012).

17. Nwakaire, J & Obi, F.O. & Ugwuishiwu, B. Agricultural Waste Concept, Generation, Utilization, and Management. Nigerian Journal of Technology.

35. 957-964 (2016).

18. Sustainable Health Enterprises (SHE). Fact Sheet. https://diningforwomen.org/programfactsheets/sustainable-health-enterprises-she/?fbclid=IwAR1wPrRGA7J5MQOfigOLNkQ1YtPKnNNf6sZA4CnsiWrFhmlny4HkARykXzw (2018).

19. Sohal R, Bhattacharyya O, Mitchell W. Value Chain Integration Strategies in Global Health. Health Management Policy and Innovation, 3(1) (2017).

27

GROWING CASSAVA: EMPLOYING AND EMPOWERING YOUNG WOMEN IN RURAL RWANDA AND UGANDA CHRISTINA MARIA DITLOF, NATASHA ROSE GIRDHARRY, IBRAHIM HASHMI, RABINA KHAN, HONEY ZAFAR Background The Toronto Thinks Global Health Case Competition challenges teams to develop integrative and feasible solutions to a specified problem for the ‘Gateway Fund’, a Canadian private foundation focused on global health development.1 This year, teams were presented with a vignette of a Rwandan woman facing unemployment challenges in her rural community.1 Currently, women have a greater unemployment rate compared to men in sub-Saharan Africa, and the majority are informally working.1–3 The main objective was to implement strategies targeting health and employment among young and middle-aged women in Rwanda and Uganda.1 The proposed solution required the involvement of local organizations, knowledge and sensitivities.1 Phase 1 (2020-2022) was the initial implementation of strategies in rural Rwanda.1 Phase 2 (2022-2024) involved adaptation and transition-to-scale in rural Uganda.1 Rwanda’s ‘Vision 2050’ wishes to improve quality of life and prosperity in their country.4 Uganda’s ‘Vision 2040’ promotes the transformation of their society into a competitive lower middle-income country.1,5 These national initiatives were accounted for in our solution targeting women’s empowerment and employment, by expanding the pre-existing cassava industry in these two countries.

Cassava is a root vegetable used in the production of biofuel,6 alcohol,7 and flour.8 Currently, Rwanda and Uganda are among the top 20 contributors of global cassava production.9 However, the cassava industry in sub-Saharan Africa is hindered by Cassava Mosaic Disease (CMD), thereby killing crops.10–14 Additionally, climate change is associated with variable rainfall patterns and drought, further impacting agricultural output.15 These environmental barriers need mitigation in order to grow this industry.

Although women in these regions are partaking in agricultural work, there are educational barriers preventing integration into the formal workforce within business, marketing, science and technology.1 Lack of education can be affected by the breach of safety experienced during school commutes in these regions, preventing women from attending.16,17 Therefore, we see the potential in growing the cassa-

28

va industry to promote women’s employment and empowerment within the formal industry, by mitigating agricultural and educational barriers in Rwanda and Uganda.

Phase 1: Rwanda Solution 1: Targeting Agricultural Antagonists To target agricultural barriers, we would partner with ‘Capacity Development for Agriculture Innovation Systems (CDAIS)’ which have pilot projects in Rwanda aiming to implement innovations to improve efficiency and sustainability for local farmers.18 Alongside our collaboration with CDAIS,18 we would partner with the ‘Virus Resistant Cassava for Africa (VIRCA)’ organization investigating methods of improving resistance against CMD outbreaks.13 Working with local women and CDAIS, we would install solar powered drip irrigation systems, which is an effective low-cost method enabling smallholder farmers to build climate change resilience.15 Promoting involvement and training of local women with CDAIS and VIRCA would empower rural Rwandan women to access opportunities in agricultural technology that may have not been previously available.

Solution 2: Improving Education and Safety To transcend cultural barriers and to mitigate problems associated with education and safety, we would partner with the local grassroots organization Global Grassroots ‘Conscious Social Change for Women,’ which has pre-existing projects focusing on factors negatively impacting women in sub-Saharan Africa.19,20 We would partner with the Ministry of Education (MINEDUC) of Rwanda via Global Grassroots, as MINEDUC has developed STEM camps for girls.21 We would increase vocational and technical training22 for women in the science, technology, and business sectors of the cassava industry, thus promoting education as a form of empowerment.

To overcome the safety barrier to education we would promote youth watch group initiatives that incentivize male students to commute with female students,23 ensuring their safety against physical and sexual violence - empowering women to access schooling without fear.

Monitoring and Evaluating Strategy Health-Related Quality of Life Questionnaire (HRQoL),24–26 would be performed to incorporate Rwanda’s ‘Vision 2050’4 and assess well-being. Through Global Grassroots, women enrolled in our educational programs would undergo literacy tests to evaluate its effectiveness.27 Crop yield (%) would be evaluated via CDAIS and VIRCA. Employment rate (%) of women upon completion of our training programs would be evaluated, ensuring that Rwandan women are successfully entering formal work.

Phase 2: Uganda Uganda has one of the highest rates of youth unemployment in sub-Saharan Africa.1 Although Rwanda faces similar youth unemployment rates as well, they have a stronger ability for market-supporting institutions thus making it ideal for Phase 1 implementation.1 Considering Uganda has a population that ranks among the youngest in the world,1 our focus in Phase 2 is the growth of cassava-directed educational programming. This would be executed by collaborating with Global Grassroots, and with ‘The Forum for African Women Educationalists’ Uganda Chapter, which promotes equitable education and job access for young women.28,29 Phase 2 would focus on the empowerment and employment of women in the cassava industry as described in Phase 1, with a focus on educational expansion of business, science, and technology - due to the larger proportion of youth in Uganda.

Conclusion The key is educational expansion directed towards young women in the cassava industry, that would contribute to an increase in rural Rwandan and Ugandan women’s empowerment within formal employment.

Author Biographies: Christina Maria Ditlof, Natasha Rose Girdharry, Ibrahim Hashmi, Rabina Khan, and Honey Zafar – we are undergraduate students at the University of Toronto, studying Life Sciences.

Our decision to participate in the 2019 Toronto Thinks Global Health Case Competition stemmed from a collective interest in stepping out of our comfort zones. We broadened our knowledge about global health by problem solving, integrating ideas, and understanding the cultural aspects of health. This was our first case competition and we were delighted to be presented with the "Best Undergraduate Team" award for our research-oriented proposed solution.

References: 1. Daniel, A. I. et al. 2019 Toronto Thinks Global Health Case Competition: Reducing Youth Unemployment to Promote Health in Rural Rwanda and Uganda. (2019).

2. Chakravarty, S., Das, S. & Vaillant, J. Gender and Youth Employment in Sub-Saharan Africa: A Review of Constraints and Effective Interventions. (The World Bank, 2017). doi:10.1596/1813-9450-8245 3. International Labour Office, Employment Sector, International Labour Office & Social Protection Sector. The informal economy in Africa: promoting transition to formality : challenges and strategies. (ILO, 2009).

4. Gatete, C. The Rwanda we want: Towards ‘Vision 2050’.

(2016).

5. Government of Uganda. UGANDA VISION 2040. Uganda National Web Portal Available at: https://www.gou.go.ug/content/uganda-vision-2040.

6. Nuwamanya, E., Chiwona-Karltun, L., Kawuki, R. S. & Baguma, Y. Bio-Ethanol Production from Non-Food Parts of Cassava (Manihot esculenta Crantz). AMBIO 41, 262–270 (2012).

7. Campos Benvenga, M. A., Henriques Librantz, A. F., Curvelo Santana, J. C. & Tambourgi, E. B. Genetic algorithm applied to study of the economic viability of alcohol production from Cassava root from 2002 to 2013. Journal of Cleaner Production 113, 483–494 (2016).

8. Sanchez, H. D., Osella, C. A. & Torre, M. A. Optimization of Gluten-Free Bread Prepared from Cornstarch, Rice Flour, and Cassava Starch. Journal of Food Science 67, 416–419 (2002).

9. Sen Nag, O. Top Cassava Producing Countries In The World. World Atlas (2017). Available at: https://www.worldatlas.com/articles/top-cassava-producing-countries-in-theworld.html.

10. Munganyinka, E. et al. Cassava brown streak disease in Rwanda, the associated viruses and disease phenotypes. Plant Pathology 67, 377–387 (2018).

11. Patil, B. L., Legg, J. P., Kanju, E. & Fauquet, C. M. Cassava brown streak disease: a threat to food security in Africa. Journal of General Virology 96, 956–968 (2015).

12. Legg, J. et al. A global alliance declaring war on cassava viruses in Africa. Food Security 6, 231–248 (2014).

13. Taylor, N. J. et al. The VIRCA Project: Virus resistant cassava for Africa. GM Crops & Food 3, 93–103 (2012).

14. Wagaba, H. et al. Field Level RNAi-Mediated Resistance to Cassava Brown Streak Disease across Multiple Cropping Cycles and Diverse East African Agro-Ecological Locations.

Frontiers in Plant Science 7, (2017).

15. Schmitter, P., Kibret, K. S., Lefore, N. & Barron, J. Suitability mapping framework for solar photovoltaic pumps for smallholder farmers in sub-Saharan Africa. Applied Geography 94, 41–57 (2018).

16. Spencer, R. Sexual Violence. Global Grassroots (2009).

Available at: http://globalgrassroots.org/sexual_violence.html.

17. Waite, R. Domestic Violence. (2009). Available at: http:// globalgrassroots.org/domestic_violence.html.

18. CDAIS. CDAIS Mission. CDAIS (2017). Available at: https://

29

(2016).

5. Government of Uganda. UGANDA VISION 2040. Uganda National Web Portal Available at: https://www.gou.go.ug/ content/uganda-vision-2040.

6. Nuwamanya, E., Chiwona-Karltun, L., Kawuki, R. S. & Baguma, Y. Bio-Ethanol Production from Non-Food Parts of Cassava (Manihot esculenta Crantz). AMBIO 41, 262–270 (2012).

7. Campos Benvenga, M. A., Henriques Librantz, A. F., Curvelo Santana, J. C. & Tambourgi, E. B. Genetic algorithm applied to study of the economic viability of alcohol production from Cassava root from 2002 to 2013. Journal of Cleaner Production 113, 483–494 (2016).

8. Sanchez, H. D., Osella, C. A. & Torre, M. A. Optimization of Gluten-Free Bread Prepared from Cornstarch, Rice Flour, and Cassava Starch. Journal of Food Science 67, 416–419 (2002).

9. Sen Nag, O. Top Cassava Producing Countries In The World. World Atlas (2017). Available at: https://www. worldatlas.com/articles/top-cassava-producing-countriesin-the-world.html.

10. Munganyinka, E. et al. Cassava brown streak disease in Rwanda, the associated viruses and disease phenotypes.

Plant Pathology 67, 377–387 (2018).

11. Patil, B. L., Legg, J. P., Kanju, E. & Fauquet, C. M. Cassava brown streak disease: a threat to food security in Africa.

Journal of General Virology 96, 956–968 (2015).

12. Legg, J. et al. A global alliance declaring war on cassava viruses in Africa. Food Security 6, 231–248 (2014).

13. Taylor, N. J. et al. The VIRCA Project: Virus resistant cassava for Africa. GM Crops & Food 3, 93–103 (2012).

14. Wagaba, H. et al. Field Level RNAi-Mediated Resistance to Cassava Brown Streak Disease across Multiple Cropping Cycles and Diverse East African Agro-Ecological Locations.

Frontiers in Plant Science 7, (2017).

15. Schmitter, P., Kibret, K. S., Lefore, N. & Barron, J. Suitability mapping framework for solar photovoltaic pumps for smallholder farmers in sub-Saharan Africa. Applied Geography 94, 41–57 (2018).

16. Spencer, R. Sexual Violence. Global Grassroots (2009).

Available at: http://globalgrassroots.org/sexual_violence. html.

17. Waite, R. Domestic Violence. (2009). Available at: http:// globalgrassroots.org/domestic_violence.html.

18. CDAIS. CDAIS Mission. CDAIS (2017). Available at: https://cdais.net/home/about-us/mission-and-vision/.

19. Global Grassroots. Rwanda. Global Grassroots Conscious Social Change for Women (2019). Available at: http://globalgrassroots.org/rwanda.html.

20. Global Grassroots. Uganda. Global Grassroots Conscious Social Change for Women (2019). Available at: http://globalgrassroots.org/uganda.html.

21. MINEDUC Opens a Mentoring Camp for Girls in STEM. Republic of Rwanda Ministry of Education (2019). Available at: http://mineduc.gov.rw/media/news/details-news/?tx_

30

ttnews%5Btt_news%5D=867&cHash=71f60ac3874e1926c5909a2cdd892677.

22. Rwanda - Technical and Vocational Education and Training. VVob Education for Development Available at: https:// www.vvob.be/en/programmes/rwanda-technical-and-vocational-education-and-training.

23. Mwasikakata, M. Assessment of public employment services and active labour market policies in Rwanda. (2017).

24. U.S. Department of Health & Human Services.

Health-Related Quality of Life (HRQOL). Centres for Disease Control and Prevention (2018). Available at: https:// www.cdc.gov/hrqol/index.htm.

25. Yin, S., Njai, R., Barker, L., Siegel, P. Z. & Liao, Y. Summarizing health-related quality of life (HRQOL): development and testing of a one-factor model. Population Health Metrics 14, 22 (2016).

26. Karimi, M. & Brazier, J. Health, Health-Related Quality of Life, and Quality of Life: What is the Difference? PharmacoEconomics 34, 645–649 (2016).

27. Friedlander, E., Gasana, J. & Goldenberg, C. Literacy Boost in Rwanda - Reading Assessment Baseline Report.

(2014).

28. FAWE. Forum for African Women EducationalistsUganda Chapter. Forum for African Women Educationalists Available at: https://www.faweuganda.org/.

29. FAWE. Vision, Mission & Objectives. FAWE Rwanda Chapter (2017). Available at: https://www.fawerwa.org/whowe-are/mission-vision/.

Juxtaposition |â&#x20AC;&#x201A; Environmental Health and Justice

31

32

Juxtaposition | Environmental Health and Justice