Perceptions and pathways: Linking biodiversity to health and well-being in lower-income contexts

1. The biodiversity loss and human health crises are deeply interconnected, but existing frameworks linking the two are largely derived from high-income contexts, limiting their applicability to much of the world. While these frameworks have been valuable, this gap is especially critical in rapidly urbanising low- and middle income regions, where health inequalities and biodiversity loss converge. 2. To address this gap, we conducted research in Accra, Ghana, exploring how urban biodiversity influences health and well-being. Using photovoice, 36 participants documented their lived experiences of local biodiversity and their perceptions of its impact on their health and well-being. The resulting data were coded both using emergent and a priori codes based on existing conceptual frameworks. 3. We found that biodiversity interacts with multiple domains of health and wellbeing through four pathways (‘reducing harm’, ‘building capacities’, ‘restoring capacities’ and ‘causing harm’) that align with existing framings. 4. We also observed two additional pathways (‘spirituality’ and ‘livelihood support’), both of which may have greater prominence in lower income contexts. Incorporating these pathways into our understanding of how biodiversity influences health and well-being contributes to a more inclusive framework that reflects the socio-economic and cultural diversity of rapidly urbanising regions in low- and middle-income regions. 5. We present an adapted framework that integrates these pathways, offering a context-sensitive model to guide future research. Such a framework is essential for informing policy and practice in a way that benefits a broader range of communities, and thus, potentially, better allows us to address health and biodiversity crises together.