| Summary: | Health systems are underprepared for the effects of an increasingly stressed planet. In this dissertation, I used a multi-methods, pragmatist approach to identify influences on planetary health-informed health systems change in a Circumpolar and diverse healthcare setting, and to explore transferable knowledge for other contexts. Through a mixed-methods systemic review, I identified factors that influence adaptation of patient-planetary health (P-PH) co-benefit prescribing using content analysis. Barriers included a lack of knowledge and time; facilitators included policy statements and guidelines from respected associations. Informed by this review, I then conducted interviews exploring physician perspectives around P-PH co-benefit prescribing in a Circumpolar region. Using reflexive thematic analysis, I found the current healthcare system does not support planetary health, with many physicians discussing difficulties. I then held a sharing circle with Indigenous Elders from the same area, and inductively coded the data to generate key themes and a systems map. Findings included four interconnected themes: the past and how we got here; where we are now; where we need to go in the future; and reflections. Overall, health systems were viewed as devoid of any environmental context or consideration. I then carried out reflexive thematic analysis regarding nature prescriptions in the context of Indigenous Peoples. Findings included the need for things to be done “in the right way”, and the sentiment that the Land is not just an experience but a way of life. Lastly, I carried out a scoping review to identify current planetary health frameworks for health systems. Using content analysis to identify the different domains, I described six overarching categories including, as examples: key structural components for environmentally sustainable health systems; climate resilient and sustainable technologies and infrastructure; and evaluation and accountability mechanisms. By triangulating data across these studies, I identified common elements, including an implicit focus and understanding that some level of the status quo (i.e., Nature disconnection) is still being perpetuated within research and discourse around planetary health-related health systems change.
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