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This paper addresses the merits of public health activism that advocates for social change in which health is the outcome of interest. We acknowledge that while efforts at the individual level are important, social network models consider the underlying mechanisms that lie outside the public health sector. This paper considers the inequitable health of Indigenous people who bear a disproportionate share of the negative health consequences due to economic development programs that follow an assimilation model. This paper discusses a combination of theoretical constructs to understand and solve the problems at hand. It concludes that while the attention paid to technological and behavioral solutions at the individual level yields important health outcomes, attention should also be paid to structural causes that address social, political and economic barriers to prevent disease, disability and premature death. [ABSTRACT FROM PUBLISHER]

A response by Daniel Peplow and Sarah Augustine to a letter to the editor about their article on self-diagnosis of environmental and public health is presented.

The indigenous Wayana community of Puleowime (Apetina) in Suriname is susceptible to the effects of mercury because they consume large amounts of fish compared to mainstream communities. Small-scale and artisanal gold mining activities occur at numerous sites in eastern and southeastern Suriname placing the Wayana at risk from exposure to mercury released into the environment. A previous community-led risk assessment study showed that the Wayana were at a high lifetime risk of adverse effects from exposure to mercury. Subsequent to this earlier study, the residents of Puleowime requested assistance in a community-led follow-up research project to determine for themselves whether there were health impacts associated with exposure to mercury contamination. Neurotoxic effects consistent with methylmercury exposure were documented in an exposed population through a battery of neurological tests. Although the specific motor and cognitive batteries were not exactly the same, similar associations were observed between neurologic impairment and hair mercury concentrations compared to other studies in the Amazonia region where mean hair mercury levels were in the subacute range.