Co-exploring how environments shape brain health through a planetary health lens: a photovoice study in Auckland, Aotearoa New Zealand

BMJ Open. 2026 Apr 8;16(4):e112021. doi: 10.1136/bmjopen-2025-112021.

ABSTRACT

OBJECTIVES: Dementia prevention and climate action share a common imperative: safeguarding future generations' health. Despite evidence that nearly half of dementia cases could be prevented by addressing modifiable risk factors, current interventions focused mostly on individual behaviours have yielded mixed cognitive benefits. At the same time, climate change is introducing unprecedented environmental stressors, including air pollution, extreme heat exposure and degraded green spaces, that compound dementia risk. This study aimed to explore how midlife adults perceive the relationship between their daily environments, brain health-related behaviours and planetary health.

DESIGN: Qualitative study using the photovoice method.

SETTING: Community setting in Auckland, Aotearoa New Zealand.

PARTICIPANTS: 14 community-dwelling adults aged 40-65 years residing in Auckland, Aotearoa New Zealand.

METHODS: Participants took photographs and shared narratives to document how their daily environments nurture or threaten lifestyle factors related to brain health. The project involved a five-session participatory process, and data were analysed using reflexive thematic analysis informed by a planetary health framework.

RESULTS: Reflexive thematic analysis, underpinned by a planetary health framework, revealed four inter-related themes: (1) nature as restorative and protective; (2) the mental burden of pollution, sensory overload and climate-driven landscape changes; (3) the protective role of social connection, community care and routines; (4) the co-benefits of education and mindful, eco-friendly behaviours.

CONCLUSIONS: These findings underscore that midlife adults perceive their brain health as intertwined with ecological and social contexts. Dementia risk reduction strategies may therefore benefit from integrating planetary health perspectives that consider environmental conditions alongside social determinants of health. By centring lived experiences and diverse perspectives, photovoice generated context-rich insights that can guide research on more holistic approaches to dementia risk reduction.

PMID:41951261 | DOI:10.1136/bmjopen-2025-112021