Environmental Determinants of Health

'I've just heard that there are people who feel like they need to exercise': a photo-elicitation study of values and priorities influencing physical activity in a socioeconomically disadvantaged neighbourhood in Uppsala, Sweden

OBJECTIVE

People living in socioeconomically disadvantaged neighbourhoods in Sweden engage less in physical activity compared with the general population, contributing to an elevated risk of cardiometabolic diseases. To inform targeted and effective public health interventions, understanding residents' lived experiences is essential. This study sought to understand the values and priorities associated with physical activity by people living in a socioeconomically disadvantaged neighbourhood in Region Uppsala, Sweden, informing a public health intervention to prevent cardiometabolic diseases and promote healthy and active living.

DESIGN

The study employed a photo-elicitation methodology, combining participants' photographs with semistructured interviews. Data were analysed using reflexive thematic analysis.

SETTING

A socioeconomically disadvantaged neighbourhood in the city of Uppsala, Sweden, characterised by a large proportion of households with low income, a large percentage of individuals living on economic aid, high unemployment rates, low educational attainment and high levels of poor health.

PARTICIPANTS

A total of 15 participants (8 women and 7 men) were purposively sampled between February and August 2023 and recruited via fieldwork, social media and local stakeholders.

RESULTS

Participants described challenging conditions for physical activity, including conflicting values and priorities between themselves and the local authorities. Four main areas emerged as sources of tension; difficulties influencing decision-making processes affecting the neighbourhood, unmet needs of gender-separated physical activity spaces, discrepancy between the perceived pressure and individual motivation to be active, and their perception of health being solely an individualised responsibility, but their need of support.

CONCLUSIONS

This study underscores the importance of understanding and navigating the values and priorities influencing physical activity among residents in a socioeconomically disadvantaged neighbourhood, when designing public health interventions. Findings reveal that residents' needs for being physically active are not met by the authorities who are perceived to have different priorities, and that the lack of influence of citizen voices undermines trust in the local authorities.

Drivers of healthcare expenditure growth in West Africa: A panel data investigation

Per capita health expenditure in West African countries appears to have assumed a growing trend over the years. This may not be unconnected with the critical role played by health in economic growth, sustainable development and human capital formation. This study analysed drivers of healthcare expenditure in West Africa, using panel data analysis. Random Effects estimating technique was preferred to pooled Ordinary Least Squares and Fixed Effects techniques based on Hausman and Breusch-Pagan Lagrangian multiplier tests. Data employed were sourced from World Bank's world development indicators. The findings indicated that number of people using at least basic sanitation services, incidence of tuberculosis, malaria incidence, and per capita GDP, significantly increased healthcare expenditure in West Africa within the study period. Infant and under-five mortality (UFM) rates raised healthcare expenditure but insignificantly in the sub-region. The study recommends the need to reduce malaria and tuberculosis incidences as well as UFM rate in West Africa through appropriate policy enactment. Such policies should include adequate investment in education, increased per capita income, development of malaria vaccines, maintenance of hygienic environment and free treatment of tuberculosis patients.

Happiness and air quality: microdata analysis in Indonesia

BACKGROUND

While economics is growing in Indonesia, its Happiness Index remains steady. Regarding the average concentration of dissolved particles, Indonesia is ranked sixth globally. Many factors can affect happiness. Environmental conditions, especially air quality, are considered to influence individual happiness. Therefore, this research investigates the impact of air quality and health on happiness.

METHODS

Data used in this study is the microdata of Indonesia's Happiness Survey (SPTK) in 2021. With more than 70,000 respondents, the study uses Ordered Probit as an analysis method with subjective happiness as the dependent variable. The independent variables used in this study are air quality, age, gender, housing area per capita, marital status, and health status. All independent variables except age are categorical. The variable of interest, air quality, is coded "1" if the IKU achieves the Strategic Plan's target of 84.2 and "0" otherwise. IKU is a regional air quality index that combines two substances.

RESULTS

At a significance level of 5%, there is a positive relationship between subjective happiness and air quality. In other words, if air quality (IKU) meets the Strategic Plan target (≥ 84.2), then a person is more likely to have a higher level of happiness. It can be explained more with the marginal effect. The marginal effect concludes that if the target is achieved, the probability of having a lower level of happiness decreases by up to 2.8%, and a very high level of happiness rises by 5.1%. Regarding health status, the rarer someone gets sick, the happier she/he is.

CONCLUSION

The study finds that air pollution could lower happiness, while better health increases happiness. Therefore, it is important to meet the target of IKU and to improve public health. Some good practices can be adopted to achieve this goal.

The relationship between perceptions of electronic health record usability and clinical importance of social and environmental determinants of health on provider documentation

Social and environmental determinants of health (SEDH) data in the electronic health record (EHR) can be inaccurate and incomplete. Providers are in a unique position to impact this issue as they both obtain and enter this data, however, the variability in screening and documentation practices currently limits the ability to mobilize SEDH data for secondary uses. This study explores whether providers' perceptions of clinical importance of SEDH or EHR usability influenced data entry by analyzing two relationships: (1) provider charting behavior and clinical consideration of SEDH and (2) provider charting behavior and ease of EHR use in charting. We performed a cross-sectional study using an 11-question electronic survey to assess self-reported practices related to clinical consideration of SEDH elements, EHR usability and SEDH documentation of all staff physicians, identified using administrative listserves, at Penn State Health Hershey Medical Center during September to October 2021. A total of 201 physicians responded to and completed the survey out of a possible 2,478 identified staff physicians (8.1% response rate). A five-point Likert scale from "never" to "always" assessed charting behavior and clinical consideration. Responses were dichotomized as consistent/inconsistent and vital/not vital respectively. EHR usability was assessed as "yes" or "no" responses. Fisher's exact tests assessed the relationship between charting behavior and clinical consideration and to compare charting practices between different SEDHs. Cumulative measures were constructed for consistent charting and ease of charting. A generalized linear mixed model (GLMM) compared SDH and EDH with respect to each cumulative measure and was quantified using odds ratios (OR) and 95% confidence intervals (CI). Our results show that provider documentation frequency of an SEDH is associated with perceived clinical utility as well as ease of charting and that providers were more likely to consistently chart on SDH versus EDH. Nuances in these relationships did exist with one notable example comparing the results of smoking (SDH) to infectious disease outbreaks (EDH). Despite similar percentages of physicians reporting that both smoking and infectious disease outbreaks are vital to care, differences in charting consistency and ease of charting between these two were seen. Taken as a whole, our results suggest that SEDH quality optimization efforts cannot consider physician perceptions and EHR usability as siloed entities and that EHR design should not be the only target for intervention. The associations found in this study provide a starting point to understand the complexity in how clinical utility and EHR usability influence charting consistency of each SEDH element, however, further research is needed to understand how these relationships intersect at various levels in the SEDH data optimization process.

Residential green environments are associated with human milk oligosaccharide diversity and composition

Increased exposure to greener environments has been suggested to lead to health benefits in children, but the associated mechanisms in early life, particularly via biological mediators such as altered maternal milk composition, remain largely unexplored. We investigated the associations between properties of the mother's residential green environment, measured as (1) greenness (Normalized Difference Vegetation index, NDVI), (2) Vegetation Cover Diversity (VCDI) and (3) Naturalness Index (NI), and human milk oligosaccharides (HMOs), known for their immune- and microbiota-related health effects on the infant (N = 795 mothers). We show that HMO diversity increases and concentrations of several individual HMOs and HMO groups change with increased VCDI and NI in residential green environments. This suggests that variation in residential green environments may influence the infant via maternal milk through modified HMO composition. The results emphasize the mediating role of breastfeeding between the residential green environments and health in early life.