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Münzel T, Hahad O, Lelieveld J, Aschner M, Nieuwenhuijsen MJ, Landrigan PJ, Daiber A. Soil and water pollution and cardiovascular disease. Nat Rev Cardiol 2024:10.1038/s41569-024-01068-0. [PMID: 39317838 DOI: 10.1038/s41569-024-01068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/26/2024]
Abstract
Healthy, uncontaminated soils and clean water support all life on Earth and are essential for human health. Chemical pollution of soil, water, air and food is a major environmental threat, leading to an estimated 9 million premature deaths worldwide. The Global Burden of Disease study estimated that pollution was responsible for 5.5 million deaths related to cardiovascular disease (CVD) in 2019. Robust evidence has linked multiple pollutants, including heavy metals, pesticides, dioxins and toxic synthetic chemicals, with increased risk of CVD, and some reports suggest an association between microplastic and nanoplastic particles and CVD. Pollutants in soil diminish its capacity to produce food, leading to crop impurities, malnutrition and disease, and they can seep into rivers, worsening water pollution. Deforestation, wildfires and climate change exacerbate pollution by triggering soil erosion and releasing sequestered pollutants into the air and water. Despite their varied chemical makeup, pollutants induce CVD through common pathophysiological mechanisms involving oxidative stress and inflammation. In this Review, we provide an overview of the relationship between soil and water pollution and human health and pathology, and discuss the prevalence of soil and water pollutants and how they contribute to adverse health effects, focusing on CVD.
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Affiliation(s)
- Thomas Münzel
- University Medical Center Mainz, Department of Cardiology, Johannes Gutenberg University Mainz, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
| | - Omar Hahad
- University Medical Center Mainz, Department of Cardiology, Johannes Gutenberg University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Jos Lelieveld
- Atmospheric Chemistry Department, Max Planck Institute for Chemistry, Mainz, Germany
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Philip J Landrigan
- Global Observatory on Planetary Health, Boston College, Boston, MA, USA
- Centre Scientifique de Monaco, Monaco, Monaco
| | - Andreas Daiber
- University Medical Center Mainz, Department of Cardiology, Johannes Gutenberg University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
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2
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Nathvani R, D V, Clark SN, Alli AS, Muller E, Coste H, Bennett JE, Nimo J, Moses JB, Baah S, Hughes A, Suel E, Metzler AB, Rashid T, Brauer M, Baumgartner J, Owusu G, Agyei-Mensah S, Arku RE, Ezzati M. Beyond here and now: Evaluating pollution estimation across space and time from street view images with deep learning. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166168. [PMID: 37586538 PMCID: PMC7615099 DOI: 10.1016/j.scitotenv.2023.166168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
Advances in computer vision, driven by deep learning, allows for the inference of environmental pollution and its potential sources from images. The spatial and temporal generalisability of image-based pollution models is crucial in their real-world application, but is currently understudied, particularly in low-income countries where infrastructure for measuring the complex patterns of pollution is limited and modelling may therefore provide the most utility. We employed convolutional neural networks (CNNs) for two complementary classification models, in both an end-to-end approach and as an interpretable feature extractor (object detection), to estimate spatially and temporally resolved fine particulate matter (PM2.5) and noise levels in Accra, Ghana. Data used for training the models were from a unique dataset of over 1.6 million images collected over 15 months at 145 representative locations across the city, paired with air and noise measurements. Both end-to-end CNN and object-based approaches surpassed null model benchmarks for predicting PM2.5 and noise at single locations, but performance deteriorated when applied to other locations. Model accuracy diminished when tested on images from locations unseen during training, but improved by sampling a greater number of locations during model training, even if the total quantity of data was reduced. The end-to-end models used characteristics of images associated with atmospheric visibility for predicting PM2.5, and specific objects such as vehicles and people for noise. The results demonstrate the potential and challenges of image-based, spatiotemporal air pollution and noise estimation, and that robust, environmental modelling with images requires integration with traditional sensor networks.
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Affiliation(s)
- Ricky Nathvani
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
| | - Vishwanath D
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Sierra N Clark
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Abosede S Alli
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - Emily Muller
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Henri Coste
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - James E Bennett
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - James Nimo
- Department of Physics, University of Ghana, Accra, Ghana
| | | | - Solomon Baah
- Department of Physics, University of Ghana, Accra, Ghana
| | - Allison Hughes
- Department of Physics, University of Ghana, Accra, Ghana
| | - Esra Suel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Advanced Spatial Analysis, University College London, London, UK
| | - Antje Barbara Metzler
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Theo Rashid
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jill Baumgartner
- Institute for Health and Social Policy, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - George Owusu
- Institute of Statistical, Social & Economic Research, University of Ghana, Accra, Ghana
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, Accra, Ghana
| | - Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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3
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Danielli S, Ashrafian H, Darzi A. Healthy city: global systematic scoping review of city initiatives to improve health with policy recommendations. BMC Public Health 2023; 23:1277. [PMID: 37393224 PMCID: PMC10314468 DOI: 10.1186/s12889-023-15908-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/12/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Global health will increasingly be determined by cities. Currently over half of the world's population, over 4 billion people, live in cities. This systematic scoping review has been conducted to understand what cities are doing to improve health and healthcare for their populations. METHODS We conducted a systematic search to identify literature on city-wide initiatives to improve health. The study was conducted in accordance with PRISMA and the protocol was registered with PROSPERO (CRD42020166210). RESULTS The search identified 42,137 original citations, yielding 1,614 papers across 227 cities meeting the inclusion criteria. The results show that the majority of initiatives were targeted at non-communicable diseases. City health departments are making an increasing contribution; however the role of mayors appears to be limited. CONCLUSION The collective body of evidence identified in this review, built up over the last 130 years, has hitherto been poorly documented and characterised. Cities are a meta-system with population health dictated by multiple interactions and multidirectional feedback loops. Improving health in cities requires multiple actions, by multiple actors, at every level. The authors use the term 'The Vital 5'. They are the five most important health risk factors; tobacco use; harmful alcohol use; physical-inactivity, unhealthy diet and planetary health. These 'Vital 5' are most concentrated in deprived areas and show the greatest increase in low and middle income countries. Every city should develop a comprehensive strategy and action plan to address these 'Vital 5'.
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Affiliation(s)
- Shaun Danielli
- Kings Health Partners, Guys Hospital, London, SE1 9RT, UK.
- Imperial College London, South Kensington Campus, London, SW7 2NA, UK.
| | - Hutan Ashrafian
- Imperial College London, South Kensington Campus, London, SW7 2NA, UK
| | - Ara Darzi
- Imperial College London, South Kensington Campus, London, SW7 2NA, UK
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Ortigoza A, Braverman A, Hessel P, Di Cecco V, Friche AA, Teixeira Caiaffa W, Diez Roux AV. Women's empowerment and infant mortality in Latin America: evidence from 286 cities. CITIES & HEALTH 2023; 7:93-101. [PMID: 36818398 PMCID: PMC7614198 DOI: 10.1080/23748834.2021.1908794] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Levels of women's empowerment (WE) can contribute to differences in infant mortality rates (IMRs) across cities. We used a cross-sectional multilevel study to examine associations of WE with IMRs across 286 cities in seven Latin American countries. We estimated IMRs for 2014-2016 period and combined city socioeconomic indicators into factors reflecting living conditions and service provision. WE was operationalized: (1) in cities, by using scores for women's labor force participation (WLFP) and educational attainment among women derived from education and employment indicators disaggregated by sex; (2) in countries, by including a scale of enforcements of laws related to women's rights. We estimated adjusted percent differences in IMRs associated with higher WE scores across all cities and stratified by country GDP. We found substantial heterogeneity in IMRs and WE across cities. Higher WLFP was associated with lower IMRs. Higher women's educational attainment was associated with lower IMRs only in cities from countries with lower GDP. Poorer national enforcement of laws protecting women's rights was associated with higher IMRs in all countries. Women's empowerment could have positive implications for population health. Fostering women's socioeconomic development and girls' education should be part of strategies to reduce IMRs in cities of Global South.
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Affiliation(s)
- Ana Ortigoza
- Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
| | - Ariela Braverman
- Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
| | - Philipp Hessel
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | - Vanessa Di Cecco
- Instituto Salud Colectiva, Universidad Nacional de Lanus, Buenos Aires, Argentina
| | - Amélia Augusta Friche
- Observatório de Saúde Urbana em Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Waleska Teixeira Caiaffa
- Observatório de Saúde Urbana em Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
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Nathvani R, Clark SN, Muller E, Alli AS, Bennett JE, Nimo J, Moses JB, Baah S, Metzler AB, Brauer M, Suel E, Hughes AF, Rashid T, Gemmell E, Moulds S, Baumgartner J, Toledano M, Agyemang E, Owusu G, Agyei-Mensah S, Arku RE, Ezzati M. Characterisation of urban environment and activity across space and time using street images and deep learning in Accra. Sci Rep 2022; 12:20470. [PMID: 36443345 PMCID: PMC9703424 DOI: 10.1038/s41598-022-24474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
The urban environment influences human health, safety and wellbeing. Cities in Africa are growing faster than other regions but have limited data to guide urban planning and policies. Our aim was to use smart sensing and analytics to characterise the spatial patterns and temporal dynamics of features of the urban environment relevant for health, liveability, safety and sustainability. We collected a novel dataset of 2.1 million time-lapsed day and night images at 145 representative locations throughout the Metropolis of Accra, Ghana. We manually labelled a subset of 1,250 images for 20 contextually relevant objects and used transfer learning with data augmentation to retrain a convolutional neural network to detect them in the remaining images. We identified 23.5 million instances of these objects including 9.66 million instances of persons (41% of all objects), followed by cars (4.19 million, 18%), umbrellas (3.00 million, 13%), and informally operated minibuses known as tro tros (2.94 million, 13%). People, large vehicles and market-related objects were most common in the commercial core and densely populated informal neighbourhoods, while refuse and animals were most observed in the peripheries. The daily variability of objects was smallest in densely populated settlements and largest in the commercial centre. Our novel data and methodology shows that smart sensing and analytics can inform planning and policy decisions for making cities more liveable, equitable, sustainable and healthy.
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Affiliation(s)
- Ricky Nathvani
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Sierra N Clark
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Emily Muller
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Abosede S Alli
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - James E Bennett
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - James Nimo
- Department of Physics, University of Ghana, Accra, Ghana
| | | | - Solomon Baah
- Department of Physics, University of Ghana, Accra, Ghana
| | - A Barbara Metzler
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Esra Suel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- ETH Zurich, Zurich, Switzerland
| | | | - Theo Rashid
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Emily Gemmell
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Simon Moulds
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Jill Baumgartner
- Department of Equity, Ethics and Policy, School of Population and Global Health, McGill University, Montreal, Canada
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montreal, Canada
| | - Mireille Toledano
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Mohn Centre for Children's Health and Wellbeing, School of Public Health, Imperial College London, London, UK
| | - Ernest Agyemang
- Department of Geography and Resource Development, University of Ghana, Accra, Ghana
| | - George Owusu
- Institute of Statistical, Social and Economic Research, University of Ghana, Accra, Ghana
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, Accra, Ghana
| | - Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA.
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana.
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Doyle YG, Solomon BD, Owusu G. Cities and global health: fragmented housing policies increase health risks for vulnerable people. BMJ 2022; 379:e069671. [PMID: 36318978 DOI: 10.1136/bmj-2021-069671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - George Owusu
- Institute of Statistical, Social and Economic Research, School of Social Sciences, University of Ghana, Accra, Ghana
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Tay DA, Ocansey RTA. Impact of Urbanization on Health and Well-Being in Ghana. Status of Research, Intervention Strategies and Future Directions: A Rapid Review. Front Public Health 2022; 10:877920. [PMID: 35836994 PMCID: PMC9273841 DOI: 10.3389/fpubh.2022.877920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/03/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Ghana like other African countries is facing multiple health threats due to expansion of urban populations. Globally, the urbanization phenomenon has received considerable attention and modest steps have been undertaken to address it. Ghana is stalling on implementation of policies and interventions targeted at alleviating the menace. Objectives This review examined research evidence, interventions, and policies relating to urbanization and threats to health and well-being of people living in Ghana. The review focused on three areas including urbanization threats to health and well-being, health risks associated with urbanization, and interventions and policies. Materials and Methods The search spanned from year 2000 to February 2022 covering documents related to urbanization, health, and well-being. Databases used for the search include African Journals Online, Annual Reviews (Biomedical, Life & Physical sciences, Social Sciences), BioMedCentral, BioOne, BLDS digital library, Cambridge University Press, ClinicalKey, CINAHL, University of Ghana Digital Collections/UGSpace, JSTOR, Medline and Wiley Online Library. Results Environmental risk factors, urban planning, water-related, behavior-related, and socioeconomic factors were important urbanization threats to health and well-being. Health risks identified include airborne diseases, waterborne diseases, malaria, and non-communicable diseases such as hypertension and lung cancer. Additionally, there is evidence of non-implementation and/or non-enforcement of existing interventions and policies. Conclusion and Recommendation Evidence from this rapid review shows that urbanization impacts on health and well-being of people in Ghana. Urbanization threats that expose populations to health risks could be reduced through commitment to implementation, surveillance and monitoring of policies and interventions. Communities and individuals must be equipped to take control of their health and well-being.
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Bollyky TJ. Oral Rehydration Salts, Cholera, and the Unfinished Urban Health Agenda. Trop Med Infect Dis 2022; 7:67. [PMID: 35622694 PMCID: PMC9143002 DOI: 10.3390/tropicalmed7050067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 12/10/2022] Open
Abstract
Cholera has played an outsized role in the history of how cities have transformed from the victims of disease into great disease conquerors. Yet the current burden of cholera and diarrheal diseases in the fast-urbanizing areas of low-income nations shows the many ways in which the urban health agenda remains unfinished and must continue to evolve.
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Wang Y, Tsai TC, Duncan D, Ji J. Association of city-level walkability, accessibility to biking and public transportation and socio-economic features with COVID-19 infection in Massachusetts, USA: An ecological study. GEOSPATIAL HEALTH 2022; 17. [PMID: 35147011 DOI: 10.4081/gh.2022.1017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/16/2021] [Indexed: 06/14/2023]
Abstract
With people restricted to their residences, neighbourhood characteristics may affect behaviour and risk of coronavirus disease 2019 (COVID-19) infection. We aimed to analyse whether neighbourhoods with higher walkability, public transit, biking services and higher socio-economic status were associated with lower COVID-19 infection during the peak of the COVID-19 pandemic in Massachusetts. We used Walk Score®, Bike Score®, and Transit Score® indices to assess the walkability and transportation of 72 cities in Massachusetts, USA based on availability of data and collected the total COVID-19 case numbers of each city up to 10 April 2021. We used univariate and multivariate linear models to analyse the effects of these scores on COVID-19 cases per 100,000 in each city, adjusting for demographic covariates and all covariates, respectively. In the 72 cities studied, the average Walk Score, Transit Score and Bike Score was 48.7, 36.5 and 44.1, respectively, with a total of 426,182 COVID-19 cases. Higher Walk Score, Transit Score, and Bike Score rankings were negatively associated with COVID-19 cases per 100,000 persons (<0.05). Cities with a higher proportion of Hispanic population and a lower median household income were associated with more COVID-19 cases per 100,000 (P<0.05). Higher Walk Score, Transit Score and Bike Score were shown to be protective against COVID-19 transmission, while socio-demographic factors were associated with COVID-19 infection. Understanding the complex relationship of how the structure of the urban environment may constrain commuting patterns for residents and essential workers during COVID-19 would offer potential insights on future pandemic preparedness and response.
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Affiliation(s)
- Yucheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing.
| | - Thomas C Tsai
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Dustin Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
| | - John Ji
- Vanke School of Public Health, Tsinghua University, Beijing.
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Bixby H, Bennett JE, Bawah AA, Arku RE, Annim SK, Anum JD, Mintah SE, Schmidt AM, Agyei-Asabere C, Robinson BE, Cavanaugh A, Agyei-Mensah S, Owusu G, Ezzati M, Baumgartner J. Quantifying within-city inequalities in child mortality across neighbourhoods in Accra, Ghana: a Bayesian spatial analysis. BMJ Open 2022; 12:e054030. [PMID: 35027422 PMCID: PMC8762100 DOI: 10.1136/bmjopen-2021-054030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Countries in sub-Saharan Africa suffer the highest rates of child mortality worldwide. Urban areas tend to have lower mortality than rural areas, but these comparisons likely mask large within-city inequalities. We aimed to estimate rates of under-five mortality (U5M) at the neighbourhood level for Ghana's Greater Accra Metropolitan Area (GAMA) and measure the extent of intraurban inequalities. METHODS We accessed data on >700 000 women aged 25-49 years living in GAMA using the most recent Ghana census (2010). We summarised counts of child births and deaths by five-year age group of women and neighbourhood (n=406) and applied indirect demographic methods to convert the summaries to yearly probabilities of death before age five years. We fitted a Bayesian spatiotemporal model to the neighbourhood U5M probabilities to obtain estimates for the year 2010 and examined their correlations with indicators of neighbourhood living and socioeconomic conditions. RESULTS U5M varied almost five-fold across neighbourhoods in GAMA in 2010, ranging from 28 (95% credible interval (CrI) 8 to 63) to 138 (95% CrI 111 to 167) deaths per 1000 live births. U5M was highest in neighbourhoods of the central urban core and industrial areas, with an average of 95 deaths per 1000 live births across these neighbourhoods. Peri-urban neighbourhoods performed better, on average, but rates varied more across neighbourhoods compared with neighbourhoods in the central urban areas. U5M was negatively correlated with multiple indicators of improved living and socioeconomic conditions among peri-urban neighbourhoods. Among urban neighbourhoods, correlations with these factors were weaker or, in some cases, reversed, including with median household consumption and women's schooling. CONCLUSION Reducing child mortality in high-burden urban neighbourhoods in GAMA, where a substantial portion of the urban population resides, should be prioritised as part of continued efforts to meet the Sustainable Development Goal national target of less than 25 deaths per 1000 live births.
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Affiliation(s)
- Honor Bixby
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
| | - James E Bennett
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Ayaga A Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Raphael E Arku
- Department of Environmental Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Samuel K Annim
- Ghana Statistical Service, Accra, Ghana
- University of Cape Coast, Cape Coast, Ghana
| | | | | | - Alexandra M Schmidt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Brian E Robinson
- Department of Geography, McGill University, Montreal, Québec, Canada
| | - Alicia Cavanaugh
- Department of Geography, McGill University, Montreal, Québec, Canada
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, Legon, Greater Accra, Ghana
| | - George Owusu
- Institute of Statistical, Social and Economic Research, University of Ghana, Accra, Ghana
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
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11
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Boyce MR, Cordoba Asprilla M, van Loenen B, McClelland A, Rojhani A. Urban pandemic response: Survey results describing the experiences from twenty-five cities during the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000859. [PMID: 36962772 PMCID: PMC10021545 DOI: 10.1371/journal.pgph.0000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/01/2022] [Indexed: 12/02/2022]
Abstract
Since first being detected in Wuhan, China in late December 2019, COVID-19 has demanded a response from all levels of government. While the role of local governments in routine public health functions is well understood-and the response to the pandemic has highlighted the importance of involving local governments in the response to and management of large, multifaceted challenges-their role in pandemic response remains more undefined. Accordingly, to better understand how local governments in cities were involved in the response to the COVID-19 pandemic, we conducted a survey involving cities in the Partnership for Healthy Cities to: (i) understand which levels of government were responsible, accountable, consulted, and informed regarding select pandemic response activities; (ii) document when response activities were implemented; (iii) characterize how challenging response activities were; and (iv) query about future engagement in pandemic and epidemic preparedness. Twenty-five cities from around the world completed the survey and we used descriptive statistics to summarize the urban experience in pandemic response. Our results show that national authorities were responsible and accountable for a majority of the activities considered, but that local governments were also responsible and accountable for key activities-especially risk communication and coordinating with community-based organizations and civil society organizations. Further, most response activities were implemented after COVID-19 had been confirmed in a city, many pandemic response activities proved to be challenging for local authorities, and nearly all local authorities envisioned being more engaged in pandemic preparedness and response following the COVID-19 pandemic. This descriptive research represents an important contribution to an expanding evidence base focused on improving the response to the ongoing COVID-19 pandemic, as well as future outbreaks.
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Affiliation(s)
- Matthew R Boyce
- Center for Global Health Science & Security, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | | | - Breanna van Loenen
- Resolve to Save Lives, New York City, New York, United States of America
| | - Amanda McClelland
- Resolve to Save Lives, New York City, New York, United States of America
| | - Ariella Rojhani
- Vital Strategies, New York City, New York, United States of America
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Boyce MR, Asprilla MC, van Loenen B, McClelland A, Rojhani A. How do local-level authorities engage in epidemic and pandemic preparedness activities and coordinate with higher levels of government? Survey results from 33 cities. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000650. [PMID: 36962601 PMCID: PMC10022361 DOI: 10.1371/journal.pgph.0000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022]
Abstract
The COVID-19 pandemic suggests that there are opportunities to improve preparedness for infectious disease outbreaks. While much attention has been given to understanding national-level preparedness, relatively little attention has been given to understanding preparedness at the local-level. We, therefore, aim to describe (1) how local governments in urban environments were engaged in epidemic preparedness efforts before the COVID-19 pandemic and (2) how they were coordinating with authorities at higher levels of governance before COVID-19. We developed a survey and distributed it to 50 cities around the world involved in the Partnership for Healthy Cities. The survey included several question formats including free-response, matrices, and multiple-choice questions. RACI matrices, a project management tool that helps explain coordination structures, were used to understand the level of government responsible, accountable, consulted, and informed regarding select preparedness activities. We used descriptive statistics to summarize local-level engagement in preparedness. Local authorities from 33 cities completed the survey. Prior to the COVID-19 pandemic, 20 of the cities had completed infectious disease risk assessments, 10 completed all-hazards risk assessments, 11 completed simulation exercises, 10 completed after-action reviews, 19 developed preparedness and response plans, three reported involvement in their country's Joint External Evaluation of the International Health Regulations, and eight cities reported involvement in the development of their countries' National Action Plan for Health Security. RACI matrices revealed various models of epidemic preparedness, with responsibility often shared across levels, and national governments accountable for the most activities, compared to other governance levels. In conclusion, national governments maintain the largest role in epidemic and pandemic preparedness but the role of subnational and local governments is not negligible. Local-level actors engage in a variety of preparedness activities and future efforts should strive to better include these actors in preparedness as a means of bolstering local, national, and global health security.
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Affiliation(s)
- Matthew R Boyce
- Center for Global Health Science & Security, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | | | - Breanna van Loenen
- Resolve to Save Lives, New York City, New York, United States of America
| | - Amanda McClelland
- Resolve to Save Lives, New York City, New York, United States of America
| | - Ariella Rojhani
- Vital Strategies, New York City, New York, United States of America
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Ji JS, Liu L, Yan L, Zeng Y. Comparing Effects of FOXO3A and Residing in Urban Areas on Longevity: A Gene-Environment Interaction Study. J Gerontol A Biol Sci Med Sci 2021; 77:1549-1556. [PMID: 34875051 DOI: 10.1093/gerona/glab362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Indexed: 11/12/2022] Open
Abstract
Forkhead box O3 (FOXO3A) is a candidate longevity gene. Urban residents are also positively associated with longer life expectancy. We conducted a gene-environment interaction to assess the synergistic effect of FOXO3A and urban/rural environments on mortality. We included 3085 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used single nucleotide polymorphisms (SNPs) rs2253310, rs2802292, and rs4946936 to identify the FOXO3A gene and classified residential locations as "urban" and "rural." Given the open cohort design, we used the Cox-proportional hazard regression models to assess the mortality risk. We found the minor allele homozygotes of FOXO3A to have a protective effect on mortality [HR (95% CI) for rs4946936 TT vs. CC: 0.807 (0.653, 0.996); rs2802292 GG vs TT: 0.812 (0.67, 0.985); rs2253310 CC vs. GG: 0.808 (0.667, 0.978)]. Participants living in urban areas had a lower risk of mortality [HR of the urban vs. the rural: 0.854 (0.759, 0.962)]. The interaction between FOXO3A and urban and rural regions was statistically significant (pinteraction<0.01). Higher air pollution (fine particulate matter: PM2.5) and lower residential greenness (Normalized Difference Vegetation Index: NDVI) both contributed to higher mortality. After adjusting for NDVI and PM2.5, the protective effect size of FOXO3A SNPs was slightly attenuated while the protective effect size of living in an urban environment increased. The effect size of the beneficial effect of FOXO3 on mortality is roughly equivalent to that of living in urban areas. Our research findings indicate the effect of places of residence and genetic predisposition of longevity are intertwined.
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Affiliation(s)
- John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China.,Global Health Research Center, Duke Kunshan University, Kunshan, China.,Environmental Research Center, Duke Kunshan University, Kunshan, China.,Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Linxin Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Lijing Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Yi Zeng
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China.,Center for the Study of Aging and Human Development, Duke Medical School, Durham, NC, USA
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Sarkar C, Lai KY, Ni MY, Kumari S, Leung GM, Webster C. Liveable residential space, residential density, and hypertension in Hong Kong: A population-based cohort study. PLoS Med 2021; 18:e1003824. [PMID: 34727119 PMCID: PMC8562807 DOI: 10.1371/journal.pmed.1003824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypertension is a leading preventable risk factor of chronic disease and all-cause mortality. Housing is a fundamental social determinant of health. Yet, little is known about the impacts of liveable residential space and density on hypertension. METHODS AND FINDINGS This retrospective observational study (median follow-up of 2.2 years) leveraged the FAMILY Cohort, a large territory-wide cohort in Hong Kong, Special Administrative Region, People's Republic of China to quantify associations of objectively measured liveable space and residential density with blood pressure outcomes among adults aged ≥16 years. Blood pressure outcomes comprised diastolic blood pressure (DBP), systolic blood pressure (SBP), mean arterial pressure (MAP), and hypertension. Liveable space was measured as residential floor area, and density was assessed using the number of residential units per building block and neighborhood residential unit density within predefined catchments. Multivariable regression models examined associations of liveable floor area and residential density with prevalent and incident hypertension. We investigated effect modifications by age, sex, income, employment status, and housing type. Propensity score matching was further employed to match a subset of participants who moved to smaller residences at follow-up with equivalent controls who did not move, and generalized linear models examined the impact of moving to smaller residences upon blood pressure outcomes. Our fully adjusted models of prevalent hypertension outcomes comprised 30,439 participants at baseline, while 13,895 participants were available for incident models at follow-up. We found that each interquartile range (IQR) increment in liveable floor area was associated with lower DBP (beta [β] = -0.269 mm Hg, 95% confidence interval [CI]: -0.419 to -0.118, p < 0.001), SBP (β = -0.317 mm Hg, -0.551 to -0.084, p = 0.008), MAP (β = -0.285 mm Hg, -0.451 to -0.119 with p < 0.001), and prevalent hypertension (odds ratio [OR] = 0.955, 0.918 to 0.993, p = 0.022) at baseline. Each IQR increment in residential units per building block was associated with higher DBP (β = 0.477 mm Hg, 0.212 to 0.742, p = <0.001), SBP (β = 0.750 mm Hg, 0.322 to 1.177, p = <0.001), MAP (β = 0.568 mm Hg, 0.269 to 0.866, p < 0.001), and prevalent hypertension (OR = 1.091, 1.024 to 1.162, p = 0.007). Each IQR increase in neighborhood residential density within 0.5-mi street catchment was associated with lower DBP (β = -0.289 mm Hg, -0.441 to -0.137, p = <0.001), SBP (β = -0.411 mm Hg, -0.655 to -0.168, p < 0.001), MAP (β = -0.330 mm Hg, -0.501 to -0.159, p = <0.001), and lower prevalent hypertension (OR = 0.933, 0.899 to 0.969, p < 0.001). In the longitudinal analyses, each IQR increment in liveable floor area was associated with lower DBP (β = -0.237 mm Hg, -0.431 to -0.043, p = 0.016), MAP (β = -0.244 mm Hg, -0.444 to -0.043, p = 0.017), and incident hypertension (adjusted OR = 0.909, 0.836 to 0.988, p = 0.025). The inverse associations between larger liveable area and blood pressure outcomes were more pronounced among women and those residing in public housing. In the propensity-matched analysis, participants moving to residences of lower liveable floor area were associated with higher odds of incident hypertension in reference to those who did not move (OR = 1.623, 1.173 to 2.199, p = 0.002). The major limitations of the study are unmeasured residual confounding and loss to follow-up. CONCLUSIONS We disentangled the association of micro-, meso-, and macrolevel residential densities with hypertension and found that higher liveable floor area and neighborhood scale residential density were associated with lower odds of hypertension. These findings suggest adequate housing in the form of provisioning of sufficient liveable space and optimizing residential density at the building block, and neighborhood levels should be investigated as a potential population-wide preventive strategy for lowering hypertension and associated chronic diseases.
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Affiliation(s)
- Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- School of Public Health, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Ka Yan Lai
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Michael Y. Ni
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- School of Public Health, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Sarika Kumari
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Gabriel M. Leung
- School of Public Health, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Chris Webster
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
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15
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Clark SN, Bennett JE, Arku RE, Hill AG, Fink G, Adanu RM, Biritwum RB, Darko R, Bawah A, Duda RB, Ezzati M. Small area variations and factors associated with blood pressure and body-mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data. PLoS Med 2021; 18:e1003850. [PMID: 34762663 PMCID: PMC8584976 DOI: 10.1371/journal.pmed.1003850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Body-mass index (BMI) and blood pressure (BP) levels are rising in sub-Saharan African cities, particularly among women. However, there is very limited information on how much they vary within cities, which could inform targeted and equitable health policies. Our study aimed to analyse spatial variations in BMI and BP for adult women at the small area level in the city of Accra, Ghana. METHODS AND FINDINGS We combined a representative survey of adult women's health in Accra, Ghana (2008 to 2009) with a 10% random sample of the national census (2010). We applied a hierarchical model with a spatial term to estimate the associations of BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with demographic, socioeconomic, behavioural, and environmental factors. We then used the model to estimate BMI and BP for all women in the census in Accra and calculated mean BMI, SBP, and DBP for each enumeration area (EA). BMI and/or BP were positively associated with age, ethnicity (Ga), being currently married, and religion (Muslim) as their 95% credible intervals (95% CrIs) did not include zero, while BP was also negatively associated with literacy and physical activity. BMI and BP had opposite associations with socioeconomic status (SES) and alcohol consumption. In 2010, 26% of women aged 18 and older had obesity (BMI ≥ 30 kg/m2), and 21% had uncontrolled hypertension (SBP ≥ 140 and/or DBP ≥ 90 mm Hg). The differences in mean BMI and BP between EAs at the 10th and 90th percentiles were 2.7 kg/m2 (BMI) and in BP 7.9 mm Hg (SBP) and 4.8 mm Hg (DBP). BMI was generally higher in the more affluent eastern parts of Accra, and BP was higher in the western part of the city. A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated. CONCLUSIONS We observed that variation of BMI and BP across neighbourhoods within Accra was almost as large as variation across countries among women globally. Localised measures are needed to address this unequal public health challenge in Accra.
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Affiliation(s)
- Sierra N. Clark
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- MRC Centre for Environment and Health, Imperial College London, United Kingdom
| | - James E. Bennett
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- MRC Centre for Environment and Health, Imperial College London, United Kingdom
| | - Raphael E. Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Allan G. Hill
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Richard M. Adanu
- Department of Population, Family, and Reproductive Health, University of Ghana, Accra, Ghana
| | | | - Rudolph Darko
- School of Medicine, University of Ghana, Accra, Ghana
| | - Ayaga Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Rosemary B. Duda
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- MRC Centre for Environment and Health, Imperial College London, United Kingdom
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, United Kingdom
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Moulds S, Buytaert W, Templeton MR, Kanu I. Modeling the Impacts of Urban Flood Risk Management on Social Inequality. WATER RESOURCES RESEARCH 2021; 57:e2020WR029024. [PMID: 38130829 PMCID: PMC7615406 DOI: 10.1029/2020wr029024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/19/2021] [Indexed: 12/23/2023]
Abstract
The exposure of urban populations to flooding is highly heterogeneous, with the negative impacts of flooding experienced disproportionately by the poor. In developing countries experiencing rapid urbanization and population growth a key distinction in the urban landscape is between planned development and unplanned, informal development, which often occurs on marginal, flood-prone land. Flood risk management in the context of informality is challenging, and may exacerbate existing social inequalities and entrench poverty. Here, we adapt an existing socio-hydrological model of human-flood interactions to account for a stratified urban society consisting of planned and informal settlements. In the first instance, we use the model to construct four system archetypes based on idealized scenarios of risk reduction and disaster recovery. We then perform a sensitivity analysis to examine the relative importance of the differential values of vulnerability, risk-aversion, and flood awareness in determining the relationship between flood risk management and social inequality. The model results suggest that reducing the vulnerability of informal communities to flooding plays an important role in reducing social inequality and enabling sustainable economic growth, even when the exposure to the flood hazard remains high. Conversely, our model shows that increasing risk aversion may accelerate the decline of informal communities by suppressing economic growth. On this basis, we argue for urban flood risk management which is rooted in pro-poor urban governance and planning agendas which recognize the legitimacy and permanence of informal communities in cities.
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Affiliation(s)
- Simon Moulds
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Wouter Buytaert
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Michael R Templeton
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Ishmael Kanu
- Department of Civil Engineering, Fourah Bay College, University of Sierra Leone, Freetown, Sierra Leone
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Space-time characterization of community noise and sound sources in Accra, Ghana. Sci Rep 2021; 11:11113. [PMID: 34045545 PMCID: PMC8160008 DOI: 10.1038/s41598-021-90454-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Abstract
Urban noise pollution is an emerging public health concern in growing cities in sub-Saharan Africa (SSA), but the sound environment in SSA cities is understudied. We leveraged a large-scale measurement campaign to characterize the spatial and temporal patterns of measured sound levels and sound sources in Accra, Ghana. We measured sound levels and recorded audio clips at 146 representative locations, involving 7-days (136 locations) and 1-year measurements between 2019 and 2020. We calculated metrics of noise levels and intermittency and analyzed audio recordings using a pre-trained neural network to identify sources. Commercial, business, and industrial areas and areas near major roads had the highest median daily sound levels (LAeq24hr: 69 dBA and 72 dBA) and the lowest percentage of intermittent sound; the vice-versa was found for peri urban areas. Road-transport sounds dominated the overall sound environment but mixtures of other sound sources, including animals, human speech, and outdoor music, dominated in various locations and at different times. Environmental noise levels in Accra exceeded both international and national health-based guidelines. Detailed information on the acoustical environmental quality (including sound levels and types) in Accra may guide environmental policy formulation and evaluation to improve the health of urban residents.
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Barsties LS, Daalderop LA, Lagendijk J, van Steenbergen F, Been JV, Bertens LCM, Waelput AJM, van Zoest H, Loorbach D, Steegers EAP. Addressing perinatal health inequities in Dutch municipalities: Protocol for the Healthy Pregnancy 4 All-3 programme. Health Policy 2020; 125:385-392. [PMID: 33487480 DOI: 10.1016/j.healthpol.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Health inequities are already present at birth and affect individuals' health and socioeconomic outcomes across the life course. Addressing these inequities requires a cross-sectoral approach, covering the first 1,000 days of life. We believe that - in the Dutch context - municipal governments can be the main responsible actor to drive such an approach, since they are primarily responsible for organising adequate public health. Therefore, we aim to identify and develop transformative change towards the implementation of perinatal health into municipal approaches and policies concerning health inequities. METHODS A transition analysis will be combined with action research in six Dutch municipalities. Interviews and interactive group sessions with professionals and organisations that are relevant for the institutional embedding of perinatal health into approaches and policies regarding health inequities, will be organised in each municipality. As a follow-up, a questionnaire will be administered among all participants one year after completion of the group sessions. DISCUSSION We expect to gain insights into the role of municipalities in addressing perinatal health inequities, learn more about the interaction between different key stakeholders, and identify barriers and facilitators for a cross-sectoral approach to perinatal health. This knowledge will serve to inform the development of approaches to perinatal health inequities in areas with relatively poor perinatal health outcomes, both in the Netherlands and abroad.
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Affiliation(s)
- Lisa S Barsties
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands; Dutch Research Institute for Transitions, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | - Leonie A Daalderop
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands; Dutch Research Institute for Transitions, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | - Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Frank van Steenbergen
- Dutch Research Institute for Transitions, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands; Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Adja J M Waelput
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Hanneke van Zoest
- Pharos, The Dutch Centre of Expertise on Health Disparities, PO Box 13318, 3507 LH, Utrecht, the Netherlands.
| | - Derk Loorbach
- Dutch Research Institute for Transitions, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Hoernke K. A socially just recovery from the COVID-19 pandemic: a call for action on the social determinants of urban health inequalities. J R Soc Med 2020; 113:482-484. [PMID: 32915092 PMCID: PMC7731647 DOI: 10.1177/0141076820948817] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Katarina Hoernke
- Institute for Global Health, University College London, London WC1E 6BT, UK
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Sorensen TB, Wilson R, Gregson J, Shankar B, Dangour AD, Kinra S. Is night-time light intensity associated with cardiovascular disease risk factors among adults in early-stage urbanisation in South India? A cross-sectional study of the Andhra Pradesh Children and Parents Study. BMJ Open 2020; 10:e036213. [PMID: 33444171 PMCID: PMC7678398 DOI: 10.1136/bmjopen-2019-036213] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/16/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To explore associations of night-time light intensity (NTLI), a novel proxy for continuous urbanisation levels, with mean systolic blood pressure (SBP), body mass index (BMI), fasting serum low-density lipoprotein (LDL) and fasting plasma glucose (FPG), among adults in early-stage urbanisation in Telangana, South India. DESIGN Cross-sectional analysis of the third wave of the Andhra Pradesh Children and Parents Study cohort. SETTING 28 villages representing a continuum of urbanisation levels, ranging from rural settlement to medium-sized town in Telangana, South India. PARTICIPANTS Data were available from 6944 participants, 6236 of whom were eligible after excluding pregnant women, participants younger than 18 years of age and participants missing data for age. Participants were excluded if they did not provide fasting blood samples, had implausible or missing outcome values, were medicated for hypertension or diabetes or had triglyceride levels invalidating derived LDL. The analysis included 5924 participants for BMI, 5752 participants for SBP, 5287 participants for LDL and 5328 participants for FPG. RESULTS Increasing NTLI was positively associated with mean BMI, SBP and LDL but not FPG. Adjusted mean differences across the range of village-level NTLI were 1.0 kg/m2 (95% CI 0.01 to 1.9) for BMI; 4.2 mm Hg (95% CI 1.0 to 7.4) for SBP; 0.3 mmol/L (95% CI -0.01 to 0.7) for LDL; and -0.01 mmol/L (95% CI -0.4 to 0.4) for FPG. Associations of NTLI with BMI and SBP were stronger in older age groups. CONCLUSION The association of NTLI with cardiovascular disease (CVD) risk factors identify NTLI as a potentially important tool for exploring urbanisation-related health. Consistent associations of moderate increases in urbanisation levels with important CVD risk factors warrant prevention strategies to curb expected large public health impacts from continued and rapid urbanisation in India.
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Affiliation(s)
- Tina Bonde Sorensen
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Robin Wilson
- Department of Geography & Environment, University of Southampton, Southampton, UK
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, UK
| | - Alan D Dangour
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Lazarus G, Kirchner HL, Siswanto BB. Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis. J Telemed Telecare 2020; 28:632-641. [PMID: 32996348 DOI: 10.1177/1357633x20960627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Acute coronary syndrome (ACS) patients residing in rural areas are predisposed to higher risk of poor outcomes due to substantial delays in disease management, emphasising the importance of emerging telecardiology technologies in delivering emergency services in such settings. This meta-analysis aimed to investigate the impacts of prehospital telecardiology strategies on the clinical outcomes of rural ACS patients. METHODS A literature search was performed of articles published up to April 2020 through six databases. Included studies were assessed for bias risk using the ROBINS-I tool, and a random-effects model was utilised to estimate effect sizes. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS Twelve studies with a total of 3989 patients were included in this review. Prehospital telecardiology in the form of tele-electrocardiography (tele-ECG) enabled prompt diagnosis and triage, resulting in a decreased door-to-balloon (DTB) time (mean difference = -25.53 minutes, 95% confidence interval (CI) -36.08 to -14.97 minutes; I2 = 98%), as well as lower in-hospital mortality (odds ratio (OR) = 0.57, 95% CI 0.36-0.92) and long-term mortality (OR = 0.52, 95% CI 0.39-0.69) rates, both with negligible heterogeneity (I2 = 0%). GRADE assessment yielded very low to moderate certainty of evidence.Conclusion Prehospital tele-ECG appeared to be an effective and worthwhile approach in the management of rural ACS patients, as shown by moderate quality evidence on lower long-term mortality. Given the uncertainties of the evidence quality on DTB time and in-hospital mortality, future studies with a higher quality of evidence are required to confirm our findings.
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Affiliation(s)
| | - H L Kirchner
- Department of Population Health Sciences, Geisinger Clinic, USA
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Indonesia
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22
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Boyce MR, Katz R. Rapid urban health security assessment tool: a new resource for evaluating local-level public health preparedness. BMJ Glob Health 2020; 5:bmjgh-2020-002606. [PMID: 32546588 PMCID: PMC7299020 DOI: 10.1136/bmjgh-2020-002606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 12/21/2022] Open
Abstract
Urbanisation will be one of the defining demographic trends of the 21st century-creating unique opportunities for sustainable capacity development, as well as substantial risks and challenges for managing public health and health emergencies. Plans and policies for responding to public health emergencies are generally framed at higher levels of governance, but developing, improving and sustaining the capacities necessary for implementing these policies is a direct function of local-level authorities. Evaluating local-level public health capacities is an important process for identifying strengths and weaknesses that can impact the preparedness for, detection of and response to health security threats. However, while various evaluations and assessments exist for evaluating capacities at other levels, currently, there are no readily available health security assessments for the local-level. In this paper, we describe a tool-the Rapid Urban Health Security Assessment (RUHSA) Tool-that is based on a variety of other relevant assessments and guidance documents. Assessing capacities allow for local-level authorities to identify the strengths and weaknesses of their local health security systems, create multiyear action plans and prioritise opportunities for improving capacities, effectively engage with development partners to target resources effectively and develop compelling narratives and a legacy of leadership. While the RUHSA Tool was not designed to be used in the midst of a public health emergency, such as the ongoing COVID-19 pandemic, it may also be adapted to inform a checklist for prioritising what capacities and activities a city needs to rapidly develop or to help focus requests for assistance.
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Affiliation(s)
- Matthew R Boyce
- Center for Global Health Science & Security, Georgetown University, Washington, District of Columbia, USA
| | - Rebecca Katz
- Center for Global Health Science & Security, Georgetown University, Washington, District of Columbia, USA
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Delás J. [The street as a political priority]. GACETA SANITARIA 2020; 35:209-210. [PMID: 32586616 DOI: 10.1016/j.gaceta.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jordi Delás
- Servicio de Medicina Interna, Hospital Universitari Sagrat Cor, Grupo Quironsalud; Departament de Medicina, Universitat de Barcelona, Barcelona, España.
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24
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Baumgartner J, Brauer M, Ezzati M. The role of cities in reducing the cardiovascular impacts of environmental pollution in low- and middle-income countries. BMC Med 2020; 18:39. [PMID: 32089131 PMCID: PMC7038592 DOI: 10.1186/s12916-020-1499-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/21/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND As low- and middle-income countries urbanize and industrialize, they must also cope with pollution emitted from diverse sources. MAIN TEXT Strong and consistent evidence associates exposure to air pollution and lead with increased risk of cardiovascular disease occurrence and death. Further, increasing evidence, mostly from high-income countries, indicates that exposure to noise and to both high and low temperatures may also increase cardiovascular risk. There is considerably less research on the cardiovascular impacts of environmental conditions in low- and middle-income countries (LMICs), where the levels of pollution are often higher and the types and sources of pollution markedly different from those in higher-income settings. However, as such evidence gathers, actions to reduce exposures to pollution in low- and middle-income countries are warranted, not least because such exposures are very high. Cities, where pollution, populations, and other cardiovascular risk factors are most concentrated, may be best suited to reduce the cardiovascular burden in LMICs by applying environmental standards and policies to mitigate pollution and by implementing interventions that target the most vulnerable. The physical environment of cities can be improved though municipal processes, including infrastructure development, energy and transportation planning, and public health actions. Local regulations can incentivize or inhibit the polluting behaviors of industries and individuals. Environmental monitoring can be combined with public health warning systems and publicly available exposure maps to inform residents of environmental hazards and encourage the adoption of pollution-avoiding behaviors. Targeted individual or neighborhood interventions that identify and treat high-risk populations (e.g., lead mitigation, portable air cleaners, and preventative medications) can also be leveraged in the very near term. Research will play a key role in evaluating whether these approaches achieve their intended benefits, and whether these benefits reach the most vulnerable. CONCLUSION Cities in LMICs can play a defining role in global health and cardiovascular disease prevention in the next several decades, as they are well poised to develop innovative, multisectoral approaches to pollution mitigation, while also protecting the most vulnerable.
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Affiliation(s)
- Jill Baumgartner
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1110 Pine Avenue West, Montreal, QC, H3A 1A3, Canada.
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Center for Environment and Health, Imperial College London, London, UK
- WHO Collaborating Centre for NCD Surveillance and Epidemiology, Imperial College London, London, UK
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Atti Le giornate della ricerca scientificae delle esperienze professionali dei giovani: Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI) Roma 20-21 dicembre 2019. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 60:E1-E85. [PMID: 32258536 PMCID: PMC7105054 DOI: 10.15167/2421-4248/jpmh2019.60.4s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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