Healthy places: exploring the evidence

Show me the money! Associations between tree canopy and hospital costs in cities for cardiovascular disease events in a longitudinal cohort study of 110,134 participants

Health benefits from urban greening are assumed to translate into reduced healthcare expenditure, yet few studies have tested this. A total of 110,134 participants in the Sax Institute's 45 and Up Study in the Australian cities of Sydney, Newcastle, or Wollongong were linked with hospital cost data for cardiovascular disease (CVD) events (e.g., acute myocardial infarctions) up to 30 June 2018. Associations between percentages of total green space, tree canopy, and open grass within 1.6 km of participants homes and annual per person measured CVD-related hospital costs were analysed using generalised linear model (GLM) with gamma density as a component of a two-part mixture model, adjusting for confounders. Overall, 26,243 participants experienced a CVD-related hospitalisation. Incidence was lower among participants with 10 % more tree canopy (OR 0.98, 95 %CI 0.96, 0.99), but not with higher total green space or open grass percentages. Total costs of hospitalisations per year were lower with 10 % more tree canopy (means ratio 0.96, 95 %CI 0.95, 0.98), but also higher with 10 % more open grass (means ratio 1.04, 95 %CI 1.02, 1.06). It was estimated that raising tree canopy cover to 30 % or more for individuals with currently less than 10 % could lead to a within-sample annual saving per person of AU$ 193 overall and AU$ 569 for those who experienced one or more CVD-related hospital admissions. This projects to an estimated annual health sector cost reduction of AU$ 19.3 million per 100,000 individuals for whom local tree canopy cover is increased from less than 10 % to 30 % or higher. In conclusion, this longitudinal study is among the first to analyse measured healthcare cost data in relation to urban green space in general, and with differentiation between major types of greenery relevant to urban planning policies in cities around the world. In sum, this study advances an increasingly important and international focus of research by reporting on the lower burden of CVD and fewer associated hospitalisations stemming from upstream investments that protect and restore urban tree canopy, which not only translates into substantial reduced costs for the health sector, but also helps to create regenerative cities and flourishing communities.

A health data led approach for assessing potential health benefits of green and blue spaces: Lessons from an Irish case study

Research producing evidence-based information on the health benefits of green and blue spaces often has within its design, the potential for inherent or implicit bias which can unconsciously orient the outcomes of such studies towards preconceived hypothesis. Many studies are situated in proximity to specific or generic green and blue spaces (hence, constituting a green or blue space led approach), others are conducted due to availability of green and blue space data (hence, applying a green or blue space data led approach), while other studies are shaped by particular interests in the association of particular health conditions with presence of, or engagements with green or blue spaces (hence, adopting a health or health status led approach). In order to tackle this bias and develop a more objective research design for studying associations between human health outcomes and green and blue spaces, this paper discussed the features of a methodological framework suitable for that purpose after an initial, year-long, exploratory Irish study. The innovative approach explored by this study (i.e., the health-data led approach) first identifies sample sites with good and poor health outcomes from available health data (using data clustering techniques) before examining the potential role of the presence of, or engagement with green and blue spaces in creating such health outcomes. By doing so, we argue that some of the bias associated with the other three listed methods can be reduced and even eliminated. Finally, we infer that the principles and paradigm adopted by the health data led approach can be applicable and effective in analyzing other sustainability problems beyond associations between human health outcomes and green and blue spaces (e.g., health, energy, food, income, environment and climate inequality and justice etc.). The possibility of this is also discussed within this paper.

Social wellbeing, values, and identity among Caiçara small-scale fishers in southeastern Brazil

Although much in the lives of members of the Caiçara small-scale fishing communities of Lázaro and Saco da Ribeira in Ubatuba, southeastern Brazil would suggest hardship, that population expresses a surprising degree of satisfaction with life. In this paper, we use a social wellbeing lens as applied through an ethnographic, mixed methods approach to reflect on this overall sense that lives rooted in small-scale fishing are well worth living despite their many challenges. We see the classic maritime anthropology theme of identity at the heart of meaning and life satisfaction. Identity provides core aspects of how people engage with their realities and anchors values that are reference points in work and social relations. With reference to the relational nuances revealed by the social wellbeing perspective, however, we show that Caiçara and small-scale fishing identities are not monolithic, but reflect gender and other social positions, and personal and familial experiences. These experiences include grappling with the complex effects of economic, social, political, and environmental changes. We conclude by arguing that fisheries policy that seeks to prioritize human wellbeing would benefit by adopting a social wellbeing perspective. Fisheries policy could thereby take into account identity, values, and relational elements of social life that give meaning and a sense of belonging to small-scale fishers, while also recognizing the cross-cutting and often contradictory variations in human experience that arise from social and economic differences. This social fabric of small-scale fishers' lives shapes their intentions and actions and is thus a necessary complication to the practice of fisheries management that its proponents need to consider.

Expanding current definitions of environmental stewardship through organizational mission statement analysis

In recent years, environmental stewardship has been emphasized as one solution to social-ecological sustainability concerns, especially at the local scale. The Stewardship Mapping and Assessment Project (STEW-MAP) is a national research program developed by the USDA Forest Service that has been implemented at numerous locations in the United States and internationally. This study compared the mission statements of environmental stewardship groups in the Los Angeles River Watershed to previously proposed definitions and frameworks of organizational environmental stewardship to see how well they were reflected. A thematic analysis of the mission statements was also carried out to identify locally important themes and priorities. Results show that, although often consistent, the mission statements do not always reflect existing concepts around environmental stewardship. Additionally, environmental stewardship is not always explicit in the mission statements of organizations that are known to conduct these activities. We suggest that non-traditional groups that engage in stewardship work (i.e., research institutions) as well as groups focused on social issues are overlooked actors in sustainable city goals. A more comprehensive definition of environmental stewardship may be needed to bridge the gap between research and practice.

Mental health and air temperature: Attributable risk analysis for schizophrenia hospital admissions in arid urban climates

Health researchers have examined the physiological impacts of extreme air temperature on the human body. Yet, the mental health impacts of temperature have been understudied. Research has shown that the environment can create circumstances that exacerbate mental health issues. This may be particularly challenging for some of the fastest growing cities, located in hot, dry climates. Given the theoretical relationship between air temperature and mental health, we seek to measure the association between temperature and schizophrenia hospital admissions in an arid urban climate and quantify the associated public health burden. We collected 86,672 hospitalization records for schizophrenia from 2006 to 2014 in Maricopa County, Arizona, USA. Using a distributed lag non-linear model (DLNM), we tested for a statistical association between temperature and schizophrenia hospital admissions after controlling for year, season, weekends, and holidays. We calculated the cumulative attributable risk of nighttime temperature on schizophrenia for the entire dataset as well as among demographic subgroups. The relative risk of schizophrenia hospital admissions increased with both high and low temperatures. Statistical models using daily minimum temperature were more strongly associated with hospitalization than those using mean or maximum. Schizophrenia hospital admissions increased on days with minimum temperatures above 30 °C and below 3 °C, with some subgroups experiencing higher rates of hospitalization. The total fraction of schizophrenia hospital admissions attributable to non-optimal minimum temperature is 3.45 % (CI: -4.91-10.80 %) and high minimum temperature is 0.28 % (CI: -1.18-1.78 %). We found that non-whites and males appear to be at a slightly increased risk than the general population, although there did not appear to be a statistically significant difference. A conservative estimate of healthcare costs annually from non-optimal temperature attributed schizophrenia hospitalization is $1.95 million USD. Therefore, nighttime cooling strategies and efforts could increase the accessibility of shelters to reduce overnight exposure to extreme air temperature.

Who is Planning for Environmental Justice, And How

Problem research strategy and findings

Environmental justice (EJ) seeks to correct legacies of disproportionately burdening low-income and Black, Indigenous, and people of color (BIPOC) communities with environmental hazards that contribute to health inequalities. Federal and state policies increasingly require plans to assess and incorporate EJ principles. The current lack of accessible data and plan evaluation on EJ has been a barrier to policy setting and benchmarking. We created a framework for analyzing content across a large corpus of plans by using quantitative text analysis on 461 California city general plans, also known as comprehensive plans. To verify results and identify specific policies, we conducted content analysis on a subset of seven plans. Demonstrating the broad applicability of EJ principles in planning, policies spanned all required elements of general plans: housing, circulation, land use, health, safety, open space, air quality, and noise. We found that the most headway in EJ planning has been made in cities with a majority population of color and well before the 2018 California state mandate to address EJ. Policies were primarily focused on preventing adverse exposures as opposed to correcting for legacies of inequality. Further, although all policies address vulnerable populations and places, very few specifically addressed race or racism. Thus, EJ has been largely operationalized as health equity.

Takeaway for practice

We identified 628 EJ policies focused on vulnerable populations across the seven city plans included in content analysis. The smorgasbord of policy approaches provided fodder for cities across the United States to incorporate an EJ approach to planning. Gaps in focus areas reveal room for policy innovation (e.g., emphasis on language justice, formerly incarcerated individuals, and noise ordinance policing). We invite planners and community advocates to search across California's plans for EJ policy inspiration, and to use the appendix of EJ policies cataloged in this research as a benchmark of city-level innovation.

Health empowerment scripts: Simplifying social/green prescriptions

Social prescriptions are one term commonly used to describe non-pharmaceutical approaches to healthcare and are gaining popularity in the community, with evidence highlighting psychological benefits of reduced anxiety, depression and improved mood and physiological benefits of reduced risk of cardiovascular disease and reduced hypertension. The relationship between human health benefits and planetary health benefits is also noted. There are, however, numerous barriers, such as duration and frequencies to participate in activities, access, suitability, volition and a range of unpredictable variables (such as inclement weather, shifting interests and relocating home amongst others) impeding a comprehensive approach to their use on a wider scale. From a multidisciplinary perspective, this commentary incorporates a salutogenic and nature-based approach to health, we also provide a range of recommendations that can be undertaken at the patient level to assist in shifting the acknowledged systemic barriers currently occurring. These include using simple language to explain the purpose of health empowerment scripts, ensuing personal commitment to a minimum timeframe, enabling ease of access, co-designing a script program, providing ongoing motivational support and incorporating mindfulness to counter unexpected disruptions.

The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind

The role of courtyards and other outdoor spaces in the recovery of acute mental healthcare users has been gaining international appreciation and recognition. However, the physical properties and conditions necessary for therapeutic and rehabilitative engagement remain to be clearly established. This paper contributes to that knowledge by triangulating evidence from the literature, exemplar case studies of good practice and first-hand accounts of the experiences of staff and service users from four acute mental health facilities. The findings are then aligned with a well-established recovery framework (CHIMES) in light of existing landscape architecture knowledge. Within the complexity of varied mental health environments, this work establishes landscape architectural design requirements and qualities essential for recovery. Rather than adopting a prescriptive quantitative approach setting out areas, numbers of elements, etc., the proposed framework recommends a performance-based model and the creation of a cohesive network of microspaces that mesh into a design of outdoor areas. In this way, design details, materials, vegetation and the variety of spaces can be modified to suit service user population demographics and site-specific needs.

Voronoi Diagrams for Senior-Friendly Cities

Motives: Active aging places (AAP) should be identified during the COVID-19 pandemic to ensure the sanitary safety of seniors, prevent older adults from feeling excluded, and eliminate health threats that discourage seniors from being active. Aim: The aim of this study was to apply a new analytical approach with the use of Voronoi diagrams in GIS tools to spatially identify the AAP in the context of apparent social dynamics. Methods: An empirical study was conducted with the use of qualitative (literature review, questionnaire survey, AAP classification, visualization of AAP location with GIS tools) and quantitative methods (AAP ranking based on a statistical analysis of survey responses). Results: Voronoi diagrams were used to determine the accessibility of selected objects in the city of Olsztyn and identify spaces that belong to the social logic of space.

The Multisensory/Snoezelen Environment to Optimize the Dental Care Patient Experience

This article provides a brief overview of how the environment can affect behavior and that well-designed spaces can affect how patients handle stress. The application of the Snoezelen multisensory interactive calming strategies and devices that were installed in all facets of a community dental practice are described. These principles of creating a calming dental home improved behavior, cooperation, and satisfaction with care in persons with disabilities and reduced the need for sedation or general anesthesia. It is proposed that the creation of similar clinics with multisensory calming features could improve community access to dental care for persons with special needs.

Uptake of HIV testing among aging adults in Agincourt, South Africa: perception of community, social network, and individual characteristics

This cross-sectional study examined the impact of perception of community, social network and individual variables on the likelihood of voluntary HIV testing of people 40 years and older living in Agincourt, South Africa. The data came from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in SA (HAALSI) Cohort from Agincourt. We applied three logistic regression models. Results showed that voluntary uptake of HIV testing was significantly associated with two network factors, namely friendships within the network and frequency of fighting in the network. At the community level, attachment to place was significantly associated with voluntary testing, while at the individual level, education, sexual behaviour, employment and age were significantly associated with the voluntary uptake of HIV testing. The implications of these findings are that age-appropriate interventions must be devised to sensitise older people in Agincourt about HIV risks. Also, leadership at the community level and in social networks must encourage members to consider voluntary testing for their own and community interests.

Activities, Housing Situation and Other Factors Influencing Psychological Strain Experienced During the First COVID-19 Lockdown in Switzerland

Background: The Coronavirus disease 2019 (COVID-19) crisis and the corresponding first nationwide lockdown from mid-March to 10 May 2020 engendered considerable psychological strain among people in Switzerland. This study analyzes determinants of changes in subjective levels of psychological strain experienced during the lockdown. Methods: An online survey conducted as part of a larger mixed methods study examined the material and emotional aspects of individual reactions to the lockdown from a socio-ecological perspective. Participants (N = 5932) were asked about their personal and employment status, housing features, changes in various activities (e.g., physical activity, watching TV, social media use) and aspects of mental distress and well-being. Results: A substantial share of participants reported to feel depressed (33%) and anxious (43%) more often during the COVID-19 lockdown than before, whereas significantly (p < 0.001) less persons reported a decrease of these negative feelings (depressed 17%; anxious 14%). Women, single people, students and people who lost their jobs or were temporally unemployed due to the lockdown experienced a particularly strong increase of subjective psychological strain. Important residential factors reducing subjective psychological strain were the general comfort of the housing situation and having a private garden or multiple types of outdoor space. Considering leisure activities, the strongest positive psychological effect resulted from increased physical activities, followed by reading and cooking. However, 45% of the participants reported a decreased frequency of physical activity during the lockdown compared to before, whereas significantly less persons (26%) reported a corresponding increase (p < 0.001). Conclusion: Consistent with other studies, the results indicate a substantial reduction of subjective psychological well-being of the population during the first COVID-19 lockdown in Switzerland. The psychological burdens which the participants experienced differ depending on personal characteristics and situational factors. Negative psychological and economic consequences and gender inequalities should accordingly be carefully considered and actively prevented when designing COVID-19 measures. Supportive economic and social, cognitive and behavioral psychological interventions need to be designed and implemented to maintain the well-being of residents during lockdown.

Permanent Supportive Housing Design Characteristics Associated with the Mental Health of Formerly Homeless Adults in the U.S. and Canada: An Integrative Review

The built environment directly and indirectly affects mental health, especially for people transitioning from long-term homelessness to permanent supportive housing (PSH) who often experience co-occurring behavioral health challenges. Despite a rapid increase in PSH availability, little research examines influences of architecture and design within this context. This integrative review synthesized limited research on PSH design in the U.S. and Canada to identify built environment characteristics associated with PSH residents’ mental health, highlight gaps in the literature, and prioritize future research directions. A systematic search for peer-reviewed articles was conducted using nine databases drawing from multiple disciplines including architecture, environmental psychology, interior design, psychology, psychiatry, medicine, and nursing. Seventeen articles met inclusion criteria. Study design, methodology, built environment properties, place attributes, and relevant findings were extracted and iteratively analyzed. Three domains relevant to architecture and design were identified related to home, ontological security, and trauma sensitivity; dwelling unit type, privacy, control, safety, housing quality and location, and access to amenities; and shared common space. Integrative review results emphasize the potential of architecture and design to contribute to improved built environment quality and mental health outcomes among PSH residents. Methodological limitations and directions for future research are also discussed.

Urban Nature: Does Green Infrastructure Relate to the Cultural and Creative Vitality of European Cities?

The COVID-19 pandemic severely upended cultural and creative production, consumption, and interactions in cities. Open green spaces, parks, forests, and gardens—green infrastructure—were instead utilized by citizens as a substitute for stimulating social interactions, sustainable tourism, and green growth. (1) The purpose of this research is to understand whether the availability of green infrastructure relates to the Cultural and Creative Cities Monitor (CCCM) benchmarking project developed by the Joint Research Centre of the European Commission performance. Does new evidence suggest revising the CCCM conceptual framework and related urban policies, especially in relation to the EU Green Deal? (2) Data from OpenStreetMap was used to count the amount of green infrastructure in 184 European Cities covered by the CCM and was then correlated with the sub-indices of the CCCM. (3) We found a moderately positive correlation of green infrastructure with the cultural vibrancy of a city and a weak positive correlation with the enabling environment of a city. (4) In light of the COVID-19 pandemic, the EU Green Deal and several other policy initiatives aimed at urban greening, we recommend that the CCCM include an Urban Nature sub-index as one of the performance indicators of the CCCM. An Urban Nature sub-index will broaden the goal of the CCCM by providing policymakers with a better understanding of actions and strategies to allow culture to contribute to social inclusion and green growth strategies in cities.

Regenerating Sponge City to Sponge Watershed through an Innovative Framework for Urban Water Resilience

In recent years, cities universal are advocating ‘resilience’ in terms of water-related challenges. Accompanied by the development of sponge city construction, several emerging stormwater management practices are prevailing worldwide. This paper proposes a regenerative argument for sponge city construction from the urban scale towards the watershed scale by strengthening the urban water resilience and sustainability. An innovative framework is established to address urban water issues and human livability via 20 conventional and advanced indicators and the interrelations between the modules of water resilience, water resource, water treatment, water ecology, waterscape, and water management. Six representative cities from the sponge city construction pilot in South China have been selected, and the compatibility and divergence between their guidelines and the sponge watershed framework are revealed through pair analyses and parameter calculation. The diverse perspectives behind the scores have been discussed carefully, and the successful experiences of excellent cities are systematically summarized and promoted. The analyses and findings in this research have significant methodological implications for shifting the sponge city practice towards linking urban development with watershed ecological conservation. The proposed framework and strategies provide a reference for an integrated solution of watershed health and wellbeing in the next generation sponge city practice.

The Impact of Local Green Spaces of Historically and Culturally Valuable Residential Areas on Place Attachment

Environmental qualities significantly affect the behaviors and place attachment of users, especially in residential areas. In addition to creating environmental comfort, local green spaces can increase users’ place attachment, improve their mood, enhance friendly company and facilitate social interactions. The study sought to investigate the impact of local green spaces in the historically and culturally valuable residential fabric of Hamadan City in Iran on increasing residents’ social attachment. Derived from the literature on the subject, the conceptual model of the study shows the impact of such factors as social, functional, emotional and spatial bonds on place attachment in the residential context. A total number of 410 residents in the old neighborhoods of Hamadan City were selected by random sampling with a balanced proportion of gender and residence duration in the selected area. The designed questionnaire was distributed among the sample population and the collected data were analyzed using the structural equation modeling method. Then, the t-test and bootstrapping in Smart PLS software were used for testing the research hypotheses and evaluating the significance of the relationships between the research variables in the structural model. The results indicated that among the four types of bonds examined in relation to place attachment, emotional bonds, functional bonds, social bonds and spatial bonds, respectively, had a direct and significant impact on place attachment from the viewpoint of residents. The stronger the sociocultural bonds in historically and culturally valuable residential areas, the more prominent the role of local green spaces in place attachment based on residence duration becomes.

Effects of exposure to immersive videos and photo slideshows of forest and urban environments

A large number of studies have demonstrated the benefits of natural environments on people's health and well-being. For people who have limited access to nature (e.g., elderly in nursing homes, hospital patients, or jail inmates), virtual representations may provide an alternative to benefit from the illusion of a natural environment. For this purpose and in most previous studies, conventional photos of nature have been used. Immersive virtual reality (VR) environments, however, can induce a higher sense of presence compared to conventional photos. Whether this higher sense of presence leads to increased positive impacts of virtual nature exposure is the main research question of this study. Therefore, we compared exposure to a forest and an urban virtual environment in terms of their respective impact on mood, stress, physiological reactions, and cognition. The environments were presented via a head-mounted display as (1) conventional photo slideshows or (2) 360[Formula: see text] videos. The results show that the forest environment had a positive effect on cognition and the urban environment disturbed mood regardless of the mode of presentation. In addition, photos of either urban or forest environment were both more effective in reducing physiological arousal compared to immersive 360[Formula: see text] videos.

Effects of an urban regeneration program on related social determinants of health in Chile: A pre-post intervention study

Urban regeneration programs, such as "Programa Quiero mi Barrio" (PQMB) that is carried out in neighborhoods with greater deprivation across Chile, can improve health and quality of life in socio-economically deprived neighborhoods. The aim of this study was to analyze the effects of this program on the physical, social, and safety environments of neighborhoods intervened between 2011 and 2018, according to gender and socioeconomic position. Four indices and six sub-indices were constructed to measure physical, social, and safety environments of the neighborhoods. We conducted a pre- and post-intervention analysis with 2095 people using linear models adjusted for repeated measurements. After the intervention, participants had an improved perception of physical, social, and safety environments, as well as the use of spaces, particularly among women and people with higher levels of education. Therefore, the PQMB program is a form of public policy that can improve the quality of life and health of people living in underprivileged areas.

Curriculum development in health and the built environment: creating a multidisciplinary platform to enhance knowledge and engagement

Purpose –

Our lived experiences are complex, dynamic and increasingly connected locally and globally through virtual realities that call for an evolution and responsiveness from the field of architecture education. To ensure future built environments are designed to nurture healing and health, this paper aims to address a critical need in architecture education to integrate knowledge of health and social-behavioral disciplines in students' course work. The authors will outline the process of preparing a new multidisciplinary course on health and the built environment (HBE) at the School of Architecture and Planning at Morgan State University in Baltimore, USA, as an effort to challenge the barriers of discipline-specific pathways to learning in the field of architecture.

Design/methodology/approach –

The central question is how to develop an active learning pedagogy to foster a multidisciplinary learning environment focused on the "practice" (how to) of human-design-oriented approaches to improve the capability of built and natural environments to promote health and healing. The course intentionally centered on the real-life experiences of students to ground their new understanding of health and well-being fields. The course proposal went through an extensive peer-review process of reviewers from the National Institute of Health (NIH) and other departments at Morgan State University to ensure a balance between health- and architecture-specific curricula with a transdisciplinary approach to understanding complex health issues.

Findings –

This paper shows the effectiveness of tools and techniques applied in the course to challenge architectural students to integrate various health and behavior perspectives in their designs and to apply health and healing principals to their current and future design projects.

Originality/value –

While there are courses in American universities that offer a traditional introduction to health concerns related to the built environment, there is limited focus on the perspective of the design field approach to improve health and healing outcomes.

IoT Monitoring of Urban Tree Ecosystem Services: Possibilities and Challenges

Urban green infrastructure plays an increasingly significant role in sustainable urban development planning as it provides important regulating and cultural ecosystem services. Monitoring of such dynamic and complex systems requires technological solutions which provide easy data collection, processing, and utilization at affordable costs. To meet these challenges a pilot study was conducted using a network of wireless, low cost, and multiparameter monitoring devices, which operate using Internet of Things (IoT) technology, to provide real-time monitoring of regulatory ecosystem services in the form of meaningful indicators for both human health and environmental policies. The pilot study was set in a green area situated in the center of Moscow, which is exposed to the heat island effect as well as high levels of anthropogenic pressure. Sixteen IoT devices were installed on individual trees to monitor their ecophysiological parameters from 1 July to 31 November 2019 with a time resolution of 1.5 h. These parameters were used as input variables to quantify indicators of ecosystem services related to climate, air quality, and water regulation. Our results showed that the average tree in the study area during the investigated period reduced extreme heat by 2 °C via shading, cooled the surrounding area by transferring 2167 ± 181 KWh of incoming solar energy into latent heat, transpired 137 ± 49 mm of water, sequestered 8.61 ± 1.25 kg of atmospheric carbon, and removed 5.3 ± 0.8 kg of particulate matter (PM10). The values of the monitored processes varied spatially and temporally when considering different tree species (up to five to ten times), local environmental conditions, and seasonal weather. Thus, it is important to use real-time monitoring data to deepen understandings of the processes of urban forests. There is a new opportunity of applying IoT technology not only to measure trees functionality through fluxes of water and carbon, but also to establish a smart urban green infrastructure operational system for management.

Investigating the Relationship between the Third Places and the Level of Happiness for Seniors in Taiwan

Taiwan has actively promoted the concept of "successful aging" in recent years. The Executive Yuan drafted the White Paper for Aged Society, which set the primary goal to enable seniors to deal with daily life more independently. Although ‘third places’ enable seniors to live independently, the third places that Taiwanese seniors like are not well understood. Consequently, by investigating third places, this study will investigate the environment of achieving successful aging and happiness among seniors. This study uses the questionnaire survey, and the data of this study were collected from October to November 2018 in Taichung City Central District. A questionnaire survey was conducted in several administrative agencies and participants were selected by random sampling among the over-55-year-old citizens who were already retired. An estimate of 90% confidence limits with 5% marginal error gave us a sample size of 257. This study finally received 200 efficient samples. The women’s top five choices of third places are the traditional market, supermarket, restaurant, daily necessities shop, and coffee shop. The men’s top five choices of third places are the traditional market, supermarket, daily necessities shop, restaurant, and a friend’s house. For seniors familiar with the concept of third places, the more often they go to third places, the higher happiness they achieve. This result investigates the importance of having awareness of third places for seniors. Therefore, we should encourage them to go to third places and engage in social activities frequently to achieve successful aging.

Neighborhood context and non-small cell lung cancer outcomes in Florida non-elderly patients by race/ethnicity

OBJECTIVE

The purpose of this study was to investigate the relationship between neighborhood environment and lung cancer outcomes among Florida residents younger than 65 years of age.

METHODS AND MATERIALS

This was a retrospective cohort study that included patients diagnosed with non-small cell lung cancer (NSCLC) in Florida from January 2005 to December 2014 (n = 22,750). Multi-level, mixed-effect logistic regression models were used for two outcomes: receipt of treatment and receipt of surgery. Survival analyses, using proportional subdistribution hazard models, were conducted to examine the impact of neighborhood characteristics on risk of death due to lung cancer with adjustment for individual-level variables. Neighborhood exposures of interest were census tract level black and Hispanic segregation combined with economic deprivation.

RESULTS

White patients who lived in low black segregation/high deprivation areas had 15 % lower odds of receiving surgery (95 % CI: 0.76-0.93). However, the likelihood of receiving surgery for black patients who lived in high black segregation/low deprivation and high black segregation/high deprivation was lower than for black patients who lived in low black segregation/low deprivation neighborhoods (level 3 AOR = 0.56 [0.38-0.85]; level 4 AOR = 0.69 [0.54-0.88]). Living in suburban and rural areas increased the risk of lung cancer death for white patients by 14 % (95 % CI: 1.05-1.24) and 26 % (95 % CI: 1.08-1.46), respectively. Living in rural areas increased the risk of death for black patients by 54 % r (SHR = 1.54 [1.19-2.0]). Black patients who live in high Hispanic segregation/high deprivation had 36 % increased risk of death compared to black patients who lived in low Hispanic segregation/low deprivation areas.

CONCLUSION

This study suggests that when investigating cancer disparities, merely adjusting for race/ethnicity does not provide sufficient explanation to understand survival and treatment variations. Lung cancer outcomes are impacted by neighborhood environments that are formed based on the distribution of race, ethnicity and class.

Effects of the Health Promotion Programs on Happiness

The Healthy City program is a comprehensive health promotion program implemented by local governments to improve citizens’ health. The Healthy City program aims to improve citizens’ quality of life through health promotion activities in daily life. It also improves health by eliminating health risk factors and increasing citizens’ happiness. Therefore, this study investigated the effects of the Healthy City program on the happiness index of local residents and the correlation between the Healthy City program and the happiness index using quality of life as a parameter. We conducted a questionnaire survey of residents of Seoul, where Healthy City networks are actively promoted. A total of 392 responses were obtained. Structural equations were used to analyze the collected data. The Healthy City program had positive effects on the happiness index. In other words, it increased the happiness index by improving the health of the local residents. Relevant policy efforts are also being made to advance health services through Healthy City programs. For an effective Healthy City program, it is necessary to implement policies regarding health equity, to expand Healthy City programs based on a settings approach, and to implement a sustainable Healthy City program through the establishment of Healthy City governance.

Nature as nurture: Rural older women's perspectives on the natural environment

Rural older women are surrounded by nature, a dynamic context for human development. Informed by place attachment and attention restoration theory, and guided by a life course perspective, this qualitative study focused on the perceived influence of nature in the lives of 34 rural older women. Using grounded theory techniques to analyze in-depth interviews, two primary findings emerged: (a) nature was integral to the women's identity; and (b) interactions with nature were motivated by prior positive spiritual and psychological outcomes. Findings revealed the power of the natural environment as a resource for coping with the challenges associated with aging.

[Contribution of natural spaces to human health and wellbeing]

Natural spaces and especially urban green and blue spaces have been recognised for a long time as spaces with great potential for protecting and promoting human health and well-being. They may affect human physical, mental and social health and well-being in various ways. On one hand, this comes to pass through reduction and moderation of potential environmental health risks (e. g. noise, particulate matter, heat), psycho-physiological effects of nature experience, as well as physical effects of exposure to natural compounds and elements. On the other hand, natural spaces can affect health and well-being indirectly e. g. through motivation of health promoting behaviour (e. g. more physical activity) and through use as outdoor meeting spaces, by decreasing aggression, and through the resulting positive effects on social well-being. Yet, some potential adverse health effects of nature and landscapes have been reported, too (e. g. insecurity or fear in confusing or unmaintained natural spaces, potential rivalry in usage, allergies or skin irritations due to natural elements, risk of communicable diseases from vectors). Against the background of positive effects of natural spaces, creating, restoring and enhancing urban green and blue spaces are often claimed in terms of sustainable and integrated urban development. But which associations and impacts exist between natural spaces and health? What are the resulting demands when integrating natural spaces for a health-promoting implementation practice? This overview article provides some answers to these questions.

Analysis of Environmental Issues with an Application of Civil Complaints: The Case of Shiheung City, Republic of Korea

The aim of this study was to better identify the information generated by citizens and to explore the regional social phenomenon whereby higher quality urban services focused on understanding regional issues are promoted. Citizens voluntarily and continuously communicate with local government both online and offline. We wanted to determine how civic information can be applied to urban planning. We selected Shiheung City, Republic of Korea, as our study area, as the city is formed of various types of land use: industrial areas, agricultural land, and residential areas. This area is facing developmental pressure with released development-restricted areas, and has been environmentally damaged by industrial complexes. We conducted a semantic network analysis of the top 10% most commonly used nouns in civil complaints to determine the keywords. Each thematic map we created was based on geographical information to explain the temporary, continuous, and chronic issues. The chronic problems were discussed in relation to the regional development process. The process of identifying and analyzing local issues by analyzing information voluntarily provided by citizens plays an important role in government-led urban management planning and policy formation and can contribute to decision making in the development of future urban policies.

An Exploration of Lactation Facilities and Planning in U.S. Higher Education Campuses

BACKGROUND

Women in academia face challenges in continuing breastfeeding. Higher education campuses are investing in lactation support, but little is known about their approaches. This study explores the planning and design of lactation spaces on college and university campuses from the perspectives of campus planners and facility professionals, administrators, and other decision-makers.

MATERIALS AND METHODS

We conducted an online survey with a convenience sample of members of the Society for College and University Planning (SCUP). Representatives from each U.S. member campus were invited to participate in an online survey.

RESULTS

One hundred five individuals responded, representing their institutions; 94% reported at least one dedicated lactation space (range 0-50). Sixty-eight percent reported having a policy for creating/identifying lactation spaces; 28% reported that the lactation space was included in campus construction standards. Over 80% of spaces were structurally enclosed, lockable, Americans with Disabilities Act (ADA) compliant, and had open electrical outlets and in-room light control. Campus/facility planning was involved in lactation space planning at 77% of institutions and in funding for creation and maintenance at 59%.

CONCLUSIONS

Many campuses are building lactation infrastructure, but there is considerable variability in approaches and accommodations for lactation at higher education institutions. While local conditions, constraints, and demands will inform program development, decision-makers can leverage campus resources, recommendations, and design best practices to improve lactation experiences of women.

Unequal residential exposure to air pollution and noise: A geospatial environmental justice analysis for Ghent, Belgium

Following the growing empirical evidence on the health effects of air pollution and noise, the fair distribution of these impacts receives increasing attention. The existing environmental inequality studies often focus on a single environmental impact, apply a limited range of covariates or do not correct for spatial autocorrelation. This article presents a geospatial data analysis on Ghent (Belgium), combining residential exposure to air pollution and noise with socioeconomic variables and housing variables. The global results show that neighborhoods with lower household incomes, more unemployment, more people of foreign origin, more rental houses, and higher residential mobility, are more exposed to air pollution, but not to noise. Multiple regression models to explain exposure to air pollution show that residential mobility and percentage of rental houses are the strongest predictors, stressing the role of the housing market in explaining which people are most at risk. Applying spatial regression models leads to better models but reduces the importance of all covariates, leaving income and residential mobility as the only significant predictors for air pollution exposure. While traditional multiple regression models were not significant for explaining noise exposure, spatial regression models were, and also indicate the significant contribution of income to the model. This means income is a robust predictor for both air pollution and noise exposure across the whole urban territory. The results provide a good starting point for discussions about environmental justice and the need for policy action. The study also underlines the importance of taking spatial autocorrelation into account when analyzing environmental inequality.

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We found socioeconomic inequalities in exposure to air pollution and noise.

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Median household income was the most significant predictor overall.

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Residential mobility was an important predictor for air pollution exposure.

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Spatial autocorrelation distorts traditional multiple regression results.

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The results contribute to environmental justice debates.

Communal space and depression: A structural-equation analysis of relational and psycho-spatial pathways

The new urban landscape in countries experiencing unprecedented urban transformation has a profound impact on the global burden of depression. Based on survey data from 39 neighborhoods in Guangzhou, China, this study assesses the relationship between communal space and depression. To unravel the relational and psycho-spatial embeddedness of communal space, a structural equation analysis suggests that neither the use of nor the sense of communal space has a direct association with depressive symptoms. Instead, the indirect effect of the use of communal space on depression is mediated by neighborhood-based social networks and neighborhood attachment, while the indirect effect of the sense of communal space on depression is only mediated by neighborhood attachment. Given the presence of indirect relational and psycho-spatial pathways linking communal space and depression, this study argues that the place-making and relational approaches should be integrated to provide a holistic view of the socio-spatial nature of urban landscape.

Farming for Life Quality and Sustainability: A Literature Review of Green Care Research Trends in Europe

Green care is an innovative approach that combines simultaneously caring for people and caring for land through three elements that have not been previously connected: (1) multifunctional agriculture and recognition of the plurality of agricultural system values; (2) social services and health care; and (3) the possibility of strengthening the farming sector and local communities. The current research provides a comprehensive overview of green care in Europe as a scientific discipline through a literature review (n = 98 studies). According to our results, the Netherlands, the UK, Norway and Sweden followed by Italy have led the scientific studies published in English. Green care research comprises a wide range of perspectives and frameworks (social farming, care farming, nature-based solutions, etc.) with differences in their specificities. Green care studies have mainly focused on measuring the effectiveness of therapeutic interventions. Studies that evaluate its relevance in socio-economic and environmental terms are still limited. According to our results, the most common users studied were people suffering from psychological and mental ill health, while the most common activities were horticulture, animal husbandry and gardening. Finally, we discuss the potential of green care to reconnect people with nature and to diversify the farming sector providing new public services associated with the relational values society obtains from the contact with agricultural systems.

For the Love of Nature: Exploring the Importance of Species Diversity and Micro-Variables Associated with Favorite Outdoor Places

Although the restorative benefits of nature are widely acknowledged, there is a limited understanding of the attributes of natural environments that are fundamental to restorative experiences. Faced with growing human populations and a greater awareness of the wellbeing benefits natural environments provide, park agencies and planners are increasingly challenged with balancing human and ecological outcomes in natural areas. This study examines the physical and experiential qualities of natural environments people referred to when describing their connection to their most valued natural environments in an online questionnaire. Recruited primarily via a public radio program, respondents were asked to identify their favorite places and explain what they loved about those places. Favorite places are considered exemplars of restorative environments and were classified based on an existing park typology. Reasons people liked particular sites were classified into three domains: setting, activity, or benefit. Content analysis was used to identify the attributes most commonly associated with favorite places. These attributes were then related to the four components of restorative environments according to Attention Restoration Theory. In contrast to previous research, we found that "fascination" was the most important component of favorite places. Possible reasons for this contrast, namely, respondents' median age, and the likelihood of a high degree of ecological literacy amongst the study population are discussed. South Australians' favorite environments comprise primarily hilly, wooded nature parks, and botanical gardens, in stark contrast to the vast arid areas that dominate the state. Micro-variables such as birds, plants, wildlife, native species, and biodiversity appear particularly important elements used to explain people's love of these sites. We discuss the implications of these findings and their potential value as an anchor for marketing campaigns seeking to encourage contact with nature, as well as education programs designed to improve people's understanding of important but intangible concepts such as biodiversity. The findings have clear, practical implications for park managers given the modifiable nature of many of the attributes identified as being most important to our respondents, and we believe attention to such elements has the potential to simultaneously enhance people's nature experiences, optimize restorative outcomes, and improve environmental stewardship.

Neighborhood-resources for the development of a strong SOC and the importance of understanding why and how resources work: a grounded theory approach

BACKGROUND

Providing individuals with psychosocial resources such as sense of coherence (SOC) seems a beneficial strategy for health promotion in the neighborhood. In order to become a supporting theory for health promotion, Salutogenesis should renew its focus on resources for health, and explore how the development of a strong SOC can be facilitated.

METHODS

Relevant issues were explored using a Grounded Theory- approach. Three focus-group-sessions and three in-depth interviews were conducted with strategically sampled participants. The transcripts of the focus groups were initially analyzed line-by-line to ensure that insights emerged from the data. We then applied focused and systemic analyses to achieve axial coding, and to include insights into how social interactions during focus groups may reveal social processes in real-life-neighborhoods. The data from the in-depth interviews were used to validate and fill emerging categories, as well as to ensure data-saturation.

RESULTS

Findings indicate the importance of repeated experiences with resources and every-day-challenges to develop a strong SOC. Active engagement with resources is a favorable condition for significant experiences, which enhance the internalization of resources. Core experiences are characterized by a re-organization of resources. Participation in intellectual meaning-making through equal power dialogue seems to broaden perspectives and promote the strengthening of SOC. A strong SOC can also be described as a deeper understanding of how and why resources work, which allows for a more flexible use of resources, including replacing missing resources.

CONCLUSION

A new understanding of SOC as an intuitive understanding of how, why and under which circumstances resources work, as well as a new focus on everyday life and repeated experiences might facilitate new approaches to a purposeful strengthening of SOC through the planning and implementation of public measures.

Socioeconomic Inequalities in Green Space Quality and Accessibility-Evidence from a Southern European City

Background: The provision of green spaces is an important health promotion strategy to encourage physical activity and to improve population health. Green space provision has to be based on the principle of equity. This study investigated the presence of socioeconomic inequalities in geographic accessibility and quality of green spaces across Porto neighbourhoods (Portugal). Methods: Accessibility was evaluated using a Geographic Information System and all the green spaces were audited using the Public Open Space Tool. Kendall’s tau-b correlation coefficients and ordinal regression were used to test whether socioeconomic differences in green space quality and accessibility were statistically significant. Results: Although the majority of the neighbourhoods had an accessible green space, mean distance to green space increased with neighbourhood deprivation. Additionally, green spaces in the more deprived neighbourhoods presented significantly more safety concerns, signs of damage, lack of equipment to engage in active leisure activities, and had significantly less amenities such as seating, toilets, cafés, etc. Conclusions: Residents from low socioeconomic positions seem to suffer from a double jeopardy; they lack both individual and community resources. Our results have important planning implications and might contribute to understanding why deprived communities have lower physical activity levels and poorer health.

Third Places for Health Promotion with Older Adults: Using the Consolidated Framework for Implementation Research to Enhance Program Implementation and Evaluation

This study extends the concept of third places to include community sites where older adults gather, often for meals or companionship. The Consolidated Framework for Implementation Research guided program implementation and evaluation. Depending upon health promotion program needs, the physical infrastructure of a site is important, but a supportive director (champion) can often overcome identified deficits. Senior centers may be locally classified into four types based upon eligibility requirements of residents in affiliated housing and services offered. Participants who attend these centers differ in important ways across types by most sociodemographic as well as certain health and health care characteristics.

Greener living environment healthier people?: Exploring green space, physical activity and health in the Doetinchem Cohort Study

BACKGROUND

Evidence is emerging that more green space in the living environment is associated with better health, partly via the pathway of physical activity.

OBJECTIVES

We explored the cross-sectional and longitudinal associations between green space and physical activity and several health indicators in the Doetinchem Cohort Study.

METHODS

A random sample of men and women aged 20-59years at baseline was measured max 5 times with 5year-intervals in the period 1987-2012. Data of round 3-5 were used. Measurements were based on examinations (height, weight, blood pressure) or questionnaires (physical activity, perceived health, depressive symptoms, chronic conditions). The percentage of green space (mainly urban and agricultural green) around the home address (125m and 1km) was calculated using satellite data.

RESULTS

More agricultural green was associated with less time spent on bicycling (β1km=-0.15, 95%CL -0.13; -0.04) and sports (β1km=-0.04, 95%CL -0.07; -0.01) and more time spent on gardening (β1km=0.16, 95%CL 0.12; 0.19) and odd jobs (β1km=0.10, 95%CL 0.05; 0.15), and this was in the other direction for urban green. For only a few of the many health indicators a positive association with green was found, and mainly for total green within 1km radius. Longstanding green or a transition to more green did not show more pronounced associations with health.

CONCLUSIONS

For the green space range of the Doetinchem area the findings do not strongly support the hypothesis that the percentage of green in the living environment affects health positively. The distinction by type of green may, however, be relevant for physical activity.

Landscape and Health: Connecting Psychology, Aesthetics, and Philosophy through the Concept of Affordance

In this paper we address a frontier topic in the humanities, namely how the cultural and natural construction that we call landscape affects well-being and health. Following an updated review of evidence-based literature in the fields of medicine, psychology, and architecture, we propose a new theoretical framework called "processual landscape," which is able to explain both the health-landscape and the medical agency-structure binomial pairs. We provide a twofold analysis of landscape, from both the cultural and naturalist points of view: in order to take into account its relationship with health, the definition of landscape as a cultural product needs to be broadened through naturalization, grounding it in the scientific domain. Landscape cannot be distinguished from the ecological environment. For this reason, we naturalize the idea of landscape through the notion of affordance and Gibson's ecological psychology. In doing so, we stress the role of agency in the theory of perception and the health-landscape relationship. Since it is the result of continuous and co-creational interaction between the cultural agent, the biological agent and the affordances offered to the landscape perceiver, the processual landscape is, in our opinion, the most comprehensive framework for explaining the health-landscape relationship. The consequences of our framework are not only theoretical, but ethical also: insofar as health is greatly affected by landscape, this construction represents something more than just part of our heritage or a place to be preserved for the aesthetic pleasure it provides. Rather, we can talk about the right to landscape as something intrinsically linked to the well-being of present and future generations.

Advancing Sustainability through Urban Green Space: Cultural Ecosystem Services, Equity, and Social Determinants of Health

Urban green spaces provide an array of benefits, or ecosystem services, that support our physical, psychological, and social health. In many cases, however, these benefits are not equitably distributed across diverse urban populations. In this paper, we explore relationships between cultural ecosystem services provided by urban green space and the social determinants of health outlined in the United States Healthy People 2020 initiative. Specifically, we: (1) explore connections between cultural ecosystem services and social determinants of health; (2) examine cultural ecosystem services as nature-based health amenities to promote social equity; and (3) recommend areas for future research examining links between urban green space and public health within the context of environmental justice.

Effects of the Residential Environment on Health in Japan Linked with Travel Behavior

This paper aims to clarify how the residential environment is associated with overall health-related quality of life (QOL) via active travel (walking and cycling), by reflecting the influence of different trip purposes in Japan. The health-related QOL includes physical, mental, and social dimensions. For this study we implemented a questionnaire survey in 20 cities in Japan in 2010 and obtained valid answers from 1202 respondents. The residential environment is defined in terms of distances to and densities of different daily facilities extracted from both the survey and external GIS data. We found that the effects of residential environment on active travel behavior are mixed and limited, depending on types of trip makers. Unexpectedly, travel behavior has no direct effects on the health-related QOL. The residential environment, which is only observed indirectly via lifestyle habits for commuters, has limited effects on health. As for noncommuters, neither their travel behavior nor the residential environment influences their health-related QOL.

Green Buildings and Health

Green building design is becoming broadly adopted, with one green building standard reporting over 3.5 billion square feet certified to date. By definition, green buildings focus on minimizing impacts to the environment through reductions in energy usage, water usage, and minimizing environmental disturbances from the building site. Also by definition, but perhaps less widely recognized, green buildings aim to improve human health through design of healthy indoor environments. The benefits related to reduced energy and water consumption are well-documented, but the potential human health benefits of green buildings are only recently being investigated. The objective of our review was to examine the state of evidence on green building design as it specifically relates to indoor environmental quality and human health. Overall, the initial scientific evidence indicates better indoor environmental quality in green buildings versus non-green buildings, with direct benefits to human health for occupants of those buildings. A limitation of much of the research to date is the reliance on indirect, lagging and subjective measures of health. To address this, we propose a framework for identifying direct, objective and leading "Health Performance Indicators" for use in future studies of buildings and health.