COVID-19 and Cities: from Urban Health strategies to the pandemic challenge. A Decalogue of Public Health opportunities

COVID-19 impacts on mobility, environment, and health of active transportation users

Active transportation could be an effective way to promote healthy physical activity, especially during pandemics like COVID-19. A comprehensive evaluation of health outcomes derived from COVID-19 induced active transportation can assist multiple stakeholders in revisiting strategies and priorities for supporting active transportation during and beyond the pandemic. We performed a two-step reviewing process by combining a scoping review with a narrative review to summarize published literature addressing the influence of COVID-19 on mobility and the environment that can lead to various health pathways and health outcomes associated with active transportation. We summarized the COVID-19 induced changes in active transportation demand, built environment, air quality, and physical activity. The results demonstrated that, since the pandemic began, bike-sharing users dropped significantly while recreational bike trips and walking activities increased in some areas. Meanwhile, there have been favorable changes to the air quality and the built environment for active transportation users. We then discussed how these changes impact health outcomes during the pandemic and their implications for urban planning and policymaking. This review also suggests that walking and biking can make up for the reduced physical activities during the pandemic, helping people stay active and healthy.

The Adoption of Digital Technologies and Artificial Intelligence in Urban Health: A Scoping Review

As more people live in cities, the impact of urban settings on population health has been increasing. One of the main strategies to cope with urbanization is adopting artificial intelligence (AI) and new digital technologies to develop new urban services that improve citizens’ health and well-being. The aim of this study is to review urban interventions and adopting digital technologies and AI-based algorithms to improve population health. A scoping review of the literature was conducted by querying MEDLINE, Web of Science, and Scopus databases. The included studies were categorized into one urban health area, suggested by the WHO, according to the type of intervention investigated. Out of 3733 records screened, 12 papers met all inclusion criteria. Four studies investigated the “outdoor and indoor pollution” area, one “climate change”, one “housing”, two “health and social services” and four “urban transport” areas. Only one article used a comprehensive approach to public health, investigating the use of AI and digital technologies both to characterize exposure conditions to health determinants and to monitor population health effects, while the others were limited to characterizing exposure conditions to health determinants, thus employing a preliminary public health perspective. From this point of view, countries should foster synergy for the development of research on digital technologies to address the determinants of health in the urban context. From a global health perspective, sharing results with the scientific community would also allow other countries to use those technologies that have been shown to be effective, paving the way for more sustainable living conditions worldwide.

The Importance of Outdoor Spaces during the COVID-19 Lockdown in Aotearoa—New Zealand

The novel Coronavirus (COVID-19) outbreak and its extensive variants have caused drastic changes to people’s habits and routines in many countries worldwide, including Aotearoa—New Zealand. The levels of lockdown and/or movement limitations affected how people used outdoor spaces, often keeping them away from nature’s benefits. The COVID-19 pandemic and the measures adopted to control it provide an interesting experiment investigating the links between nature exposure, recreational use of outdoor spaces, and people’s health and wellbeing under extreme conditions. Using an online survey distributed during lockdown and based on 212 responses, this article explores the different typologies of the outdoor spaces that people had access to during lockdown and the associated physical activities practised. It investigates how outdoor space affects our emotional response and how such space and related activities can help us cope with confinement. The results of this study enable us to better understand those spatial elements and characteristics of outdoor spaces that are essential to people’s wellbeing, especially in unusual circumstances where access is restricted.

Modelling the complexity of pandemic-related lifestyle quality change and mental health: an analysis of a nationally representative UK general population sample

PURPOSE

The COVID-19 pandemic has affected the way many individuals go about their daily lives. This study attempted to model the complexity of change in lifestyle quality as a result of the COVID-19 pandemic and its context within the UK adult population.

METHODS

Data from the COVID-19 Psychological Research Consortium Study (Wave 3, July 2020; N = 1166) were utilised. A measure of COVID-19-related lifestyle change captured how individuals' lifestyle quality had been altered as a consequence of the pandemic. Exploratory factor analysis and latent profile analysis were used to identify distinct lifestyle quality change subgroups, while multinomial logistic regression analysis was employed to describe class membership.

RESULTS

Five lifestyle dimensions, reflecting partner relationships, health, family and friend relations, personal and social activities, and work life, were identified by the EFA, and seven classes characterised by distinct patterns of change across these dimensions emerged from the LPA: (1) better overall (3.3%), (2) worse except partner relations (6.0%), (3) worse overall (2.5%), (4) better relationships (9.5%), (5) better except partner relations (4.3%), (6) no different (67.9%), and (7) worse partner relations only (6.5%). Predictor variables differentiated membership of classes. Notably, classes 3 and 7 were associated with poorer mental health (COVID-19 related PTSD and suicidal ideation).

CONCLUSIONS

Four months into the pandemic, most individuals' lifestyle quality remained largely unaffected by the crisis. Concerningly however, a substantial minority (15%) experienced worsened lifestyles compared to before the pandemic. In particular, a pronounced deterioration in partner relations seemed to constitute the more severe pandemic-related lifestyle change.

COVID-19 as a social disease: qualitative analysis of COVID-19 prevention needs, impact of control measures and community responses among racialized/ethnic minorities in Antwerp, Belgium

Background

In high income countries, racialized/ethnic minorities are disproportionally affected by COVID-19. Despite the established importance of community involvement in epidemic preparedness, we lack in-depth understanding of these communities’ experiences with and responses to COVID-19. We explored information and prevention needs, coping mechanisms with COVID-19 control measures and their impact on lived experiences among selected racialized/ethnic minority communities.

Methods

This qualitative rapid assessment conducted in Antwerp/Belgium used an interpretative and participatory approach. We included migrant communities with geographic origins ranging from Sub-Saharan Africa, North-Africa to the Middle East, Orthodox Jewish communities and professional community workers. Data were collected between May 2020–May 2021 through key informant-, in-depth interviews and group discussions (N = 71). Transcripts were analyzed inductively, adopting a reflexive thematic approach. A community advisory board provided feedback throughout the research process.

Results

Participants indicated the need for tailored information in terms of language and timing. At the start of the epidemic, they perceived official public health messages as insufficient to reach all community members. Information sources included non-mainstream (social) media and media from home countries, hampering a nuanced understanding of virus transmission mechanisms and local and national protection measures. Participants felt the measures’ most negative impact on their livelihoods (e.g. loss of income, disruption of social and immigration support). Economic insecurity triggered chronic stress and fears at individual and family level. High degrees of distrust in authorities and anticipated stigma were grounded in previously experienced racial and ethnic discrimination. Community-based initiatives mitigated this impact, ranging from disseminating translated and tailored information, providing individual support, and successfully reaching community members with complex needs (e.g. the elderly, digitally illiterate people, those with small social networks or irregular legal status).

Conclusion

Study participants’ narratives showed how coping with and responding to COVID-19 was strongly intertwined with socio-economic and ethnic/racial characteristics. This justifies conceptualizing COVID-19 a social disease. At the same time, communities demonstrated resilience in responding to these structural vulnerabilities. From a health equity perspective, we provide concrete policy recommendations grounded in insights into communities’ structural vulnerabilities and resilience.

A Systematic Review of Objective Factors Influencing Behavior in Public Open Spaces

As a significant part of outdoor built-environment, public open spaces are closely associated with people's daily lives. Studies of outdoor behavior in these spaces can shed light on users' environmental perceptions and contribute to the promotion of physiological and psychological health. Many recent studies are case studies focused where observations, surveys and interviews have been conducted to understand the factors influencing people's behavior on one or few sites or city environments. There have been few reviews related to this topic, and none have been based on the systematic understanding of influencing factors. This paper presents a systematic review of interactions between behavior and the built environment in public open spaces, and highlights the impacts of diverse and objective influencing factors. Followed the rules of PRISMA method (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), 109 papers published in 2000-2021 were selected and reviewed. The distribution of the studied interactions is analyzed, and the impacts of four distinct factors: personal background, location and context, environmental component, and climate stimuli, are extracted, categorized, and specified. Moreover, outdoor health benefits are discussed based on which, crucial factors that require emphasis after the outbreak of COVID-19 are identified. Throughout this paper, behavioral influencing processes, including objective influencing factors, subjective feedback, and the relationships involved, are considered to provide a comprehensive picture. With the robust classification of existing factors, architects, urban designers, policy makers and fellow researches could be easier to get a more comprehensive trend from the past. This paper also provides guidance for future research, especially given that COVID-19 has created huge changes to outdoor needs and customary behavior. Systematic Review Registration: http://www.prisma-statement.org/.

The Role of Urban Environment Design on Health During the COVID-19 Pandemic: A Scoping Review

The COVID-19 pandemic has had a significant impact on the ways and times of living and using urban spaces, specifically referring to the dimension of daily life. The restrictive measures introduced during the lockdown periods have necessarily led to a re-evaluation of proximity scale bringing particularly attention to issues relating to public transport and mobility and to the quality and distribution of open public spaces. This scoping review explores the relationship between the urban environment design and health referring to the constraints imposed by the COVID-19 pandemic in the period from 2020 to 2021, with two main objectives: (i) to investigate the recurring urban design topics and issues related to the spatial and social needs stressed by the emergency; (ii) to identify the urban design measures both experienced during the health emergency and proposed in view of a post-COVID urban and territorial planning as they are considered impactful on health promotion. The search strategy was based on a set of keywords searched in two electronic databases which allowed the identification of a total of 1,135 contributions. After defining the eligibility criteria, we proceeded to the screening process concluded with the inclusion of 19 studies. The analysis of the contributions led to the systematization of six main urban topics-and to the corresponding spatial requirements and project proposals-highlighted as relevant and supportive in terms of the promotion of inhabitant's public health: (i) transport, mobility and accessibility; (ii) green and outdoor spaces; (iii) public and pedestrians' spaces; (iv) care services and health network; (v) communications; (vi) public and business services. The resulting framework is useful for guiding healthy city planning toward public policies, tools, regulations, urban measures, and emergency contrast provisions, that contribute to increasing the effectiveness in terms of safety and well-being.

Pandemic resilient cities: Possibilities of repairing Polish towns and cities during COVID-19 pandemic

Cities, due to population density and the complexity of human interactions, experience specific problems arising from their functioning in the era of the Covid-19 pandemic. Many scientists who publish their findings in contemporary literature agree on the need to shape pandemic resilient cities by making changes to the functional-spatial structure and preparing cities for rapid revitalization [regeneration] in the post-pandemic period. The main objective of the research is to identify the most important problems regarding service infrastructure deficiencies in the nine medium-sized Polish cities selected for research located in the Warsaw agglomeration, which are well connected with Warsaw. The research was based on: analysis of selected GIS spatial data, demographic data from the Polish Central Statistical Office, surveys among residents, on their needs during pandemic constraints. The focus was on three important aspects of development in the era of the pandemic: access to first-need services, access to greenery and active recreation areas, accessibility and transport efficiency problems. The research revealed changes in the way people travel and do their essential shopping, inadequate cycling infrastructure and problems with the availability of essential services close to where they live. The research programme varies, although the diagnosis and the possibility of transforming the functional-spatial structure of the cities studied as typical medium-sized cities in the impact zone of a large centre dominate. The conclusions provide examples of proposals for tactical urbanism planning solutions that could rapidly improve the quality of residence in a low-budget way. Finally, the proposals and guidelines for creating sustainable pandemic resilient cities are described. The article investigates the aspect of urban resilience related to transport, services, relaxation, while using the method of tactical urbanism as a remedy for cities' pandemic problems.

Responsiveness and Adaptability of Healthcare Facilities in Emergency Scenarios: COVID-19 Experience

The COVID-19 pandemic revealed many vulnerabilities of the contemporary built environment along with limited preparedness and low efficiency in mitigating unexpected and unprecedented challenges. This article discusses the efficiency and responsiveness of basic hospital spatial layouts in three different scenarios: normal operation; the segregation of a large number of patients and still providing them with access to emergency healthcare, typical for a pandemic; and a sudden, extremely high number of admissions typical for compound disasters and terrorist attacks. A set of parameters and a method for general adaptability assessment (GAAT) that can be used as a tool in decision-making processes as well as evaluation of both existing facilities and the new models for resilient hospitals resulting from the experience of the pandemic are proposed. The paper emphasizes why factors among which adaptability, convertibility, and scalability should be at the very core of hospital development and management strategies. It also discusses new models of adaptable healthcare facilities that enable day-to-day operations to continue alongside a pandemic, and other emergency scenarios.

Accelerating the Nature Deficit or Enhancing the Nature-Based Human Health during the Pandemic Era: An International Study in Cambodia, Indonesia, Japan, South Korea, and Myanmar, following the Start of the COVID-19 Pandemic

In modern society, the opportunity to experience nature is separate from everyday life, requiring time and effort. Since the start of the COVID-19 pandemic, restrictions on freedom of activity and communication around the world have become a crisis, causing a nature deficit by accelerating the process of separation from nature. At the same time, the pandemic has increased people’s motivation to return to nature, providing an opportunity to seek experiences and health recovery in nature. The authors conducted an international cross-sectional study in five Asian countries, investigating changes in the perception of recreational activities and health restoration in the natural environment, one of the many effects of the COVID-19 pandemic on human society. An online survey, completed by 524 respondents, has confirmed the efficacy of the SEM model, which includes COVID-19 stress, increased indoor activity, a preference for the natural environment, and the perception of health recovery. Although the five countries had different response values for each theme, the stress caused by restricted activities and communication during the pandemic was linked to a preference for natural experiences and the motivation to visit natural environments in all five countries, ultimately affecting perceptions of health recovery in nature. This study has shown that the COVID-19 pandemic, a disaster afflicting all human civilization, has changed people’s perceptions by enhancing their preference for natural recreational activities and health. It has accelerated people’s return to nature and fostered a positive perception of nature’s ability to promote good health.

Spatio-Temporal Effects of Multi-Dimensional Urbanization on Carbon Emission Efficiency: Analysis Based on Panel Data of 283 Cities in China

Under the influence of complex urbanization, improving the carbon emission efficiency (CEE) plays an important role in the construction of low-carbon cities in China. Based on the panel data of 283 prefectural-level cities in China from 2005 to 2017, this study evaluated the CEE by the US-SBM model, and explored the spatial agglomeration evolution characteristics of CEE from static and dynamic perspectives by integrating ESDA and Spatial Markov Chains. Then, the spatial heterogeneity of the impacts of multi-dimensional urbanization on CEE were analyzed by using the Geographically and Temporally Weighted Regression (GTWR). The results show that: (1) with the evolution of time, the CEE has a trend of gradual improvement, but the average is 0.4693; (2) from the perspective of spatial static agglomeration, the “hot spots” of CEE mainly concentrated in Shandong Peninsula, Pearl River Delta, and Chengdu-Chongqing urban agglomeration; The dynamic evolution of CEE gradually forms the phenomenon of “club convergence”; (3) urbanization of different dimensions shows spatial heterogeneity to CEE. The impact of economic urbanization in northern cities on CEE shows an inverted “U” shape, and the negative impact of spatial urbanization on CEE appears in the northwest and resource-based cities around Bohai Sea. Population and social urbanization have a positive promoting effect on CEE after 2010. These findings may help China to improve the level of CEE at the city level and provide a reference for low-carbon decision-making.

Bibliometric Analysis of Post Covid-19 Management Strategies and Policies in Hospitality and Tourism

The strategic perspective of management policies gained utmost importance during the post-Covid era. The researchers are trying to introduce strategies that can help organizations cope with post-crisis destruction. Yet, the research on the topic is fragmented, mainly related to the hospitality and tourism industry. This manuscript aims to present scholarly research findings dealing with the post-Covid-19 management strategies in the hospitality and tourism industry from January 1, 2020, to July 28, 2021. These strategies can play an essential role in the survival and growth of the sectors. The study identified and acknowledged the core contributing authors, journals, countries, affiliation, corresponding authors through bibliometric, citation, and keyword analysis. It also conducted the co-occurrence analysis and reported three significant research streams and bibliometric coupling to identify four research themes for management strategies of the tourism and hospitality industry in the post-Covid era. With the help of an influential and conceptual framework, the study highlights the future challenges managers could face and suggests the possible area for reviewing and revising the existing policies by proposing future directions. Consequently, this study contributes to the current literature on post-Covid-19 management strategies and policies by developing the critical analysis of the extant literature and highlighting the understudy areas that future studies must explore to expand the scope of the research.

Public Protests and the Risk of Novel Coronavirus Disease Hospitalizations: A County-Level Analysis from California

The objective of this study was to assess the relationship between public protests and county-level, novel coronavirus disease (COVID-19) hospitalization rates across California. Publicly available data were included in the analysis from 55 of 58 California state counties (29 March–14 October 2020). Mixed-effects negative binomial regression models were used to examine the relationship between daily county-level COVID-19 hospitalizations and two main exposure variables: any vs. no protests and 1 or >1 protest vs. no protests on a given county-day. COVID-19 hospitalizations were used as a proxy for viral transmission since such rates are less sensitive to temporal changes in testing access/availability. Models included covariates for daily county mobility, county-level characteristics, and time trends. Models also included a county-population offset and a two-week lag for the association between exposure and outcome. No significant associations were observed between protest exposures and COVID-19 hospitalization rates among the 55 counties. We did not find evidence to suggest that public protests were associated with COVID-19 hospitalization within California counties. These findings support the notion that protesting during a pandemic may be safe, ostensibly, so long as evidence-based precautionary measures are taken.

Post-pandemic lifestyle changes and their interaction with resident behavior in housing and neighborhoods: Bursa, Turkey

COVID-19 pandemic has re-raised questions about healthy housing and residential environments. The aim of this study is to examine lifestyle changes during the pandemic and their reflections in the use of housing. The study also compares households on different socioeconomic levels in Bursa, the study area. Bursa is a Turkish metropolis that was affected by the spread of COVID-19. Data were collected from 500 residents of 30 neighborhoods in the city's three most populous districts, Osmangazi, Nilüfer and Yildirim. The participants were selected using stratified sampling and interviewed face-to-face using questionnaires. Reliability analysis, frequency distributions, descriptive statistics, ANOVA and the chi-squared test were used to evaluate the data. The results indicate that the participants' hygiene habits, shopping behaviors, transportation habits and frequency of their contact with neighbors and friends have changed. Most of the participants live in apartments, and they need flexible designs that can be used for different purposes. They need toilets and ventilation spaces at the entrances of their homes. The use of balconies has increased. During the pandemic, the use of urban green spaces decreased in general, and the use of open areas around homes increased. High-income residents have advantages in terms of lifestyle, housing and residential environments, so their awareness about and observance of pandemic rules were higher. Lifestyles, housing, residential environments and urban opportunities differ as a result of socioeconomic segregation, and lower-income residents are more vulnerable to disease. Future studies should consider potential risks to humanity in order to address the housing-related problems of disadvantaged groups.

Relationship between Built Environment and COVID-19 Dispersal Based on Age Stratification: A Case Study of Wuhan

The outbreak of COVID-19 (coronavirus disease 2019) has become the focus of attention in the field of urban geography. Built environment, such as the layout of public spaces like transportation hubs and urban open spaces, is an important factor affecting the spread of the epidemic. However, due to the different behavior patterns of different age groups, the intensity and frequency of their use of various built environment spaces may vary. Based on this, we selected patients that were infected, with a non-manipulated time period, and the classification of human behavior patterns; we then conducted a regression analysis study on the spatial distribution and building environment of these COVID-19 patients. The results showed that the spatial distribution of young and middle-aged patients (18–59 years old) was more homogeneous, while the spatial distribution of elderly patients (60 years old and above) had a strong clustering characteristic. Moreover, the significant built environment factors exhibited in the two populations were extremely different. More diverse urban facilities and public spaces exhibited influential properties for older patients, while middle-aged and young adults were more influenced by commuting facilities. It can be said that the built environment shows different influences and mechanisms on the transmission of respiratory infectious diseases in different populations. Therefore, the results of this paper can inform decision makers who expect to reduce the occurrence of urban respiratory infectious diseases by improving the urban built environment.

COVID-19, the Built Environment, and Health

BACKGROUND

Since the dawn of cities, the built environment has both affected infectious disease transmission and evolved in response to infectious diseases. COVID-19 illustrates both dynamics. The pandemic presented an opportunity to implement health promotion and disease prevention strategies in numerous elements of the built environment.

OBJECTIVES

This commentary aims to identify features of the built environment that affect the risk of COVID-19 as well as to identify elements of the pandemic response with implications for the built environment (and, therefore, for long-term public health).

DISCUSSION

Built environment risk factors for COVID-19 transmission include crowding, poverty, and racism (as they manifest in housing and neighborhood features), poor indoor air circulation, and ambient air pollution. Potential long-term implications of COVID-19 for the built environment include changes in building design, increased teleworking, reconfigured streets, changing modes of travel, provision of parks and greenspace, and population shifts out of urban centers. Although it is too early to predict with confidence which of these responses may persist, identifying and monitoring them can help health professionals, architects, urban planners, and decision makers, as well as members of the public, optimize healthy built environments during and after recovery from the pandemic. https://doi.org/10.1289/EHP8888.

Association between Urban Greenspace and Health: A Systematic Review of Literature

The current review aimed to explore the association between urban greenspaces and health indicators. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure and two selected health outcomes (objectively measured physical activity (PA) and mental health outcomes (MH)). Two electronic databases—PubMed/Medline and Excerpta Medica dataBASE (EMBASE)—were searched from 1 January 2000 to 30 September 2020. Only articles in English were considered. Out of 356 retrieved articles, a total of 34 papers were included in our review. Of those, 15 assessed the association between urban greenspace and PA and 19 dealt with MH. Almost all the included studies found a positive association between urban greenspace and both PA and MH, while a few demonstrated a non-effect or a negative effect on MH outcomes. However, only guaranteeing access is not enough. Indeed, important elements are maintenance, renovation, closeness to residential areas, planning of interactive activities, and perceived security aspects. Overall, despite some methodological limitations of the included studies, the results have shown almost univocally that urban greenspaces harbour potentially beneficial effects on physical and mental health and well-being.

Housing Spaces in Nine European Countries: A Comparison of Dimensional Requirements

Modern housing units must meet new needs and requirements; housing dimensions and functional characteristics are relevant issues, mainly considering population ageing and disability. The housing standards of nine European countries were compared to analyze their ability to satisfy new population need, in terms of size. The regulations were downloaded from the websites of the official channels of each country. A wide variability in room size was observed (e.g., single room: from 9 m² in Italy to 7 m² in France, to the absence of any limit in England and Wales, Germany-Hesse, and Denmark). Italian and French legislations define housing dimension considering the room destination and the number of people. The Swedish regulation provides performance requirements and functional indications but does not specify the minimum dimensions of habitable rooms. The rooms’ minimum heights vary between 2.70 m in Italy and Portugal and 2.60 m in the Netherlands, but no limits are established in England and Wales. A diverse approach among European countries regulations is observed: from a market-oriented logic one (e.g., England and Wales) in which room minimum dimensions are not defined to a prescriptive one (Italy) and one that is functionality-oriented (the Netherlands). However, considering the health, social, environmental, and economic trends, many of these standards should be revised.

First Detection of Severe Acute Respiratory Syndrome Coronavirus 2 on the Surfaces of Tourist-Recreational Facilities in Italy

A Coronavirus disease (COVID-19), caused by a new virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spreads via direct contact through droplets produced by infected individuals. The transmission of this virus can also occur via indirect contact if objects and surfaces are contaminated by secretions from individuals with COVID-19 or asymptomatic carriers. Environmental contamination with SARS-CoV-2 is high in hospital settings; on the contrary, surface contamination in non-healthcare settings is still poorly studied. In this study, the presence of SARS-CoV-2 on the surfaces of 20 tourist-recreational facilities was investigated by performing a total of 100 swabs on surfaces, including refrigerator handles, handrails, counters, tables, and bathroom access doors. Six (6%) swabs from four (20%) tourist-recreational facilities tested positive for SARS-CoV-2; the surfaces that were involved were toilet door handles, refrigerator handles, handrails, and bar counters. This study highlights that SARS-CoV-2 is also present in non-healthcare environments; therefore, in order to limit this worrying pandemic, compliance with behavioral rules and the adoption of preventive and protective measures are of fundamental importance not only in healthcare or work environments but also in life environments.

The Associations of Built Environment with Older People Recreational Walking and Physical Activity in a Chinese Small-Scale City of Yiwu

Physical activity would bring in plenty of health benefits, especially recreational physical activity (RPA). Previous studies have suggested that built environment would affect older people's recreational walking (RW) and RPA, but how the effects exist in a small-scale Chinese city remains unclear. Two hundred and fifty-two older participants were recruited in the city of Yiwu using cross-sectional survey of random samples in 2019. RW and RPA level of participants and perceived scores of built environments were collected using the International Physical Activity Questionnaire and Neighborhood Environment Walkability Scale, respectively. Linear regression analysis was conducted to investigate the association of built environment with older people's RW and RPA. The results showed that two main factors affecting older people's RW and RPA were residential density and aesthetics. Additionally, access to services was related to RW, and street connectivity was correlated with RPA. The associations of RW with built environment varied slightly with demographic variables included in the regression model. All the results suggested that lower residential density, better aesthetics environment, and higher street connectivity would motivate older people to engage more in RW and RPA. The better access to services encourages only RW, not RPA, in older people. These findings would be helpful for policy decision makers in the urban construction process in Yiwu. More studies are needed to enlarge the scientific evidence base about small-scale cities in China.

Combining the Digital, Social and Physical Layer to Create Age-Friendly Cities and Communities

This qualitative investigation makes suggestions about creating age-friendly cities for older adults focusing on three domains of the World Health Organization (WHO) age-friendly city framework namely “Communication and Information”, “Outdoor Spaces and Buildings” and “Social Participation”. The authors present two case studies, the first one focusing on older adults using activity wearables for health self-management in the neighborhood, and the second one focusing on older adults engaged in social prescribing activities in the community. The authors then reflect on the relationships of the domains and future opportunities for age-friendly cities. These case studies apply a co-design and citizen-based approach focusing within these larger frameworks on emotions, values and motivational goals of older adults. Results suggest how the convergence of the often siloed age-friendly city components based on older adults’ goals and input can lead to better social participation and longer-term health outcomes. The authors propose that the digital, physical and social aspects need to be considered in all domains of age-friendly cities to achieve benefits for older adults. Further work involving older adults in the future shaping of age-friendly neighborhoods and cities, and identifying barriers and opportunities is required.

Trends in Social Acceptance of Renewable Energy Across Europe-A Literature Review

Social acceptance has proven to be a significant barrier in the implementation of renewable energy systems (hereinafter “RES”). While a general acceptance of RES is high, low local acceptance has hindered the development of renewable energy projects (hereinafter “REP”). This study assesses the determinants of local and general social acceptance of REP across Europe through a qualitative analysis from 25 case studies of the most significant social drivers and barriers that include all European countries. These case studies contain qualitative and quantitative analyses of the main factors for social acceptance of many representative groups including residents, stakeholders, and experts. Understanding the influences of social acceptance enables us to create strategies that will promote the development of REP by mitigating any public opposition.

Reliability of T-WSI to Evaluate Neighborhoods Walkability and Its Changes over Time

More walkable neighborhoods are linked to increased physical activity. The Walking Suitability Index of the territory (T-WSI) is an easy method to evaluate walkability on the basis of direct observation. T-WSI provides 12 indicators divided into 4 categories (practicability, safety, urbanity, pleasantness); the weighted analysis of these indicators gives an overall score of the actual usability of the neighborhood. The aim of the study is to evaluate the ability of T-WSI’ indicators to measure, in a reliable way, any street’s walkability variations occurred over time. The investigation was performed in 2018 in nine urban neighborhoods of Rieti city. Cronbach’s α is used to evaluate internal consistency of T-WSI; Intraclass Correlation Coefficient (ICC) is used to evaluate the reproducibility of measurements (or ratings) made by different investigators. Cronbach’s α is 0.89 (± 0.02); ICC is also good (ICC = 0.89; 95% CI: 0.84–0.92). The results of the 2018 investigation are also compared with those collected in 2016 in the same districts. The results show that T-WSI is a reliable and easy to use tool, useful to measure the effectiveness of the interventions already realized at local level, but it could also contribute to making decisions to develop regeneration projects.

COVID-19 Lockdown: Housing Built Environment's Effects on Mental Health

Since the World Health Organization (WHO) declared the coronavirus infectious disease 2019 (COVID-19) outbreak a pandemic on 11 March, severe lockdown measures have been adopted by the Italian Government. For over two months of stay-at-home orders, houses became the only place where people slept, ate, worked, practiced sports, and socialized. As consolidated evidence exists on housing as a determinant of health, it is of great interest to explore the impact that COVID-19 response-related lockdown measures have had on mental health and well-being. We conducted a large web-based survey on 8177 students from a university institute in Milan, Northern Italy, one of the regions most heavily hit by the pandemic in Europe. As emerged from our analysis, poor housing is associated with increased risk of depressive symptoms during lockdown. In particular, living in apartments <60 m² with poor views and scarce indoor quality is associated with, respectively, 1.31 (95% CI: 1046–1637), 1.368 (95% CI: 1166–1605), and 2.253 (95% CI: 1918–2647) times the risk of moderate–severe and severe depressive symptoms. Subjects reporting worsened working performance from home were over four times more likely to also report depression (OR = 4.28, 95% CI: 3713–4924). Housing design strategies should focus on larger and more livable living spaces facing green areas. We argue that a strengthened multi-interdisciplinary approach, involving urban planning, public mental health, environmental health, epidemiology, and sociology, is needed to investigate the effects of the built environment on mental health, so as to inform welfare and housing policies centered on population well-being.

Black and Minority Ethnic (BAME) Alliance Against COVID-19: One Step Forward

During the COVID-19 pandemic, the data of Department of Health in United Kingdom (UK) showed an increase mortality and morbidity among the Black and Minority Ethnic (BAME) population. This high mortality can be due to social factors, genetic and immunological factors. Metabolic factors like high prevalence of diabetes, obesity, metabolic syndrome and hypertension were also found to contribute to the increased risk of COVID-19 infection in BAME population. In addition, a large number of BAME population are working in jobs that involve regular and daily contact with public, and this may increase risk of encountering COVID-19 infection. Therefore, future research should address all these factors and generate the correct health policy that will allow us to combat the danger of COVID-19. We recommend the establishment of BAME alliance against COVID-19 in order to improve occupational risks and hazards, adequate income protection, culturally and linguistically appropriate public health communications and decreasing barriers in accessing healthcare. The BAME alliance will initially focus on (i) development of central system to record data about COVID-19 patients from BAME population (ii) involvement of healthcare professionals and researchers from ethnic minorities and (iii) multidisciplinary and inter-institution collaboration; for example, civil engineers and architects need to think about house design and ventilation that decrease risk of COVID-19 especially in BAME populations.

COVID-19 mortality rate in nine high-income metropolitan regions

We analyzed the spread of the COVID-19 epidemic in 9 metropolitan regions of the world with similar socio-demographic characteristics, daytime commuting population and business activities: the New York State, Bruxelles-Capital, the Community of Madrid, Catalonia, the Île-de-France Region, the Greater London county, Stockholms län, Hovedstaden (Copenhagen) and the Lombardy Region. The Lombardy region reported the highest COVID-19 crude mortality rate (141.0 x 100,000) 70-days after the onset of the epidemic, followed by the Community of Madrid (132.8 x 100,000) New York State (120.7 x 100,000). The large variation in COVID-19 mortality and case-fatality rates for COVID-19 in different age strata suggested a more accurate analysis and interpretation of the epidemic dynamics after standardization of the rates by age. The share of elder populations (>70 years) over total population varies widely in the considered study settings, ranging from 6.9% in Catalonia to 17.0% in Lombardy. When taking age distribution into consideration the highest standardized mortality rate was observed in the State of New York (257.9 x 100,000); with figures in most of the European regions concentrated between 123.3 x 100,000 in Greater London and 177.7 x 100,000 in Bruxelles-Capital, lower in French and Danish regions. We also report and critical appraise, when available, COVID-19 mortality figures in capital cities, nursing homes, as well as excess mortality at country level. Our data raise awareness on the need for a more in-depth epidemiological analysis of the current COVID-19 public health emergency that further explores COVID-19 mortality determinants associated with health services delivery, community-level healthcare, testing approaches and characteristics of surveillance systems, including classification of COVID-19 deaths. (www.actabiomedica.it)

COVID-19 and Healthcare Facilities: a Decalogue of Design Strategies for Resilient Hospitals

BACKGROUND AND AIM

The COVID-19 pandemic has upended the global healthcare systems. The surge in infections and sick critically ill patients has tested the resilience of healthcare infrastructures and facilities forcing organizations to quickly adapt and embrace emergency solutions. The paper proposes a decalogue of design strategies applicable both to new hospitals and to the refurbishment of existing hospitals.

METHODS

The authors conducted observations at hospitals, during public health webinars and through experts working groups from March to May 2020.

RESULTS

In this commentary, the authors present a list of strategies for creating critical care surge capacity and exploring design strategies for healthcare design for resilient hospital facilities. The strategies are organized into two tiers: I) design and II) operations. The (I) Design phase strategies are: 1) Strategic Site Location; 2) Typology Configuration; 3) Flexibility; 4) Functional program; 5) User-centerdness. The (II) Operation phase strategies are: 6) Healthcare network on the territory; 7) Patient safety; 8) HVAC and indoor air quality; 9) Innovative finishing materials and furniture; 10) Healthcare digital innovation.

CONCLUSIONS

Hospitals, health care systems, and institutions urgently need to assess their resources, identify potential bottlenecks, and create strategies for increasing critical care surge capacity. The COVID-19 pandemic disrupted healthcare operations and accelerated the processes of innovation and transformation. The design and operational strategies can enable the achievement of resilient hospital facilities. Further multidisciplinary researches is needed  to validate the strategies empirically.

COVID-19 and Living space challenge. Well-being and Public Health recommendations for a healthy, safe, and sustainable housing

BACKGROUND AND AIM OF THE WORK

The ongoing pandemic of COVID-19 is a strong reminder that the lockdown period has changed the way that people and communities live, work, and interact, and it's necessary to make resilient the built environment, both outdoor and mainly the indoor spaces: housing, workplaces, public buildings, and entertainment facilities. How can we re-design the concept of Well-being and Public Health in relation to the living places of the future?

METHODS

According to the previous statements and scenario, this paper aims to integrate the building hygiene and well-being, focusing the possible responses, both existing and for the new buildings, taking home a strong message from this "period" of physical distancing.

RESULTS

The Well-being and Public Health recommendations for a healthy, safe, and sustainable housing are framed into the following key points: 1. Visible and accessible green elements and spaces; 2. Flexibility, adaptability, sharing, and crowding of living spaces, and compliant functions located into the buildings; 3. Re-appropriation of the basic principles and archetypes of sustainable architecture, thermal comfort and Indoor Air Quality (IAQ); 4. Water consumption and Wastewater Management; 5. Urban Solid Waste Management; 6. Housing automation and electromagnetic fields; 7. Indoor building and finishing materials.

CONCLUSIONS

The Well-being and Public Health recommendations for a healthy, safe and sustainable housing may provide a useful basis for Designers, Policy Makers (fostering tax incentives for building renewal), Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform living places in healthier and Salutogenic spaces.

How Can Design Features and Other Factors Affect the Indoor Air Quality in Inpatient Rooms? Check-Lists for the Design Phase, Daily Procedures and Maintenance Activities for Reducing the Air Concentrations of Chemical Pollution

Indoor Air Quality (IAQ) is one of main topics of Public Health on which international institutions and countries are taking action. With regards to healing architectures, several studies have reported data analysis and case studies to improve users' health (patients, and medical and administrative staffs), but there are not enough regarding volatile organic compounds (VOCs). Regarding chemical pollution of indoor air, the Scientific Community has highlighted that there are several factors that affect the IAQ, in particular the design and management, and energetic efficiency, of inpatient wards. Several stakeholders, from the designers to the managers, are responsible for the indoor air in healing environments. Supported by analysis of the State of the Art and the main factors that influence the heterogeneous scenario of inpatient wards, the paper presents three check-lists, designed for supporting the stakeholders during the design phase, or for the daily procedures and maintenance activities, for pre-assessment of factors that affect chemical pollution, and for the definition of strategies to be applied. In fact, in such environments IAQ assumes a particular meaning and importance, both for the vulnerability of the patients and for the long time spent by the sanitary staff. The multidisciplinary approach emphasizes the continuous need for interdisciplinary knowledge and skills aimed at finding solutions able to protect users' health status (including patients, workers and visitors), especially in the field of the indoor air issue.