Healthy Design and Urban Planning Strategies, Actions, and Policy to Achieve Salutogenic Cities

Comprehensive evaluation of global health cities development levels

Introduction

How to scientifically assess the health status of cities and effectively assist in formulating policies and planning for health city development remains a profound challenge in building a global "health community."

Methods

This study employs the Building Research Establishment's International Healthy Cities Index (BRE HCI), encompassing ten environmental categories and fifty-eight indicators, to guide and support the scientific development of healthy cities. The entropy weight-TOPSIS method and the rank sum ratio (RSR) method were applied to comprehensively rank and categorize the health development levels of fifteen global cities. Furthermore, through cluster analysis, this research identifies universal and unique indicators that influence the development of healthy cities.

Results

The results indicate that: (1) Within the scope of 58 evaluation indicators, the precedence in weight allocation is accorded to the kilometres of bicycle paths and lanes per 100,000 population (0.068), succeeded by m2 of public indoor recreation space per capita (0.047), and kilometres of bicycle paths and lanes per 100,000 population (0.042). (2) Among the ten environmental categories, the top three in terms of weight ranking are transport (0.239), leisure and recreation (0.172), and resilience (0.125). Significant disparities exist between different cities and environmental categories, with the issue of uneven health development within cities being particularly prominent. (3) The study categorizes the development levels of healthy cities into three tiers based on composite scores: it classifies Singapore, Shanghai, and Amsterdam at an excellent level; places Dubai and Johannesburg at a comparatively poor level; and situates the remaining ten cities at a moderate level. (4) The analysis identifies 53 international common indicators and 5 characteristic indicators from the 58 indicators based on the significance of the clustering analysis (p < 0.05).

Discussion

The study proposes four strategic recommendations based on these findings: establishing a comprehensive policy assurance system, refining urban spatial planning, expanding avenues for multi-party participation, and augmenting distinctive health indicators. These measures aim to narrow the developmental disparities between cities and contribute to healthy global cities' balanced and sustainable growth. However, due to existing limitations in sample selection, research methodology application, and the control of potential confounding variables, further in-depth studies are required in the future.

Health-Oriented Environmental Categories, Individual Health Environments, and the Concept of Environment in Public Health

The term 'environment' is not uniformly defined in the public health sciences, which causes crucial inconsistencies in research, health policy, and practice. As we shall indicate, this is somewhat entangled with diverging pathogenic and salutogenic perspectives (research and policy priorities) concerning environmental health. We emphasise two distinct concepts of environment in use by the World Health Organisation. One significant way these concepts differ concerns whether the social environment is included. Divergence on this matter has profound consequences for the understanding of health and disease, for measures derived from that understanding targeting health promotion and disease prevention, and consequently, for epistemic structures and concept development in scientific practice. We hope to improve the given situation in public health by uncovering these differences and by developing a fruitful way of thinking about environment. Firstly, we side with the salutogenic conception of environment as a health resource (as well as a source of health risks). Secondly, we subdivide the concept of environment into four health-oriented environmental categories (viz., natural, built-material, socio-cultural, and psychosocial) and we link these with other theoretical notions proposed in the health sciences literature. Thirdly, we propose that in public health 'environment' should be understood as consisting of all extrinsic factors that influence or are influenced by the health, well-being, and development of an individual. Consequently, none of the four categories should be excluded from the concept of environment. We point out the practical relevance and fruitfulness of the conception of environment as a health source and frame this in causal terms, representing individual health environments as causal networks. Throughout, we side with the view that for the design of human health-promoting settings, increased attention and consideration of environmental resources of salutogenic potential is particularly pressing.

Investigating the role of the built environment, socio-economic status, and lifestyle factors in the prevalence of chronic diseases in Mashhad: PLS-SEM model

Background

Chronic diseases remain a significant contributor to both mortality and disability in our modern world. Physical inactivity and an unhealthy diet are recognized as significant behavioral risk factors for chronic diseases, which can be influenced by the built environment and socio-economic status (SES). This study aims to investigate the relationship between the built environment, SES, and lifestyle factors with chronic diseases.

Methods

The current study was conducted in Mashhad's Persian cohort, which included employees from Mashhad University of Medical Sciences (MUMS). In the study, 5,357 participants from the cohort were included. To assess the state of the built environment in Mashhad, a Geographic Information System (GIS) map was created for the city and participants in the Persian Mashhad study. Food intake and physical exercise were used to assess lifestyle. A food frequency questionnaire (FFQ) was used to assess food intake. To assess food intake, the diet quality index was computed. To assess the link between variables, the structural model was created in accordance with the study's objectives, and partial least square structural equation modeling (PLS-SEM) was utilized.

Results

The chronic diseases were positively associated with male sex (p < 0.001), married (p < 0.001), and higher age (p < 0.001). The chronic diseases were negatively associated with larger family size (p < 0.05), higher SES (p < 0.001), and higher diet quality index (DQI) (p < 0.001). No significant relationship was found between chronic disease and physical activity.

Conclusion

Food intake and socioeconomic status have a direct impact on the prevalence of chronic diseases. It seems that in order to reduce the prevalence of chronic diseases, increasing economic access, reducing the class gap and increasing literacy and awareness should be emphasized, and in the next step, emphasis should be placed on the built environment.

Ecological pollution features and health risk exposure to heavy metals via street dust and topsoil from Nkpor and Onitsha in Anambra, Nigeria

The manuscript presents the investigation results on the pollution and risk of metal mines, and it is considered an important report on environmental pollution near mines in Nigeria, with archival value. The research involved soil sampling and heavy metal analysis for about 12 months in three metal mines. Based on these results, the paper provides information on pollution levels and hazards using well-known methods like pollution and ecological risk indexes. The increasing population in urban communities attracted by various industrial, economic and social activities causes contamination of atmospheric environment that can affect human health. We investigated heavy metal distributions, correlation coefficient among elements, ecological indices and probable health risk assessment in street dust and topsoil from Nkpor and Onitsha urban suburb, Nigeria. The mean concentration of heavy metals in car dust from Onitsha and Nkpor suburb follows thus: Fe > Mn > Cu > As > Pb > Ni > Cr. The decreasing trend of heavy metal in rooftop dust from both area: Fe > Mn > Cu > Pb > As > Ni > Cr whereas metal contents in topsoil were: Fe > Mn > Cu > Pb > Ni > Cr > As for both areas. The degree of pollution indices was characterized by contamination factor (CF), geo-accumulation factor (I-geo), pollution load index (PLI), Nemerow (PN), ecological and potential ecological risk index (ER and PERI) which indicated low pollution in the urban street environment. The results of Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA) showed that the estimated heavy metals displayed sources from atmospheric deposition, natural origin and anthropogenic sources. Risk assessment revealed that ingestion of dust and soil was the significant route for heavy metals exposure to the populace followed by inhalation, then dermal contact. Considering all factors, non-cancer risk was more prominent in children than adults and no significant health hazard could be attributed to both aged groups as of the period of study except for As and Ni that needs constant monitoring to avoid exceeding organ damaging threshold limit of 1 × 10-4.

Source-specific probabilistic risk evaluation of potentially toxic metal(loid)s in fine dust of college campuses based on positive matrix factorization and Monte Carlo simulation

Contamination, hazard level and source of 10 widely concerned potentially toxic metal(loid)s (PTMs) Co, As, Pb, Cr, Cu, Zn, Ni, Mn, Ba, and V in fine dust with particle size below 63 μm (FD63) were investigated to assess the environmental quality of college campuses and influencing factors. PTMs sources were qualitatively analyzed using statistical methods and quantitatively apportioned using positive matrix factorization. Probabilistic contamination degrees of PTMs were evaluated using enrichment factor and Nemerow integrated enrichment factor. Eco-health risk levels of content-oriented and source-oriented for PTMs were evaluated using Monte Carlo simulation. Mean levels of Zn (643.8 mg kg-1), Pb (146.0 mg kg-1), Cr (145.9 mg kg-1), Cu (95.5 mg kg-1), and Ba (804.2 mg kg-1) in FD63 were significantly larger than soil background values. The possible sources of the concerned PTMs in FD63 were traffic non-exhaust emissions, natural source, mixed source (auto repair waste, paints and pigments) and traffic exhaust emissions, which accounted for 45.7%, 25.4%, 14.5% and 14.4% of total PTMs contents, respectively. Comprehensive contamination levels of PTMs were very high, mainly caused by Zn pollution and non-exhaust emissions. Combined ecological risk levels of PTMs were low and moderate, chiefly caused by Pb and traffic exhaust emissions. The non-cancer risks of the PTMs in FD63 to college students fell within safety level, while the carcinogenic PTMs in FD63 had a certain cancer risks to college students. The results of source-specific health risk assessment indicated that Cr and As were the priority PTMs, and the mixed source was the priority pollution source of PTMs in FD63 from college campuses, which should be paid attention to by the local government.

Does healthy city construction facilitate green growth in China? Evidence from 279 cities

In the face of the challenge of balancing urban economic development and environmental protection, the concept of a healthy city has emerged as a promising model for sustainable urban development. This study empirically investigates the impact of healthy city construction on green growth by utilizing a difference-in-difference model estimation on a panel dataset of 279 Chinese prefecture-level cities from 2007 to 2019. The findings reveal that healthy city construction significantly contributes to green growth, particularly in pilot cities, and this effect is observed across cities of different sizes and economic bases. Additionally, we identify two channels through which healthy city construction promotes green growth: enhancing innovation capacity and enriching human resources. These findings have implications not only for Chinese cities navigating the path towards green growth but also for other developing nations striving for economic transformation and environmentally sustainable development.

Community Empowerment Assessment and Community Nursing Diagnosis for Climate Change Mitigation and Adaptation in the Northern Region of the Portuguese Atlantic Coast: A Mixed-Methods Study Using MAIEC Framework

The Community Intervention and Empowerment Assessment Model (MAIEC) offers a framework for community empowerment in several fields such as Climate Change (CC), the largest health emergency crisis globally, through diagnosis and interventions in Community Health Nursing. This study aims to assess the level of community empowerment in climate change mitigation and adaptation, and to identify nursing diagnosis through the MAIEC clinical decision matrix, within a local intermunicipal association in the northern region of the Portuguese Atlantic Coast. A convergent mixed-methods design was used, applying a focus group technique to a purposive sampling of ten key stakeholders of this community. A Portuguese version of the Empowerment Assessment Rating Scale and a questionnaire were both applied to the same participants, and qualitative and quantitative data generated were analysed using a content analysis technique and an Excel database sheet created using Microsoft Office 365. The analysis of the Portuguese northern community exposed: a low level of community empowerment for mitigation and adaptation to climate change; a nursing diagnosis of community management impairments in several dimensions, such as community process, community participation and community leadership. However, the study confirmed that MAIEC contributed to future community-based solutions, responding to the challenges of climate change, and enabling the planning of interventions to address MAIEC diagnoses in the form of CC-specific training and recommendations for new cooperation approaches from all stakeholders. This study was not registered.

Assessing the association between overcrowding and human physiological stress response in different urban contexts: a case study in Salzburg, Austria

Overcrowding in densely populated urban areas is increasingly becoming an issue for mental health disorders. Yet, only few studies have examined the association between overcrowding in cities and physiological stress responses. Thus, this study employed wearable sensors (a wearable camera, an Empatica E4 wristband and a smartphone-based GPS) to assess the association between overcrowding and human physiological stress response in four types of urban contexts (green space, transit space, commercial space, and blue space). A case study with 26 participants was conducted in Salzburg, Austria. We used Mask R-CNN to detect elements related to overcrowding such as human crowds, sitting facilities, vehicles and bikes from first-person video data collected by wearable cameras, and calculated a change score (CS) to assess human physiological stress response based on galvanic skin response (GSR) and skin temperature from the physiological data collected by the wristband, then this study used statistical and spatial analysis to assess the association between the change score and the above elements. The results demonstrate the feasibility of using sensor-based measurement and quantitative analysis to investigate the relationship between human stress and overcrowding in relation to different urban elements. The findings of this study indicate the importance of considering human crowds, sitting facilities, vehicles and bikes to assess the impact of overcrowding on human stress at street level.

Climate Change Prevention through Community Actions and Empowerment: A Scoping Review

As society tries to tackle climate change around the globe, communities need to reduce its impact on human health. The purpose of this review is to identify key stakeholders involved in mitigating and adapting to climate change, as well as the type and characteristics of community empowerment actions implemented so far to address the problem. Published and unpublished studies from January 2005 to March 2022 in English and Portuguese were included in this review. The search, conducted on PubMed, CINAHL, Scopus, MEDLINE, Scopus, Web of Science, SciELO, and RCAAP (Repositório Científico de Acesso Aberto de Portugal), followed a three-step search strategy. Data extraction was performed by two independent reviewers, using an extraction tool specifically designed for the review questions. Twenty-seven studies were eligible for inclusion: six used interviews as a qualitative method, three were systematic reviews, three were case study analyses, three used surveys and questionnaires as quantitative methods, two used integrative baseline reviews, and three utilized a process model design. Six studies targeted local, public and private stakeholders. Community settings were the context target of fifteen studies, whereas twelve specifically referred to urban settings. Seven types of community actions were acknowledged across the globe, characterised as hybrid interventions and referring to the leading stakeholders: local governments, non-governmental organizations, civil society, universities, public health, and private sectors.

A methodological proposal to evaluate the health hazard scenario from COVID-19 in Italy

2019 Coronavirus disease (COVID-19) had a big impact in Italy, mainly concentrated in the northern part of the Country. All this was mainly due to similarities of this area with Wuhan in Hubei Province, according to geographical, environmental and socio-economic points of view. The basic hypothesis of this research was that the presence of atmospheric pollutants can generate stress on health conditions of the population and determine pre-conditions for the development of diseases of the respiratory system and complications related to them. In most cases the attention on environmental aspects is mainly concentrated on pollution, neglecting issues such as land management which, in some way, can contribute to reducing the impact of pollution. The reduction of land take and the decrease in the loss of ecosystem services can represent an important aspect in improving environmental quality. In order to integrate policies for environmental change and human health, the main factors analyzed in this paper can be summarized in environmental, climatic and land management. The main aim of this paper was to produce three different hazard scenarios respectively related to environmental, climatic and land management-related factors. A Spatial Analytical Hierarchy Process (AHP) method has been applied over thirteen informative layers grouped in aggregation classes of environmental, climatic and land management. The results of the health hazard maps show a disparity in the distribution of territorial responses to the pandemic in Italy. The environmental components play an extremely relevant role in the definition of the red zones of hazard, with a consequent urgent need to renew sustainable development strategies. The comparison of hazard maps related to different scenarios provides decision makers with tools to orient policy choices with a different degree of priority according to a place-based approach. In particular, the geospatial representation of risks could be a tool for legitimizing the measures chosen by decision-makers, proposing a renewed approach that highlights and takes account of the differences between the spatial contexts to be considered - Regions, Provinces, Municipalities - also in terms of climatic and environmental variables.

Selected Research Issues of Urban Public Health

Health is created within the urban settings of people’s everyday lives. In this paper we define Urban Public Health and compile existing evidence regarding the spatial component of health and disease in urban environments. Although there is already a substantial body of single evidence on the links between urban environments and human health, focus is mostly on individual health behaviors. We look at Urban Public Health through a structural lens that addresses health conditions beyond individual health behaviors and identify not only health risks but also health resources associated with urban structures. Based on existing conceptual frameworks, we structured evidence in the following categories: (i) build and natural environment, (ii) social environment, (iii) governance and urban development. We focused our search to review articles and reviews of reviews for each of the keywords via database PubMed, Cochrane, and Google Scholar in order to cover the range of issues in urban environments. Our results show that linking findings from different disciplines and developing spatial thinking can overcome existing single evidence and make other correlations visible. Further research should use interdisciplinary approaches and focus on health resources and the transformation of urban structures rather than merely on health risks and behavior.

Housing and Health: Here We Go Again

Housing is one of the major determinants of human health and the current COVID-19 pandemic has highlighted its relevance. The authors summarize the main issues, including dimensional standards, indoor air quality, safety, accessibility, neighborhoods, and area characteristics. The authors propose an operating scheme in order to implement actions to improve residential wellbeing on a local, national, and international level.

Risk and sources of heavy metals and metalloids in dust from university campuses: A case study of Xi'an, China

College students study and live at university for several years; however, the pollution levels, ecological health risks, and sources of heavy metals and metalloids (HMMs) in the dust found at university campuses are still unknown. In this study, dust samples from university campuses in Xi'an were collected and the Zn, Mn, As, Pb, V, Cr, Co, Cu, Ba, and Ni contents were measured using X-ray fluorescence spectrometry. The pollution levels and ecological health risks of these HMMs were evaluated using the geo-accumulation, pollution load, and potential ecological risk indices and a health risk assessment model while their sources were apportioned using positive matrix factorization. The mean HMM concentrations in the dust were higher than the corresponding background values in the topsoil of Shaanxi Province. The Mn, V, Co, As, and Ni concentrations in the dust samples analyzed were within the levels categorized as no pollution by the geo-accumulation index standard, whereas other HMMs caused pollution to different degrees. Assessment of the pollution load index indicated that the dust samples analyzed were moderate contamination with HMMs. Pb and Cu in the dust presented considerable and moderate ecological risks, respectively; the other HMMs presented low ecological risks. The combined ecological risk of the HMMs measured in the dust samples was considerable. The non-carcinogenic and carcinogenic risks to male and female college students were within the safe levels. This study found three main sources of the HMMs measured in the dust: traffic, natural, and mixed sources (the latter including automobile repair industry waste and paints and pigments), which accounted for 47.5%, 29.3%, and 23.2% of the total HMM concentration, respectively.

Sustainable Development and Resilience: A Combined Analysis of the Cities of Rotterdam and Thessaloniki

The concept of a resilient city and its relationship with sustainable development has already received wide attention among academics, practitioners, and decision-makers, especially in the last decade. For many scholars, resilience is one of the concepts of sustainable development, in the sense that even more sustainability is an essential goal for development, and resilience is a way of thinking and acting that would lead us towards achieving sustainability. Moreover, resilience is about building and planning to future-proof cities. Resilience is a process that represents a new way of thinking, determining which urban challenges and crises have the lowest impact, and also building back better and evolving. The main aim of this study is to identify the potential relationship between sustainable development and resilience by using the Espiner et al. model. The model, which was created in reference to nature-based tourism destinations, suggests that the relationship between sustainability and resilience in tourism can be illustrated by three potential states: emergent, developing, and mature. In the present study, we adapt these potential states in case studies of the cities of Rotterdam (The Netherlands) and Thessaloniki (Greece), in order to demonstrate whether they are emergent, developing, or mature, by examining the critical documents of the (a) City Resilience Framework, and (b) Resilient Strategy Reports for Thessaloniki and Rotterdam, respectively.

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.

Oncogenic Role of miRNA in Environmental Exposure to Plasticizers: A Systematic Review

The daily environmental exposure of humans to plasticizers may adversely affect human health, representing a global issue. The altered expression of microRNAs (miRNAs) plays an important pathogenic role in exposure to plasticizers. This systematic review summarizes recent findings showing the modified expression of miRNAs in cancer due to exposure to plasticizers. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, we performed a systematic review of the literature published in the past 10 years, focusing on the relationship between plasticizer exposure and the expression of miRNAs related to cancer. Starting with 535 records, 17 articles were included. The results support the hypothesis that exposure to plasticizers causes changes in or the deregulation of a number of oncogenic miRNAs and show that the interaction of plasticizers with several redundant miRNAs, such as let-7f, let-7g, miR-125b, miR-134, miR-146a, miR-22, miR-192, miR-222, miR-26a, miR-26b, miR-27b, miR-296, miR-324, miR-335, miR-122, miR-23b, miR-200, miR-29a, and miR-21, might induce deep alterations. These genotoxic and oncogenic responses can eventually lead to abnormal cell signaling pathways and metabolic changes that participate in many overlapping cellular processes, and the evaluation of miRNA-level changes can be a useful target for the toxicological assessment of environmental pollutants, including plastic additives and plasticizers.

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.

Maternal exposure to air pollution and umbilical asprosin concentration, a novel insulin-resistant marker

Air pollution exposure during pregnancy has been associated with abnormal glucose hemostasis in the fetus, which may result in the programming of type 2 diabetes mellitus (T2DM) development in future life. Therefore, we investigated the association of maternal exposure to particulate matters (PMs) and traffic indicators with umbilical asprosin concentration, a novel insulin-resistant inducing adipokine, in newborns. Accordingly, 759 mother-newborn pairs from Sabzevar, Iran (2018-2019) participated in our study. Maternal exposure to PM₁, PM_2.5 and PM₁₀ concentrations was estimated using spatial-temporal models developed for the study area. The associations of exposure to traffic indicators (total street length in 100, 300 and 500 m buffers around home and proximity of mothers to nearest major roads) and air pollution with umbilical asprosin concentration were estimated using linear regression models, adjusted for potential confounders. The median (interquartile range (IQR)) of umbilical asprosin concentration was 30.4 (19.1) ng/mL. In fully adjusted models, each one IQR increase in PM₁₀ and PM_2.5 were associated with 26.43 ng/mL (95% CI: 10.97, 41.88) and 31.76 ng/mL (95% CI: 15.66, 47.86) increase in umbilical asprosin concentration, respectively. A similarity result was observed for total street length in 100 m buffer. An increase in proximity to major roads was associated with a decrease of -21.48 ng/mL (95% CI: 33.29, -9.67) in umbilical asprosin concentration. Our results suggested that maternal exposure to air pollution during pregnancy could increase the umbilical asprosin concentration. These novel findings may improve our understanding of the mechanisms whereby air pollutants impaired glucose hemostasis during the fetal period.

Impact of the environment on the health: From theory to practice

The Erice 56 Charter titled "Impact of the environment on the health: from theory to practice" was unanimously approved at the end of the 56th course of the "International School of Epidemiology and Preventive Medicine G. D'Alessandro" held from 3rd to November 7, 2019 in Erice - Sicily (Italy) and promoted by the Study Group of "Environment and Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The course, that included lectures, open discussions and guided working groups, was aimed to provide a general training on epidemiological and toxicological aspects of the environmental health impact, to be used by public health professionals for risk assessment, without forgetting the risk communications. At the end of the course 12 key points were agreed among teachers and students: they underlined the need of specific training and research, in the perspective of "One Health" and "Global Health", also facing emerging scientific and methodological issues and focusing on communication towards stakeholders. This Discussion highlight the need to improve knowledge of Health and Environment topic in all sectors of health and environmental prevention and management.

Air pollutants and risk of death due to COVID-19 in Italy

The present work aims to study the role of air pollutants in relation to the number of deaths per each Italian province affected by COVID-19. To do that, specific mortality from COVID-19 has been standardized for each Italian province and per age group (10 groups) ranging from 0 to 9 years to >90 years, based on the 2019 national population figures. The link between air pollutants and COVID-19 mortality among Italian provinces was studied implementing a linear regression model, whereas the wide set of variables were examined by means of LISA (Local Indicators of Spatial Autocorrelation), relating the spatial component of COVID-19 related data with a mix of environmental variables as explanatory variables. As results, in some provinces, namely the Western Po Valley provinces, the SMR (Standardized Mortality Ratio) is much higher than expected, and the presence of PM₁₀ was independently associated with the case status. Furthermore, the results for LISA on SMR and PM₁₀ demonstrate clusters of high-high values in the wide Metropolitan area of Milan and the Po Valley area respectively, with a certain level of overlap of the two distributions in the area strictly considered Milan. In conclusion, this research appears to find elements to confirm the existence of a link between pollution and the risk of death due to the disease, in particular, considering land take and air pollution, this latter referred to particulate (PM₁₀). For this reason, we can reiterate the need to act in favour of policies aimed at reducing pollutants in the atmosphere, by means of speeding up the already existing plans and policies, targeting all sources of atmospheric pollution: industries, home heating and traffic.

A Survey on Daily Activity Inclination and Health Complaints among Urban Youth in Malaysia

Environmental influence is one of the attributing factors for health status. Chronic interaction with electronic display technology and lack of outdoor activities might lead to health issues. Given the concerns about the digital impact on lifestyle and health challenges, we aimed to investigate the daily activity inclination and health complaints among the Malaysian youth. A self-administered questionnaire covering lifestyle and health challenges was completed by 220 youths aged between 16 and 25. There were a total of 22 questions. Seven questions inspected the patterns of indoor and outdoor activities. Fifteen questions focused on the visual and musculoskeletal symptoms linked to both mental and physical health. The total time spent indoors (15.0 ± 5.4 hours/day) was significantly higher than that spent outdoors (2.5 ± 2.6 hours/day) (t = 39.01, p < 0.05). Total time engrossed in sedentary activities (13.0 ± 4.5 hours/day) was significantly higher than that in nonsedentary activities (4.5 ± 3.8 hours/day) comprised of indoor sports and any outdoor engagements (t = 27.10, p < 0.05). The total time spent on electronic related activities (9.5 ± 3.7 hours/day) was were higher than time spent on printed materials (3.4 ± 1.6 hours/day) (t = 26.01, p < 0.05). The association of sedentary activities was positive in relation to tired eyes (χ² = 17.58, p < 0.05), sensitivity to bright light (χ² = 12.10, p < 0.05), and neck pain (χ² = 17.27, p < 0.05) but negative in relation to lower back pain (χ² = 8.81, p < 0.05). Our youth spent more time in building and engaged in sedentary activities, predominantly electronic usage. The health-related symptoms, both visual and musculoskeletal symptoms, displayed a positive association with a sedentary lifestyle and a negative association with in-building time.

BIM for Healthy Buildings: An Integrated Approach of Architectural Design based on IAQ Prediction

The relationship between users and the built environment represents a fundamental aspect of health. The factors that define the properties linked to health and well-being are increasingly becoming part of building design. In these terms, building information modelling (BIM) and BIM-based performance simulation take on a priority role. Among the key features for the design of Healthy Buildings, indoor air quality (IAQ) plays a central role. There are numerous indoor pollutants with significant health effects; volatile organic compounds (VOCs) are to be mentioned among these. The paper presents the proposal of an integrated workflow in the BIM process for the check and control of VOC emissions from building materials and their concentration in confined environments. The workflow is developed through the systematisation of IAQ parameters for the open BIM standard, the integration in the BIM process of a numerical model for the prediction of the VOCs concentration in the indoor environment, and the development of model checkers for performance verification. The results show a good adhesion between the numerical model and the implementation in BIM, providing the designer with a rapid control instrument of IAQ in the various phases of the building design. The present study is the first development focused on TVOC, but implementable concerning other aspects of IAQ, as needed for the effectiveness of performance building-based design for health and wellness issues.

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.

Walkable Urban Environments: An Ergonomic Approach of Evaluation

Background. The salutogenicity of urban environments is significantly affected by their ergonomics, i.e., by the quality of the interactions between citizens and the elements of the built environment. Measuring and modelling urban ergonomics is thus a key issue to provide urban policy makers with planning solutions to increase the well-being, usability and safety of the urban environment. However, this is a difficult task due to the complexity of the interrelations between the urban environment and human activities. The paper contributes to the definition of a generalized model of urban ergonomics and salutogenicity, focusing on walkability, by discussing the relevant parameters from the large and variegated sets proposed in the literature, by discussing the emerging model structure from a data mining process, by considering the background of the relevant functional dependency already established in the literature, and by providing evidence of the solutions’ effectiveness. The methodology is developed for a case study in central Italy, with a focus on the mobility issue, which is a catalyst to generate more salutogenic and sustainable behaviors.

COVID 19—A Qualitative Review for the Reorganization of Human Living Environments

The COVID-19 pandemic is changing people’s habits and behaviors and will reshape city layout and management. Among the different areas of research to be explored, the paper outlines first inputs to use the COVID-19 health crisis as a “window of opportunity” to trigger a sustainable transition of urban living environments, through actions to reshape and territorial organization after COVID-19 and in preparation for future health. Before having a vaccine or medications that ensure a non-lethal disease course, there will be a phase of responsibility and coexistence with the virus. It will be a period whose duration experts are still unable to quantify. What changes in the city organization, behaviors and uses of spaces will we observe in the living environments? Will this lead to a sustainability transition? The paper proposes a qualitative review to investigate how the droplet might travel through the air and how COVID-19 has spread in different urban contexts to outline a comprehensive reflection on the future of the city and strategies for more resilient communities and territories. To achieve this goal, the paper proposes the need of a comparison between skills related to physics aspects, such as fluid dynamics (to assess how droplets spread) and skills related to architectural, urban and territorial design (to evaluate the conditions of indoor and outdoor living environments).

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.

Corruption and Solid Waste Management in Mbarara Municipality, Uganda

Mbarara Municipality in Western Uganda has for many years struggled to manage municipal solid waste. Leaders in this municipality have mainly attributed this persistent problem to poor financing, failure to enforce existing solid waste management laws and regulations, limited community participation, deprived attitude by the public towards waste collection, and tendency of municipal dwellers to litter. No in-depth academic study in Mbarara Municipality has ever been done to expose and illustrate how corruption directly happens and influence solid waste management. This study fills this knowledge gap by illustrating how corruption influences poor solid waste management in Mbarara Municipality. The study finds that municipal technical officials, garbage truck drivers, their turn boys, garbage sorters, factory owners, and private land grabbers all involved in different forms of corruption have directly and indirectly turned solid waste collection and disposal into a very costly problem to the municipal council and the general public. The article recommends that fighting corruption in all its forms without fear or favor, encouraging them to play their role particularly in sorting waste, adoption of smart technologies, and putting in place measures that attract private investors while protecting the public can help in the effective management of solid waste in Mbarara Municipality.

Environmental Risks Perception Among Citizens Living Near Industrial Plants: A Cross-Sectional Study

The present work is a cross-sectional study aimed at assessing the risk perception and evaluating the community outrage linked to environmental factors among a self-selected sample of citizens living in an area characterized by the presence of industrial structures of high emotional impact. An anonymous questionnaire was administered to the population by publishing a Google form URL code in local and regional newspapers and via social media. The resulting data were entered on Excel and analyzed. Qualitative variables were summarized with absolute and relative (percentage) frequencies. The results showed that the event that causes the greatest worry was air pollution, with 92.6% of the respondents stating that they perceived the problem as "very" or "quite" worrying. Furthermore, all the health problems investigated in relation to environmental quality aroused concern among the interviewees, with 93.1% believing there was a cause-effect relationship between environmental quality and health. Overall, as other studies had previously underlined, the survey shows that the perceived risks are not always in line with the real ones, Thus, it is imperative to articulate interventions aimed at offering the population objective tools to enable them to interpret the risks themselves. In this regard, a fundamental role is played by adequate communication between the competent bodies and political decision-makers and the population.

Testing the Multiple Pathways of Residential Greenness to Pregnancy Outcomes Model in a Sample of Pregnant Women in the Metropolitan Area of Donostia-San Sebastián

Residential greenness may positively impact diverse human health indicators through the reduction of air pollution, the improvement of psychological health, and the promotion of physical activity. Previous studies indicate a weak but positive association with pregnancy outcomes. Our aim was to test the multiple pathways from residential greenness to pregnancy outcomes model, using residential NO₂ concentrations, psychological health, and moderate-to-vigorous physical activity (MVPA) during the first trimester of pregnancy, in a sample of 440 pregnant women residing in Donostia, Spain. Three metrics of residential greenness were calculated around each participant’s home address: normalized difference vegetation index (NDVI) within 300 m, and green space (>5000 m²) availability within 300 and 500 m. Residential NO₂ concentrations, psychological health, and MVPA were explored as mediators of the associations between these metrics and the following pregnancy outcomes: birth weight (BW), low birth weight (LBW), prematurity, small for gestational age (SGA), and large for gestational age (LGA). Educational attainment, parity, and body mass index (BMI) were treated as covariates. Counterfactual mediation analyses showed very low to null statistical support for an association between any of the greenspace metrics and pregnancy outcomes in the full sample. Green space availability (300 m) was associated with lower BW and showed a marginal protective effect against LGA.

Mortality inequalities by occupational status and type of job in men and women: results from the Rome Longitudinal Study

OBJECTIVES

Socioeconomic inequalities have a strong impact on population health all over the world. Occupational status is a powerful determinant of health in rich societies. We aimed at investigating the association between occupation and mortality in a large metropolitan study.

DESIGN

Cohort study.

SETTING

Rome, capital of Italy.

PARTICIPANTS

We used the Rome Longitudinal Study, the administrative cohort of residents in Rome at the 2001 general census, followed until 2015. We selected residents aged 15-65 years at baseline. For each subject, we had information on sex, age and occupation (occupational status and type of job) according to the Italian General Census recognition.

MAIN OUTCOME MEASURES

We investigated all-cause, cancer, cardiovascular and accidental mortality, major causes of death in the working-age population. We used Cox proportional hazards models to investigate the association between occupation and all-cause and cause-specific mortality in men and women.

RESULTS

We selected 1 466 726 subjects (52.1% women). 42 715 men and 29 915 women died during the follow-up. In men, 47.8% of deaths were due to cancer, 26.7% to cardiovascular causes and 6.4% to accidents, whereas in women 57.8% of deaths were due to cancer, 19.3% to cardiovascular causes and 3.5% to accidents. We found an association between occupational variables and mortality, more evident in men than in women. Compared with employed, unemployed had a higher risk of mortality for all causes with an HR=1.99 (95% CI 1.92 to 2.06) in men and an HR=1.49 (95% CI 1.39 to 1.60) in women. Compared with high-qualified non-manual workers, non-specialised manual workers had a higher mortality risk (HR=1.68, 95% CI 1.59 to 1.77 and HR=1.30, 95% CI 1.20 to 1.40, for men and women, respectively).

CONCLUSIONS

This study shows the importance of occupational variables as social health determinants and provides evidence for policy-makers on the necessity of integrated and preventive policies aimed at improving the safety of the living and the working environment.

Planning and Design Support Tools for Walkability: A Guide for Urban Analysts

We present a survey of operational methods for walkability analysis and evaluation, which we hold show promise as decision-support tools for sustainability-oriented planning and urban design. An initial overview of the literature revealed a subdivision of walkability studies into three main lines of research: transport and land use, urban health, and livable cities. A further selection of articles from the Scopus and Web of Science databases focused on scientific papers that deal with walkability evaluation methods and their suitability as planning and decision-support tools. This led to the definition of a taxonomy to systematize and compare the methods with regard to factors of walkability, scale of analysis, attention on profiling, aggregation methods, spatialization and sources of data used for calibration and validation. The proposed systematization aspires to offer to non-specialist but competent urban analysts a guide and an orienteering, to help them integrate walkability analysis and evaluation into their research and practice.

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

BACKGROUND AND AIM OF THE WORK

The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it's necessary to make resilient the systems and local capacities to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities?

METHODS

According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the "period" of physical distancing.  Results. Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services' plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism.  Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services' network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders' awareness of the factors affecting Public Health in the cities.

CONCLUSIONS

The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments. (www.actabiomedica.it).

Synergies in Design and Health. The role of architects and urban health planners in tackling key contemporary public health challenges

Background and aim:

Important public health improvements have been achieved over the past decades, but new challenges are emerging and progress cannot be taken for granted. Urban settlements host most of the global population, but they are also sources of several threats. The aim of the paper is to investigate the role of architects and planners in contributing to overcome these critical health challenges and propose strategic actions for collaboration with the public health workforce.

Methods:

Taking global trends and public health challenges as starting point, a scoping literature review has been conducted to illustrate the possible synergies that architecture and public health workforce should exploit to support population health improvement and tackle key public health challenges.

Results:

The built environment affects climate change and public health through the use of resources, site location, and green spaces. In architecture curricula, limited space is devoted to health and vice versa. There is an urgent need for recognition of the benefits of collaboration and cross-fertilisation between public health and planning workforce from local to global levels.

Conclusion:

Public health is evolving from a bio-medical to a socio-anthropological approach and architects/planners have fundamental roles; further collaboration, research and training are needed.

The campaign "This Is Public Health" in Italy, set up by a team of Public Health Schools in Northern Italy

Despite the great effort to raise awareness among health promotion, nowadays Public Health policies are not often recognized as important tools. For this reason, the Health in All Policies (HiAP) approach is instrumental in tackling this information gap. In 2018, the US Association of Schools & Programs of Public Health (ASPPH) launched an international campaign called “This is Public Health” (TIPH), whose aim was “to brand public health and raise awareness of how it affects individuals, communities and populations”. The Association of Schools of Public Health in the European Region (ASPHER), in coordination with ASPPH, decided to create a European campaign to support and to reproduce the American one, by opening a challenge among the European Public Health Schools. The Schools and Programs of PH of Vita-Salute “San Raffaele” University, Milan, University of Parma, University of Pavia and Politecnico of Milan won this bid. In this “briefing on” we present a report on the Italian project for raising awareness of Public Health among general population and health care personell.

The Role of Urban Morphology Design on Enhancing Physical Activity and Public Health

Along with environmental pollution, urban planning has been connected to public health. The research indicates that the quality of built environments plays an important role in reducing mental disorders and overall health. The structure and shape of the city are considered as one of the factors influencing happiness and health in urban communities and the type of the daily activities of citizens. The aim of this study was to promote physical activity in the main structure of the city via urban design in a way that the main form and morphology of the city can encourage citizens to move around and have physical activity within the city. Functional, physical, cultural-social, and perceptual-visual features are regarded as the most important and effective criteria in increasing physical activities in urban spaces, based on literature review. The environmental quality of urban spaces and their role in the physical activities of citizens in urban spaces were assessed by using the questionnaire tool and analytical network process (ANP) of structural equation modeling. Further, the space syntax method was utilized to evaluate the role of the spatial integration of urban spaces on improving physical activities. Based on the results, consideration of functional diversity, spatial flexibility and integration, security, and the aesthetic and visual quality of urban spaces plays an important role in improving the physical health of citizens in urban spaces. Further, more physical activities, including motivation for walking and the sense of public health and happiness, were observed in the streets having higher linkage and space syntax indexes with their surrounding texture.

Housing Demand in Urban Areas and Sanitary Requirements of Dwellings in Italy

The phenomenon of urbanisation is becoming increasingly prevalent on a global level, and the health issues regarding the urban environment are of primary importance in public health. Accordingly, the present manuscript describes an analysis of the housing conditions of Italian urban areas, referring to the city of Sassari (Sardinia), Italy, focused on the dwelling structural and sanitary conditions issued by the Italian regulations. Data relating to the housing conditions of the population were acquired by the Local Hygiene and Public Health Service (SISP), in a period between 2012 and 2016. Qualitative variables were summarised with absolute and relative (percentages) frequencies, whereas quantitative variables with means and standard deviations depending on their parametric distribution. Statistical comparisons for qualitative and quantitative variables were performed with the χ ² test or Student's t-test, respectively. A p value less than 0.05 was considered statistically significant. Finally, the dwellings and the collected variables were georeferenced on a city map. During the 2012-2016 observation period, 363 certification requests were received from 193 (53.2%) foreign-born citizens and 170 (46.8%) Italians at the SISP offices. The main reasons relate to the request for a residency permit (46.6%) and to obtain a subsidy from the local government (32.8%). Overall, 15.4% of dwellings were found to be improper, while 35.3% and 22.0% were found to be unhygienic and uninhabitable, respectively. The foreigners' homes were found to be suitable in 82.7% of cases; the housing of Italian citizens, on the contrary, was found to be suitable in 28% of the observations. The present study offers a cross section of the housing conditions of Italian urban areas, referring to the city of Sassari. To the authors' best knowledge, this observation is the first one carried out in Sardinia and one of the first observations in Italy. It has emerged that "hygienically unsuitable" homes are those that, in most cases, are located in the city centre. Moreover, the Italian population is hit by a significant housing problem, due to overcrowding, uninhabitability, and unhygienic conditions. Overall, our findings suggest that it is necessary to develop a multidisciplinary approach to guarantee public health, with safe dwellings homes and the surrounding urban context alongside the development of social relations. Nevertheless, there is still little evidence available today on the population housing conditions, especially regarding the private indoor environment, and further research is needed to bridge this knowledge gap.

Solid Wastes Provide Breeding Sites, Burrows, and Food for Biological Disease Vectors, and Urban Zoonotic Reservoirs: A Call to Action for Solutions-Based Research

Background: Infectious disease epidemiology and planetary health literature often cite solid waste and plastic pollution as risk factors for vector-borne diseases and urban zoonoses; however, no rigorous reviews of the risks to human health have been published since 1994. This paper aims to identify research gaps and outline potential solutions to interrupt the vicious cycle of solid wastes; disease vectors and reservoirs; infection and disease; and poverty.

Methods: We searched peer-reviewed publications from PubMed, Google Scholar, and Stanford Searchworks, and references from relevant articles using the search terms (“disease” OR “epidemiology”) AND (“plastic pollution,” “garbage,” and “trash,” “rubbish,” “refuse,” OR “solid waste”). Abstracts and reports from meetings were included only when they related directly to previously published work. Only articles published in English, Spanish, or Portuguese through 2018 were included, with a focus on post-1994, after the last comprehensive review was published. Cancer, diabetes, and food chain-specific articles were outside the scope and excluded. After completing the literature review, we further limited the literature to “urban zoonotic and biological vector-borne diseases” or to “zoonotic and biological vector-borne diseases of the urban environment.”

Results: Urban biological vector-borne diseases, especially Aedes-borne diseases, are associated with solid waste accumulation but vector preferences vary over season and region. Urban zoonosis, especially rodent and canine disease reservoirs, are associated with solid waste in urban settings, especially when garbage accumulates over time, creating burrowing sites and food for reservoirs. Although evidence suggests the link between plastic pollution/solid waste and human disease, measurements are not standardized, confounders are not rigorously controlled, and the quality of evidence varies. Here we propose a framework for solutions-based research in three areas: innovation, education, and policy.

Conclusions: Disease epidemics are increasing in scope and scale with urban populations growing, climate change providing newly suitable vector climates, and immunologically naïve populations becoming newly exposed. Sustainable solid waste management is crucial to prevention, specifically in urban environments that favor urban vectors such as Aedes species. We propose that next steps should include more robust epidemiological measurements and propose a framework for solutions-based research.

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

Background and aim of the work.

The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it’s necessary to make the systems and local capacities resilient to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities?

Methods.

According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the “period” of physical distancing.

Results.

Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services’ plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism. Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services’ network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders’ awareness of the factors affecting Public Health in the cities.

Conclusions.

The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments. (www.actabiomedica.it)

Chemical Pollution in Healing Spaces: The Decalogue of the Best Practices for Adequate Indoor Air Quality in Inpatient Rooms

Indoor air quality (IAQ) is one of the main topics in which governments are focusing. In healthcare facilities, several studies have reported data analysis and case studies to improve users' health. Nowadays, although many studies have been conducted related to the biological and physical risks, the chemical risks have been less investigated and only in some specific functional areas of the hospitals. Starting from some systematic reviews and research works, this paper aims to list the best healthy practices for an adequate IAQ in inpatient wards. In particular, the decalogue lists the strategies related to chemical pollution, starting from design and management, with a focus on (a) localization of hospitals and inpatient rooms, (b) hospital room, (c) microclimatic parameters, (d) ventilation systems, (e) materials and finishing, (f) furniture and equipment, (g) cleaning products and activities, (h) maintenance and (i) management activities, and (l) users and workers. The multidisciplinary approach emphasizes the need for interdisciplinary knowledge and skills aimed to find solutions able to protect users' health status. The design and management decision-making, ranging from the adequate choices of construction site and hospital exposure, finishing materials, cleaning and maintenance activities, etc., which can affect the IAQ must be carried out based on scientific research and data analysis.

How Does the Built Environment in Compact Metropolitan Cities Affect Health? A Systematic Review of Korean Studies

This systematic review aimed to examine the associations between health-related outcomes and the built environment (BE) characteristics of compact metropolitan cities in Korea using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Searching the three Korean academic databases and PubMed, two independent reviewers identified 27 empirical articles published between 2011 and 2016. Data extracted for review included the study characteristics, the variables and measurement methods related to the BE and health-related outcomes, and the findings on the associations between the BE characteristics and health-related outcomes. Vote counting was used to assess the consistency of associations and the direction of associations between the BE characteristics and health-related outcomes. All of the reviewed studies used cross-sectional designs. The objective BE qualities were commonly examined. The BE characteristics associated with health-related outcomes in the reviewed articles included land use, street environment, transportation infrastructure, green and open spaces, and neighborhood facilities. Street environment, transportation infrastructure, and green and open spaces had consistent positive associations with physical health. Mixed land use and neighborhood facilities, however, had inconsistent associations with physical health. Generally, insufficient findings were reported in the association between the BE characteristics and mental and social health. The accessibility of the BE in a compact urban environment was the prominent attribute related to health promotion, health challenges, and health equity. An international comparative analysis of compact cities with different urban contexts and scale is required. Interdisciplinary urban health strategies are recommended based on the associations between the BE characteristics and health-related outcomes.

The Pleasure of Walking: An Innovative Methodology to Assess Appropriate Walkable Performance in Urban Areas to Support Transport Planning

The Walking Suitability Index of the Territory–T-WSI is an innovative methodology to assess walkability. Unlike other methods and tools in this field designed to evaluate walkability on given origin-destination paths, T-WSI is conceived for area-wide assessments, typically at the neighborhood level. This can be achieved by visual surveys to collect data, which are easy to perform at street level, their further process via an algorithm, and their aggregation to assess the walking performance levels of the test area. The paper describes such methodology, which includes the development of 12 indicators associated with four main evaluation categories (Practicability, Safety, Urbanity and Appeal), and its application to a case study in a medium-size town in central Italy. Results are described and elaborated to highlight T-WSI’s contribution to help decision makers in the urban governance process, typically in the fields of land use, mobility management and maintenance, coherently with the research objective to enlarge the potential of walkability methodologies thus far available up to area-level assessment.

Walkable Environments and Healthy Urban Moves: Urban Context Features Assessment Framework Experienced in Milan

Recent studies in public health have focused on determining the influences of the built environment on the population’s physical and mental health status. In order to promote active transport and physical activity, considered favorable behavior for the prevention non-communicable diseases (NCDs) such as obesity, it is necessary to reduce the negative effects of the built environment and develop positive ones, such as, for example, a walkable urban space. The aim of the research is to define a city’s walkability assessment framework capable of highlighting points of strength and weakness in its urban environment. All of the aspects that have a direct influence (evidence-based) on fostering the adoption of healthy lifestyles or promoting active transport as a strategy to increase the level of physical activity due to the existence of daily urban travel should be considered. After conducting a literature review aimed at identifying all of the existing assessment tools, 20 research studies were examined in detail. The new evaluation method arises from the comparison and critical selection of the various qualitative–quantitative indicators found, integrated into a multi-criteria analysis structure of dual-scale survey, with reference to walkability and paying attention to those indicators that have implications on health promotion. The new assessment framework, named Milano Walkability Measurement (MWM), is applicable in different urban contexts and was tested in two different areas of Milan. The Macro dimension (i.e., Density, Diversity, and Design criteria) refers to the urban scale and examines the city from a top view. It describes quantitatively the overall urban factors (urban area size equal to 1.5 Km2; typology of data: archival). The Micro dimension (i.e., Usefulness, Safeness, Comfort, and Aesthetics criteria) investigates the city at the street scale level. It describes qualitatively features of the outdoor spaces (road length of about 500/700 mt; typology of data: observational). Finally, the framework was weighted by comparison with a panel of experts. The expected results were reflected in the design recommendations based on the collected qualitative-quantitative data. The developed assessment method brings innovative criteria such as the multi-scaling assessment phase (Macro and Micro) and the ability to take into consideration aspects that according to the literature have relationships with health promotion linked to the improvement of a healthy lifestyle, related to daily active transportation choices. The design recommendations are useful both to policy-makers, to make evidence-based specific choices, and to designers, to understand what aspects of the urban environment must be improved or implemented in order to promote a walkable city.

Physical Activity and Thyroid Cancer Risk: A Case-Control Study in Catania (South Italy)

Background: The health benefits of physical activity are well established, but the association between physical activity and thyroid cancer remains poorly understood. The aim of the study was to investigate the relationship between physical activity and thyroid cancer in order to determine type, frequency, and duration of exercise needed to maximize prevention. Method: Cases, diagnosed from January 2009 to July 2018, and controls were enrolled at the University Hospital “Policlinico-Vittorio Emanuele” of Catania (South Italy). Logistic regression models were used to estimate the crude and adjusted odds ratios (ORs) and their 95% confidence intervals. Results: A total of 106 cases (91.2% papillary type) and 217 controls were enrolled. Physical activity was rare in Catania (32.8%) and was not correlated to risk of total thyroid cancer (OR: 0.997; 95% CI: 0.515–1.929). Conversely, walking every day for at least 60 minutes reduced the risk of thyroid cancer (OR: 0.357; 95% CI: 0.157–0.673). Conclusions: Our study showed that daily walking duration was associated with lower risk of thyroid cancer using a case-control study. Unfortunately, the frequency of physical activity often declines with age, particularly among the elderly, thus more research on physical activity adherence is needed to determine which approaches are most effective in promoting sustained physical activity participation.

Urban Sprawl and Health Outcome Associations in Sicily

Urban sprawl has several negative impacts on the environment, the economy, and human health. The main objective of this work was to formulate and validate a sprawl/compactness index for Sicilian municipalities and evaluate its association with health outcomes. An ecological study was conducted with 110 municipalities in Sicily, Italy. Principal component analysis was adopted to create the sprawl/compactness Sicilian index, and linear regression analysis was used to evaluate the association between the sprawl index and health outcomes. More variance of the new sprawl index was explained by the working factor, followed by density, surface extension, and land use mix. When validating the index, we found that public transportation had an inverse relation with sprawl increase (p < 0.001), and private transportation was directly related to the increase in sprawl (p < 0.001). After controlling for the Sicilian socio-economic deprivation index and overall mortality, cardiovascular mortality was the only outcome directly associated with the increase in the sprawl index (odds ratio = 0.0068, p < 0.001). Urban sprawl has to be monitored in Sicily over time to understand the evolution of the urbanization phenomenon and its relationship with health outcomes such as cardiovascular mortality. The use of the sprawl index should help policymakers define the necessary strategic aspects and actions to improve human health and quality of life in cities through a multi-sectorial approach.

Population Distrust of Drinking Water Safety. Community Outrage Analysis, Prediction and Management

The aim of the work is to evaluate the effectiveness of the risk communication strategies in cases of unsafe drinking water supply in Sardinia, the Italian context with the highest population distrust in drinking water safety. During the period 2010–2015, the ordinances published on the institutional websites were analyzed, and the population risk perception was evaluated by applying, for the first time in public health threats, the “OUTRAGE Prediction & Management” software released by Sandman. Overall, 417 ordinances issued by the Sardinian Municipalities were found. Only 1.5% of the ordinances reported information about parameters, concentrations, and risks to health, whereas 4.8% indicated only the parameters and non-standard levels. By contrast, 53.2% specified only the non-standard parameter, and 40.5% indicated a generic non-drinking motivation. The outrage assessment showed values exceeding the threshold of risk acceptance, attributable to the lack and low clarity of the information reported by the ordinances. The present study allowed us to highlight critical issues in risk communication of the quality of drinking water.

Built Environment Features and Pedestrian Accidents: An Italian Retrospective Study

Daily walking is a recommended physical activity. It can be an all-age suitable, environment-friendly transport option. However, traffic crashes are a widely recognized risk factor, associated with drivers’ errors or a combination of several environmental factors, including physical characteristics of the road space. The aim of this study was to assess the characteristics of built environments on pedestrian safety. Data on road accidents that had occurred between 2005 and 2015, in Alghero, Italy, were retrieved and matched with spatial and functional street qualities. On-street parking was found to increase the risk of pedestrian accidents by about two times, whereas, narrow travel lanes and intersections reduced the incidence of crashes and their public relevance. These field results could inform urban health and spatial planning policies with the final goal of improving health and providing more sustainable models of urban organization.