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Dyer GMC, Khomenko S, Adlakha D, Anenberg S, Behnisch M, Boeing G, Esperon-Rodriguez M, Gasparrini A, Khreis H, Kondo MC, Masselot P, McDonald RI, Montana F, Mitchell R, Mueller N, Nawaz MO, Pisoni E, Prieto-Curiel R, Rezaei N, Taubenböck H, Tonne C, Velázquez-Cortés D, Nieuwenhuijsen M. Exploring the nexus of urban form, transport, environment and health in large-scale urban studies: A state-of-the-art scoping review. ENVIRONMENTAL RESEARCH 2024; 257:119324. [PMID: 38844028 DOI: 10.1016/j.envres.2024.119324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND As the world becomes increasingly urbanised, there is recognition that public and planetary health relies upon a ubiquitous transition to sustainable cities. Disentanglement of the complex pathways of urban design, environmental exposures, and health, and the magnitude of these associations, remains a challenge. A state-of-the-art account of large-scale urban health studies is required to shape future research priorities and equity- and evidence-informed policies. OBJECTIVES The purpose of this review was to synthesise evidence from large-scale urban studies focused on the interaction between urban form, transport, environmental exposures, and health. This review sought to determine common methodologies applied, limitations, and future opportunities for improved research practice. METHODS Based on a literature search, 2958 articles were reviewed that covered three themes of: urban form; urban environmental health; and urban indicators. Studies were prioritised for inclusion that analysed at least 90 cities to ensure broad geographic representation and generalisability. Of the initially identified studies, following expert consultation and exclusion criteria, 66 were included. RESULTS The complexity of the urban ecosystem on health was evidenced from the context dependent effects of urban form variables on environmental exposures and health. Compact city designs were generally advantageous for reducing harmful environmental exposure and promoting health, with some exceptions. Methodological heterogeneity was indicative of key urban research challenges; notable limitations included exposure and health data at varied spatial scales and resolutions, limited availability of local-level sociodemographic data, and the lack of consensus on robust methodologies that encompass best research practice. CONCLUSION Future urban environmental health research for evidence-informed urban planning and policies requires a multi-faceted approach. Advances in geospatial and AI-driven techniques and urban indicators offer promising developments; however, there remains a wider call for increased data availability at local-levels, transparent and robust methodologies of large-scale urban studies, and greater exploration of urban health vulnerabilities and inequities.
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Affiliation(s)
- Georgia M C Dyer
- Barcelona Institute for Global Health (ISGlobal), Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fern'andez Almagro, 3-5, 28029, Madrid, Spain
| | - Sasha Khomenko
- Barcelona Institute for Global Health (ISGlobal), Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fern'andez Almagro, 3-5, 28029, Madrid, Spain
| | - Deepti Adlakha
- Delft University of Technology, Mekelweg 5, 2628, Delft, Netherlands
| | - Susan Anenberg
- Environmental and Occupational Health Department, George Washington University, Milken Institute School of Public Health, 20052, New Hampshire Avenue, Washington, District of Colombia, United States
| | - Martin Behnisch
- Leibniz Institute of Ecological Urban and Regional Development, Weberpl 1, 01217, Dresden, Germany
| | - Geoff Boeing
- University of Southern California, 90007, Los Angeles, United States
| | - Manuel Esperon-Rodriguez
- Hawkesbury Institute for the Environment, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia; School of Science, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Antonio Gasparrini
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1E 7HT, London, United Kingdom
| | - Haneen Khreis
- MRC Epidemiology Unit, Cambridge University, CB2 0AH, Cambridge, United Kingdom
| | - Michelle C Kondo
- USDA-Forest Service, Northern Research Station, 100 North 20th Street, Ste 205, 19103, Philadelphia, PA, United States
| | - Pierre Masselot
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1E 7HT, London, United Kingdom
| | - Robert I McDonald
- The Nature Conservancy, 4245 North Fairfax Drive Arlington, 22203, Virginia, United States
| | - Federica Montana
- Barcelona Institute for Global Health (ISGlobal), Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fern'andez Almagro, 3-5, 28029, Madrid, Spain
| | - Rich Mitchell
- Institute of Health and Wellbeing, University of Glasgow, 90 Byres Road, Glasgow, G20 0TY, United Kingdom
| | - Natalie Mueller
- Barcelona Institute for Global Health (ISGlobal), Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fern'andez Almagro, 3-5, 28029, Madrid, Spain
| | - M Omar Nawaz
- Environmental and Occupational Health Department, George Washington University, Milken Institute School of Public Health, 20052, New Hampshire Avenue, Washington, District of Colombia, United States
| | - Enrico Pisoni
- European Commission, Joint Research Centre (JRC), 2749, Ispra, Italy
| | | | - Nazanin Rezaei
- University of California Santa Cruz, 1156 High Street, 95064, California, United States
| | - Hannes Taubenböck
- German Aerospace Centre (DLR), Earth Observation Center (EOC), 82234, Oberpfaffenhofen, Germany; Institute for Geography and Geology, Julius-Maximilians-Universität Würzburg, 97074, Würzburg, Germany
| | - Cathryn Tonne
- Barcelona Institute for Global Health (ISGlobal), Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fern'andez Almagro, 3-5, 28029, Madrid, Spain
| | - Daniel Velázquez-Cortés
- Barcelona Institute for Global Health (ISGlobal), Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fern'andez Almagro, 3-5, 28029, Madrid, Spain
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health (ISGlobal), Doctor Aiguader 88, 08003, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fern'andez Almagro, 3-5, 28029, Madrid, Spain.
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Lamprecht N, Erlanger TE, Utzinger J, Winkler MS. Prospects and Perspectives of Health Impact Assessment: A Systematic Review of the Peer-Reviewed Literature From June 2007 to January 2023. Public Health Rev 2024; 45:1606649. [PMID: 38689833 PMCID: PMC11059091 DOI: 10.3389/phrs.2024.1606649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
Objectives In 2008, an analysis investigating health impact assessment (HIA) practice found that only 6% of HIA-related peer-reviewed publications had a focus on low- and medium-developed countries, whereas 94% were conducted in countries with a high or very high development state. We aimed to update and deepen these observations. Methods We conducted a systematic review, searching PubMed and Web of Science for HIA-related papers published in the scientific literature from June 2007 to January 2023. Only applied HIA and papers with HIA as a subject were included. Results The search yielded 3,036 publications and the final selection consisted of 1,019 publications. The annual number of total publications increased considerably over the past 15 years. Whereas research-driven HIA (n = 460) showed a steep increase, step-by-step HIA (n = 71) did not show a clear trend. Conclusion The gap between the number of HIA-related peer-reviewed publications focusing on low/medium and high/very high developed countries has diminished from 6/94 to 11/89. There is a growing tendency to apply the terminology HIA for health impact modelling studies and quantitative health risk assessments.
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Affiliation(s)
- Nina Lamprecht
- Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- Swiss Federal Institute of Technology (ETH Zürich), Zürich, Switzerland
- University of Basel, Basel, Switzerland
| | - Tobias E. Erlanger
- Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Mirko S. Winkler
- Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Schramm A, Hacon SDS, Périssé ARS. Health Impact Assessment in protected areas: a proposal for urban contexts in Brazil. CAD SAUDE PUBLICA 2023; 39:e00087223. [PMID: 38055545 DOI: 10.1590/0102-311xen087223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 12/08/2023] Open
Abstract
The use of Health Impact Assessment (HIA) in the establishment of an urban protected area can enhance the positive impacts and mitigate the negative impacts resulting from its implementation. Brazil hosts some of the most important biodiversity hotspots in the world and the HIA may benefit biodiversity and human health. These areas are commonly created without any preceding survey to assess their impacts on health. Protected areas located in urban zones are essential to maintain environmental balance and quality of life in cities. It promotes positive impacts on health, providing ecosystem services and salutogenic benefits. However, they can generate negative impacts such as the violation of human rights, property speculation, spread of vectorial diseases, and psychosocial stress. Based on the identification of the potential impacts of urban protected areas on health and best practices, this qualitative and exploratory study justifies the use of HIA in urban protected areas, especially in the Brazil, and indicates the main elements for the construction of a methodological approach to contribute to the Sustainable Development Goals and one of its alternatives, the Buen Vivir approach.
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Affiliation(s)
- Ana Schramm
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Sandra de Souza Hacon
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Kalel ZS, Gulis G, Aringazina AM. Implementation of Health Impact Assessment in the Healthcare System of the Republic of Kazakhstan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2335. [PMID: 36767699 PMCID: PMC9915209 DOI: 10.3390/ijerph20032335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
The Health Impact Assessment (hereinafter referred to as HIA) is an effective method for predicting potential health impacts from decisions. Little is known about the implementation of the HIA in the Republic of Kazakhstan (further, RK). In addition, the Russian language literature has not yet been reviewed in terms of HIA-related knowledge. By conducting a literature review of enabling factors, including Russian language literature, on the implementation of the HIA and studying governance systems in RK, we aim to suggest an implementation process to implement the HIA in RK. After careful analysis of the governance system, we suggest set up of a HIA support unit under the National Scientific Center for Health Development and discuss the possible benefits. The proposed center should guide the implementation of the HIA in RK.
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Affiliation(s)
- Zhan S. Kalel
- Caspian International School of Medicine, Caspian University, 521 Seifullin Street, Almaty 050000, Kazakhstan
| | - Gabriel Gulis
- Unit for Health Promotion Research, University of Southern Denmark, Degnevej 14, Esbjerg 6700, Denmark
- Olomouc University Social Health Institute OUSHI, Palacky University Olomouc, Katerinska 653/17, 77900 Olomouc, Czech Republic
| | - Altyn M. Aringazina
- Caspian International School of Medicine, Caspian University, 521 Seifullin Street, Almaty 050000, Kazakhstan
- AlmaU School of Health Sciences, Almaty Management University, 227 Rozybakiev Street, 050060 Almaty, Kazakhstan
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Green L, Ashton K, Bellis M, Clements T, Douglas M. Predicted and observed impacts of COVID-19 lockdowns: two Health Impact Assessments in Scotland and Wales. Health Promot Int 2022; 37:6823570. [DOI: 10.1093/heapro/daac134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Health Impact Assessment is a key approach used internationally to identify positive or negative impacts of policies, plans and proposals on health and well-being. In 2020, HIAs were undertaken in Scotland and Wales to identify the potential health and well-being impacts of the ‘stay at home’ and physical distancing measures implemented at the start of the coronavirus disease (COVID-19) pandemic. There is sparse evidence evaluating whether the impacts predicted in HIAs occur following policy implementation. This paper evaluates the impacts anticipated in the COVID-19 HIAs against actual observed trends. The processes undertaken were compared and predicted impacts were tabulated by population groups and main determinants of health. Routine data and literature evidence were collated to compare predicted and observed impacts. Nearly all health impacts anticipated in both HIAs have occurred in the direction predicted. There have been significant adverse impacts through multiple direct and indirect pathways including loss of income, social isolation, disruption to education and services, and psychosocial effects. This research demonstrates the value of prediction in impact assessment and fills a gap in the literature by comparing the predicted impacts identified within the HIAs with observed trends. Post-COVID-19 recovery should centre health and well-being within future policies and decisions. Processes like HIA can support this as part of a ‘health in all policies’ approach to improve the health and well-being of populations.
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Affiliation(s)
- Liz Green
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-being’, Public Health Wales , Number 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ , UK
- Department of International Health, Care and Public Health Research Institute – CAPHRI, Maastricht University , Maastricht , The Netherlands
| | - Kathryn Ashton
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-being’, Public Health Wales , Number 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ , UK
- Department of International Health, Care and Public Health Research Institute – CAPHRI, Maastricht University , Maastricht , The Netherlands
| | - Mark Bellis
- Policy and International Health, WHO Collaborating Centre on ‘Investment in Health and Well-being’, Public Health Wales , Number 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ , UK
- Department of Public Health and Life Sciences, Bangor University , College Road, Bangor LL57 2DG , UK
| | - Timo Clements
- Department of Public Health and Life Sciences, Bangor University , College Road, Bangor LL57 2DG , UK
| | - Margaret Douglas
- Usher Institute, University of Edinburgh, Medical School , Teviot Place, Edinburgh EH8 9AG , UK
- Public Health Scotland , Gyle Square, Edinburgh EH12 9EB , UK
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Wadende P, Francis O, Musuva R, Mogo E, Turner-Moss E, Were V, Obonyo C, Foley L. Foodscapes, finance, and faith: Multi-sectoral stakeholder perspectives on the local population health and wellbeing in an urbanizing area in Kenya. Front Public Health 2022; 10:913851. [PMID: 36505008 PMCID: PMC9731138 DOI: 10.3389/fpubh.2022.913851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/28/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Rapid urbanization (growth of cities) can upset the local population's health and wellbeing by creating obesogenic environments which increase the burden of non-communicable diseases (NCDs). It is important to understand how stakeholders perceive the impact of urbanizing interventions (such as the construction of a new hypermarket) on the health and wellbeing of local populations. Because low- and middle-income countries (LMICs) lack the reliable infrastructure to mitigate the effects of obesogenic environments, so engaging stakeholders who influence dietary habits is one population-level strategy for reducing the burden of NCDs caused by newly built developments. Methods We conducted key informant interviews with 36 stakeholders (25 regulatory and 11 local community stakeholders) from Kisumu and Homa Bay Counties of Western Kenya in June 2019. We collected stakeholders' perspectives on the impacts of a new Mall and supermarket in Kisumu, and existing supermarkets in Homa Bay on the health and wellbeing of local populations. Results Through thematic discourse analysis, we noted that some stakeholders thought supermarkets enabled access to unhealthy food items despite these outlets being also reliable food sources for discerning shoppers. Others linked the changing physical environment to both an increase in pollution and different types of diseases. Stakeholders were unsure if the pricing and convenience of supermarkets would stop local populations from buying from their usual small-scale food vendors. The key finding of this study was that engaging relevant stakeholders as part of population health impact assessments of new developments in cities are important as it directs focus on health equity and prevention in instances of resource constraints. The findings highlight, also, that community members have a strong awareness of the potential for interventions that would improve the health and wellbeing of local populations.
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Affiliation(s)
- Pamela Wadende
- School of Education and Human Resource Development, Kisii University, Kisii, Kenya,*Correspondence: Pamela Wadende
| | - Oliver Francis
- MRC Epidemiology Unit, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
| | - Rosemary Musuva
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ebele Mogo
- MRC Epidemiology Unit, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
| | - Eleanor Turner-Moss
- MRC Epidemiology Unit, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
| | - Vincent Were
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Charles Obonyo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Louise Foley
- MRC Epidemiology Unit, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
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Kligerman DC, Cardoso TADO, Cohen SC, de Azevedo DCB, Toledo GDA, de Azevedo APCB, Charlesworth SM. Methodology for a Comprehensive Health Impact Assessment in Water Supply and Sanitation Programmes for Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12776. [PMID: 36232082 PMCID: PMC9565092 DOI: 10.3390/ijerph191912776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Based on the broader concept of health proposed by the Pan-American Health Organization/World Health Organization (PAHO/ WHO), 2018, and the absence in the literature of indices that translate the causal relationship between sanitation and health, a methodology for assessing the health impact of a water and sanitation programmes, known as a Health Impact Assessment (HIA), was developed, specifically in the Brazilian context, and focused on a school in the northeast of the country. Through exploratory and descriptive evidence, and using documentary research as a method, a retrospective survey was carried out from 2000 to 2022 using documents proposing evaluation methodologies. A single document was found to fit the research objective, which was used to develop the proposed HIA methodology. Development of the methodology consisted of two stages: definition of the health dimensions and selection of the indicators making up each dimension. The HIA methodology was then applied to a school in northeast Brazil to test its use, before a water-efficient management intervention was going to be used. The overall score of 46% indicated that there was room for improvement, which the new management approach could facilitate. This methodology is therefore proposed to be an instrument for the evaluation of public water and sanitation policies, thus assisting managers in the decision-making process and in guiding sanitation programs and plans.
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Affiliation(s)
- Débora Cynamon Kligerman
- Departamento de Saneamento e Saúde Ambiental (DSSA)(ENSP), Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro 21041-210, Brazil
| | | | - Simone Cynamon Cohen
- Departamento de Saneamento e Saúde Ambiental (DSSA)(ENSP), Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro 21041-210, Brazil
| | - Déborah Chein Bueno de Azevedo
- Núcleo de Tecnologia e Logística em Saúde (NUTEC) (ENSP), Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro 21040-361, Brazil
| | - Graziella de Araújo Toledo
- Departamento de Saneamento e Saúde Ambiental (DSSA)(ENSP), Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro 21041-210, Brazil
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Plass D, Hilderink H, Lehtomäki H, Øverland S, Eikemo TA, Lai T, Gorasso V, Devleesschauwer B. Estimating risk factor attributable burden - challenges and potential solutions when using the comparative risk assessment methodology. Arch Public Health 2022; 80:148. [PMID: 35624479 PMCID: PMC9137119 DOI: 10.1186/s13690-022-00900-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/12/2022] [Indexed: 03/21/2024] Open
Abstract
Background Burden of disease analyses quantify population health and provide comprehensive overviews of the health status of countries or specific population groups. The comparative risk assessment (CRA) methodology is commonly used to estimate the share of the burden attributable to risk factors. The aim of this paper is to identify and address some selected important challenges associated with CRA, illustrated by examples, and to discuss ways to handle them. Further, the main challenges are addressed and finally, similarities and differences between CRA and health impact assessments (HIA) are discussed, as these concepts are sometimes referred to synonymously but have distinctly different applications. Results CRAs are very data demanding. One key element is the exposure-response relationship described e.g. by a mathematical function. Combining estimates to arrive at coherent functions is challenging due to the large variability in risk exposure definitions and data quality. Also, the uncertainty attached to this data is difficult to account for. Another key issue along the CRA-steps is to define a theoretical minimal risk exposure level for each risk factor. In some cases, this level is evident and self-explanatory (e.g., zero smoking), but often more difficult to define and justify (e.g., ideal consumption of whole grains). CRA combine all relevant information and allow to estimate population attributable fractions (PAFs) quantifying the proportion of disease burden attributable to exposure. Among many available formulae for PAFs, it is important to use the one that allows consistency between definitions, units of the exposure data, and the exposure response functions. When combined effects of different risk factors are of interest, the non-additive nature of PAFs and possible mediation effects need to be reflected. Further, as attributable burden is typically calculated based on current exposure and current health outcomes, the time dimensions of risk and outcomes may become inconsistent. Finally, the evidence of the association between exposure and outcome can be heterogeneous which needs to be considered when interpreting CRA results. Conclusions The methodological challenges make transparent reporting of input and process data in CRA a necessary prerequisite. The evidence for causality between included risk-outcome pairs has to be well established to inform public health practice.
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Affiliation(s)
- Dietrich Plass
- German Environment Agency, Section Exposure Assessment and Environmental Health Indicators, Berlin, Germany.
| | - Henk Hilderink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Heli Lehtomäki
- Finnish Institute for Health and Welfare (THL), Health Security, Environmental Health, Helsinki, Finland.,University of Eastern Finland (UEF), Faculty of Health Sciences, School of Pharmacy, Kuopio, Finland
| | - Simon Øverland
- Section for Health Care Collaboration, Haukeland University Hospital, Bergen, Norway
| | - Terje A Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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Rapid health impact assessment of a Danish policy document: One Denmark without Parallel Societies: No Ghettos in 2030. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01375-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Health and Economic Impacts Assessment of O 3 Exposure in Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111646. [PMID: 34770158 PMCID: PMC8583463 DOI: 10.3390/ijerph182111646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
Health effects related to exposure to air pollution such as ozone (O3) have been documented. The World Health Organization has recommended the use of the Sum of O3 Means Over 35 ppb (SOMO35) to perform Health Impact Assessments (HIA) for long-term exposure to O3. We estimated the avoidable mortality associated with long-term exposure to tropospheric O3 in 14 cities in Mexico using information for 2015. The economic valuation of avoidable deaths related to SOMO35 exposure was performed using the willingness to pay (WTP) and human capital (HC) approaches. We estimated that 627 deaths (95% uncertainty interval (UI): 227–1051) from respiratory diseases associated with the exposure to O3 would have been avoided in people over 30 years in the study area, which confirms the public health impacts of ambient air pollution. The avoidable deaths account for almost 1400 million USD under the WTP approach, whilst the HC method yielded a lost productivity estimate of 29.7 million USD due to premature deaths. Our findings represent the first evidence of the health impacts of O3 exposure in Mexico, using SOMO35 metrics.
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Thondoo M, Goel R, Tatah L, Naraynen N, Woodcock J, Nieuwenhuijsen M. The Built Environment and Health in Low- and Middle-Income Countries: a Review on Quantitative Health Impact Assessments. Curr Environ Health Rep 2021; 9:90-103. [PMID: 34514535 DOI: 10.1007/s40572-021-00324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Features and attributes of the built environment (BE) impact positively and negatively on health, especially in cities facing unprecedented urban population growth and mass motorization. A common approach to assess the health impacts of built environment is health impact assessment (HIA), but it is rarely used in low- and middle-income countries (LMICs) where urbanization rates are fastest. This article reviews selected HIA case studies from LMICs and reports the methods and tools used to support further implementation of quantitative HIAs in cities of LMICs. RECENT FINDINGS In total, 24 studies were reviewed across Algeria, Brazil, China, India, Iran, Kenya, Thailand, Turkey, and Mauritius. HIAs examine specific pathways through which the built environment acts: air pollution, noise, physical activity, and traffic injury. Few HIAs of BE addressed more than one exposure pathway at a time, and most studies focused on air pollution across the sectors of transport and energy. A wide number of tools were used to conduct exposure assessment, and different models were applied to assess health impacts of different exposures. Those HIAs rely on availability of local concentration data and often use models that have set exposure-response functions (ERFs). ERFs were not adapted to local populations except for HIAs conducted in China. HIAs of BE are being successfully conducted in LMICs with a variety of tools and datasets. Scaling and expanding quantitative health impact modeling in LMICs will require further study on data availability, adapted models/tools, low technical capacity, and low policy demand for evidence from modeling studies. As case studies with successful use of evidence from modeling emerge, the uptake of health impact modeling of BE is likely to increase in favor of people and planet.
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Affiliation(s)
- M Thondoo
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park, Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - R Goel
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - L Tatah
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N Naraynen
- Department of Economics, International Business School, Xi'an Jiaotong-Liverpool University, Suzhou, Jiangsu Province, China
| | - J Woodcock
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Mark Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park, Dr. Aiguader, 88, 08003, Barcelona, Spain. .,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK. .,Department of Biomedicine, University Pompeu Fabra (UPF), 08005, Barcelona, Spain. .,Department of Environmental Epidemiology, Municipal Institute of Medical Research, IMIM-Hospital del Mar), 08003, Barcelona, Spain. .,Department of Epidemiology and Public Health, CIBER Epidemiología Y Salud Pública (CIBERESP), 28029, Madrid, Spain.
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Jabot F. L’évaluation d’impact sur la santé pour scruter et sculpter les politiques. SANTE PUBLIQUE 2021; Vol. 33:7-16. [PMID: 34372643 DOI: 10.3917/spub.211.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Health impact assessment (HIA) is a prospective approach that consists of identifying the potential consequences, both negative and positive, of an intervention on the health of populations with the aim of improving it. Identified as a specific practice in 1999, it rapidly gained in popularity and was progressively deployed on all continents with variations in terms of implementation strategies, area of application, scales of implementation, modes of governance, institutions and actors involved. It is currently booming in France and Quebec, where it is generating real expectations with regard to the issues of health inequalities, democracy and the coordination of sectoral policies. This article, based on our research, provides a brief portrait of HIA in France and introduces questions on the strengths, limitations and added-value of the approach. This special issue sheds light on the practice through applications in different fields and contexts, emphasizes the methodological, political and social issues related to the process as well as the challenges to be met in order to strengthen the potential of HIA to improve decision-making and develop policies and projects that promote health.
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Associations between Natural Resource Extraction and Incidence of Acute and Chronic Health Conditions: Evidence from Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116052. [PMID: 34199822 PMCID: PMC8200105 DOI: 10.3390/ijerph18116052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/03/2022]
Abstract
Natural resource extraction projects are often accompanied by complex environmental and social-ecological changes. In this paper, we evaluated the association between commodity extraction and the incidence of diseases. We retrieved council (district)-level outpatient data from all public and private health facilities from the District Health Information System (DHIS2). We combined this information with population data from the 2012 national population census and a geocoded list of resource extraction projects from the Geological Survey of Tanzania (GST). We used Poisson regression with random effects and cluster-robust standard errors to estimate the district-level associations between the presence of three types of commodity extraction (metals, gemstone, and construction materials) and the total number of patients in each disease category in each year. Metal extraction was associated with reduced incidence of several diseases, including chronic diseases (IRR = 0.61, CI: 0.47–0.80), mental health disorders (IRR = 0.66, CI: 0.47–0.92), and undernutrition (IRR = 0.69, CI: 0.55–0.88). Extraction of construction materials was associated with an increased incidence of chronic diseases (IRR = 1.47, CI: 1.15–1.87). This study found that the presence of natural resources commodity extraction is significantly associated with changes in disease-specific patient volumes reported in Tanzania’s DHIS2. These associations differed substantially between commodities, with the most protective effects shown from metal extraction.
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Lyatuu I, Loss G, Farnham A, Winkler MS, Fink G. Short-term effects of national-level natural resource rents on life expectancy: A cross-country panel data analysis. PLoS One 2021; 16:e0252336. [PMID: 34048480 PMCID: PMC8162665 DOI: 10.1371/journal.pone.0252336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
While a substantial amount of literature addresses the relationship between natural resources and economic growth, relatively little is known regarding the relationship between natural resource endowment and health at the population level. We construct a 5-year cross-country panel to assess the impact of natural resource rents on changes in life expectancy at birth as a proxy indicator for population health during the period 1970-2015. To estimate the causal effects of interest, we use global commodity prices as instrumental variables for natural resource rent incomes in two-stage-least squares regressions. Controlling for country and year fixed effects, we show that each standard deviation increase in resource rents results in life expectancy increase of 6.72% (CI: 2.01%, 11.44%). This corresponds to approximately one additional year of life expectancy gained over five years. We find a larger positive effect of rents on life expectancy in sub-Saharan Africa (SSA) compared to other world regions. We do not find short-term effects of rents on economic growth, but show that increases in resource rents result in sizeable increases in government revenues in the short run, which likely translate into increased spending across government sectors. This suggests that natural resources can help governments finance health and other development-oriented programs needed to improve population health.
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Affiliation(s)
- Isaac Lyatuu
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Georg Loss
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Andrea Farnham
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mirko S. Winkler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Optimizing the health benefits of climate change policies using health impact assessment. J Public Health Policy 2021; 41:139-154. [PMID: 31481736 DOI: 10.1057/s41271-019-00189-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Health impact assessment (HIA) is a tool that can be used to examine the potential health impacts of proposed climate change policies and offer recommendations to promote health and mitigate adverse health consequences of such policies. We used an HIA database, a literature search, and expert consultation to identify 12 HIAs of the proposed climate change policies from six states in the U.S. These policies included cap-and-trade legislation, heat-wave and sea-level-rise mitigation and adaptation, transportation policy impacts of climate change, carbon-reduction strategy scenarios, soil- and water-conservation strategies, urban forest canopy for climate adaptation, overheating buildings, and regional transportation plan and sustainable communities strategies. In four descriptive summaries, we found that HIAs foster stakeholder engagement and provide useful health-promoting recommendations. HIAs can facilitate cross-sector collaboration, help optimize the health co-benefits of climate change policies, and raise awareness among decision makers of health impacts of those proposed policies.
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Data for a city-level health impact assessment of urban transport in Mauritius. Data Brief 2021; 34:106658. [PMID: 33385026 PMCID: PMC7770510 DOI: 10.1016/j.dib.2020.106658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
Participatory quantitative Health Impact Assessments (HIAs) in developing countries are rare partly due to data scarcity. This paper reports on primary data collected in the city of Port Louis to complete a HIA of urban transport planning in Mauritius. We conducted a full-chain participatory HIA to assess health impacts on the basis of a transport mode shift in Port Louis, Mauritius [1]. By applying mixed-methods, we estimated averted deaths per year and economic outcomes by assessing the health determinants of air pollution, traffic deaths and physical activity. The participatory quantitative HIA included [1] baseline data collection [2] co-validation of transport policy scenarios with stakeholders and [3] quantitative modelling of health impacts. We used the risk assessment method for HIA appraisal. The data can be reused for epidemiological analysis and different types of impact assessments.
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Thondoo M, Mueller N, Rojas-Rueda D, de Vries D, Gupta J, Nieuwenhuijsen MJ. Participatory quantitative health impact assessment of urban transport planning: A case study from Eastern Africa. ENVIRONMENT INTERNATIONAL 2020; 144:106027. [PMID: 32827806 PMCID: PMC7434638 DOI: 10.1016/j.envint.2020.106027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/19/2020] [Accepted: 07/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND High rates of motorization in urban areas of Africa have adverse effects on public health. Transport-related mortality will increase as a result of inadequate transport infrastructure, air pollution and sedentary lifestyles. Health Impact Assessments (HIAs) have proven to be a successful tool to predict and mitigate negative health impact of urban transport planning policies, programmes or projects. Yet, there is a gap of evidence on transport and health in African countries. The aim of this study is assessing the health impacts of transport scenarios in Port Louis (city of 119,018 inhabitants in Mauritius) using a full chain participatory HIA model. METHODS We estimated health and economic impacts associated to transport scenarios with qualitative data and quantitative comparative risk assessment methods. The health impact modeling was based on differences between the baseline and three transport scenarios (worse, good, ideal), estimating the averted deaths per year and economic outcomes by assessing health determinants of air pollution (AP), traffic deaths and physical activity (PA). Data on air pollution and traffic fatalities were obtained from public data sources. Data used to construct scenarios, establish baseline travel mode shares and physical activity were collected through (a) open-ended individual interviews (IDIs) with 14 stakeholders (b) closed-ended survey questions to 600 citizens and (c) 2 focus group discussions (FGDs) with the same 14 stakeholders from (a). RESULTS In Port Louis, the worse-case transport scenario (doubling in car trips and a reduction in walking, motorcycle, and public transport), resulted in a total increment of 3.28 premature deaths per year. The good-case scenario (reducing car trips by half and increasing walking, motorcycle, and public transport trips) resulted in a total increment of 0.79 premature deaths per year. The ideal-case scenario (reduction in car and motorcycle trips and an increase in walking and public transport trips) resulted in a total reduction of 13.72 premature deaths per year. We estimated USD 23 millions of economic benefits related to mortality if the ideal-case was achieved. CONCLUSION Participatory HIA shows that implementing transport policies aiming for less than an ideal situation may not be adequate or sufficient to avoid negative transport-related mortality in Mauritius. Urban transport planning is an opportunity to encourage physical activity in rapidly urbanizing settings of Africa. Transport policies should aim to restrict all forms of private motorized vehicles and promote active and public transport to support public health. We highly recommend the use of participatory approaches in quantitative HIA to ensure context specificity and policy relevance.
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Affiliation(s)
- M Thondoo
- Barcelona Institute for Global Health (ISGlobal), Centre for Research in Environmental Epidemiology (CREAL), 08003 Barcelona, Spain; Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, 1018 WV Amsterdam, the Netherlands; Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain.
| | - N Mueller
- Barcelona Institute for Global Health (ISGlobal), Centre for Research in Environmental Epidemiology (CREAL), 08003 Barcelona, Spain; Department of Biomedicine, University Pompeu Fabra (UPF), 08005 Barcelona, Spain; Department of Epidemiology and Public Health, CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - D Rojas-Rueda
- Department of Environmental and Radiological Health Sciences, Colorado State University, 80523 Fort Collins, CO, USA
| | - D de Vries
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, 1018 WV Amsterdam, the Netherlands
| | - J Gupta
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, 1018 WV Amsterdam, the Netherlands
| | - M J Nieuwenhuijsen
- Barcelona Institute for Global Health (ISGlobal), Centre for Research in Environmental Epidemiology (CREAL), 08003 Barcelona, Spain; Department of Biomedicine, University Pompeu Fabra (UPF), 08005 Barcelona, Spain; Department of Environmental Epidemiology, Municipal Institute of Medical Research (IMIM-Hospital del Mar), 08003 Barcelona, Spain; Department of Epidemiology and Public Health, CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
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Thondoo M, De Vries DH, Rojas-Rueda D, Ramkalam YD, Verlinghieri E, Gupta J, Nieuwenhuijsen MJ. Framework for Participatory Quantitative Health Impact Assessment in Low- and Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207688. [PMID: 33096783 PMCID: PMC7589915 DOI: 10.3390/ijerph17207688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 12/20/2022]
Abstract
Background: Conducting health impact assessments (HIAs) is a growing practice in various organizations and countries, yet scholarly interest in HIAs has primarily focused on the synergies between exposure and health outcomes. This limits our understanding of what factors influence HIAs and the uptake of their outcomes. This paper presents a framework for conducting participatory quantitative HIA (PQHIA) in low- and middle-income countries (LMICs), including integrating the outcomes back into society after an HIA is conducted. The study responds to the question: what are the different components of a participatory quantitative model that can influence HIA implementation in LMICs? Methods: To build the framework, we used a case study from a PQHIA fieldwork model developed in Port Louis (Mauritius). To explore thinking on the participatory components of the framework, we extract and analyze data from ethnographic material including fieldnotes, interviews, focus group discussions and feedback exercises with 14 stakeholders from the same case study. We confirm the validity of the ethnographic data using five quality criteria: credibility, transferability, dependability, confirmability, and authenticity. We build the PQHIA framework connecting the main HIA steps with factors influencing HIAs. Results: The final framework depicts the five standard HIA stages and summarizes participatory activities and outcomes. It also reflects key factors influencing PQHIA practice and uptake of HIA outcomes: costs for participation, HIA knowledge and interest of stakeholders, social responsibility of policymakers, existing policies, data availability, citizen participation, multi-level stakeholder engagement and multisectoral coordination. The framework suggests that factors necessary to complete a participatory HIA are the same needed to re-integrate HIA results back into the society. There are three different areas that can act as facilitators to PQHIAs: good governance, evidence-based policy making, and access to resources. Conclusions: The framework has several implications for research and practice. It underlines the importance of applying participatory approaches critically while providing a blueprint for methods to engage local stakeholders. Participatory approaches in quantitative HIAs are complex and demand a nuanced understanding of the context. Therefore, the political and cultural contexts in which HIA is conducted will define how the framework is applied. Finally, the framework underlines that participation in HIA does not need to be expensive or time consuming for the assessor or the participant. Yet, participatory quantitative models need to be contextually developed and integrated if they are to provide health benefits and be beneficial for the participants. This integration can be facilitated by investing in opportunities that fuel good governance and evidence-based policy making.
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Affiliation(s)
- Meelan Thondoo
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona Institute for Global Health (ISGlobal), 08003 Barcelona, Spain
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, 1018 WV Amsterdam, The Netherlands; (D.H.D.V.); (J.G.)
- Faculty of Medicine and Health Sciences, University of Barcelona (UB), 08036 Barcelona, Spain
- Correspondence: (M.T.); (M.J.N.)
| | - Daniel H. De Vries
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, 1018 WV Amsterdam, The Netherlands; (D.H.D.V.); (J.G.)
| | - David Rojas-Rueda
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA;
| | - Yashila D. Ramkalam
- Faculty of Social Sciences, University of Mauritius, Reduit 80837, Mauritius;
| | - Ersilia Verlinghieri
- Transport Studies Unit, University of Oxford, Oxford OX1 3QY, UK;
- Active Travel Academy, University of Westminster, London W1B 2UW, UK
| | - Joyeeta Gupta
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, 1018 WV Amsterdam, The Netherlands; (D.H.D.V.); (J.G.)
| | - Mark J. Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona Institute for Global Health (ISGlobal), 08003 Barcelona, Spain
- Department of Biomedicine, University Pompeu Fabra (UPF), 08005 Barcelona, Spain
- Department of Environmental Epidemiology, Municipal Institute of Medical Research (IMIM-Hospital del Mar), 08003 Barcelona, Spain
- Department of Epidemiology and Public Health, CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: (M.T.); (M.J.N.)
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Jabot F, Tremblay E, Rivadeneyra A, Diallo TA, Lapointe G. A Comparative Analysis of Health Impact Assessment Implementation Models in the Regions of Montérégie (Québec, Canada) and Nouvelle-Aquitaine (France). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6558. [PMID: 32916887 PMCID: PMC7559264 DOI: 10.3390/ijerph17186558] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022]
Abstract
Many countries have introduced health impact assessment (HIA) at the national, regional, or local levels. In France and in Québec, there is increasing interest in using HIA to inform decision-makers and influence policies, programs, and projects. This paper aims to compare HIA implementation models in two regions: Nouvelle-Aquitaine (France) and Montérégie (Québec, Canada) using a case study methodology. The objective is to gain a better understanding of the similarities and differences in the approaches used to achieve the operationalization of HIA. The methodological approach involves four steps: (1) design of an analytical framework based on the literature; (2) exchanges within the research team and review of documents concerning the two implementation strategies under study; (3) development of the case studies based on the proposed framework; and (4) cross-comparison analysis of the case studies. The findings show that the two regions share certain similarities, including the strong commitment and political will of the public health organizations involved and a well-established culture of engaging in intersectoral action with municipal partners. Differences mainly concern their different approaches to implementing HIAs in accordance with the regional policies and the organizational and administrative contexts in place. This study identifies potential avenues for supporting the practice of HIA at the municipal level.
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Affiliation(s)
- Françoise Jabot
- Univ Rennes, EHESP, CNRS, ARENES–UMR 6051, F-35000 Rennes, France
| | - Emile Tremblay
- Direction of environmental health and toxicology, Institut National de Santé Publique du Québec, Quebec City, QC G1V 5B3, Canada; (E.T.); (G.L.)
| | | | - Thierno Amadou Diallo
- National Collaborating Centre for Healthy Public Policy, Montreal, QC H2P 1E2, Canada;
| | - Geneviève Lapointe
- Direction of environmental health and toxicology, Institut National de Santé Publique du Québec, Quebec City, QC G1V 5B3, Canada; (E.T.); (G.L.)
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Nieuwenhuijsen MJ. Urban and transport planning pathways to carbon neutral, liveable and healthy cities; A review of the current evidence. ENVIRONMENT INTERNATIONAL 2020; 140:105661. [PMID: 32307209 DOI: 10.1016/j.envint.2020.105661] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Half the world population lives in cities and this is likely to increase to 70% over the next 20 years. Suboptimal urban and transport planning has led to e.g. high levels of air pollution and noise, heat island effects and lack of green space and physical activity and thereby an increase in morbidity and premature mortality. How can better urban and transport planning improve public health? METHODS A narrative meta-review around a number of cutting edge and visionary studies and practices on how to improve public health through better urban and transport planning reported in the literature and from meetings over the past few years. RESULTS We describe the latest quantitative evidence of how cities can become healthier through better urban and transport planning. It focuses and provides evidence for important interventions, policies and actions that can improve public health, including the need for land use changes, reduce car dependency and move towards public and active transportation, greening of cities, visioning, citizen involvement, collaboration, leadership and investment and systemic approaches. Health impact assessment studies have recently provided new powerful quantitative evidence on how to make cities healthier and will be used as examples. At the same time these measures make also our cities more sustainable (i.e. carbon neutral) and liveable creating multiple benefits. CONCLUSION Better urban and transport planning can lead to carbon neutral, more liveable and healthier cities, particularly through land use changes, a move from private motorised transportation to public and active transportation and greening of cities.
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Affiliation(s)
- Mark J Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Mary MacKillop Institute for Health Research, Melbourne, Australia.
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Dietler D, Lewinski R, Azevedo S, Engebretsen R, Brugger F, Utzinger J, Winkler MS. Inclusion of Health in Impact Assessment: A Review of Current Practice in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114155. [PMID: 32532108 PMCID: PMC7312242 DOI: 10.3390/ijerph17114155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/15/2022]
Abstract
Natural resource extraction projects, including those in the mining sector, have various effects on human health and wellbeing, with communities in resource-rich areas in sub-Saharan Africa (SSA) being particularly vulnerable. While impact assessments (IA) can predict and mitigate negative effects, it is unclear whether and to what extent health aspects are included in current IA practice in SSA. For collecting IA reports, we contacted 569 mining projects and 35 ministries regulating the mining sector. The reports obtained were complemented by reports identified in prior research. The examination of the final sample of 44 IA reports revealed a heavy focus on environmental health determinants and included health outcomes were often limited to a few aspects, such as HIV, malaria and injuries. The miniscule yield of reports (1.6% of contacted projects) and the low response rate by the contacted mining companies (18%) might indicate a lack of transparency in the IA process of the mining sector in SSA. To address the shortcomings identified, policies regulating IA practice should strengthen the requirements for public disclosure of IA reports and promote a more comprehensive inclusion of health in IA, be it through stand-alone health impact assessment or more rigorous integration of health in other forms of IA.
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Affiliation(s)
- Dominik Dietler
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (R.L.); (S.A.); (J.U.); (M.S.W.)
- University of Basel, P.O. Box, CH-4001 Basel, Switzerland
- Correspondence:
| | - Ruth Lewinski
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (R.L.); (S.A.); (J.U.); (M.S.W.)
- University of Basel, P.O. Box, CH-4001 Basel, Switzerland
- Department of Humanities, Social- and Political Sciences, Swiss Federal Institute of Technology, Clausiusstrasse 37, CH-8092 Zurich, Switzerland; (R.E.); (F.B.)
| | - Sophie Azevedo
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (R.L.); (S.A.); (J.U.); (M.S.W.)
- University of Basel, P.O. Box, CH-4001 Basel, Switzerland
- Department of Humanities, Social- and Political Sciences, Swiss Federal Institute of Technology, Clausiusstrasse 37, CH-8092 Zurich, Switzerland; (R.E.); (F.B.)
| | - Rebecca Engebretsen
- Department of Humanities, Social- and Political Sciences, Swiss Federal Institute of Technology, Clausiusstrasse 37, CH-8092 Zurich, Switzerland; (R.E.); (F.B.)
| | - Fritz Brugger
- Department of Humanities, Social- and Political Sciences, Swiss Federal Institute of Technology, Clausiusstrasse 37, CH-8092 Zurich, Switzerland; (R.E.); (F.B.)
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (R.L.); (S.A.); (J.U.); (M.S.W.)
- University of Basel, P.O. Box, CH-4001 Basel, Switzerland
| | - Mirko S. Winkler
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; (R.L.); (S.A.); (J.U.); (M.S.W.)
- University of Basel, P.O. Box, CH-4001 Basel, Switzerland
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Ramirez-Rubio O, Daher C, Fanjul G, Gascon M, Mueller N, Pajín L, Plasencia A, Rojas-Rueda D, Thondoo M, Nieuwenhuijsen MJ. Urban health: an example of a "health in all policies" approach in the context of SDGs implementation. Global Health 2019; 15:87. [PMID: 31856877 PMCID: PMC6924052 DOI: 10.1186/s12992-019-0529-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cities are an important driving force to implement the Sustainable Development Goals (SDGs) and the New Urban Agenda. The SDGs provide an operational framework to consider urbanization globally, while providing local mechanisms for action and careful attention to closing the gaps in the distribution of health gains. While health and well-being are explicitly addressed in SDG 3, health is also present as a pre condition of SDG 11, that aims at inclusive, safe, resilient and sustainable cities. Health in All Policies (HiAP) is an approach to public policy across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP is key for local decision-making processes in the context of urban policies to promote public health interventions aimed at achieving SDG targets. HiAPs relies heavily on the use of scientific evidence and evaluation tools, such as health impact assessments (HIAs). HIAs may include city-level quantitative burden of disease, health economic assessments, and citizen and other stakeholders' involvement to inform the integration of health recommendations in urban policies. The Barcelona Institute for Global Health (ISGlobal)'s Urban Planning, Environment and Health Initiative provides an example of a successful model of translating scientific evidence into policy and practice with regards to sustainable and healthy urban development. The experiences collected through ISGlobal's participation implementing HIAs in several cities worldwide as a way to promote HiAP are the basis for this analysis. AIM The aim of this article is threefold: to understand the links between social determinants of health, environmental exposures, behaviour, health outcomes and urban policies within the SDGs, following a HiAP rationale; to review and analyze the key elements of a HiAP approach as an accelerator of the SDGs in the context of urban and transport planning; and to describe lessons learnt from practical implementation of HIAs in cities across Europe, Africa and Latin-America. METHODS We create a comprehensive, urban health related SDGs conceptual framework, by linking already described urban health dimensions to existing SDGs, targets and indicators. We discuss, taking into account the necessary conditions and steps to conduct HiAP, the main barriers and opportunities within the SDGs framework. We conclude by reviewing HIAs in a number of cities worldwide (based on the experiences collected by co-authors of this publication), including city-level quantitative burden of disease and health economic assessments, as practical tools to inform the integration of health recommendations in urban policies. RESULTS A conceptual framework linking SDGs and urban and transportplanning, environmental exposures, behaviour and health outcomes, following a HiAP rationale, is designed. We found at least 38 SDG targets relevant to urban health, corresponding to 15 SDGs, while 4 important aspects contained in our proposed framework were not present in the SDGs (physical activity, noise, quality of life or social capital). Thus, a more comprehensive HiAP vision within the SDGs could be beneficial. Our analysis confirmed that the SDGs framework provides an opportunity to formulate and implement policies with a HiAP approach. Three important aspects are highlighted: 1) the importance of the intersectoral work and health equity as a cross-cutting issue in sustainable development endeavors; 2) policy coherence, health governance, and stakeholders' participation as key issues; and 3) the need for high quality data. HIAs are a practical tool to implement HiAP. Opportunities and barriers related to the political, legal and health governance context, the capacity to inform policies in other sectors, the involvement of different stakeholders, and the availability of quality data are discussed based on our experience. Quantitative assessments can provide powerful data such as: estimates of annual preventable morbidity and disability-adjusted life-years (DALYs) under compliance with international exposure recommendations for physical activity, exposure to air pollution, noise, heat, and access to green spaces; the associated economic impacts in health care costs per year; and the number of preventable premature deaths when improvements in urban and transport planning are implemented. This information has been used to support the design of policies that promote cycling, walking, public, zero and low-emitting modes of transport, and the provision of urban greening or healthy public open spaces in Barcelona (e.g. Urban Mobility, Green Infrastructure and Biodiversity Plans, or the Superblocks's model), the Bus Rapid Transit and Open Streets initiatives in several Latin American cities or targeted SDGs assessments in Morocco. CONCLUSIONS By applying tools such as HIA, HiAP can be implemented to inform and improve transport and urban planning to achieve the 2030 SDG Agenda. Such a framework could be potentially used in cities worldwide, including those of less developed regions or countries. Data availability, taking into account equity issues, strenghtening the communication between experts, decision makers and citizens, and the involvement of all major stakeholders are crucial elements for the HiAP approach to translate knowledge into SDG implementation.
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Affiliation(s)
| | - Carolyn Daher
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
| | - Gonzalo Fanjul
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
| | - Mireia Gascon
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Natalie Mueller
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Leire Pajín
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
| | - Antoni Plasencia
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Hospital Clínic-Universitat de Barcelona (UB), Barcelona, Spain
| | - David Rojas-Rueda
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, USA
| | - Meelan Thondoo
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Hospital Clínic-Universitat de Barcelona (UB), Barcelona, Spain
- University of Amsterdam, AISSR, Amsterdam, The Netherlands
| | - Mark J Nieuwenhuijsen
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Automatic Classification of Sarcopenia Level in Older Adults: A Case Study at Tijuana General Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183275. [PMID: 31489909 PMCID: PMC6765933 DOI: 10.3390/ijerph16183275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/29/2019] [Accepted: 08/31/2019] [Indexed: 01/10/2023]
Abstract
This paper presents a study based on data analysis of the sarcopenia level in older adults. Sarcopenia is a prevalent pathology in adults of around 50 years of age, whereby the muscle mass decreases by 1 to 2% a year, and muscle strength experiences an annual decrease of 1.5% between 50 and 60 years of age, subsequently increasing by 3% each year. The World Health Organisation estimates that 5–13% of individuals of between 60 and 70 years of age and 11–50% of persons of 80 years of age or over have sarcopenia. This study was conducted with 166 patients and 99 variables. Demographic data was compiled including age, gender, place of residence, schooling, marital status, level of education, income, profession, and financial support from the State of Baja California, and biochemical parameters such as glycemia, cholesterolemia, and triglyceridemia were determined. A total of 166 patients took part in the study, with an average age of 77.24 years. The purpose of the study was to provide an automatic classifier of sarcopenia level in older adults using artificial intelligence in addition to identifying the weight of each variable used in the study. We used machine learning techniques in this work, in which 10 classifiers were employed to assess the variables and determine which would provide the best results, namely, Nearest Neighbors (3), Linear SVM (Support Vector Machines) (C = 0.025), RBF (Radial Basis Function) SVM (gamma = 2, C = 1), Gaussian Process (RBF (1.0)), Decision Tree (max_depth = 3), Random Forest (max_depth=3, n_estimators = 10), MPL (Multilayer Perceptron) (alpha = 1), AdaBoost, Gaussian Naive Bayes, and QDA (Quadratic Discriminant Analysis). Feature selection determined by the mean for the variable ranking suggests that Age, Systolic Arterial Hypertension (HAS), Mini Nutritional Assessment (MNA), Number of chronic diseases (ECNumber), and Sodium are the five most important variables in determining the sarcopenia level, and are thus of great importance prior to establishing any treatment or preventive measure. Analysis of the relationships existing between the presence of the variables and classifiers used in moderate and severe sarcopenia revealed that the sarcopenia level using the RBF SVM classifier with Age, HAS, MNA, ECNumber, and Sodium variables has 82′5 accuracy, a 90′2 F1, and 82′8 precision.
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Acute and Cumulative Effects of Haze Fine Particles on Mortality and the Seasonal Characteristics in Beijing, China, 2005-2013: A Time-Stratified Case-Crossover Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132383. [PMID: 31277519 PMCID: PMC6650878 DOI: 10.3390/ijerph16132383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/16/2022]
Abstract
We observed significant effects of particulate matter (PM2.5) on cause-specific mortality by applying a time-stratified case-crossover and lag-structure designs in Beijing over a nine-year study period (2005–2013). The year-round odds ratio (OR) was 1.005 on the current day with a 10 μg/m3 increase in PM2.5 for all-cause mortality. For cardiovascular mortality and stroke, the ORs were 1.007 and 1.008 on the current day, respectively. Meanwhile, during a lag of six days, the cumulative effects of haze on relative risk of mortality, respiratory mortality and all-cause mortality was in the range of 2~11%. Moreover, we found a significant seasonal pattern in the associations for respiratory mortality: significant associations were observed in spring and fall, while for all-cause mortality, cardiovascular mortality, cardiac and stroke, significant associations were observed in winter. Moreover, increasing temperature would decrease risks of mortalities in winter taking fall as the reference season. We concluded that in summer, temperature acted as a direct enhancer of air pollutants; while in winter and spring, it was an index of the diameter distribution and composition of fine particles.
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