A review of frameworks for developing environmental health indicators for climate change and health

Climate-related health impact indicators for public health surveillance in a changing climate: a systematic review and local suitability analysis

Climate change challenges public health. Effective management of climate-related health risks relies on robust public health surveillance (PHS) and population health indicators. Despite existing global and country-specific indicators, their integration into local PHS systems is limited, impacting decision-making. We conducted a systematic review examining population health indicators relevant to climate change impacts and their suitability for national PHS systems. Guided by a registered protocol, we searched multiple databases and included 41 articles. Of these, 35 reported morbidity indicators, and 39 reported mortality indicators. Using Chile as a case study, we identified three sets of indicators for the Chilean PHS. The high-priority set included vector-, food-, and water-borne diseases, as well as temperature-related health outcomes indicators due to their easy integration into existing PHS systems. This review highlights the importance of population health indicators in monitoring climate-related health impacts, emphasising the need for local contextual factors to guide indicator selection.

Funding

This research project was partly funded by ANID Chile and University College London. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.

Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project) - study protocol

INTRODUCTION

The European Environment Agency estimates that 75% of the European population lives in cities. Despite the many advantages of city life, the risks and challenges to health arising from urbanisation need to be addressed in order to tackle the growing burden of disease and health inequalities in cities. This study, Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project), aims to investigate the complex association between the urban environmental exposures (UrbEEs) and health.

METHODS AND ANALYSIS

DAS-EP is a Spanish multiregional cross-sectional project that combines population health surveys (PHS) and geographical information systems (GIS) allowing to collect rich individual-level data from 17 000 adult citizens participating in the PHS conducted in the autonomous regions of the Basque Country, Andalusia, and the Valencian Community, and the city of Barcelona in the years 2021-2023. This study focuses on the population living in cities or metropolitan areas with more than 100 000 inhabitants. UrbEEs are described by objective estimates at participants' home addresses by GIS, and subjective indicators present in PHS. The health outcomes included in the PHS and selected for this study are self-perceived health (general and mental), prevalence of chronic mental disorders, health-related quality of life, consumption of medication for common mental disorders and sleep quality. We aim to further understand the direct and indirect effects between UrbEEs and health, as well as to estimate the impact at the population level, taking respondents' sociodemographic and socioeconomic characteristics, and lifestyle into consideration.

ETHICS AND DISSEMINATION

The study was approved by the regional Research Ethics Committee of the Basque Country (Ethics Committee for Research Involving Medicinal Products in the Basque Country; PI2022138), Andalusia (Biomedical Research Ethics Committee of the Province of Granada; 2078-N-22), Barcelona (CEIC-PSMar; 2022/10667) and the Valencian Community (Ethics Committee for Clinical Research of the Directorate General of Public Health and Center for Advanced Research in Public Health; 20221125/04). The results will be communicated to the general population, health professionals, and institutions through conferences, reports and scientific articles.

Applying deep learning to manage urban ecosystems in arid Abha, Saudi Arabia: Remote sensing-based modelling for ecological condition assessment and decision-making

This study aims to quantitatively and qualitatively assess the impact of urbanisation on the urban ecosystem in the city of Abha, Saudi Arabia, by analysing land use changes, urbanisation processes and their ecological impacts. Using a multidisciplinary approach, a novel remote sensing-based urban ecological condition index (RSUSEI) will be developed and applied to assess the ecological status of urban surfaces. Therefore, the identification and quantification of urbanisation is important. To do so, we used hyper-tuned artificial neural network (ANN) as well as Land Cover Change Rate (LCCR), Land Cover Index (LCI) and Landscape Expansion Index (LEI). For the development of (RSUSEI), we have used four advanced models such as fuzzy Logic, Principle Component Analysis (PCA), Analytical Hierarchy Process (AHP) and fuzzy Analytical Hierarchy Process (FAHP) to integrate various ecological parameters. In order to obtain more information for better decision making in urban planning, sensitivity and uncertainty analyses based on a deep neural network (DNN) were also used. The results of the study show a multi-layered pattern of urbanisation in Saudi Arabian cities reflected in the LCCR, indicating rapid urban expansion, especially in the built-up areas with an LCCR of 0.112 over the 30-year period, corresponding to a more than four-fold increase in urban land cover. At the same time, the LCI shows a remarkable increase in 'built-up' areas from 3.217% to 13.982%, reflecting the substantial conversion of other land cover types to urban uses. Furthermore, the LEI emphasises the complexity of urban growth. Outward expansion (118.98 km2), Edge-Expansion (95.22 km2) and Infilling (5.00 km2) together paint a picture of a city expanding outwards while filling gaps in the existing urban fabric. The RSUSEI model shows that the zone of extremely poor ecological condition covers an area of 157-250 km2, while the natural zone covers 91-410 km2. The DNN based sensitivity analysis is useful to determine the optimal model, while the integrated models have lower input parameter uncertainty than other models. The results of the study have significant implications for the management of urban ecosystems in arid areas and the protection of natural habitats while improving the quality of life of urban residents. The RSUSEI model can be used effectively to assess urban surface ecology and inform urban management techniques.

Indicators to support local public health to reduce the impacts of heat on health

Heat exposure presents a significant weather-related health risk in England and Wales, and is associated with acute impacts on mortality and adverse effects on a range of clinical conditions, as well as increased healthcare costs. Most heat-related health outcomes are preventable with health protection measures such as behavioural changes, individual cooling actions, and strategies implemented at the landscape level or related to improved urban infrastructure. We review current limitations in reporting systems and propose ten indicators to monitor changes in heat exposures, vulnerabilities, heat-health outcomes, and progress on adaptation actions. These indicators can primarily inform local area decision-making in managing risks across multiple sectors such as public health, adult and social care, housing, urban planning, and education. The indicators can be used alongside information on other vulnerabilities relevant for heat and health such as underlying morbidity or housing characteristics, to prioritise the most effective adaptation actions for those who need it the most.

Management Approaches to Health and Safety at Work during Prevention Intervention Planning

This work deals with a systematic review of the literature data concerning the theme of integrated approaches to occupational health and safety management, with particular reference to the programming of assistance plans, which guide companies' organizational choices by also addressing the principles of Total Worker Health. In the current regulatory framework on this issue, the UNI ISO 45001: 2018 standard "Occupational health and safety management systems-Requirements and guidance for use" (published on 12 March 2018)" assumes relevance, defining dynamic approaches to occupational health and safety management systems-paying particular attention to external contextual factors that may influence corporate organizational decisions. The adoption of these systems is not mandatory but allows companies to fulfill their duties in terms of health and safety at work through an organizational approach aimed at the awareness, involvement, and participation of all subjects of the company prevention system, progressing past the phase of mere technological and prescriptive approaches towards a holistic vision of prevention that places the person at the center of preventive actions. In this context, the role of institutional networks and socio-economic partnerships assumes particular importance via the activation of territorial assistance interventions to support companies aimed at improving risk management levels. To this end, the importance of verifying the effectiveness of assistance interventions emerges from the scientific debate using indicators such as quantitative indicators aimed at measuring the performance of all phases of an intervention, with particular attention to their effects in terms of the improved solutions developed.

Climate Change, Fragility, and Child Mortality; Understanding the Role of Water Access and Diarrheal Disease Amongst Children Under Five During the MDG Era

The present study examined the influence of improvements to Water, Sanitation, and Hygiene (WASH) infrastructure on rates of under-five mortality specifically from diarrheal disease amongst children in fragile states. The World Bank's Millennium Development Goals and Sustainable Development Goals both include a specific target of reduction in preventable disease amongst children, as well as goal to improve WASH. Although gains have been made, children under the age of five remain particularly vulnerable to diarrheal mortality in states identified as fragile. Increasingly, climate change is placing undue pressure on states labeled fragile due to their inability to properly prepare for, or respond to, natural disasters that further compromise WASH development and water safety. The impact of climate change upon child health outcomes is neither direct nor linear and necessitates a linkage framework that can account for complex pathways between environmental pressures and public health outcomes. The World Health Organization's Drive Force-Pressure-State-Exposure-Effect-Action conceptual framework was used to draw the connections between seemingly disparate, and highly nuanced, environmental, and social measures. Using a multilevel hierarchical model, this analysis used a publicly available UNICEF data set that reported rates of mortality specifically from diarrheal disease amongst children age five and younger. All 171 formally recognized countries were included, which showed a decline in diarrheal disease over time when investments in WASH infrastructure are compared. As states experience increased pressure because of climate change, this area of intervention is key for immediate health and safety of children under-five, as well as assisting fragile states long-term as the move toward stability.

Assessing Psychosocial Health Impacts of Climate Adaptation: A Critical Review

The urgency of dealing with risks associated with climate change and the need for effective response measures to their impacts are increasing daily the world over. Literature abounds regarding the impacts of climate change on physical, psychosocial, and other health outcomes. In contrast, little research exists on the health impacts of response measures to climate change. This critical review seeks to contribute towards closing this gap through a synthesis of current literature on the psychosocial health outcomes of climate adaptation actions. Our results found both positive and negative outcomes associated with psychosocial health that may result from climate adaptation actions. We propose the utilization of well-developed conceptual frameworks and evaluation tools in assessment and analysis of these outcomes. Ultimately, there is need to expand similar and related areas of research more broadly and on psychosocial effects, specifically.

Environmental and Social Factors Associated with High Chronic Kidney Disease Mortality Rates in Municipalities of Guatemala: An Ecological Study of Municipal-Level Mortality Data

The purpose of this study was to determine the association between social and environmental indicators and high mortality rates from chronic kidney disease (CKD) in municipalities of Guatemala. An ecological study of municipal-level factors associated with CKD mortality in Guatemala was conducted. Crude mortality rates were calculated for the 2009-2019 period for each of the country's 340 municipalities, by gender and age groups. Municipal-level social and environmental indicators were used as independent variables. Linear regression was used for bivariate and multivariate analysis. A total of 28,723 deaths from CKD were documented for the 2009-2019 period. Average crude mortality rate for all ages for the country's 340 municipalities was 70.66 per 100,000 [0-502.99]. Very highly positive associations with high mortality rates were found in two agrarian territories where land use is mainly for permanent crops (e.g., sugar cane, coffee, rubber, banana, plantain, African palm) and pastures for cattle, with very low percentages of land covered by forests or protected areas. Social factors related to poverty and environmental factors related to agricultural use of land may play a role in the high CKD mortality rates documented in a cluster of municipalities of Guatemala.

Climate Change and Health in Urban Areas with a Mediterranean Climate: A Conceptual Framework with a Social and Climate Justice Approach

The consequences of climate change are becoming increasingly evident and highlight the important interdependence between the well-being of people and ecosystems. Although climate change is a global phenomenon, its causes and consequences vary dramatically across territories and population groups. Among settings particularly susceptible to health impacts from climate change are cities with a Mediterranean climate. Here, impacts will put additional pressure on already-stressed ecosystems and vulnerable economies and societies, increasing health inequalities. Therefore, this article presents and discusses a conceptual framework for understanding the complex relationship between climate change and health in the context of cities with Mediterranean climate from a social and climate justice approach. The different elements that integrate the conceptual framework are: (1) the determinants of climate change; (2) its environmental and social consequences; (3) its direct and indirect impacts on health; and (4) the role of mitigation and adaptation policies. The model places special emphasis on the associated social and health inequalities through (1) the recognition of the role of systems of privilege and oppression; (2) the distinction between structural and intermediate determinants of climate change at the root of health inequalities; (3) the role of individual and collective vulnerability in mediating the effects of climate change on health; and (4) the need to act from a climate justice perspective to reverse health inequities.

Exploring Environmental Health Inequalities: A Scientometric Analysis of Global Research Trends (1970-2020)

Environmental health inequalities (EHI), understood as differences in environmental health factors and in health outcomes caused by environmental conditions, are studied by a wide range of disciplines. This results in challenges to both synthesizing key knowledge domains of the field. This study aims to uncover the global research status and trends in EHI research, and to derive a conceptual framework for the underlying mechanisms of EHI. In total, 12,320 EHI publications were compiled from the Web of Science core collection from 1970 to 2020. Scientometric analysis was adopted to characterize the research activity, distribution, focus, and trends. Content analysis was conducted for the highlight work identified from network analysis. Keyword co-occurrence and cluster analysis were applied to identify the knowledge domain and develop the EHI framework. The results show that there has been a steady increase in numbers of EHI publications, active journals, and involved disciplines, countries, and institutions since the 2000s, with marked differences between countries in the number of published articles and active institutions. In the recent decade, environment-related disciplines have gained importance in addition to social and health sciences. This study proposes a framework to conceptualize the multi-facetted issues in EHI research referring to existing key concepts.

Health Interventions for Preventing Climate-Sensitive Diseases: Scoping Review

Climate variations cause public health problems, but the literature is still scarce on studies involving health interventions against climate-sensitive diseases. The objective of this review was to identify health interventions for the prevention of such diseases. We conducted a scoping review using the JBI Methodology. Six large research databases were searched (PubMed, Scopus, Web of Science, Lilacs, Embase, and Cochrane). The following inclusion criterion was used: studies addressing health interventions to prevent climate-sensitive diseases or consequences of climate on people's health. The exclusion criteria consisted of thesis, dissertations, conference proceedings, studies with unclear information/methodology, and studies not addressing climate-related health interventions. No language or date restrictions were applied. Of 733 studies identified and screened by title and abstract, 55 studies underwent full-text screening, yielding 13 studies for review. The health interventions identified were classified into three levels of management. The macro level included the use of epidemiological models, renewable energy, and policies sensitive to climate change. The meso level comprised interventions such as the creation of environmental suitability maps, urban greening, chemoprophylaxis, water security plans, and sanitation projects, among other measures. Some interventions are at the intersection, such as educational campaigns and the modification of artificial larvae sites. Finally, the micro level contained interventions such as the inspection of window screens and the use of light-colored clothing and repellents. The health interventions at the macro, meso, and micro levels and the intersection may serve as a basis for public managers to implement appropriate interventions against climate-sensitive diseases.

Towards Integrated Air Pollution Monitoring and Health Impact Assessment Using Federated Learning: A Systematic Review

Environmental issues such as environmental pollutions and climate change are the impacts of globalization and become debatable issues among academics and industry key players. One of the environmental issues which is air pollution has been catching attention among industrialists, researchers, and communities around the world. However, it has always neglected until the impacts on human health become worse, and at times, irreversible. Human exposure to air pollutant such as particulate matters, sulfur dioxide, ozone and carbon monoxide contributed to adverse health hazards which result in respiratory diseases, cardiorespiratory diseases, cancers, and worst, can lead to death. This has led to a spike increase of hospitalization and emergency department visits especially at areas with worse pollution cases that seriously impacting human life and health. To address this alarming issue, a predictive model of air pollution is crucial in assessing the impacts of health due to air pollution. It is also critical in predicting the air quality index when assessing the risk contributed by air pollutant exposure. Hence, this systemic review explores the existing studies on anticipating air quality impact to human health using the advancement of Artificial Intelligence (AI). From the extensive review, we highlighted research gaps in this field that are worth to inquire. Our study proposes to develop an AI-based integrated environmental and health impact assessment system using federated learning. This is specifically aims to identify the association of health impact and pollution based on socio-economic activities and predict the Air Quality Index (AQI) for impact assessment. The output of the system will be utilized for hospitals and healthcare services management and planning. The proposed solution is expected to accommodate the needs of the critical and prioritization of sensitive group of publics during pollution seasons. Our finding will bring positive impacts to the society in terms of improved healthcare services quality, environmental and health sustainability. The findings are beneficial to local authorities either in healthcare or environmental monitoring institutions especially in the developing countries.

Gender and tobacco epidemic in South Korea: implications from age-period-cohort analysis and the DPSEEA framework

OBJECTIVES

To understand a 20-year trend of gender-specific smoking prevalence among adults in South Korea.

DESIGN

Age-period-cohort analysis using the intrinsic estimator method was applied to examine the separate contribution of age, period and cohort effect on smoking prevalence. The Driving Force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework was used to explain the observed smoking trends by mapping potential determinants and to address policy implications.

SETTING

General adult population in South Korea.

PARTICIPANTS

34 828 men and 43 632 women who aged 19-78 years, were not currently pregnant and were without a prior diagnosis of cardiovascular disease or cancer.

OUTCOME MEASURES

Gender-specific current smoking prevalence using the 1998-2017 Korea National Health and Nutrition Examination Survey.

RESULTS

Our results showed gender-specific age and birth cohort effects. More specifically, the smoking prevalence peaked at their mid-20s (prevalence rate ratio (PRR): 1.54, 95% CI: 1.49 to 1.59) and cohort born in 1959-1963 (PRR: 1.63, 95% CI: 1.57 to 1.70) and then decreased in men. On the other hand, in women, the smoking prevalence consistently increased until their mid-40s (PRR: 1.53, 95% CI: 1.27 to 1.84) and in recent birth cohort groups (PRR in 1994-1998 cohort: 1.55, 95% CI: 1.13 to 2.13). The period effects declined from 1998-2002 to 2003-2007, following increasing fluctuations in both genders. The smoking-DPSEEA framework showed the absence of policy actions to target female smokers and emphasised a proactive approach that tackles the upstream causes for smoking in women.

CONCLUSIONS

Men and women are clearly in different phases of the smoking epidemic in Korean population, and gender-tailored policies should be implemented.

Tracking the impacts of climate change on human health via indicators: lessons from the Lancet Countdown

BACKGROUND

In the past decades, climate change has been impacting human lives and health via extreme weather and climate events and alterations in labour capacity, food security, and the prevalence and geographical distribution of infectious diseases across the globe. Climate change and health indicators (CCHIs) are workable tools designed to capture the complex set of interdependent interactions through which climate change is affecting human health. Since 2015, a novel sub-set of CCHIs, focusing on climate change impacts, exposures, and vulnerability indicators (CCIEVIs) has been developed, refined, and integrated by Working Group 1 of the "Lancet Countdown: Tracking Progress on Health and Climate Change", an international collaboration across disciplines that include climate, geography, epidemiology, occupation health, and economics.

DISCUSSION

This research in practice article is a reflective narrative documenting how we have developed CCIEVIs as a discrete set of quantifiable indicators that are updated annually to provide the most recent picture of climate change's impacts on human health. In our experience, the main challenge was to define globally relevant indicators that also have local relevance and as such can support decision making across multiple spatial scales. We found a hazard, exposure, and vulnerability framework to be effective in this regard. We here describe how we used such a framework to define CCIEVIs based on both data availability and the indicators' relevance to climate change and human health. We also report on how CCIEVIs have been improved and added to, detailing the underlying data and methods, and in doing so provide the defining quality criteria for Lancet Countdown CCIEVIs.

CONCLUSIONS

Our experience shows that CCIEVIs can effectively contribute to a world-wide monitoring system that aims to track, communicate, and harness evidence on climate-induced health impacts towards effective intervention strategies. An ongoing challenge is how to improve CCIEVIs so that the description of the linkages between climate change and human health can become more and more comprehensive.

Adaptive pressure-driven multi-criteria spatial decision-making for a targeted placement of green and grey runoff control infrastructures

Traditional runoff control measures ignore the spatial imbalance of regional pressures, thereby failing to achieve a site-specific placement for green and grey infrastructure simultaneously. A multi-criterion decision-making framework for runoff control infrastructure spatial planning was therefore developed in this study. The pressure-state-response framework was applied to creatively match the pressure induced adjustment demands with the infrastructure effectiveness. The pressures were quantified from the perspective of environment, economy, and ecology on a grid scale. States were considered as the relative priority of regional pressure adjustment demand in multiple perspectives. Responses were presented as state-targeted green and grey infrastructure placement. Multi-perspective effectiveness of different green and grey infrastructure was simultaneously evaluated at an effective scale of controlling 1 m³/s runoff for comparison. Methods such as data mining, hydrological model simulation, and remote sensing inversion were combined to quantify the regional pressures. The capital investment and ecological impact of infrastructures were quantified from a life cycle perspective. A case study was carried out in Wuhan, China. The study area was clustered by gridded pressure into three regions. In region Ⅰ, ecological and environmental pressure were of higher weight. In region Ⅱ, the environmental pressure was dominant. In region Ⅲ, the ecological pressure took precedence over the environmental and economic constraints. The area ratios of the region Ⅰ, Ⅱ, and Ⅲ were 43%, 36%, and 21% respectively. The result indicated a synergy and spatial heterogeneity of multi-perspective pressures, and further demonstrating that expert experience tends to fail to weigh the multi-function of green and grey infrastructures for coping with the pressures. Results also stated that green infrastructures were more acceptable in areas that aspire to achieve simultaneous runoff control and ecological improvement. The decision-making framework developed in this study can maximize the overall performance by providing targeted infrastructure placement solutions.

Climate Change, Conflict, and Resource Extraction: Analyses of Nigerian Artisanal Mining Communities and Ominous Global Trends

Background:

The 2010 lead poisoning outbreak that claimed the lives of more than 400 children in artisanal gold mining villages in Zamfara, Nigeria is the tragic result of high gold prices, a geologic anomaly, and processing of ores in residential areas. Today, these villages face a growing crisis related to conflict and climate change. While the situation in Zamfara is unparalleled in many ways, the interactions between climate change, conflict, and mining consistently overlap a global scale. The scope of this analysis extends beyond the Nigerian crisis.

Objectives:

Understanding the complexities of challenges faced in Zamfara provides insight into how these issues impact vulnerable communities globally, and which strategies should be considered to solve this wicked problem.

Methods:

Analysis of the relationships between climate change, conflict, and mining in Zamfara and globally via literature review and examination of current events in the Sahel region.

Findings:

Supporting healthy artisanal mining communities, as was prioritized in Zamfara, must be a focus of environmental, health, and mineral management policies. This includes the consideration of multiple environmental health challenges, the protection of vulnerable groups, government-supported formalization programs, and meaningful involvement of local leadership in developing, implementing, and sustaining intervention strategies to enshrine ASM as a poverty reduction, climate change adaptation strategy.

Conclusions:

Rapidly rising metal prices and demand will continue to fuel environmental health crises associated with mining. Given Africa’s growing role in the global mineral economy and the massive number of subsistence communities who will continue to be impacted by climate change, strategies that support responsible artisanal mining are both a necessity for preventing future health crises and an opportunity for promoting regional stability and peace.

A Food Security Indicator Framework for British Columbia, Canada

Food security is a determinant of health and increasingly recognized as a focus for health promotion. Led by the Population and Public Health Program, British Columbia Centre for Disease Control, this article outlines the process of development and the evidence-based conceptual framework that guides the systematic selection of food security indicators in the Province. A phased, iterative approach to develop the food security framework was adopted. Phase 1 consisted of a literature search of food security indicator models, and key informant discussions. Phase 2 consisted of modification of the model based on stakeholder consultation. The framework development occurred between January 2016 and April 2019. A structured scan of the literature found no existing conceptual frameworks specific to food security indicators in the Global North. The most relevant and frequently used frameworks for indicator reporting identified were environmental health indicator frameworks. This article presents a matrix framework based on existing environmental health indicator frameworks. It integrates environmental health causal networks (e.g., determinants-current state-impact-response) with food security elements identified as (a) individual and household food insecurity, (b) food systems, and (c) capacity. This framework contributes to food security performance monitoring in the Global North and fills an important gap in evaluating the impact of the public health response to food security. Use of this comprehensive framework can enable program planners and policy makers to be clear about where and how they are attempting to assess, influence and monitor food security, and illustrate the interconnectedness between indicators.

Exploring the relationship between urbanization and water environment based on coupling analysis in Nanjing, East China

The degradation of water environment (WE) has constrained the sustainable development of cities, while the rapid urbanization also exacerbates water environment change. However, the complicated relationship between urbanization and WE is far from clearly understood. In this study, a comprehensive index system for urbanization and WE was applied along with the System Index Evaluation Model (SIEM) and a Coupling Coordination Degree Model (CCDM) to analyze the coupling between urbanization and WE in Nanjing, East China, from 1990 to 2018. The comprehensive index of urbanization increased from 0.0392 in 1990 to 0.9890 in 2018, showing a clear increasing trend. Demographic and spatial urbanization made the largest contribution to urbanization development from 1990 to 2010, while economic urbanization became the largest contributor to urbanization development between 2011 and 2018. Under the combined effects of pressure, state, and response subsystems, the comprehensive WE index showed an upward trend with some fluctuations from 1990 to 2018. The degree of coupling coordination between urbanization and WE displayed an overall upward tendency, growing from 0.18 in 1990 to 0.95 in 2018. The coupling coordination state transitioned from a serious imbalance during the low coupling period (1990-1992) into the superior coordination of the highly coupled period (2011-2018). With the continuous urbanization in the future, in addition to ensuring the optimal management of surface water, protection of groundwater should be reinforced. The results advance our understanding of the dynamic relationship between urbanization and WE and provide important implications for urban planning and water resource protection.

Conceptual frameworks regarding waterborne diseases in sub-Saharan Africa and the need of for a new approach to urban exposomes

Sub-Saharan African countries, like many other low-income countries, have experienced urban socioeconomic inequalities due to rapid and unplanned urbanization. These processes have resulted in the creation of poor urban areas lacking basic sanitation, water, and hygiene facilities, and subjacent public health issues such as the spread of waterborne diseases. A system for the demarcation of disease transmission areas already exists, but the traditional framework is less appropriate in sub-Saharan Africa, making it necessary to divide these urban areas more adequately. In addition, the construction of frameworks and tools more specific to waterborne disease-related issues is essential. We propose restructuring sub-Saharan urban areas into more specific areas of exposure to waterborne diseases and associated exposomes, and then use this restructuring of urban areas of exposure to waterborne diseases in a conceptual framework that takes into account causes of exposure, impacts, and interventions. The division of urban areas into public, domestic, and individual exposure areas facilitates a more straightforward understanding of the dynamics of waterborne exposomes. Moreover, the inclusion of this division in the driving force-pressure-state-exposure-effect-action framework allows an effective stratified implementation of urban public health policies.

Perception of Health Challenges, Self-Rated Health and Feeling of Empowerment in a Changing Climate and Environment with Permafrost Thawing

Climate change is a global challenge which has direct and indirect health impacts on the lives of people and communities in the Arctic. The aim of our study was to evaluate the perception of permafrost thaw and health challenges and to determine which perceived environmental and adaptation factors relate to self-rated health and, more specifically, to feeling of empowerment when facing the changes and impacts of climate change and permafrost thawing. Questionnaire data (n = 100) were collected from one community located in Greenland, Disko Bay. Data were analyzed by cross-tabulation and the significances were tested either by Pearson’s χ2 test, Fisher’s exact test or by the t-test, when applicable. Based on these analyses, logistic and linear regression analyses were used to evaluate the associations between demographic variables, challenges posed by permafrost thaw and self-rated health, and associations between feeling of empowerment and perceived environmental/adaptation factors. The results indicated that climate change was not assessed as being a direct risk for the health of local people or their feeling of empowerment. Nature seemed to play an important role for local people, and not being in the natural environment for recreational activities seemed to decrease feeling of empowerment (OR 0.42, p = 0.042, 95% CI 0.17–0.97). This paper provides new, multidisciplinary research information about the perception of health challenges, health, and feeling of empowerment among people living in an environment impacted by permafrost thaw and climate change.

Toward an Integrated System of Climate Change and Human Health Indicators: A Conceptual Framework

Environmental health indicators are helpful for tracking and communicating complex health trends, informing science and policy decisions, and evaluating public health actions. When provided on a national scale, they can help inform the general public, policy makers, and public health professionals about important trends in exposures and how well public health systems are preventing those exposures from causing adverse health outcomes. There is a growing need to understand national trends in exposures and health outcomes associated with climate change and the effectiveness of climate adaptation strategies for health. To date, most indicators for health implications of climate change have been designed as independent, individual metrics. This approach fails to take into account how exposure-outcome pathways for climate-attributable health outcomes involve multiple, interconnected components. We propose reframing climate change and health indicators as a linked system of indicators, which can be described as follows: upstream climate drivers affect environmental states, which then determine human exposures, which ultimately lead to health outcomes; these climate-related risks are modified by population vulnerabilities and adaptation strategies. We apply this new conceptual framework to three illustrative climate-sensitive health outcomes and associated exposure-outcome pathways: pollen allergies and asthma, West Nile Virus infection, and vibriosis.

Measuring the level of environmental performance in insular areas, through key performed indicators, in the framework of waste strategy development

To measure "something that is not there", is not easy and at the same time not fully understandable and perceived by the citizens. Several elements (such as, waste production, waste management cost, social attitude and behaviour, etc.) interrupt and disturb any strategy in the framework of waste management. Additionally, through the European Green Deal (EGD), Europe is trying to achieve climate neutrality by 2050, taking into account the Circular Economy Strategy (CES) and the United Nations Sustainable Development Goals (UNSDGs). A Driving Force-Pressure-State-Impact-Response (DPSIR) breakdown was applied, to establish and organize key information's on the environmental performance (E.P) taking into consideration the existing pollution, reviewing the contemporary knowledge and existing implemented waste strategies on the driving forces, pressures, states and impacts. This paper includes several key performed indicators (KPIs), in order to evaluate the E.P of an area, through hybrid approach which cover among others, the waste compositional analysis, SWOT and PESTEL analysis, waste recycling and waste accumulation index, prevention activities, awareness activities etc. The results indicate that, the selected areas implement periodic measures, but they need to put more effort to boost their citizens to participate in any proposed waste strategy. Furthermore, the results are very valuable and helpful to policy makers, consultants, scientists, competent authorities, stakeholders etc., in order to design and promote synergies and activities (mainly in Local Authorities), to reach the proposed figures that EGD, proposed in relation with the CES as well as with the SDGs.

Research on the Establishment and Application of the Environmental Health Indicator System of Atmospheric Pollution in China

To understand the health impact represented by exposure to current atmospheric pollution in China, an environmental health indicators (EHIs) system of atmospheric pollution was established. The EHIs were based on comprehensive consideration of environment, population, economy and diseases associated with atmospheric pollution. An EHIs evaluation system of atmospheric pollution, based on corresponding EHIs data collection and weighting coefficients determined using principal component analysis, was applied to major provinces and regions in China to evaluate the environmental health status. Results showed that the EHIs of atmospheric pollution in Central and East China were low, indicating a serious environmental health condition. Prevention and management of atmospheric pollution in these regions should be strengthened and protective measures taken to improve human health. Compared with other methods, the EHIs evaluation system was more intuitive, which facilitated users to identify the environmental health status and provided support for health management and pollution prevention.

Controlling and preventing climate-sensitive noncommunicable diseases in urban sub-Saharan Africa

Research continues to highlight the link between climate change and health outcomes. There is, however, limited evidence in research, policies and in the Sustainable Development Goals (SDGs) about the impact of environmental factors on noncommunicable diseases (NCDs) for people living in urban areas of sub-Saharan Africa (SSA). Important is that 80% of NCDs are taking place in low- and middle-income countries (LMICs) and linked to a third of the deaths in SSA. The question is, what would these statistics look like if environmental risk factors (e.g., pollution, chemicals) for NCDs, linked to climate change, were prevented and controlled. This article presents a framework for understanding climatic pathways' impacts on climate-sensitive NCDs and achieving the SDGs. It further explains how current global mitigation interventions in high income urban settings, with implied health co-benefits for NCD reduction (i.e., promoting use of less polluting vehicles, bicycles, walking, public transport, green spaces), experience major implementation challenges in SSA cities (i.e., too costly, lack of availability, poor road conditions, gender and cultural norms, security problems). Recommendations are made for applying this framework to control climate change impacts on NCDs and achieving the SDGs in SSA cities. These include, support for more research on the climate - NCD nexus, ensuring health professional training includes sustainable health education, and including a focus on climate change and health in primary and secondary school curricula. Further recommendations for addressing climate-sensitive NCDs and urban environmental health towards achieving and sustaining the SDGs, are linked to promoting climate-sensitive and health policies and governance, as well as controlling the influence of advertising. Lastly, improving communication of research findings for policy makers and the public in a manner for informed policy making, and how to comprehend this information to promote the reduction and prevention of NCDs in urban SSA, is key.

Anticipating Environmental Burdens in Research and Innovation Projects. Application to the Case of Active and Healthy Ageing

In this paper; for research and innovation projects without environmental goals; a procedure is proposed to operationalize the anticipation and reflexivity of environmental concerns in the initial phases. By using the expert knowledge of specialists; we have first conducted a study to identify the general environmental topics relevant in any kind of research and innovation project not addressing the environment. In a second phase; a strategy is proposed to rank order the topics in terms of environmental relevance by means of the Analytic Hierarchy Process. To illustrate it; the case of Information and Communication Technologies for Active and Healthy Ageing is used because of its increasing importance; and because normal environmental targets are not considered. Results show that; in this case; the most relevant topic to be considered is the primary energy consumption by sources; followed by hazardous solid waste and consumption of non-renewable and scarce materials. According to the experts; these should be the main issues to be considered regarding the environmental sustainability of the outputs of such research and innovation projects. In conclusion; this paper contributes to a better understanding of how to promote a wider integration of environmental sustainability in research and innovation when environmental goals are not initially included.

Aplicación de la metodología de las “Fuerzas Motrices” y el modelo OMS de Determinantes Sociales de la Salud tomando como ejemplo la Criptosporidiosis en Colombia

Objetivos Analizar la relación que existe entre la contaminación de agua por ooquistes de Cryptosporidium spp. y los efectos en la salud de las poblaciones humanas y animales en Colombia.Métodos Es un ensayo de tipo analítico que se centró en la aplicación documentada y analizada, de la metodología de las “Fuerzas Motrices” y el modelo OMS de Determinantes Sociales de la Salud tomando como ejemplo la Criptosporidiosis.Resultados Las “fuerzas motrices” involucradas en la relación entre contaminación de agua por Cryptosporidium spp. y la salud de humanos y animales fueron el aumento en la demanda de productos pecuarios y la producción pecuaria de baja calidad; la “presión” consistió en la mala implementación de prácticas de producción, la invasión de zonas protegidas y de reservas ecológicas, y la disminución de fronteras entre lo rural y lo urbano; el “estado” se basó en la contaminación del suelo y las fuentes de agua, y en la deficiencia en el manejo de las excretas; la “exposición” radicó en la entrada de ooquistes vía fecal-oral, por la contaminación del suelo y el agua, y el “efecto” consistió en una diarrea autolimitante, una deshidratación severa, el síndrome de mala absorción y la muerte.Conclusiones Los ecosistemas pueden mantener poblaciones saludables, pero cuando son mal administrados o rápidamente alterados debido a la presión humana, también pueden estar asociados con la aparición de enfermedades, como la Criptosporidiosis.

Developing environmental health indicators [EHIs] for Iran based on the causal effect model

Background

Environmental health monitoring and its effects on health are very important in health systems. Relationship between environment and health can be done by simplifying data in understandable indicators for people and policy-makers. The present study presents the general framework for formulating environmental health quality index for Iran.

Methods

This study was implemented through expert panel at two levels: indicator domain determination and domain specific variables selection. Domain specific variables were selected based on the Driving force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework from the list of national and international variables.

Results

Seven environmental health issues [air quality, drinking water, sewage disposal, food, radiation management and housing and human settlements] were determined, and three variables were selected for air quality, 8 variables for water quality, 5 variables for sanitation, 1 variable for food quality, 3 variables for housing and human settlements, 4 variables for solid waste management and 3 variables for radiation management.

Conclusions

Environmental health indicators determination based on the causal effect model leads to a better understanding of the relationship between the environment and health by simplifying data in an understandable format for public and improves prioritization of policy-making in the environmental health. In this study, environmental health indicators for Iran were proposed.

Developing a Conceptual Framework for Environmental Health Tracking in Victoria, Australia

Victoria’s (Australia) Environment Protection Authority (EPA), the state’s environmental regulator, has recognized the need to develop an Environmental Health Tracking System (EHTS) to better understand environmental health relationships. To facilitate the process of developing an EHTS; a linkage-based conceptual framework was developed to link routinely collected environmental and health data to better understand environmental health relationships. This involved researching and drawing on knowledge from previous similar projects. While several conceptual frameworks have been used to organize data to support the development of an environmental health tracking system, Driving Force–Pressure–State–Exposure–Effect–Action (DPSEEA) was identified as the most broadly applied conceptual framework. Exposure and effects are two important components of DPSEEA, and currently, exposure data are not available for the EHTS. Therefore, DPSEEA was modified to the Driving Force–Pressure–Environmental Condition–Health Impact–Action (DPEHA) conceptual framework for the proposed Victorian EHTS as there is relevant data available for tracking. The potential application of DPEHA for environmental health tracking was demonstrated through case studies. DPEHA will be a useful tool to support the implementation of Victoria’s environmental health tracking system for providing timely and scientific evidence for EPA and other decision makers in developing and evaluating policies for protecting public health and the environment in Victoria.

The status of international collaborations in compilation of Iranian scientific articles on environmental health engineering

BACKGROUND

Scientific cooperation is one of the effective methods to access current knowledge and technologies and also to use successful experiences of researchers in developed countries by academicians living in developing countries. This study aimed to determine the level of international contribution in compilation of scientific articles in Iranian journals published in the field of environmental health engineering.

METHODS

This descriptive and retrospective study was conducted within a 10-year period (2008-2017), in which all articles published in five specialized Iranian journals of environmental health engineering were reviewed using a researcher-made checklist. The information collected in the checklist included: the year of publication, number of issues and articles, information about the status of authors' participation in terms of number of authors, sex, institutional affiliation, country, continents, and research centers. Descriptive and inferential statistics such as index of dispersion, measures of central tendency, and Chi-square and t tests were used to statistically analyze the data. Besides, VOSviewer software was used to visualize the data.

RESULTS

The review of 1276 articles published in 102 issues of the five journals of environmental health engineering in Iran showed that 184 articles were written with the participation of researchers from other countries. Most articles with the participation of international authors during the last decade were published in 2014. Chi-square test indicated a significant difference in the publication of these articles within 2014-2015 than other years (P = 0.001). Among the five journals, the best participation of international researchers was observed in J Environ Health Sci Engineer (168 articles, 91.3%). Considering the number of joint articles with Iran, the top continents were Asia, Europe, and Africa each with 117, 52, and 32 articles, respectively. India, Turkey, and Malaysia had the highest level of cooperation with Iranian researchers with 53, 16, and 14 articles, respectively. 637 authors contributed in 184 articles, of whom 469 (73.6%) were male and 121 (18.9%) were female. T test was used to compare the mean number of male and female authors in the articles with or without the participation of international researchers, which showed no significant difference.

CONCLUSION

International contribution of researchers in compilation of specialized environmental health articles was good. Given the low level of cooperation between researchers from developed European and American countries and their Iranian counterparts, it seems necessary to adopt different methods to attract more collaboration from researchers working in developed countries considering their significant role in health-related areas.

Application of the DPSEEA Model to Healthcare Waste Management

The use of health indicators is indispensable for understanding the complex relationship between the environmental and health fields. For the proposition of environmental health indicators, the Brazilian Ministry of Health (MH) recommends using a model proposed by the World Health Organization. This model is composed of the following elements: Driving Force, Pressure, State, Exposure, Effect, and Action; it is called the DPSEEA model. The objective of this study is to propose the application of this model in healthcare waste (HCW) management. This study was performed by documentary research using two data sources: a) technical reports on research on HCW from the last 15 years (outpatient, dental, hospital, veterinary, university, and primary care unit) at the University of Caxias do Sul, Brazil; and b) the MH manual entitled "Environmental Health: Basic Guide for the Construction of Indicators". The results show that the model is relevant because it makes it possible to analyse a particular context, proposing indicators and defining specific actions for the case of this study, to monitor and improve methods of managing HCW. The results also show that the proposed model is an important analytical tool for both medical waste management and planning actions that will minimize risks, particularly chemical and biological, resulting in environmental health and protection.

Evaluating Water Resource Security in Karst Areas Using DPSIRM Modeling, Gray Correlation, and Matter–Element Analysis

To evaluate the long-term security of water resources in Guizhou, this paper presents an evaluation index that incorporates the driving force–pressure–state–impact–response–management (DPSIRM) framework, the gray correlation method, and matter–element analysis. For the period of 2005–2012, our results show that water resources were within the “generally safe” limits for all years except 2006 and 2011, which were characterized by drought conditions. In karst regions, drought has a relatively large impact on water security and is compounded in Guizhou by rapid economic development, nonpoint-source agricultural pollution, and inadequate sewage treatment. Nonetheless, recent efforts to return farmland to forest and grassland and to control desertification have led to increased forest cover and higher levels of soil and water conservation, while systems have been implemented to foster the effective management of water resources in karst areas. In this study, we used both gray matter–element analysis and a DPSIRM framework to assess the state of water resources in Guizhou, the results of which were compared and verified by the gray set pair method, and to provide a reference for evaluating other karst areas.

The Importance of Using Public Health Impact Criteria to Develop Environmental Health Indicators: The Example of the Indoor Environment in New Zealand

Developing environmental health indicators is challenging and applying a conceptual framework and indicator selection criteria may not be sufficient to prioritise potential indicators to monitor. This study developed a new approach for prioritising potential environmental health indicators, using the example of the indoor environment for New Zealand. A three-stage process of scoping, selection, and design was implemented. A set of potential indicators (including 4 exposure indicators and 20 health indicators) were initially identified and evaluated against indicator selection criteria. The health indicators were then further prioritised according to their public health impact and assessed by the five following sub-criteria: number of people affected (based on environmental burden of disease statistics); severity of health impact; whether vulnerable populations were affected and/or large inequalities were apparent; whether the indicator related to multiple environmental exposures; and policy relevance. Eight core indicators were ultimately selected, as follows: living in crowded households, second-hand smoke exposure, maternal smoking at two weeks post-natal, asthma prevalence, asthma hospitalisations, lower respiratory tract infection hospitalisations, meningococcal disease notifications, and sudden unexpected death in infancy (SUDI). Additionally, indicators on living in damp and mouldy housing and children's injuries in the home, were identified as potential indicators, along with attributable burden indicators. Using public health impact criteria and an environmental burden of disease approach was valuable in prioritising and selecting the most important health impacts to monitor, using robust evidence and objective criteria.

Comprehensive Evaluation of Water Resource Security: Case Study from Luoyang City, China

The security of water resources is the core content and ultimate goal of urban water resource management agencies. The management of water resources is directly related to the needs of urban residents’ lives and the area’s socio-economic development. How to determine the effective evaluation indicators and methods is an important prerequisite to solving the water resource security problem. This study took Luoyang City as the research area and constructed a water resource security evaluation index system based on pressure-state-response framework. An analytic hierarchy process and entropy weight method were used to determine the index weight. A set pair analysis model was then introduced to evaluate the security of water resources in Luoyang from 2006 to 2016. The results of this study show that the standard of water resource security generally improved in Luoyang in the latter years of the study period. From 2006 to 2008, Luoyang was graded at the Insecurity Level. This compares to a slightly improved grading of Critical Security Level from 2009 to 2016 (except for 2013). However, the overall grade is still low. The pressure on the Luoyang water resource system mainly comes from the development of the urban socio-economy, which in turn has caused problems for both the quantity and quality of water resources. Therefore, a series of countermeasures have been introduced as a means of improving the water resource security of Luoyang, and these measures have achieved certain results. However, further improvements to the efficiency of water resource utilization and strengthening the management and protection of water resources remain necessary.

Children's Environmental Health Indicators for Pacific Island Countries

Healthy environments support the wellbeing of children and the environment thus play a cardinal role in the future of Pacific Island Countries (PICs). Children are more vulnerable and at risk to environmental hazards than adults because they breathe, drink, and eat much more relative to body weight, resulting in greater exposures in the different environments in which children find themselves every day. We examine the role that children’s environmental health indicators (CEHI) can play for PICs to highlight priorities and we prioritise actions to improve children’s environmental health and thus achieve their ‘Healthy Islands’ vision. We conducted a systematic search of relevant documented and publicly available Pacific Island Country information on children’s environmental health indicators using the general Internet, as well as databases such as PubMed, Google Scholar, relevant UN agencies, as well as regional databases. Information on CEHI was available—mainly in grey literature—but not specifically aimed at PICs. Likewise, similar observations were made for peer-reviewed literature. From this review, we compiled summaries and a framework to propose the requirements as well as provide a foundation for the development of CEHI for PICs. CEHI development for PICs should ideally be a multi-sectoral endeavour within each PIC as well as for the region. This can be achieved through public, private, and academic sector initiatives to draw in all sectors of government as well as the relevant UN agencies and regional PIC-representative organisations.

Towards environmental health equity in health impact assessment: innovations and opportunities

OBJECTIVES

As global environmental change drives inequitable health outcomes, novel health equity assessment methodologies are increasingly required. We review literatures on equity-focused HIA to clarify how equity is informing HIA practice, and to surface innovations for assessing health equity in relation to a range of exposures across geographic and temporal scales.

METHODS

A narrative review of the health equity and HIA literatures analysed English articles published between 2003 and 2017 across PubMed, PubMed Central, Biomed Central and Ovid Medline. Title and abstract reviews of 849 search results yielded 89 articles receiving full text review.

RESULTS

Considerations of equity in HIA increased over the last 5 years, but equity continues to be conflated with health disparities rather than their root causes (i.e. inequities). Lessons from six literatures to inform future HIA practice are described: HIA for healthy cities, climate change vulnerability assessment, cumulative health risk assessment, intersectionality-based policy analysis, corporate health impact assessment and global health impact assessment.

CONCLUSIONS

Academic reporting on incorporating equity in HIA practice has been limited. Nonetheless, significant methodological advancements are being made to examine the health equity implications of multiple environmental exposures.

Interactive Cumulative Burden Assessment: Engaging Stakeholders in an Adaptive, Participatory and Transdisciplinary Approach

Cumulative burden assessment (CuBA) has the potential to inform planning and decision-making on health disparities related to multiple environmental burdens. However, scholars have raised concerns about the social complexity to be dealt with while conducting CuBA, suggesting that it should be addressed in an adaptive, participatory and transdisciplinary (APT) approach. APT calls for deliberation among stakeholders by engaging them in a process of social learning and knowledge co-production. We propose an interactive stakeholder-based approach that facilitates a science-based stakeholder dialogue as an interface for combining different knowledge domains and engendering social learning in CuBA processes. Our approach allows participants to interact with each other using a flexible and auditable CuBA model implemented within a shared workspace. In two workshops we explored the usefulness and practicality of the approach. Results show that stakeholders were enabled to deliberate on cumulative burdens collaboratively, to learn about the technical uncertainties and social challenges associated with CuBA, and to co-produce knowledge in a realm of both technical and societal challenges. The paper identifies potential benefits relevant for responding to social complexity in the CuBA and further recommends exploration of how our approach can enable or constraint social learning and knowledge co-production in CuBA processes under various institutional, social and political contexts.

Children's Environmental Health Indicators for Low- and Middle-Income Countries in Asia

BACKGROUND

Given that low- and middle-income countries (LMICs) in Asia still have high child mortality rates, improved monitoring using children's environmental health indicators (CEHI) may help reduce preventable deaths by creating healthy environments.

OBJECTIVES

Thus, the aim of this study is to build a set of targeted CEHI that can be applied in LMICs in Asia through the CEHI initiative using a common conceptual framework.

METHODS

A systematic review was conducted to identify the most frequently used framework for developing CEHI. Due to the limited number of eligible records, a hand search of the reference lists and an extended search of Google Scholar were also performed. Based on our findings, we designed a set of targeted CEHI to address the children's environmental health situation in LMICs in Asia. The Delphi method was then adopted to assess the relevance, appropriateness, and feasibility of the targeted CEHI.

FINDINGS

The systematic review indicated that the Driving-Pressure-State-Exposure-Effect-Action framework and the Multiple-Exposures-Multiple-Effects model were the most common conceptual frameworks for developing CEHI. The Multiple-Exposures-Multiple-Effects model was adopted, given that its population of interest is children and its emphasis on the many-to-many relationship. Our review also showed that most of the previous studies covered upper-middle- or high-income countries. The Delphi results validated the targeted CEHI. The targeted CEHI were further specified by age group, gender, and place of residence (urban/rural) to enhance measurability.

CONCLUSIONS

Improved monitoring systems of children's environmental health using the targeted CEHI may mitigate the data gap and enhance the quality of data in LMICs in Asia. Furthermore, critical information on the complex interaction between the environment and children's health using the CEHI will help establish a regional environmental children's health action plan, named "The Children's Environment and Health Action Plan for Asia."

Developing Health-Related Indicators of Climate Change: Australian Stakeholder Perspectives

Climate-related health indicators are potentially useful for tracking and predicting the adverse public health effects of climate change, identifying vulnerable populations, and monitoring interventions. However, there is a need to understand stakeholders’ perspectives on the identification, development, and utility of such indicators. A qualitative approach was used, comprising semi-structured interviews with key informants and service providers from government and non-government stakeholder organizations in South Australia. Stakeholders saw a need for indicators that could enable the monitoring of health impacts and time trends, vulnerability to climate change, and those which could also be used as communication tools. Four key criteria for utility were identified, namely robust and credible indicators, specificity, data availability, and being able to be spatially represented. The variability of risk factors in different regions, lack of resources, and data and methodological issues were identified as the main barriers to indicator development. This study demonstrates a high level of stakeholder awareness of the health impacts of climate change, and the need for indicators that can inform policy makers regarding interventions.

The Lancet Countdown: tracking progress on health and climate change

The Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be "the greatest global health opportunity of the 21st century". The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. These focus areas form the five thematic working groups of the Lancet Countdown and represent different aspects of the complex association between health and climate change. These thematic groups will provide indicators for a global overview of health and climate change; national case studies highlighting countries leading the way or going against the trend; and engagement with a range of stakeholders. The Lancet Countdown ultimately aims to report annually on a series of indicators across these five working groups. This paper outlines the potential indicators and indicator domains to be tracked by the collaboration, with suggestions on the methodologies and datasets available to achieve this end. The proposed indicator domains require further refinement, and mark the beginning of an ongoing consultation process-from November, 2016 to early 2017-to develop these domains, identify key areas not currently covered, and change indicators where necessary. This collaboration will actively seek to engage with existing monitoring processes, such as the UN Sustainable Development Goals and WHO's climate and health country profiles. The indicators will also evolve over time through ongoing collaboration with experts and a range of stakeholders, and be dependent on the emergence of new evidence and knowledge. During the course of its work, the Lancet Countdown will adopt a collaborative and iterative process, which aims to complement existing initiatives, welcome engagement with new partners, and be open to developing new research projects on health and climate change.

A Conceptual Model to Assess Stress-Associated Health Effects of Multiple Ecosystem Services Degraded by Disaster Events in the Gulf of Mexico and Elsewhere

Few conceptual frameworks attempt to connect disaster-associated environmental injuries to impacts on ecosystem services (the benefits humans derive from nature) and thence to both psychological and physiological human health effects. To our knowledge, this study is one of the first, if not the first, to develop a detailed conceptual model of how degraded ecosystem services affect cumulative stress impacts on the health of individual humans and communities. Our comprehensive Disaster-Pressure State-Ecosystem Services-Response-Health (DPSERH) model demonstrates that oil spills, hurricanes, and other disasters can change key ecosystem components resulting in reductions in individual and multiple ecosystem services that support people's livelihoods, health, and way of life. Further, the model elucidates how damage to ecosystem services produces acute, chronic, and cumulative stress in humans which increases risk of adverse psychological and physiological health outcomes. While developed and initially applied within the context of the Gulf of Mexico, it should work equally well in other geographies and for many disasters that cause impairment of ecosystem services. Use of this new tool will improve planning for responses to future disasters and help society more fully account for the costs and benefits of potential management responses. The model also can be used to help direct investments in improving response capabilities of the public health community, biomedical researchers, and environmental scientists. Finally, the model illustrates why the broad range of potential human health effects of disasters should receive equal attention to that accorded environmental damages in assessing restoration and recovery costs and time frames.

Social determinants and lifestyles: integrating environmental and public health perspectives

OBJECTIVE

Industrialization and urbanization have been associated with an epidemiological transition, from communicable to non-communicable disease, and a geological transition that is moving the planet beyond the stable Holocene epoch in which human societies have prospered. The lifestyles of high-income countries are major drivers of these twin processes. Our objective is to highlight the common causes of chronic disease and environmental change and, thereby, contribute to shared perspectives across public health and the environment.

STUDY DESIGN

Integrative reviews focused on social determinants and lifestyles as two 'bridging' concepts between the fields of public health and environmental sustainability.

METHODS

We drew on established frameworks to consider the position of the natural environment within social determinants of health (SDH) frameworks and the position of social determinants within environmental frameworks. We drew on evidence on lifestyle factors central to both public health and environmental change (mobility- and diet-related factors). We investigated how public health's focus on individual behaviour can be enriched by environmental perspectives that give attention to household consumption practices.

RESULTS

While SDH frameworks can incorporate the biophysical environment, their causal structure positions it as a determinant and one largely separate from the social factors that shape it. Environmental frameworks are more likely to represent the environment and its ecosystems as socially determined. A few frameworks also include human health as an outcome, providing the basis for a combined public health/environmental sustainability framework. Environmental analyses of household impacts broaden public health's concern with individual risk behaviours, pointing to the more damaging lifestyles of high-income households.

CONCLUSION

The conditions for health are being undermined by rapid environmental change. There is scope for frameworks reaching across public health and environmental sustainability and a shared evidence base that captures the health- and environmentally damaging impacts of high-consumption lifestyles.

Mapping Environmental Inequalities Relevant for Health for Informing Urban Planning Interventions-A Case Study in the City of Dortmund, Germany

Spatial differences in urban environmental conditions contribute to health inequalities within cities. The purpose of the paper is to map environmental inequalities relevant for health in the City of Dortmund, Germany, in order to identify needs for planning interventions. We develop suitable indicators for mapping socioeconomically-driven environmental inequalities at the neighborhood level based on published scientific evidence and inputs from local stakeholders. Relationships between socioeconomic and environmental indicators at the level of 170 neighborhoods were analyzed continuously with Spearman rank correlation coefficients and categorically applying chi-squared tests. Reclassified socioeconomic and environmental indicators were then mapped at the neighborhood level in order to determine multiple environmental burdens and hotspots of environmental inequalities related to health. Results show that the majority of environmental indicators correlate significantly, leading to multiple environmental burdens in specific neighborhoods. Some of these neighborhoods also have significantly larger proportions of inhabitants of a lower socioeconomic position indicating hotspots of environmental inequalities. Suitable planning interventions mainly comprise transport planning and green space management. In the conclusions, we discuss how the analysis can be used to improve state of the art planning instruments, such as clean air action planning or noise reduction planning towards the consideration of the vulnerability of the population.

Spatiotemporal analysis of encroachment on wetlands: a case of Nakivubo wetland in Kampala, Uganda

Wetlands provide vital ecosystem services such as water purification, flood control, and climate moderation among others, which enhance environmental quality, promote public health, and contribute to risk reduction. The biggest threat to wetlands is posed by human activities which transform wetlands, often for short-term consumptive benefits. This paper aimed to classify and map recent land cover and provide a multi-temporal analysis of changes from 2002 to 2014 in the Nakivubo wetland through which wastewater from Kampala city drains to Lake Victoria in Uganda. The paper contributes through spatially congruent change maps showing site-specific land cover conversions. In addition, it gives insight into what happened to the wetlands, why it happened, how the changes in the wetlands affect the communities living in them, and how the situation could be better managed or regulated in future. The analysis is based on very high resolution (50-62 cm) aerial photos and satellite imagery, focus group discussions, and key informant interviews. Overall, the analysis of losses and gains showed a 62 % loss of wetland vegetation between 2002 and 2014, mostly attributable to crop cultivation. Cultivation in the wetland buffering the lake shore makes it unstable to anchor. The 2014 data shows large portions of the wetland calved away by receding lake waves. With barely no wetland vegetation buffer around the lake, the heavily polluted wastewater streams will lower the quality of lake water. Furthermore, with increased human activities in the wetland, exposure to flooding and pollution will be likely to have a greater impact on the health and livelihoods of vulnerable communities. This calls for a multi-faceted approach, coordination of the various stakeholders and engagement of wetland-dependent communities as part of the solution, and might require zoning out the wetland and restricting certain activities to specific zones.

Framework for Selecting Best Practices in Public Health: A Systematic Literature Review

Evidence-based public health has commonly relied on findings from empirical studies, or research-based evidence. However, this paper advocates that practice-based evidence derived from programmes implemented in real-life settings is likely to be a more suitable source of evidence for inspiring and guiding public health programmes. Selection of best practices from the array of implemented programmes is one way of generating such practice-based evidence. Yet the lack of consensus on the definition and criteria for practice-based evidence and best practices has limited their application in public health so far. To address the gap in literature on practice-based evidence, this paper hence proposes measures of success for public health interventions by developing an evaluation framework for selection of best practices. The proposed framework was synthesised from a systematic literature review of peer-reviewed and grey literature on existing evaluation frameworks for public health programmes as well as processes employed by health-related organisations when selecting best practices. A best practice is firstly defined as an intervention that has shown evidence of effectiveness in a particular setting and is likely to be replicable to other situations. Regardless of the area of public health, interventions should be evaluated by their context, process and outcomes. A best practice should hence meet most, if not all, of eight identified evaluation criteria: relevance, community participation, stakeholder collaboration, ethical soundness, replicability, effectiveness, efficiency and sustainability. Ultimately, a standardised framework for selection of best practices will improve the usefulness and credibility of practice-based evidence in informing evidence-based public health interventions. Significance for public healthBest practices are a valuable source of practice-based evidence on effective public health interventions implemented in real-life settings. Yet, despite the frequent branding of interventions as best practices or good practices, there is no consensus on the definition and desirable characteristics of such best practices. Hence, this is likely to be the first systematic review on the topic of best practices in public health. Having a single widely accepted framework for selecting best practices will ensure that the selection processes by different agencies are fair and comparable, as well as enable public health workers to better appreciate and adopt best practices in different settings. Ultimately, standardisation will improve the credibility and usefulness of practice-based evidence to that of research-based evidence.

Applying an Ecohealth perspective in a state of the environment report: experiences of a local public health unit in Canada

We applied an Ecohealth perspective into a State of the Environment report for Grey Bruce Health Unit and summarized environmental and health data relevant for public health practice. We aimed for comprehensiveness in our data compilation, including: standard media categories (e.g., air, water, land); and ecological indicators (e.g., vectors, forests, wetlands). Data sources included both primary (collected by an organization) and secondary (assembled by others). We organized indicators with the Driving forces-Pressure-State-Exposure-Effect-Action (DPSEEA) framework created by the World Health Organization. Indicators of air, water and land quality generally appeared to point towards a healthy state. Vector-borne diseases remained low. Forests and wetlands appeared to be in good condition, however more monitoring data was needed to determine trends in their ecological indicators. Data were not available on biodiversity and fish conditions. The results of our application of the DPSEEA framework suggest that routinely collected environmental and health data can be structured into the framework, though challenges arose due to gaps in data availability, particularly for social and gender analyses. Ecohealth approaches had legitimacy with broader healthy community partners but applying such approaches was a complex undertaking.