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Grellier J, White MP, de Bell S, Brousse O, Elliott LR, Fleming LE, Heaviside C, Simpson C, Taylor T, Wheeler BW, Lovell R. Valuing the health benefits of nature-based recreational physical activity in England. Environ Int 2024; 187:108667. [PMID: 38642505 DOI: 10.1016/j.envint.2024.108667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/15/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
Physical activity (PA) reduces the risk of several non-communicable diseases (NCDs). Natural environments support recreational PA. Using data including a representative cross-sectional survey of the English population, we estimated the annual value of nature-based PA conducted in England in 2019 in terms of avoided healthcare and societal costs of disease. Population-representative data from the Monitor of Engagement with the Natural Environment (MENE) survey (n = 47,580; representing 44,386,756) were used to estimate the weekly volume of nature-based recreational PA by adults in England in 2019. We used epidemiological dose-response data to calculate incident cases of six NCDs (ischaemic heart disease (IHD), ischaemic stroke (IS), type 2 diabetes (T2D), colon cancer (CC), breast cancer (BC) and major depressive disorder (MDD)) prevented through nature-based PA, and estimated associated savings using published costs of healthcare, informal care and productivity losses. We investigated additional savings resulting from hypothetical increases in: (a) visitor PA and (b) visitor numbers. In 2019, 22million adults > 16 years of age in England visited natural environments at least weekly. At reported volumes of nature-based PA, we estimated that 550 cases of IHD, 168 cases of IS, 1,410 cases of T2D, 41 cases of CC, 37 cases of BC and 10,552 cases of MDD were prevented, creating annual savings of £108.7million (95 % uncertainty interval: £70.3million; £150.3million). Nature-based recreational PA in England results in reduced burden of disease and considerable annual savings through prevention of priority NCDs. Strategies that increase nature-based PA could lead to further reductions in the societal burden of NCDs.
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Affiliation(s)
- James Grellier
- European Centre for Environment & Human Health, University of Exeter, Penryn, Cornwall, UK; Institute of Psychology, Jagiellonian University, Krakow, Poland.
| | - Mathew P White
- European Centre for Environment & Human Health, University of Exeter, Penryn, Cornwall, UK; Vienna Cognitive Science Hub, University of Vienna, Kolingasse 14-16, 1090 Vienna, Austria
| | - Siân de Bell
- European Centre for Environment & Human Health, University of Exeter, Penryn, Cornwall, UK; Exeter HS&DR Evidence Synthesis Centre, University of Exeter, Exeter, Devon, UK
| | - Oscar Brousse
- The Bartlett School of Environment, Energy and Resources, Faculty of the Built Environment, University College London, London, UK
| | - Lewis R Elliott
- European Centre for Environment & Human Health, University of Exeter, Penryn, Cornwall, UK
| | - Lora E Fleming
- European Centre for Environment & Human Health, University of Exeter, Penryn, Cornwall, UK
| | - Clare Heaviside
- The Bartlett School of Environment, Energy and Resources, Faculty of the Built Environment, University College London, London, UK
| | - Charles Simpson
- The Bartlett School of Environment, Energy and Resources, Faculty of the Built Environment, University College London, London, UK
| | - Tim Taylor
- European Centre for Environment & Human Health, University of Exeter, Penryn, Cornwall, UK
| | - Benedict W Wheeler
- European Centre for Environment & Human Health, University of Exeter, Penryn, Cornwall, UK
| | - Rebecca Lovell
- European Centre for Environment & Human Health, University of Exeter, Penryn, Cornwall, UK
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2
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Martin L, White MP, Elliott LR, Grellier J, Astell-Burt T, Bratman GN, Lima ML, Nieuwenhuijsen M, Ojala A, Roiko A, van den Bosch M, Fleming LE. Mechanisms underlying the associations between different types of nature exposure and sleep duration: An 18-country analysis. Environ Res 2024; 250:118522. [PMID: 38403148 DOI: 10.1016/j.envres.2024.118522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/17/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
Whilst green space has been linked to healthier sleep outcomes, the roles of specific types of nature exposure, potential underlying mechanisms, and between-country variations in nature-sleep associations have received little attention. Drawing on cross-sectional survey data from an 18-country sample of adults (N = 16,077) the current study examined: 1) the relative associations between six different types of nature exposure (streetscape greenery, blue view from home, green space within 1 km, coast within 1 km, green space visits, blue space visits) and insufficient sleep (<6 h vs. 7-10 h per day); 2) whether these relationships were mediated by better mental wellbeing and/or physical activity; and 3) the consistency of these pathways among the different countries. After controlling for covariates, neighbourhood nature measures (green space, coast within 1 km) were not significantly associated with insufficient sleep; but nature visible from home (streetscape greenery, blue views) and recreational visits to green and blue spaces were each associated with less insufficient sleep. Significant nature-sleep associations were mediated, to varying degrees, by better mental wellbeing, but not self-reported physical activity. Country-level heterogeneity in the strength of nature-sleep associations was observed. Increasing nature visible from the home may represent a promising strategy for promoting healthier sleep duration at the population level, whilst nature-based interventions encouraging individuals to spend time in local green/blue spaces may be an appropriate target to assist individuals affected by insufficient sleep.
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Affiliation(s)
- Leanne Martin
- European Centre for Environment and Human Health, University of Exeter Medical School, UK.
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, UK; Cognitive Science HUB & Urban and Environmental Psychology Group, University of Vienna, Austria
| | - Lewis R Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
| | - James Grellier
- European Centre for Environment and Human Health, University of Exeter Medical School, UK; Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), NSW, Australia; School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Gregory N Bratman
- School of Environmental and Forest Sciences, University of Washington, USA
| | - Maria L Lima
- Department of Social and Organizational Psychology, ISCTE - University Institute of Lisbon, Portugal
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ann Ojala
- Natural Resources Institute Finland (Luke), Finland
| | - Anne Roiko
- School of Pharmacy & Medical Sciences, Griffith University, Australia
| | - Matilda van den Bosch
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Natural Resources Institute Finland (Luke), Finland; School of Population and Public Health, University of British Columbia, Canada; Department of Forest and Conservation Sciences, University of British Columbia, Canada
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
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Haque SS, Bennett BJ, Brewer TD, Morrissey K, Fleming LE, Gribble MO. Correction: Marine Protected Area Expansion and Country-Level Age-Standardized Adult Mortality. Ecohealth 2024:10.1007/s10393-023-01672-5. [PMID: 38231421 DOI: 10.1007/s10393-023-01672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Sabrina S Haque
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Mailstop 1518-002-2BB, Atlanta, GA, 30322, USA
| | - Baylin J Bennett
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Thomas D Brewer
- Australian National Centre for Ocean Resources and Security, Building 233, Innovation Campus, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Karyn Morrissey
- Division of Climate and Energy Policy, Department of Technology, Management and Economics, Technical University of Denmark, Anker Engelunds Vej 1 Bygning 101A, 2800, Kgs. Lyngby, Denmark
| | - Lora E Fleming
- European Centre for the Environment and Human Health, University of Exeter Medical School, Truro Cornwall, TR1 3HD, UK
| | - Matthew O Gribble
- Department of Medicine, Division of Occupational, Environmental and Climate Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94143, USA.
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Lo Iacono G, Cook AJC, Derks G, Fleming LE, French N, Gillingham EL, Gonzalez Villeta LC, Heaviside C, La Ragione RM, Leonardi G, Sarran CE, Vardoulakis S, Senyah F, van Vliet AHM, Nichols G. A mathematical, classical stratification modeling approach to disentangling the impact of weather on infectious diseases: A case study using spatio-temporally disaggregated Campylobacter surveillance data for England and Wales. PLoS Comput Biol 2024; 20:e1011714. [PMID: 38236828 PMCID: PMC10796013 DOI: 10.1371/journal.pcbi.1011714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Disentangling the impact of the weather on transmission of infectious diseases is crucial for health protection, preparedness and prevention. Because weather factors are co-incidental and partly correlated, we have used geography to separate out the impact of individual weather parameters on other seasonal variables using campylobacteriosis as a case study. Campylobacter infections are found worldwide and are the most common bacterial food-borne disease in developed countries, where they exhibit consistent but country specific seasonality. We developed a novel conditional incidence method, based on classical stratification, exploiting the long term, high-resolution, linkage of approximately one-million campylobacteriosis cases over 20 years in England and Wales with local meteorological datasets from diagnostic laboratory locations. The predicted incidence of campylobacteriosis increased by 1 case per million people for every 5° (Celsius) increase in temperature within the range of 8°-15°. Limited association was observed outside that range. There were strong associations with day-length. Cases tended to increase with relative humidity in the region of 75-80%, while the associations with rainfall and wind-speed were weaker. The approach is able to examine multiple factors and model how complex trends arise, e.g. the consistent steep increase in campylobacteriosis in England and Wales in May-June and its spatial variability. This transparent and straightforward approach leads to accurate predictions without relying on regression models and/or postulating specific parameterisations. A key output of the analysis is a thoroughly phenomenological description of the incidence of the disease conditional on specific local weather factors. The study can be crucially important to infer the elusive mechanism of transmission of campylobacteriosis; for instance, by simulating the conditional incidence for a postulated mechanism and compare it with the phenomenological patterns as benchmark. The findings challenge the assumption, commonly made in statistical models, that the transformed mean rate of infection for diseases like campylobacteriosis is a mere additive and combination of the environmental variables.
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Affiliation(s)
- Giovanni Lo Iacono
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- Institute for Sustainability, University of Surrey, Guildford, United Kingdom
- People-Centred Artificial Intelligence Institute, University of Surrey, Guilford, United Kingdom
- Centre for Mathematical and Computational Biology, University of Surrey, Guilford, United Kingdom
| | - Alasdair J. C. Cook
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Gianne Derks
- Centre for Mathematical and Computational Biology, University of Surrey, Guilford, United Kingdom
- Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
| | - Nigel French
- New Zealand Food Safety Science & Research Centre, Massey University, Palmerston North, New Zealand
| | | | - Laura C. Gonzalez Villeta
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Clare Heaviside
- Institute for Environmental Design and Engineering, University College London, London, United Kingdom
| | - Roberto M. La Ragione
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- School of Biosciences, University of Surrey, Guilford, United Kingdom
| | - Giovanni Leonardi
- UK Health Security Agency, Chilton, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sotiris Vardoulakis
- Healthy Environments And Lives (HEAL) National Research Network, Australian National University, Canberra, ACT, Australia
| | - Francis Senyah
- UK Health Security Agency, Porton Down, United Kingdom
- Médicines Sans Frontièrs, London, United Kingdom
| | - Arnoud H. M. van Vliet
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Gordon Nichols
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
- UK Health Security Agency, Chilton, United Kingdom
- University of East Anglia, Norwich, United Kingdom
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5
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Landrigan PJ, Raps H, Cropper M, Bald C, Brunner M, Canonizado EM, Charles D, Chiles TC, Donohue MJ, Enck J, Fenichel P, Fleming LE, Ferrier-Pages C, Fordham R, Gozt A, Griffin C, Hahn ME, Haryanto B, Hixson R, Ianelli H, James BD, Kumar P, Laborde A, Law KL, Martin K, Mu J, Mulders Y, Mustapha A, Niu J, Pahl S, Park Y, Pedrotti ML, Pitt JA, Ruchirawat M, Seewoo BJ, Spring M, Stegeman JJ, Suk W, Symeonides C, Takada H, Thompson RC, Vicini A, Wang Z, Whitman E, Wirth D, Wolff M, Yousuf AK, Dunlop S. Correction: The Minderoo-Monaco Commission on Plastics and Human Health. Ann Glob Health 2023; 89:71. [PMID: 37841805 PMCID: PMC10573651 DOI: 10.5334/aogh.4331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/14/2023] [Indexed: 10/17/2023] Open
Abstract
[This corrects the article DOI: 10.5334/aogh.4056.].
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Affiliation(s)
- Philip J. Landrigan
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
- Centre Scientifique de Monaco, Medical Biology Department, MC
| | - Hervé Raps
- Centre Scientifique de Monaco, Medical Biology Department, MC
| | - Maureen Cropper
- Economics Department, University of Maryland, College Park, US
| | - Caroline Bald
- Global Observatory on Planetary Health, Boston College, US
| | | | | | | | | | | | | | - Patrick Fenichel
- Université Côte d’Azur
- Centre Hospitalier, Universitaire de Nice, FR
| | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
| | | | | | | | - Carly Griffin
- Global Observatory on Planetary Health, Boston College, US
| | - Mark E. Hahn
- Biology Department, Woods Hole Oceanographic Institution, US
- Woods Hole Center for Oceans and Human Health, US
| | - Budi Haryanto
- Department of Environmental Health, Universitas Indonesia, ID, US
- Research Center for Climate Change, Universitas Indonesia, ID
| | - Richard Hixson
- College of Medicine and Health, University of Exeter, UK
| | - Hannah Ianelli
- Global Observatory on Planetary Health, Boston College, US
| | - Bryan D. James
- Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution, US
- Department of Biology, Woods Hole Oceanographic Institution, US
| | | | - Amalia Laborde
- Department of Toxicology, School of Medicine, University of the Republic, UY
| | | | - Keith Martin
- Consortium of Universities for Global Health, US
| | - Jenna Mu
- Global Observatory on Planetary Health, Boston College, US
| | | | - Adetoun Mustapha
- Nigerian Institute of Medical Research, Lagos, Nigeria
- Lead City University, NG
| | - Jia Niu
- Department of Chemistry, Boston College, US
| | - Sabine Pahl
- University of Vienna, Austria and University of Plymouth, UK
| | | | - Maria-Luiza Pedrotti
- Laboratoire d’Océanographie de Villefranche sur mer (LOV), Sorbonne Université, FR
| | - Jordan Avery Pitt
- Biology Department, Woods Hole Oceanographic Institution, US
- Woods Hole Center for Oceans and Human Health, US
| | | | - Bhedita Jaya Seewoo
- Minderoo Foundation, AU
- School of Biological Sciences, The University of Western Australia, AU
| | | | - John J. Stegeman
- Biology Department and Woods Hole Center for Oceans and Human Health, Woods Hole Oceanographic Institution, US
| | - William Suk
- Superfund Research Program, National Institutes of Health, National Institute of Environmental Health Sciences, US
| | | | - Hideshige Takada
- Laboratory of Organic Geochemistry (LOG), Tokyo University of Agriculture and Technology, JP
| | | | | | - Zhanyun Wang
- Technology and Society Laboratory, WEmpa-Swiss Federal Laboratories for Materials and Technology, CH
| | - Ella Whitman
- Global Observatory on Planetary Health, Boston College, US
| | | | | | | | - Sarah Dunlop
- Minderoo Foundation, AU
- School of Biological Sciences, The University of Western Australia, AU
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Haque SS, Bennett BJ, Brewer TD, Morrissey K, Fleming LE, Gribble MO. Marine Protected Area Expansion and Country-Level Age-Standardized Adult Mortality. Ecohealth 2023; 20:236-248. [PMID: 38114749 PMCID: PMC10757699 DOI: 10.1007/s10393-023-01658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 09/28/2023] [Indexed: 12/21/2023]
Abstract
Many countries have adopted targets to increase marine protected areas (MPAs) to limit the degradation of water bodies. Although there is evidence that MPAs can conserve marine life and promote biodiversity, there are limited data on the human health implications of MPAs. Using panel data from 1990, 2000, and 2014, we estimated the country-level associations between MPAs (i.e., percentage of territorial waters designated as marine reserves) and age-standardized mortality (i.e., age-standardized probability of dying between 15 and 60 years from all-causes among ages 15-60/100,000 population) by sex, among 110 countries. We fit mixed-effects linear regression models of mortality as a function of current MPA coverage, gross domestic product growth, year, the prior extent of MPA, electricity coverage, governance, and country-level random effects. We observed a significant inverse association between current MPA coverage and adult mortality. For each 5-percentage-point increase in current MPA coverage, a country had 0.982 times the geometric means of female and male mortality [geometric mean ratio: 0.982 (95% CI 0·976, 0·988)] conditional on past %MPA coverage and other modeled variables. The model showed no significant residual association of mortality with past %MPA conditional on current %MPA and other modeled variables. This is one of the first studies to show a positive association between increasing marine conservation and human health. This macro-level study suggests there may be important co-benefits for human health from expanding MPAs that merit further investigation.
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Affiliation(s)
- Sabrina S Haque
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Mailstop 1518-002-2BB, Atlanta, GA, 30322, USA
| | - Baylin J Bennett
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Thomas D Brewer
- Australian National Centre for Ocean Resources and Security, Building 233, Innovation Campus, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Karyn Morrissey
- Division of Climate and Energy Policy, Department of Technology, Management and Economics, Technical University of Denmark, Anker Engelunds Vej 1 Bygning 101A, 2800, Kgs. Lyngby, Denmark
| | - Lora E Fleming
- European Centre for the Environment and Human Health, University of Exeter Medical School, Truro Cornwall, TR1 3HD, UK
| | - Matthew O Gribble
- Department of Medicine, Division of Occupational, Environmental and Climate Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94143, USA.
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Elliott LR, Pasanen T, White MP, Wheeler BW, Grellier J, Cirach M, Bratman GN, van den Bosch M, Roiko A, Ojala A, Nieuwenhuijsen M, Fleming LE. Nature contact and general health: Testing multiple serial mediation pathways with data from adults in 18 countries. Environment International 2023; 178:108077. [PMID: 37413929 DOI: 10.1016/j.envint.2023.108077] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
The role of neighbourhood nature in promoting good health is increasingly recognised in policy and practice, but consistent evidence for the underlying mechanisms is lacking. Heterogeneity in exposure methods, outcome measures, and population characteristics, little exploration of recreational use or the role of different types of green or blue space, and multiple separate mediation models in previous studies have limited our ability to synthesise findings and draw clear conclusions. We examined multiple pathways linking different types of neighbourhood nature with general health using a harmonised international sample of adults. Using cross-sectional survey data from 18 countries (n = 15,917), we developed a multigroup path model to test theorised pathways, controlling for sociodemographic variables. We tested the possibility that neighbourhood nature (e.g. greenspace, inland bluespace, and coastal bluespace) would be associated with general health through lower air pollution exposure, greater physical activity attainment, more social contact, and higher subjective well-being. However, our central prediction was that associations between different types of neighbourhood nature and general health would largely be serially mediated by recent visit frequency to corresponding environment types, and, subsequently, physical activity, social contact, and subjective well-being associated with these frequencies. Several subsidiary analyses assessed the robustness of the results to alternative model specifications as well as effect modification by sociodemographics. Consistent with this prediction, there was statistical support for eight of nine potential serial mediation pathways via visit frequency which held for a range of alternative model specifications. Effect modification by financial strain, sex, age, and urbanicity altered some associations but did not necessarily support the idea that nature reduced health inequalities. The results demonstrate that across countries, theorised nature-health linkages operate primarily through recreational contact with natural environments. This provides arguments for greater efforts to support use of local green/blue spaces for health promotion and disease prevention.
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Affiliation(s)
- Lewis R Elliott
- European Centre for Environment and Human Health, University of Exeter, Cornwall, United Kingdom.
| | - Tytti Pasanen
- Finnish Institute for Health and Welfare, Tampere, Finland
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter, Cornwall, United Kingdom; Cognitive Science Hub, University of Vienna, Vienna, Austria
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter, Cornwall, United Kingdom
| | - James Grellier
- European Centre for Environment and Human Health, University of Exeter, Cornwall, United Kingdom; Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Marta Cirach
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gregory N Bratman
- School of Environmental and Forest Sciences, University of Washington, USA
| | - Matilda van den Bosch
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Forest and Conservation Sciences, Faculty of Forestry, University of British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia
| | - Anne Roiko
- School of Pharmacy & Medical Sciences, Griffith University, Australia
| | - Ann Ojala
- Natural Resources Institute Finland (Luke), Helsinki, Finland
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter, Cornwall, United Kingdom
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Pellens N, Boelee E, Veiga JM, Fleming LE, Blauw A. Innovative actions in oceans and human health for Europe. Health Promot Int 2023; 38:daab203. [PMID: 34935042 PMCID: PMC10405041 DOI: 10.1093/heapro/daab203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Innovative actions are local initiatives which leverage the interactions between the ocean and human health to reduce the risks and enhance the benefits for the stakeholders and the natural environment. These initiatives can have strong positive effects on human health and wellbeing as well as on the marine environment. We analysed 150 such innovative actions in Europe. Using a combined case study and survey approach, innovative actions were identified using interviews and content analysis of websites and compiled into a database. Quantitative data were analysed according to the Drivers, Pressures, State, Impact and Response (DPSIR) framework, guided by selected in-depth interviews. Overall, the innovative actions provided a positive impact on the health of both the ocean and humans through increasing food provision, water quality and tourism opportunities; and addressing environmental issues such as commercial fish stock depletion, pollution and climate change. Innovative actions contributed to meeting various targets of the Sustainable Development Goals (SDGs) 3, 13 and 14. These actions played a potential role ahead of and alongside policy. Some of the innovative actions may have potential to be put in place elsewhere. Such up-scaling would need to be adapted to local circumstances and could be facilitated by an innovative action exchange platform.
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Affiliation(s)
- Noortje Pellens
- Faculty of Geosciences, Utrecht University, Princetonlaan 8a, 3584 CB Utrecht, the Netherlands
- Deltares, PO Box 177, 2600 MH Delft and Daltonlaan 600, 3584 BK Utrecht, the Netherlands
| | - Eline Boelee
- Deltares, PO Box 177, 2600 MH Delft and Daltonlaan 600, 3584 BK Utrecht, the Netherlands
| | - Joana M Veiga
- Deltares, PO Box 177, 2600 MH Delft and Daltonlaan 600, 3584 BK Utrecht, the Netherlands
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Anouk Blauw
- Deltares, PO Box 177, 2600 MH Delft and Daltonlaan 600, 3584 BK Utrecht, the Netherlands
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9
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Jenkins AP, Lancaster AMSN, Capon A, Soapi K, Fleming LE, Jupiter SD. Human health depends on thriving oceans. Lancet 2023; 402:9-11. [PMID: 37301212 DOI: 10.1016/s0140-6736(23)01162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Aaron P Jenkins
- Centre for People, Place and Planet, Edith Cowan University, Perth, WA 6027, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Alana M S N Lancaster
- Faculty of Law, University of the West Indies, Cave Hill, Barbados; One Ocean Hub, University of Strathclyde, Glasgow, UK
| | - Anthony Capon
- Monash Sustainable Development Institute, Monash University, Melbourne, VIC, Australia
| | - Katy Soapi
- The Pacific Community Centre for Ocean Science, The Pacific Community, Suva, Fiji
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Stacy D Jupiter
- Wildlife Conservation Society, Melanesia Program, Suva, Fiji
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Pasanen TP, White MP, Elliott LR, van den Bosch M, Bratman GN, Ojala A, Korpela K, Fleming LE. Urban green space and mental health among people living alone: The mediating roles of relational and collective restoration in an 18-country sample. Environ Res 2023:116324. [PMID: 37311473 DOI: 10.1016/j.envres.2023.116324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023]
Abstract
Rates of living alone, especially in more urbanised areas, are increasing across many industrialised countries, with associated increases in feelings of loneliness and poorer mental health. Recent studies have suggested that access to nature (e.g. parks and green spaces) can reduce the stressors associated with loneliness, partly through providing opportunities to nurture personal relationships (relational restoration) and engage in normative community activities (collective restoration). Such associations might vary across different household compositions and socio-demographic or geographical characteristics, but these have not been thoroughly tested. Using data collected across 18 countries/territories in 2017-2018, we grouped urban respondents into those living alone (n = 2062) and those living with a partner (n = 6218). Using multigroup path modelling, we tested whether the associations between neighbourhood greenspace coverage (1-km-buffer from home) and mental health are sequentially mediated by: (a) visits to greenspace; and subsequently (b) relationship and/or community satisfaction, as operationalisations of relational and collective restoration, respectively. We also tested whether any indirect associations varied among subgroups of respondents living alone. Analyses showed that visiting green space was associated with greater mental well-being and marginally lower odds of using anxiety/depression medication use indirectly, mediated via both relationship and community satisfaction. These indirect associations were equally strong among respondents living alone and those living with a partner. Neighbourhood green space was, additionally, associated with more visits among respondents living with a partner, whereas among those living alone, this was sensitive to the green space metric. Within subgroups of people living alone, few overall differences were found. Some indirect pathways were, nevertheless, stronger in males, under 60-year-olds, those with no financial strain, and residents in warmer climates. In conclusion, supporting those living alone, as well as those living with a partner, to more frequently access their local greenspaces could help improve mental health via promoting relational and collective restoration.
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Affiliation(s)
- Tytti P Pasanen
- Faculty of Social Sciences / Psychology, Tampere University, Kalevantie 4, 33014, Tampere University, Finland; Environmental Health Unit, Finnish Institute for Health and Welfare, Kuopio, Finland.
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK; Cognitive Science HUB, University of Vienna, Vienna, Austria
| | - Lewis R Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK
| | - Matilda van den Bosch
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; School of Population and Public Health, University of British Columbia, Canada; Department of Forest and Conservation Sciences, University of British Columbia, Canada
| | - Gregory N Bratman
- School of Environmental and Forest Sciences, University of Washington, USA; Department of Psychology, University of Washington, USA
| | - Ann Ojala
- Natural Resources Institute Finland (Luke), Finland
| | - Kalevi Korpela
- Faculty of Social Sciences / Psychology, Tampere University, Kalevantie 4, 33014, Tampere University, Finland
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK
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Landrigan PJ, Raps H, Cropper M, Bald C, Brunner M, Canonizado EM, Charles D, Chiles TC, Donohue MJ, Enck J, Fenichel P, Fleming LE, Ferrier-Pages C, Fordham R, Gozt A, Griffin C, Hahn ME, Haryanto B, Hixson R, Ianelli H, James BD, Kumar P, Laborde A, Law KL, Martin K, Mu J, Mulders Y, Mustapha A, Niu J, Pahl S, Park Y, Pedrotti ML, Pitt JA, Ruchirawat M, Seewoo BJ, Spring M, Stegeman JJ, Suk W, Symeonides C, Takada H, Thompson RC, Vicini A, Wang Z, Whitman E, Wirth D, Wolff M, Yousuf AK, Dunlop S. The Minderoo-Monaco Commission on Plastics and Human Health. Ann Glob Health 2023; 89:23. [PMID: 36969097 PMCID: PMC10038118 DOI: 10.5334/aogh.4056] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Background Plastics have conveyed great benefits to humanity and made possible some of the most significant advances of modern civilization in fields as diverse as medicine, electronics, aerospace, construction, food packaging, and sports. It is now clear, however, that plastics are also responsible for significant harms to human health, the economy, and the earth's environment. These harms occur at every stage of the plastic life cycle, from extraction of the coal, oil, and gas that are its main feedstocks through to ultimate disposal into the environment. The extent of these harms not been systematically assessed, their magnitude not fully quantified, and their economic costs not comprehensively counted. Goals The goals of this Minderoo-Monaco Commission on Plastics and Human Health are to comprehensively examine plastics' impacts across their life cycle on: (1) human health and well-being; (2) the global environment, especially the ocean; (3) the economy; and (4) vulnerable populations-the poor, minorities, and the world's children. On the basis of this examination, the Commission offers science-based recommendations designed to support development of a Global Plastics Treaty, protect human health, and save lives. Report Structure This Commission report contains seven Sections. Following an Introduction, Section 2 presents a narrative review of the processes involved in plastic production, use, and disposal and notes the hazards to human health and the environment associated with each of these stages. Section 3 describes plastics' impacts on the ocean and notes the potential for plastic in the ocean to enter the marine food web and result in human exposure. Section 4 details plastics' impacts on human health. Section 5 presents a first-order estimate of plastics' health-related economic costs. Section 6 examines the intersection between plastic, social inequity, and environmental injustice. Section 7 presents the Commission's findings and recommendations. Plastics Plastics are complex, highly heterogeneous, synthetic chemical materials. Over 98% of plastics are produced from fossil carbon- coal, oil and gas. Plastics are comprised of a carbon-based polymer backbone and thousands of additional chemicals that are incorporated into polymers to convey specific properties such as color, flexibility, stability, water repellence, flame retardation, and ultraviolet resistance. Many of these added chemicals are highly toxic. They include carcinogens, neurotoxicants and endocrine disruptors such as phthalates, bisphenols, per- and poly-fluoroalkyl substances (PFAS), brominated flame retardants, and organophosphate flame retardants. They are integral components of plastic and are responsible for many of plastics' harms to human health and the environment.Global plastic production has increased almost exponentially since World War II, and in this time more than 8,300 megatons (Mt) of plastic have been manufactured. Annual production volume has grown from under 2 Mt in 1950 to 460 Mt in 2019, a 230-fold increase, and is on track to triple by 2060. More than half of all plastic ever made has been produced since 2002. Single-use plastics account for 35-40% of current plastic production and represent the most rapidly growing segment of plastic manufacture.Explosive recent growth in plastics production reflects a deliberate pivot by the integrated multinational fossil-carbon corporations that produce coal, oil and gas and that also manufacture plastics. These corporations are reducing their production of fossil fuels and increasing plastics manufacture. The two principal factors responsible for this pivot are decreasing global demand for carbon-based fuels due to increases in 'green' energy, and massive expansion of oil and gas production due to fracking.Plastic manufacture is energy-intensive and contributes significantly to climate change. At present, plastic production is responsible for an estimated 3.7% of global greenhouse gas emissions, more than the contribution of Brazil. This fraction is projected to increase to 4.5% by 2060 if current trends continue unchecked. Plastic Life Cycle The plastic life cycle has three phases: production, use, and disposal. In production, carbon feedstocks-coal, gas, and oil-are transformed through energy-intensive, catalytic processes into a vast array of products. Plastic use occurs in every aspect of modern life and results in widespread human exposure to the chemicals contained in plastic. Single-use plastics constitute the largest portion of current use, followed by synthetic fibers and construction.Plastic disposal is highly inefficient, with recovery and recycling rates below 10% globally. The result is that an estimated 22 Mt of plastic waste enters the environment each year, much of it single-use plastic and are added to the more than 6 gigatons of plastic waste that have accumulated since 1950. Strategies for disposal of plastic waste include controlled and uncontrolled landfilling, open burning, thermal conversion, and export. Vast quantities of plastic waste are exported each year from high-income to low-income countries, where it accumulates in landfills, pollutes air and water, degrades vital ecosystems, befouls beaches and estuaries, and harms human health-environmental injustice on a global scale. Plastic-laden e-waste is particularly problematic. Environmental Findings Plastics and plastic-associated chemicals are responsible for widespread pollution. They contaminate aquatic (marine and freshwater), terrestrial, and atmospheric environments globally. The ocean is the ultimate destination for much plastic, and plastics are found throughout the ocean, including coastal regions, the sea surface, the deep sea, and polar sea ice. Many plastics appear to resist breakdown in the ocean and could persist in the global environment for decades. Macro- and micro-plastic particles have been identified in hundreds of marine species in all major taxa, including species consumed by humans. Trophic transfer of microplastic particles and the chemicals within them has been demonstrated. Although microplastic particles themselves (>10 µm) appear not to undergo biomagnification, hydrophobic plastic-associated chemicals bioaccumulate in marine animals and biomagnify in marine food webs. The amounts and fates of smaller microplastic and nanoplastic particles (MNPs <10 µm) in aquatic environments are poorly understood, but the potential for harm is worrying given their mobility in biological systems. Adverse environmental impacts of plastic pollution occur at multiple levels from molecular and biochemical to population and ecosystem. MNP contamination of seafood results in direct, though not well quantified, human exposure to plastics and plastic-associated chemicals. Marine plastic pollution endangers the ocean ecosystems upon which all humanity depends for food, oxygen, livelihood, and well-being. Human Health Findings Coal miners, oil workers and gas field workers who extract fossil carbon feedstocks for plastic production suffer increased mortality from traumatic injury, coal workers' pneumoconiosis, silicosis, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer. Plastic production workers are at increased risk of leukemia, lymphoma, hepatic angiosarcoma, brain cancer, breast cancer, mesothelioma, neurotoxic injury, and decreased fertility. Workers producing plastic textiles die of bladder cancer, lung cancer, mesothelioma, and interstitial lung disease at increased rates. Plastic recycling workers have increased rates of cardiovascular disease, toxic metal poisoning, neuropathy, and lung cancer. Residents of "fenceline" communities adjacent to plastic production and waste disposal sites experience increased risks of premature birth, low birth weight, asthma, childhood leukemia, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer.During use and also in disposal, plastics release toxic chemicals including additives and residual monomers into the environment and into people. National biomonitoring surveys in the USA document population-wide exposures to these chemicals. Plastic additives disrupt endocrine function and increase risk for premature births, neurodevelopmental disorders, male reproductive birth defects, infertility, obesity, cardiovascular disease, renal disease, and cancers. Chemical-laden MNPs formed through the environmental degradation of plastic waste can enter living organisms, including humans. Emerging, albeit still incomplete evidence indicates that MNPs may cause toxicity due to their physical and toxicological effects as well as by acting as vectors that transport toxic chemicals and bacterial pathogens into tissues and cells.Infants in the womb and young children are two populations at particularly high risk of plastic-related health effects. Because of the exquisite sensitivity of early development to hazardous chemicals and children's unique patterns of exposure, plastic-associated exposures are linked to increased risks of prematurity, stillbirth, low birth weight, birth defects of the reproductive organs, neurodevelopmental impairment, impaired lung growth, and childhood cancer. Early-life exposures to plastic-associated chemicals also increase the risk of multiple non-communicable diseases later in life. Economic Findings Plastic's harms to human health result in significant economic costs. We estimate that in 2015 the health-related costs of plastic production exceeded $250 billion (2015 Int$) globally, and that in the USA alone the health costs of disease and disability caused by the plastic-associated chemicals PBDE, BPA and DEHP exceeded $920 billion (2015 Int$). Plastic production results in greenhouse gas (GHG) emissions equivalent to 1.96 gigatons of carbon dioxide (CO2e) annually. Using the US Environmental Protection Agency's (EPA) social cost of carbon metric, we estimate the annual costs of these GHG emissions to be $341 billion (2015 Int$).These costs, large as they are, almost certainly underestimate the full economic losses resulting from plastics' negative impacts on human health and the global environment. All of plastics' economic costs-and also its social costs-are externalized by the petrochemical and plastic manufacturing industry and are borne by citizens, taxpayers, and governments in countries around the world without compensation. Social Justice Findings The adverse effects of plastics and plastic pollution on human health, the economy and the environment are not evenly distributed. They disproportionately affect poor, disempowered, and marginalized populations such as workers, racial and ethnic minorities, "fenceline" communities, Indigenous groups, women, and children, all of whom had little to do with creating the current plastics crisis and lack the political influence or the resources to address it. Plastics' harmful impacts across its life cycle are most keenly felt in the Global South, in small island states, and in disenfranchised areas in the Global North. Social and environmental justice (SEJ) principles require reversal of these inequitable burdens to ensure that no group bears a disproportionate share of plastics' negative impacts and that those who benefit economically from plastic bear their fair share of its currently externalized costs. Conclusions It is now clear that current patterns of plastic production, use, and disposal are not sustainable and are responsible for significant harms to human health, the environment, and the economy as well as for deep societal injustices.The main driver of these worsening harms is an almost exponential and still accelerating increase in global plastic production. Plastics' harms are further magnified by low rates of recovery and recycling and by the long persistence of plastic waste in the environment.The thousands of chemicals in plastics-monomers, additives, processing agents, and non-intentionally added substances-include amongst their number known human carcinogens, endocrine disruptors, neurotoxicants, and persistent organic pollutants. These chemicals are responsible for many of plastics' known harms to human and planetary health. The chemicals leach out of plastics, enter the environment, cause pollution, and result in human exposure and disease. All efforts to reduce plastics' hazards must address the hazards of plastic-associated chemicals. Recommendations To protect human and planetary health, especially the health of vulnerable and at-risk populations, and put the world on track to end plastic pollution by 2040, this Commission supports urgent adoption by the world's nations of a strong and comprehensive Global Plastics Treaty in accord with the mandate set forth in the March 2022 resolution of the United Nations Environment Assembly (UNEA).International measures such as a Global Plastics Treaty are needed to curb plastic production and pollution, because the harms to human health and the environment caused by plastics, plastic-associated chemicals and plastic waste transcend national boundaries, are planetary in their scale, and have disproportionate impacts on the health and well-being of people in the world's poorest nations. Effective implementation of the Global Plastics Treaty will require that international action be coordinated and complemented by interventions at the national, regional, and local levels.This Commission urges that a cap on global plastic production with targets, timetables, and national contributions be a central provision of the Global Plastics Treaty. We recommend inclusion of the following additional provisions:The Treaty needs to extend beyond microplastics and marine litter to include all of the many thousands of chemicals incorporated into plastics.The Treaty needs to include a provision banning or severely restricting manufacture and use of unnecessary, avoidable, and problematic plastic items, especially single-use items such as manufactured plastic microbeads.The Treaty needs to include requirements on extended producer responsibility (EPR) that make fossil carbon producers, plastic producers, and the manufacturers of plastic products legally and financially responsible for the safety and end-of-life management of all the materials they produce and sell.The Treaty needs to mandate reductions in the chemical complexity of plastic products; health-protective standards for plastics and plastic additives; a requirement for use of sustainable non-toxic materials; full disclosure of all components; and traceability of components. International cooperation will be essential to implementing and enforcing these standards.The Treaty needs to include SEJ remedies at each stage of the plastic life cycle designed to fill gaps in community knowledge and advance both distributional and procedural equity.This Commission encourages inclusion in the Global Plastic Treaty of a provision calling for exploration of listing at least some plastic polymers as persistent organic pollutants (POPs) under the Stockholm Convention.This Commission encourages a strong interface between the Global Plastics Treaty and the Basel and London Conventions to enhance management of hazardous plastic waste and slow current massive exports of plastic waste into the world's least-developed countries.This Commission recommends the creation of a Permanent Science Policy Advisory Body to guide the Treaty's implementation. The main priorities of this Body would be to guide Member States and other stakeholders in evaluating which solutions are most effective in reducing plastic consumption, enhancing plastic waste recovery and recycling, and curbing the generation of plastic waste. This Body could also assess trade-offs among these solutions and evaluate safer alternatives to current plastics. It could monitor the transnational export of plastic waste. It could coordinate robust oceanic-, land-, and air-based MNP monitoring programs.This Commission recommends urgent investment by national governments in research into solutions to the global plastic crisis. This research will need to determine which solutions are most effective and cost-effective in the context of particular countries and assess the risks and benefits of proposed solutions. Oceanographic and environmental research is needed to better measure concentrations and impacts of plastics <10 µm and understand their distribution and fate in the global environment. Biomedical research is needed to elucidate the human health impacts of plastics, especially MNPs. Summary This Commission finds that plastics are both a boon to humanity and a stealth threat to human and planetary health. Plastics convey enormous benefits, but current linear patterns of plastic production, use, and disposal that pay little attention to sustainable design or safe materials and a near absence of recovery, reuse, and recycling are responsible for grave harms to health, widespread environmental damage, great economic costs, and deep societal injustices. These harms are rapidly worsening.While there remain gaps in knowledge about plastics' harms and uncertainties about their full magnitude, the evidence available today demonstrates unequivocally that these impacts are great and that they will increase in severity in the absence of urgent and effective intervention at global scale. Manufacture and use of essential plastics may continue. However, reckless increases in plastic production, and especially increases in the manufacture of an ever-increasing array of unnecessary single-use plastic products, need to be curbed.Global intervention against the plastic crisis is needed now because the costs of failure to act will be immense.
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Affiliation(s)
- Philip J. Landrigan
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
- Centre Scientifique de Monaco, Medical Biology Department, MC
| | - Hervé Raps
- Centre Scientifique de Monaco, Medical Biology Department, MC
| | - Maureen Cropper
- Economics Department, University of Maryland, College Park, US
| | - Caroline Bald
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | | | | | | | | | | | | | - Patrick Fenichel
- Université Côte d’Azur
- Centre Hospitalier, Universitaire de Nice, FR
| | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
| | | | | | | | - Carly Griffin
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | - Mark E. Hahn
- Biology Department, Woods Hole Oceanographic Institution, US
- Woods Hole Center for Oceans and Human Health, US
| | - Budi Haryanto
- Department of Environmental Health, Universitas Indonesia, ID
- Research Center for Climate Change, Universitas Indonesia, ID
| | - Richard Hixson
- College of Medicine and Health, University of Exeter, UK
| | - Hannah Ianelli
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | - Bryan D. James
- Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution
- Department of Biology, Woods Hole Oceanographic Institution, US
| | | | - Amalia Laborde
- Department of Toxicology, School of Medicine, University of the Republic, UY
| | | | - Keith Martin
- Consortium of Universities for Global Health, US
| | - Jenna Mu
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | | | - Adetoun Mustapha
- Nigerian Institute of Medical Research, Lagos, Nigeria
- Lead City University, NG
| | - Jia Niu
- Department of Chemistry, Boston College, US
| | - Sabine Pahl
- University of Vienna, Austria
- University of Plymouth, UK
| | | | - Maria-Luiza Pedrotti
- Laboratoire d’Océanographie de Villefranche sur mer (LOV), Sorbonne Université, FR
| | | | | | - Bhedita Jaya Seewoo
- Minderoo Foundation, AU
- School of Biological Sciences, The University of Western Australia, AU
| | | | - John J. Stegeman
- Biology Department and Woods Hole Center for Oceans and Human Health, Woods Hole Oceanographic Institution, US
| | - William Suk
- Superfund Research Program, National Institutes of Health, National Institute of Environmental Health Sciences, US
| | | | - Hideshige Takada
- Laboratory of Organic Geochemistry (LOG), Tokyo University of Agriculture and Technology, JP
| | | | | | - Zhanyun Wang
- Technology and Society Laboratory, WEmpa-Swiss Federal Laboratories for Materials and Technology, CH
| | - Ella Whitman
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | | | | | - Aroub K. Yousuf
- Global Observatory on Planetary Health, Boston College, Chestnut Hill, MA, US
| | - Sarah Dunlop
- Minderoo Foundation, AU
- School of Biological Sciences, The University of Western Australia, AU
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Roland HB, Whitehead C, Fleming LE, Berdalet E, Enevoldsen HO, Gribble MO. Knowledge Sharing to Reduce Toxin Exposure Risks from Harmful Algal Blooms: Global Networks and Political Barriers. Ethn Dis 2022; 32:285-292. [PMID: 36388868 PMCID: PMC9590605 DOI: 10.18865/ed.32.4.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Harmful algal blooms (HABs) are a significant global environmental management challenge, especially with respect to microalgae that produce dangerous natural toxins. Examples of HAB toxin diseases with major global health impact include: ciguatera poisoning, paralytic shellfish poisoning (PSP), amnesic shellfish poisoning (ASP), diarrhetic shellfish poisoning (DSP), and neurotoxic (brevetoxin) shellfish poisoning (NSP). Such diseases affect communities globally and contribute to health inequalities within the United States and beyond. Sharing data and lessons learned about the factors determining bloom occurrence and associated exposure to contaminated seafood across locations can reduce public health risks. Knowledge sharing is particularly important as ongoing global environmental changes seem to alter the intensity, location, and timing of toxic HAB events, reducing the reliability of conventional guidance where toxin risks have been endemic and leading to emerging challenges in new settings. Political changes that disrupt membership in knowledge-sharing networks may impede efforts to share scientific expertise and best practices. In this commentary, we stress the importance of community and expert knowledge sharing for reducing HAB risks, both for vulnerable communities in the United States and globally. Considering the impacts of political changes, we note the indirect engagement sometimes required for continued participation in international coordination programs. As an example, we highlight how lessons learned from a Native-led toxin monitoring and testing program (the Southeast Alaska Tribal Ocean Research partnership) can inform programs in other settings. We also describe how international knowledge is mutually valuable for this program in Southeast Alaska.
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Affiliation(s)
- Hugh B. Roland
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | | | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
| | - Elisa Berdalet
- Marine Biology and Oceanography, Institute of Marine Sciences, Spanish National Research Council (ICM-CSIC), Barcelona, Spain
| | - Henrik Oksfeldt Enevoldsen
- Intergovernmental Oceanographic Commission Science and Communication Centre on Harmful Algae, IOC UNESCO, Copenhagen, Denmark
| | - Matthew O. Gribble
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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Smalley AJ, White MP, Ripley R, Atack TX, Lomas E, Sharples M, Coates PA, Groom N, Grand A, Heneberry A, Fleming LE, Depledge MH. Forest 404: Using a BBC drama series to explore the impact of nature's changing soundscapes on human wellbeing and behavior. Glob Environ Change 2022; 74:102497. [PMID: 36406626 PMCID: PMC9664366 DOI: 10.1016/j.gloenvcha.2022.102497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/10/2022] [Accepted: 02/27/2022] [Indexed: 06/16/2023]
Abstract
Extensive ecosystem degradation and increasing urbanization are altering human relationships with nature. To explore these trends, we created a transdisciplinary, narrative-led podcast series produced by the BBC, called Forest 404. The series explored the implications of a world without nature. An online experimental component mobilized audience participation (n = 7,596) to assess responses to natural soundscapes with and without abiotic, biotic, and poetic elements across five biomes. Conditions featuring the sounds of wildlife, such as bird song, were perceived to be more psychologically restorative than those without. Participants' personal lived experiences were strongly related to these outcomes; those who had memories triggered by the sounds were more likely to find them psychologically restorative and exhibited a greater motivation to preserve them. Moreover, the effects of both soundscape composition and memories on preservation behavior were partially mediated by restorative potential; respondents were more likely to want to protect the sounds they heard if they thought they might offer therapeutic outcomes. Our findings highlight the value of art-science collaborations and demonstrate how maintaining contact with the natural world can promote wellbeing and foster behaviors that protect planetary health.
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Affiliation(s)
| | | | | | | | | | | | | | - Nick Groom
- University of Exeter, UK
- University of Macau, China
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Lloret J, Carreño A, Carić H, San J, Fleming LE. Environmental and human health impacts of cruise tourism: A review. Mar Pollut Bull 2021; 173:112979. [PMID: 34598093 DOI: 10.1016/j.marpolbul.2021.112979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
The intensive growth of cruise tourism worldwide during recent decades is leading to growing concerns over the sector's global environmental and health impacts. This review combines for the first time various sources of information to estimate the magnitude of the cruise industry's environmental and public health footprints. This research shows that cruising, despite technical advances and some surveillance programmes, remains a major source of air, water (fresh and marine) and land pollution affecting fragile habitats, areas and species, and a potential source of physical and mental human health risks. Health risks impact both the people on board (crew and passengers) and on land (workers of shipyards where cruise ships are dismantled and citizens inhabiting cities with cruise ports and shipyards). In this context, we argue that the cruise industry should be held accountable with more monitoring and regulation to prevent or minimize the growing negative environmental and human health impacts.
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Affiliation(s)
- Josep Lloret
- Oceans & Human Health Chair, Institute of Aquatic Ecology, Faculty of Science, University of Girona, C/ Maria Aurèlia Capmany 69, 17003 Girona, Spain.
| | - Arnau Carreño
- Oceans & Human Health Chair, Institute of Aquatic Ecology, Faculty of Science, University of Girona, C/ Maria Aurèlia Capmany 69, 17003 Girona, Spain
| | - Hrvoje Carić
- Institute for Tourism, Vrhovec 5, 10000 Zagreb, Croatia
| | - Joan San
- Faculty of Medicine, University of Girona, c/ Emili Grahit, 77, 17003 Girona, Catalonia, Spain
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Cornwall TR1 3HD, UK.
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Elliott LR, White MP, Fleming LE, Abraham C, Taylor AH. Redesigning walking brochures using behaviour change theory: implications for walking intentions in natural environments. Health Promot Int 2021; 36:1126-1139. [PMID: 33367651 PMCID: PMC8527999 DOI: 10.1093/heapro/daaa150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Natural environments can be used to promote health through facilitating recreational walking. However, efforts to encourage this often neglect messages identified in psychological research that are effective at influencing intentions to walk. This is despite the National Institute for Health and Care Excellence stating that promotional efforts should utilize theoretical frameworks of behaviour change and be targeted towards less active adults. As an illustrative example, this experiment compared a prototypical recreational walking brochure with an "enhanced" version including such persuasive messages on people's intentions to walk for recreation in natural environments. The enhanced brochure heightened intentions for inexperienced recreational walkers through our hypothesized mechanisms, but appeared to dissuade already-experienced walkers. Optimal messaging strategies in recreational walking brochures require tailoring to more and less active readerships. Guidelines are provided for authors of recreational walking brochures, though the principles and techniques could easily be extended to other means of outdoor walking promotion.
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Affiliation(s)
- Lewis R Elliott
- European Centre for Environment and Human Health,
University of Exeter Medical School, University of Exeter, c/o Knowledge Spa,
RCHT, Truro, Cornwall TR1 3HD, UK
| | - Mathew P White
- European Centre for Environment and Human Health,
University of Exeter Medical School, University of Exeter, c/o Knowledge Spa,
RCHT, Truro, Cornwall TR1 3HD, UK
- Urban & Environmental Psychology Group,
University of Vienna, Austria
| | - Lora E Fleming
- European Centre for Environment and Human Health,
University of Exeter Medical School, University of Exeter, c/o Knowledge Spa,
RCHT, Truro, Cornwall TR1 3HD, UK
| | - Charles Abraham
- School of Psychological Sciences,
Rm. 701, Redmond Barry Building, University
of Melbourne, Parkville, VIC 3010, Australia
| | - Adrian H Taylor
- Faculty of Medicine & Dentistry, University
of Plymouth, N6, ITTC, Tamar Science Park,
Plymouth, Devon PL6 8BX, UK
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Hu X, Davies R, Morrissey K, Smith R, Fleming LE, Sharmina M, St Clair R, Hopkinson P. Single-use plastic and COVID-19 in the NHS: Barriers and opportunities. J Public Health Res 2021; 11. [PMID: 34351121 PMCID: PMC8859718 DOI: 10.4081/jphr.2021.2483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Single-use personal protective equipment (PPE) has been essential to protect healthcare workers during the COVID-19 pandemic. However, intensified use of PPE could counteract the previous efforts made by the UK NHS Trusts to reduce their plastic footprint. DESIGN AND METHODS In this study, we conducted an in-depth case study in the Royal Cornwall Hospitals NHS Trust to investigate plastic-related issues in a typical NHS Trust before, during and after the pandemic. We first collected hospital routine data on both procurement and usage of single-use PPE (including face masks, aprons, and gowns) for the time period between April 2019 and August 2020. We then interviewed 12 hospital staff across a wide remit, from senior managers to consultants, nurses and catering staff, to gather qualitative evidence on the overall impact of COVID-19 on the Trust regarding plastic use. RESULTS We found that although COVID-19 had increased the procurement and the use of single-use plastic substantially during the pandemic, it did not appear to have changed the focus of the hospital on implementing measures to reduce single-use plastic in the long term. We then discussed the barriers and opportunities to tackle plastic issues within the NHS in the post-COVID world, for example, a circular healthcare model. CONCLUSION investment is needed in technologies and processes that can recycle and reuse a wider range of single-use plastics, and innovate sustainable alternatives to replace single-use consumables used in the NHS to construct a fully operational closed material loop healthcare system.
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Affiliation(s)
- Xiaocheng Hu
- Environment and Sustainability Institute, University of Exeter, Penryn Campus, Cornwall.
| | - Roz Davies
- Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall.
| | - Karyn Morrissey
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Truro, Cornwall .
| | - Richard Smith
- University of Exeter Medical School, Exeter, Devon .
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Truro, Cornwall .
| | - Maria Sharmina
- Department of Mechanical, Aerospace and Civil Engineering, The University of Manchester, Manchester .
| | - Rebecca St Clair
- Department of Mechanical, Aerospace and Civil Engineering, The University of Manchester, Manchester .
| | - Peter Hopkinson
- University of Exeter Business School, Penryn Campus, Cornwall.
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Börger T, Campbell D, White MP, Elliott LR, Fleming LE, Garrett JK, Hattam C, Hynes S, Lankia T, Taylor T. The value of blue-space recreation and perceived water quality across Europe: A contingent behaviour study. Sci Total Environ 2021; 771:145597. [PMID: 33663957 DOI: 10.1016/j.scitotenv.2021.145597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
This study estimates the value of recreational visits to blue-space sites across 14 EU Member States, representing 78% of the Union's population. Across all countries surveyed, respondents made an average of 47 blue-space visits per person per year. Employing travel cost and contingent behaviour methods, the value of a visit is estimated at €41.32 which adds up to a recreational value of €631bn per year for the total adult population surveyed. Using the Bathing Water Directive's water quality designation, the analysis shows that a one-level improvement in water quality leads to 3.13 more visits (+6.67%), whereas a one-level deterioration leads to 9.77 fewer annual visits (-20.83%). This study provides valuations of benefits of recreation and changes of recreational values due to changes in surface water quality, which can be compared to the implementation and monitoring costs of efforts under the EU's Bathing Water, Water Framework and Marine Strategy Framework Directives.
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Affiliation(s)
- Tobias Börger
- Department of Business and Economics, Berlin School of Economics and Law, Germany; Applied Choice Research Group, University of Stirling Management School, United Kingdom.
| | - Danny Campbell
- Applied Choice Research Group, University of Stirling Management School, United Kingdom.
| | - Mathew P White
- Cognitive Science Hub, University of Vienna, Austria; European Centre for Environment and Human Health, University of Exeter Medical School, United Kingdom.
| | - Lewis R Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, United Kingdom.
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, United Kingdom.
| | - Joanne K Garrett
- European Centre for Environment and Human Health, University of Exeter Medical School, United Kingdom.
| | | | - Stephen Hynes
- Socio-Economic Marine Research Unit, Whitaker Institute, National University of Ireland, Galway, Ireland.
| | - Tuija Lankia
- Natural Resources Institute Finland (LUKE), Finland.
| | - Tim Taylor
- European Centre for Environment and Human Health, University of Exeter Medical School, United Kingdom.
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Fleming LE, Depledge M, Bouley T, Britton E, Dupont S, Eatock C, Garside R, Heymans JJ, Kellett P, Lloret J, Maycock B, Pahl S, Philippart CJM, Roberts BR, Thiele T, White MP, Wuijts S. The Ocean Decade-Opportunities for Oceans and Human Health Programs to Contribute to Public Health. Am J Public Health 2021; 111:808-811. [PMID: 33826386 DOI: 10.2105/ajph.2021.306229] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Lora E Fleming
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Michael Depledge
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Timothy Bouley
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Easkey Britton
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Sam Dupont
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Claire Eatock
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Ruth Garside
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Johanna J Heymans
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Paula Kellett
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Josep Lloret
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Bruce Maycock
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Sabine Pahl
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Catharina J M Philippart
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Bethany R Roberts
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Torsten Thiele
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Mathew P White
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Susanne Wuijts
- Lora E. Fleming, Michael Depledge, Claire Eatock, Ruth Garside, Bruce Maycock, Bethany R. Roberts, and Mathew P. White are with the European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Timothy Bouley is with the BioFeyn SAS, Paris, France. Easkey Britton is with the Whitaker Institute, National University of Ireland, Galway, Ireland. Sam Dupont is with the Department for Biological and Environmental Sciences, University of Gothenburg, Fiskebäckskil, Sweden. Johanna J. Heymans and Paula Kellett are with the European Marine Board, Ostend, Belgium. Josep Lloret is with the University of Girona, Oceans and Human Health Chair, Girona, Catalonia, Spain. Sabine Pahl is with the Cognitive Science HUB, Department of Psychology, University of Vienna, Vienna, Austria. Catharina J. M. Philippart is with the Royal Netherlands Institute for Sea Research, Texel, Netherlands. Torsten Thiele is with the Institute for Advanced Sustainability Studies, Potsdam, Germany. Susanne Wuijts is with the National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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Pouso S, Borja Á, Fleming LE, Gómez-Baggethun E, White MP, Uyarra MC. Contact with blue-green spaces during the COVID-19 pandemic lockdown beneficial for mental health. Sci Total Environ 2021; 756:143984. [PMID: 33277006 DOI: 10.31235/osf.io/gpt3r] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/04/2020] [Accepted: 11/14/2020] [Indexed: 05/26/2023]
Abstract
There is growing evidence that ecosystem services and especially the exposure to the natural world (blue-green spaces) have potential benefits for mental health and well-being. The COVID-19 pandemic and the measures adopted to control it provide a natural experiment to investigate the links between nature exposure and mental health under extreme conditions. Using a survey distributed online, we tested the following hypotheses: 1) People will show greater symptoms of depression and anxiety under lockdown conditions that did not allow contact with outdoor nature spaces; 2) Where access to public outdoor nature spaces was strictly restricted, (2a) those with green/blue nature view or (2b) access to private outdoor spaces such as a garden or balcony will show fewer symptoms of depression and anxiety, and a more positive mood. Based on 5218 responses from 9 countries, we found that lockdown severity significantly affected mental health, while contact with nature helped people to cope with these impacts, especially for those under strict lockdown. People under strict lockdown in Spain (3403 responses), perceived that nature helped them to cope with lockdown measures; and emotions were more positive among individuals with accessible outdoor spaces and blue-green elements in their views. These findings can help decision-makers in developing potential future lockdown measures to mitigate the negative impacts, helping people to be more resilient and maintain better mental health, using the benefits that ecosystem services are providing us.
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Affiliation(s)
- Sarai Pouso
- AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain.
| | - Ángel Borja
- AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain; King Abdulaziz University, Faculty of Marine Sciences, Jeddah, Saudi Arabia
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter, Knowledge Spa, Truro, UK
| | - Erik Gómez-Baggethun
- Department of International Environment and Development Studies (Noragric), Norwegian University of Life Sciences (NMBU), P.O. Box 5003, Ås N-1432, Norway; Norwegian Institute for Nature Research (NINA), Gaustadalleen 21, Oslo 0349, Norway
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter, Knowledge Spa, Truro, UK; Cognitive Science Hub, University of Vienna, Liebiggasse 5, Viena, Austria
| | - María C Uyarra
- AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain
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20
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Pouso S, Borja Á, Fleming LE, Gómez-Baggethun E, White MP, Uyarra MC. Contact with blue-green spaces during the COVID-19 pandemic lockdown beneficial for mental health. Sci Total Environ 2021; 756:143984. [PMID: 33277006 PMCID: PMC7688424 DOI: 10.1016/j.scitotenv.2020.143984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/04/2020] [Accepted: 11/14/2020] [Indexed: 05/02/2023]
Abstract
There is growing evidence that ecosystem services and especially the exposure to the natural world (blue-green spaces) have potential benefits for mental health and well-being. The COVID-19 pandemic and the measures adopted to control it provide a natural experiment to investigate the links between nature exposure and mental health under extreme conditions. Using a survey distributed online, we tested the following hypotheses: 1) People will show greater symptoms of depression and anxiety under lockdown conditions that did not allow contact with outdoor nature spaces; 2) Where access to public outdoor nature spaces was strictly restricted, (2a) those with green/blue nature view or (2b) access to private outdoor spaces such as a garden or balcony will show fewer symptoms of depression and anxiety, and a more positive mood. Based on 5218 responses from 9 countries, we found that lockdown severity significantly affected mental health, while contact with nature helped people to cope with these impacts, especially for those under strict lockdown. People under strict lockdown in Spain (3403 responses), perceived that nature helped them to cope with lockdown measures; and emotions were more positive among individuals with accessible outdoor spaces and blue-green elements in their views. These findings can help decision-makers in developing potential future lockdown measures to mitigate the negative impacts, helping people to be more resilient and maintain better mental health, using the benefits that ecosystem services are providing us.
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Affiliation(s)
- Sarai Pouso
- AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain.
| | - Ángel Borja
- AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain; King Abdulaziz University, Faculty of Marine Sciences, Jeddah, Saudi Arabia
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter, Knowledge Spa, Truro, UK
| | - Erik Gómez-Baggethun
- Department of International Environment and Development Studies (Noragric), Norwegian University of Life Sciences (NMBU), P.O. Box 5003, Ås N-1432, Norway; Norwegian Institute for Nature Research (NINA), Gaustadalleen 21, Oslo 0349, Norway
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter, Knowledge Spa, Truro, UK; Cognitive Science Hub, University of Vienna, Liebiggasse 5, Viena, Austria
| | - María C Uyarra
- AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain
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Cervera M, Bell S, Muñoz F, Mishra HS, Fleming LE, Grellier J, Carrasco-Turigas G, Nieuwenhuijsen MJ, Vert C, Gascon M. A Transdisciplinary Approach to Recovering Natural and Cultural Landscape and Place Identification: A Case Study of Can Moritz Spring (Rubí, Spain). Int J Environ Res Public Health 2021; 18:ijerph18041709. [PMID: 33578909 PMCID: PMC7916719 DOI: 10.3390/ijerph18041709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 11/16/2022]
Abstract
The perception of the quality of green and blue spaces can be key in the relationship between a community and its local landscape (i.e., place identification). The lack of transdisciplinary training and social-specific education of landscape architects regarding the complexity of landscape as a participative cultural artefact limits reaching the general population. Bridging this gap of landscape and place identification and evaluation by a local community was the main objective of the present case study conducted at an abandoned spring and seasonal stream area in Rubí (Spain). The "Steinitz method" of landscape evaluation was used as a participatory method to activate community members to learn about and express their visual preferences regarding this neglected landscape. Bottom-up interventions applying an "urban acupuncture" approach in the area identified as the least attractive by the residents were co-designed and combined with a top-down restoration of a nearby, existing but derelict and hidden, spring. In addition, before and after planning and implementing the intervention, we conducted surveys about the community perception, sense of belonging and use of the space. We observed that the lack of awareness of the inhabitants about this spring was an obstacle preventing the community from embracing the potential for health and wellbeing presented by the spring and adjacent landscape. Following the work, the landscape saw increasing use, and the historic spring was brought back to life as a resource to help people to improve their health and wellbeing.
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Affiliation(s)
- Marina Cervera
- Departament d’Urbanisme i Ordenació del Territori (DUOT), Universitat Politècnica de Catalunya- Barcelona Tech (UPC), 08028 Barcelona, Spain;
| | - Simon Bell
- Institute of Agricultural and Environmental Sciences, Estonian University of Life Sciences, 51014 Tartu, Estonia; (S.B.); (H.S.M.)
- Edinburgh School of Architecture and Landscape Architecture, University of Edinburgh, Edinburgh EH1 1JZ, UK
| | - Francesc Muñoz
- Departament de Geografia, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
| | - Himansu S. Mishra
- Institute of Agricultural and Environmental Sciences, Estonian University of Life Sciences, 51014 Tartu, Estonia; (S.B.); (H.S.M.)
| | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK; (L.E.F.); (J.G.)
| | - James Grellier
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK; (L.E.F.); (J.G.)
- Institute of Psychology, Jagiellonian University, 31-007 Krakow, Poland
| | - Glòria Carrasco-Turigas
- ISGlobal, 08193 Barcelona, Spain; (G.C.-T.).; (M.J.N.); (C.V.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08193 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Mark J. Nieuwenhuijsen
- ISGlobal, 08193 Barcelona, Spain; (G.C.-T.).; (M.J.N.); (C.V.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08193 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Cristina Vert
- ISGlobal, 08193 Barcelona, Spain; (G.C.-T.).; (M.J.N.); (C.V.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08193 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Mireia Gascon
- ISGlobal, 08193 Barcelona, Spain; (G.C.-T.).; (M.J.N.); (C.V.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08193 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-214-7363
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22
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Landrigan PJ, Stegeman JJ, Fleming LE, Allemand D, Anderson DM, Backer LC, Brucker-Davis F, Chevalier N, Corra L, Czerucka D, Bottein MYD, Demeneix B, Depledge M, Deheyn DD, Dorman CJ, Fénichel P, Fisher S, Gaill F, Galgani F, Gaze WH, Giuliano L, Grandjean P, Hahn ME, Hamdoun A, Hess P, Judson B, Laborde A, McGlade J, Mu J, Mustapha A, Neira M, Noble RT, Pedrotti ML, Reddy C, Rocklöv J, Scharler UM, Shanmugam H, Taghian G, van de Water JA, Vezzulli L, Weihe P, Zeka A, Raps H, Rampal P. Human Health and Ocean Pollution. Ann Glob Health 2020; 86:151. [PMID: 33354517 PMCID: PMC7731724 DOI: 10.5334/aogh.2831] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Pollution - unwanted waste released to air, water, and land by human activity - is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, but insufficiently recognized and inadequately controlled component of global pollution. It poses serious threats to human health and well-being. The nature and magnitude of these impacts are only beginning to be understood. Goals (1) Broadly examine the known and potential impacts of ocean pollution on human health. (2) Inform policy makers, government leaders, international organizations, civil society, and the global public of these threats. (3) Propose priorities for interventions to control and prevent pollution of the seas and safeguard human health. Methods Topic-focused reviews that examine the effects of ocean pollution on human health, identify gaps in knowledge, project future trends, and offer evidence-based guidance for effective intervention. Environmental Findings Pollution of the oceans is widespread, worsening, and in most countries poorly controlled. It is a complex mixture of toxic metals, plastics, manufactured chemicals, petroleum, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. It reaches the oceans through rivers, runoff, atmospheric deposition and direct discharges. It is often heaviest near the coasts and most highly concentrated along the coasts of low- and middle-income countries. Plastic is a rapidly increasing and highly visible component of ocean pollution, and an estimated 10 million metric tons of plastic waste enter the seas each year. Mercury is the metal pollutant of greatest concern in the oceans; it is released from two main sources - coal combustion and small-scale gold mining. Global spread of industrialized agriculture with increasing use of chemical fertilizer leads to extension of Harmful Algal Blooms (HABs) to previously unaffected regions. Chemical pollutants are ubiquitous and contaminate seas and marine organisms from the high Arctic to the abyssal depths. Ecosystem Findings Ocean pollution has multiple negative impacts on marine ecosystems, and these impacts are exacerbated by global climate change. Petroleum-based pollutants reduce photosynthesis in marine microorganisms that generate oxygen. Increasing absorption of carbon dioxide into the seas causes ocean acidification, which destroys coral reefs, impairs shellfish development, dissolves calcium-containing microorganisms at the base of the marine food web, and increases the toxicity of some pollutants. Plastic pollution threatens marine mammals, fish, and seabirds and accumulates in large mid-ocean gyres. It breaks down into microplastic and nanoplastic particles containing multiple manufactured chemicals that can enter the tissues of marine organisms, including species consumed by humans. Industrial releases, runoff, and sewage increase frequency and severity of HABs, bacterial pollution, and anti-microbial resistance. Pollution and sea surface warming are triggering poleward migration of dangerous pathogens such as the Vibrio species. Industrial discharges, pharmaceutical wastes, pesticides, and sewage contribute to global declines in fish stocks. Human Health Findings Methylmercury and PCBs are the ocean pollutants whose human health effects are best understood. Exposures of infants in utero to these pollutants through maternal consumption of contaminated seafood can damage developing brains, reduce IQ and increase children's risks for autism, ADHD and learning disorders. Adult exposures to methylmercury increase risks for cardiovascular disease and dementia. Manufactured chemicals - phthalates, bisphenol A, flame retardants, and perfluorinated chemicals, many of them released into the seas from plastic waste - can disrupt endocrine signaling, reduce male fertility, damage the nervous system, and increase risk of cancer. HABs produce potent toxins that accumulate in fish and shellfish. When ingested, these toxins can cause severe neurological impairment and rapid death. HAB toxins can also become airborne and cause respiratory disease. Pathogenic marine bacteria cause gastrointestinal diseases and deep wound infections. With climate change and increasing pollution, risk is high that Vibrio infections, including cholera, will increase in frequency and extend to new areas. All of the health impacts of ocean pollution fall disproportionately on vulnerable populations in the Global South - environmental injustice on a planetary scale. Conclusions Ocean pollution is a global problem. It arises from multiple sources and crosses national boundaries. It is the consequence of reckless, shortsighted, and unsustainable exploitation of the earth's resources. It endangers marine ecosystems. It impedes the production of atmospheric oxygen. Its threats to human health are great and growing, but still incompletely understood. Its economic costs are only beginning to be counted.Ocean pollution can be prevented. Like all forms of pollution, ocean pollution can be controlled by deploying data-driven strategies based on law, policy, technology, and enforcement that target priority pollution sources. Many countries have used these tools to control air and water pollution and are now applying them to ocean pollution. Successes achieved to date demonstrate that broader control is feasible. Heavily polluted harbors have been cleaned, estuaries rejuvenated, and coral reefs restored.Prevention of ocean pollution creates many benefits. It boosts economies, increases tourism, helps restore fisheries, and improves human health and well-being. It advances the Sustainable Development Goals (SDG). These benefits will last for centuries. Recommendations World leaders who recognize the gravity of ocean pollution, acknowledge its growing dangers, engage civil society and the global public, and take bold, evidence-based action to stop pollution at source will be critical to preventing ocean pollution and safeguarding human health.Prevention of pollution from land-based sources is key. Eliminating coal combustion and banning all uses of mercury will reduce mercury pollution. Bans on single-use plastic and better management of plastic waste reduce plastic pollution. Bans on persistent organic pollutants (POPs) have reduced pollution by PCBs and DDT. Control of industrial discharges, treatment of sewage, and reduced applications of fertilizers have mitigated coastal pollution and are reducing frequency of HABs. National, regional and international marine pollution control programs that are adequately funded and backed by strong enforcement have been shown to be effective. Robust monitoring is essential to track progress.Further interventions that hold great promise include wide-scale transition to renewable fuels; transition to a circular economy that creates little waste and focuses on equity rather than on endless growth; embracing the principles of green chemistry; and building scientific capacity in all countries.Designation of Marine Protected Areas (MPAs) will safeguard critical ecosystems, protect vulnerable fish stocks, and enhance human health and well-being. Creation of MPAs is an important manifestation of national and international commitment to protecting the health of the seas.
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Affiliation(s)
| | - John J. Stegeman
- Woods Hole Center for Oceans and Human Health, Woods Hole Oceanographic Institution, US
| | - Lora E. Fleming
- European Centre for Environment and Human Health, GB
- University of Exeter Medical School, GB
| | | | - Donald M. Anderson
- Woods Hole Center for Oceans and Human Health, Woods Hole Oceanographic Institution, US
| | | | | | - Nicolas Chevalier
- Université Côte d’Azur, FR
- Centre Hospitalier Universitaire de Nice, Inserm, C3M, FR
| | - Lilian Corra
- International Society of Doctors for the Environment (ISDE), CH
- Health and Environment of the Global Alliance on Health and Pollution (GAHP), AR
| | | | - Marie-Yasmine Dechraoui Bottein
- Intergovernmental Oceanographic Commission of UNESCO, FR
- IOC Science and Communication Centre on Harmful Algae, University of Copenhagen, DK
- Ecotoxicologie et développement durable expertise ECODD, Valbonne, FR
| | - Barbara Demeneix
- Centre National de la Recherche Scientifique, FR
- Muséum National d’Histoire Naturelle, Paris, FR
| | | | - Dimitri D. Deheyn
- Scripps Institution of Oceanography, University of California San Diego, US
| | | | - Patrick Fénichel
- Université Côte d’Azur, FR
- Centre Hospitalier Universitaire de Nice, Inserm, C3M, FR
| | | | | | | | | | | | | | - Mark E. Hahn
- Woods Hole Center for Oceans and Human Health, Woods Hole Oceanographic Institution, US
| | | | - Philipp Hess
- Institut Français de Recherche pour l’Exploitation des Mers, FR
| | | | | | - Jacqueline McGlade
- Institute for Global Prosperity, University College London, GB
- Strathmore University Business School, Nairobi, KE
| | | | - Adetoun Mustapha
- Nigerian Institute for Medical Research, Lagos, NG
- Imperial College London, GB
| | | | | | | | - Christopher Reddy
- Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution, US
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, SE
| | | | | | | | | | | | - Pál Weihe
- University of the Faroe Islands and Department of Occupational Medicine and Public Health, FO
| | | | - Hervé Raps
- Centre Scientifique de Monaco, MC
- WHO Collaborating Centre for Health and Sustainable Development, MC
| | - Patrick Rampal
- Centre Scientifique de Monaco, MC
- WHO Collaborating Centre for Health and Sustainable Development, MC
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23
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White MP, Elliott LR, Gascon M, Roberts B, Fleming LE. Blue space, health and well-being: A narrative overview and synthesis of potential benefits. Environ Res 2020; 191:110169. [PMID: 32971082 DOI: 10.1016/j.envres.2020.110169] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 05/18/2023]
Abstract
Research into the potential health and well-being benefits from exposure to green spaces such as parks and woodlands has led to the development of several frameworks linking the different strands of evidence. The current paper builds on these to provide a model of how exposure to aquatic environments, or blue spaces such as rivers, lakes and the coast, in particular, may benefit health and well-being. Although green and blue spaces share many commonalities, there are also important differences. Given the breadth of the research, spanning multiple disciplines and research methodologies, a narrative review approach was adopted which aimed to highlight key issues and processes rather than provide a definitive balance of evidence summary. Novel aspects of our framework included the inclusion of outcomes that are only indirectly good for health through being good for the environment, the addition of nature connectedness as both a trait and state, and feedback loops where actions/interventions to increase exposure are implemented. Limitations of the review and areas for future work, including the need to integrate potential benefits with potential risks, are discussed.
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Affiliation(s)
- Mathew P White
- European Centre for Environment & Human Health, University of Exeter, UK; Urban & Environmental Psychology Group, University of Vienna, Austria.
| | - Lewis R Elliott
- European Centre for Environment & Human Health, University of Exeter, UK
| | - Mireia Gascon
- Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Bethany Roberts
- European Centre for Environment & Human Health, University of Exeter, UK
| | - Lora E Fleming
- European Centre for Environment & Human Health, University of Exeter, UK
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24
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Tester-Jones M, White MP, Elliott LR, Weinstein N, Grellier J, Economou T, Bratman GN, Cleary A, Gascon M, Korpela KM, Nieuwenhuijsen M, O'Connor A, Ojala A, van den Bosch M, Fleming LE. Results from an 18 country cross-sectional study examining experiences of nature for people with common mental health disorders. Sci Rep 2020; 10:19408. [PMID: 33159132 PMCID: PMC7648621 DOI: 10.1038/s41598-020-75825-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Exposure to natural environments is associated with a lower risk of common mental health disorders (CMDs), such as depression and anxiety, but we know little about nature-related motivations, practices and experiences of those already experiencing CMDs. We used data from an 18-country survey to explore these issues (n = 18,838), taking self-reported doctor-prescribed medication for depression and/or anxiety as an indicator of a CMD (n = 2698, 14%). Intrinsic motivation for visiting nature was high for all, though slightly lower for those with CMDs. Most individuals with a CMD reported visiting nature ≥ once a week. Although perceived social pressure to visit nature was associated with higher visit likelihood, it was also associated with lower intrinsic motivation, lower visit happiness and higher visit anxiety. Individuals with CMDs seem to be using nature for self-management, but ‘green prescription’ programmes need to be sensitive, and avoid undermining intrinsic motivation and nature-based experiences.
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Affiliation(s)
- Michelle Tester-Jones
- European Centre for Environment and Human Health, University of Exeter Medical School, c/o Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, Cornwall, UK
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, c/o Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, Cornwall, UK. .,Cognitive Science Hub, Department of Psychology, Univerity of Vienna, Liebiggassse 5, 1010, Vienna, Austria.
| | - Lewis R Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, c/o Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, Cornwall, UK
| | | | - James Grellier
- European Centre for Environment and Human Health, University of Exeter Medical School, c/o Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, Cornwall, UK
| | - Theo Economou
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, UK
| | - Gregory N Bratman
- School of Environmental and Forest Sciences, University of Washington, Washington, USA
| | | | - Mireia Gascon
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Kalevi M Korpela
- Faculty of Social Sciences/ Psychology, Tampere University, Tampere, Finland
| | | | | | - Ann Ojala
- Natural Resources Institute Finland, Helsinki, Finland
| | - Matilda van den Bosch
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, c/o Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, Cornwall, UK
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25
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Garrett JK, White MP, Elliott LR, Wheeler BW, Fleming LE. Urban nature and physical activity: Investigating associations using self-reported and accelerometer data and the role of household income. Environ Res 2020; 190:109899. [PMID: 32750550 DOI: 10.1016/j.envres.2020.109899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Physical inactivity is a major public health concern. Natural, or semi-natural, environments may encourage physical activity, but the influences of socio-economic factors have been under-researched. METHODS We explored the associations between meeting physical activity (PA) guidelines and both neighbourhood green (area coverage) and blue (freshwater coverage and coastal proximity) environments for urban adults using data from the Health Survey for England [HSE] (2008/2012). We considered different domains of self-reported PA: walking (n = 18,391), sports and other exercise (n = 18,438), non-recreational (domestic/gardening/occupational; n = 18,446) and all three domains combined (n = 18,447); as well as accelerometer-derived PA data using a subsample (n = 1,774). Relationships were stratified by equivalised household income as an indicator of socio-economic status. RESULTS After adjusting for covariates, living <5 km from the coast was associated with significantly higher odds of meeting UK 2010 guidelines through self-reported total, walking and non-recreational PA (e.g. total PA, <5 km vs. >20 km, adjusted odds ratio (ORadj) = 1.26; 95% confidence interval (CI) = 1.15-1.39) but unrelated to sports and exercise. Greater neighbourhood greenspace, however, was only associated with significantly higher odds of meeting guidelines through non-recreational PA alone (e.g. 80-100% vs. <20% ORadj = 1.32; 95% CI = 1.12-1.56). Although associations were most consistent in the lowest income quintile, income-related results were mixed. Relationships were not replicated in the smaller accelerometry subsample. CONCLUSION Our self-report findings for the differing domains of PA as a function of neighbourhood green and blue space broadly replicated previous research, yet the reasons for the observed differences between PA domains and environments remain unclear. We did not observe any associations between environmental variables and accelerometer-measured PA; further research with larger samples is needed.
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Affiliation(s)
- Joanne K Garrett
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK.
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK
| | - Lewis R Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK
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26
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Dahlui M, Azzeri A, Zain MA, Mohd Noor MI, Jaafar H, Then AYH, Suhaimi J, Kari F, Creencia LA, Madarcos JR, Jose E, Fleming LE, White MP, Morrissey K, Fadzil KS, Goh HC. Health status, healthcare utilisation, and quality of life among the coastal communities in Sabah: Protocol of a population-based survey. Medicine (Baltimore) 2020; 99:e22067. [PMID: 32925742 PMCID: PMC7489655 DOI: 10.1097/md.0000000000022067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Coastal areas in Malaysia can have important impacts on the livelihoods and health of local communities. Efforts by Malaysian government to develop and improve the landscape and ecosystem have been planned; however, the progress has been relatively slow because some of the coastal areas are remote and relatively inaccessible. Thus, these coastal communities face various challenges in health, healthcare and quality of life. This paper presents a study protocol to examine the health status, healthcare utilisation, and quality of life among the coastal communities. In addition, the relationship between the community and their coastal environment is examined. METHODOLOGY AND ANALYSIS The population of interest is the coastal communities residing within the Tun Mustapha Park in Sabah, Malaysia. The data collection is planned for a duration of 6 months and the findings are expected by December 2020. A random cluster sampling will be conducted at three districts of Sabah. This study will collect 600 adult respondents (300 households are estimated to be collected) at age of 18 and above. The project is a cross sectional study via face-to-face interview with administered questionnaires, anthropometrics measurements and observation of the living condition performed by trained interviewers.
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Affiliation(s)
- Maznah Dahlui
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya
- Faculty of Public Health, University of Airlangga, Surabaya, Indonesia
| | - Amirah Azzeri
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya
- Department of Primary Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia
| | - Mohd Aizat Zain
- Department of Urban and Regional Planning, Faculty of Built Environment, University of Malaya
| | - Mohd Iqbal Mohd Noor
- Department of Urban and Regional Planning, Faculty of Built Environment, University of Malaya
- Faculty of Business Management, Universiti Teknologi MARA, 26400, Pahang, Malaysia
| | - Hafiz Jaafar
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya
- Department of Primary Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia
| | - Amy Yee Hui Then
- Institute of Biological Science, Faculty of Science, University of Malaya
| | - Julia Suhaimi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya
| | - Fatimah Kari
- Department of Economics, Faculty of Economics and Administration, University of Malaya, Kuala Lumpur, Malaysia
| | - Lota A. Creencia
- College of Fisheries and Aquatic Sciences, Western Philippines University, Puerto Princesa City, Palawan, Philippines
| | - John Roderick Madarcos
- College of Fisheries and Aquatic Sciences, Western Philippines University, Puerto Princesa City, Palawan, Philippines
| | - Edgar Jose
- College of Fisheries and Aquatic Sciences, Western Philippines University, Puerto Princesa City, Palawan, Philippines
| | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ, UK
| | - Mathew P. White
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ, UK
| | - Karyn Morrissey
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ, UK
| | - Kamal Solhaimi Fadzil
- Department of Anthropology, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Hong Ching Goh
- Department of Urban and Regional Planning, Faculty of Built Environment, University of Malaya
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27
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Young N, Sharpe RA, Barciela R, Nichols G, Davidson K, Berdalet E, Fleming LE. Marine harmful algal blooms and human health: A systematic scoping review. Harmful Algae 2020; 98:101901. [PMID: 33129458 DOI: 10.1016/j.hal.2020.101901] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/29/2020] [Accepted: 08/30/2020] [Indexed: 06/11/2023]
Abstract
Exposure to harmful algal blooms (HABs) can lead to well recognised acute patterns of illness in humans. The objective of this scoping review was to use an established methodology and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting framework to map the evidence for associations between marine HABs and observed both acute and chronic human health effects. A systematic and reproducible search of publications from 1985 until May 2019 was conducted using diverse electronic databases. Following de-duplication, 5301 records were identified, of which 380 were included in the final qualitative synthesis. The majority of studies (220; 57.9%) related to Ciguatera Poisoning. Anecdotal and case reports made up the vast majority of study types (242; 63.7%), whereas there were fewer formal epidemiological studies (35; 9.2%). Only four studies related to chronic exposure to HABs. A low proportion of studies reported the use of human specimens for confirmation of the cause of illness (32; 8.4%). This study highlighted gaps in the evidence base including a lack of formal surveillance and epidemiological studies, limited use of toxin measurements in human samples, and a scarcity of studies of chronic exposure. Future research and policy should provide a baseline understanding of the burden of human disease to inform the evaluation of the current and future impacts of climate change and HABs on human health.
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Affiliation(s)
- Nick Young
- European Centre for Environment and Human Health, Truro, UK; University of Exeter Medical School, Exeter, UK.
| | - Richard A Sharpe
- European Centre for Environment and Human Health, Truro, UK; Public Health, Cornwall Council, Truro, UK; University of Exeter Medical School, Exeter, UK
| | - Rosa Barciela
- European Centre for Environment and Human Health, Truro, UK; Met Office, Exeter, UK; University of Exeter Medical School, Exeter, UK
| | - Gordon Nichols
- Climate Change and Health Group, Centre for Radiation Chemicals and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, UK; European Centre for Environment and Human Health, Truro, UK; School of Environmental Sciences, UEA, Norwich, NR4 7TJ, UK
| | - Keith Davidson
- Scottish Association for Marine Science, Scottish Marine Institute, Oban, UK
| | - Elisa Berdalet
- Institute of Marine Sciences (ICM-CSIC), Barcelona, Spain
| | - Lora E Fleming
- European Centre for Environment and Human Health, Truro, UK; University of Exeter Medical School, Exeter, UK.
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Lloret J, Abós-Herràndiz R, Alemany S, Allué R, Bartra J, Basagaña M, Berdalet E, Campàs M, Carreño A, Demestre M, Diogène J, Fontdecaba E, Gascon M, Gómez S, Izquierdo A, Mas L, Marquès M, Pedro-Botet J, Pery M, Peters F, Pintó X, Planas M, Sabatés A, San J, Sanchez-Vidal A, Trepat M, Vendrell C, Fleming LE. The Roses Ocean and Human Health Chair: A New Way to Engage the Public in Oceans and Human Health Challenges. Int J Environ Res Public Health 2020; 17:ijerph17145078. [PMID: 32674437 PMCID: PMC7400534 DOI: 10.3390/ijerph17145078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/01/2023]
Abstract
Involving and engaging stakeholders is crucial for studying and managing the complex interactions between marine ecosystems and human health and wellbeing. The Oceans and Human Health Chair was founded in the town of Roses (Catalonia, Spain, NW Mediterranean) in 2018, the fruit of a regional partnership between various stakeholders, and for the purpose of leading the way to better health and wellbeing through ocean research and conservation. The Chair is located in an area of the Mediterranean with a notable fishing, tourist, and seafaring tradition and is close to a marine reserve, providing the opportunity to observe diverse environmental conditions and coastal and maritime activities. The Chair is a case study demonstrating that local, collaborative, transdisciplinary, trans-sector, and bottom-up approaches offer tremendous opportunities for engaging coastal communities to help support long-lasting solutions that benefit everyone, and especially those living by the sea or making their living from the goods and services provided by the sea. Furthermore, the Chair has successfully integrated most of its experts in oceans and human health from the most prestigious institutions in Catalonia. The Chair focuses on three main topics identified by local stakeholders: Fish and Health; Leisure, Health, and Wellbeing; and Medicines from the Sea. Led by stakeholder engagement, the Chair can serve as a novel approach within the oceans and human health field of study to tackle a variety of environmental and public health challenges related to both communicable and non-communicable diseases, within the context of sociocultural issues. Drawing on the example provided by the Chair, four principles are established to encourage improved participatory processes in the oceans and human health field: bottom-up, “think local”, transdisciplinary and trans-sectorial, and “balance the many voices”.
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Affiliation(s)
- Josep Lloret
- SeaHealth Research Group-Institute of Aquatic Ecology & LIPPSO-Dept. of Chemistry, University of Girona, 17003 Girona, Spain; (A.C.); (M.P.); (J.S.)
- Correspondence:
| | - Rafael Abós-Herràndiz
- Department of Primary Health Care, Institut Català de la Salut, Government of Catalonia, 08013 Barcelona and 17480 Roses, Spain; (R.A.-H.); (E.F.); (C.V.)
| | - Sílvia Alemany
- History Museum of Sant Feliu de Guíxols, Sant Feliu de Guíxols, 17220 Catalonia, Spain;
| | - Rosario Allué
- D.G. Fisheries and Maritime Affairs, Government of Catalonia, 08017 Barcelona, Spain;
| | - Joan Bartra
- Allergy Section, Pneumology Department, Institut Clínic Respiratori (ICR), Hospital Clínic, 08036 Barcelona, Spain;
| | - Maria Basagaña
- Allergology Unit, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | - Elisa Berdalet
- Institut de Ciències del Mar, CSIC, 08003 Barcelona, Spain; (E.B.); (M.D.); (F.P.); (A.S.)
| | - Mònica Campàs
- Marine and Continental Waters Programme, IRTA, Sant Carles de la Ràpita, 43540 Catalonia, Spain; (M.C.); (J.D.)
| | - Arnau Carreño
- SeaHealth Research Group-Institute of Aquatic Ecology & LIPPSO-Dept. of Chemistry, University of Girona, 17003 Girona, Spain; (A.C.); (M.P.); (J.S.)
| | - Montserrat Demestre
- Institut de Ciències del Mar, CSIC, 08003 Barcelona, Spain; (E.B.); (M.D.); (F.P.); (A.S.)
| | - Jorge Diogène
- Marine and Continental Waters Programme, IRTA, Sant Carles de la Ràpita, 43540 Catalonia, Spain; (M.C.); (J.D.)
| | - Eva Fontdecaba
- Department of Primary Health Care, Institut Català de la Salut, Government of Catalonia, 08013 Barcelona and 17480 Roses, Spain; (R.A.-H.); (E.F.); (C.V.)
| | - Mireia Gascon
- ISGlobal (Global Health Institute Barcelona), Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sílvia Gómez
- Departament of Social and Cultural Anthropology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Catalonia, Spain;
| | - Angel Izquierdo
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari de Girona Doctor Josep Trueta, 17007 Girona, Spain;
| | - Lluïsa Mas
- Sub-direcció Regional a Girona, Catalan Public Health Agency, Government of Catalonia, 17002 Girona, Spain; (L.M.); (M.T.)
| | - Montse Marquès
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, 43201 Reus, Spain;
| | - Juan Pedro-Botet
- Department of Medicine, Hospital del Mar & Universitat Autònoma de Barcelona, 08003 Barcelona, Spain;
| | - Maria Pery
- Servei d’Espais Naturals Protegits, D.G. Environmental Policies and Environment, Government of Catalonia, 08036 Barcelona, Spain;
| | - Francesc Peters
- Institut de Ciències del Mar, CSIC, 08003 Barcelona, Spain; (E.B.); (M.D.); (F.P.); (A.S.)
| | - Xavier Pintó
- Unitat de Lípids i Risc Vascular, Servei de Medicina Interna, Hospital Universitari de Bellvitge, Idibell, University of Barcelona, CiberObn, 08907 L’Hospitalet de Llobregat, Spain;
| | - Marta Planas
- SeaHealth Research Group-Institute of Aquatic Ecology & LIPPSO-Dept. of Chemistry, University of Girona, 17003 Girona, Spain; (A.C.); (M.P.); (J.S.)
| | - Ana Sabatés
- Institut de Ciències del Mar, CSIC, 08003 Barcelona, Spain; (E.B.); (M.D.); (F.P.); (A.S.)
| | - Joan San
- SeaHealth Research Group-Institute of Aquatic Ecology & LIPPSO-Dept. of Chemistry, University of Girona, 17003 Girona, Spain; (A.C.); (M.P.); (J.S.)
| | - Anna Sanchez-Vidal
- Department of Earth and Ocean Dynamics, University of Barcelona, 08028 Barcelona, Spain;
| | - Martí Trepat
- Sub-direcció Regional a Girona, Catalan Public Health Agency, Government of Catalonia, 17002 Girona, Spain; (L.M.); (M.T.)
| | - Cristina Vendrell
- Department of Primary Health Care, Institut Català de la Salut, Government of Catalonia, 08013 Barcelona and 17480 Roses, Spain; (R.A.-H.); (E.F.); (C.V.)
| | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Cornwall TR1 3HD, UK;
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Maguire K, Garside R, Poland J, Fleming LE, Alcock I, Taylor T, Macintyre H, Iacono GL, Green A, Wheeler BW. Public involvement in research about environmental change and health: A case study. Health (London) 2020; 23:215-233. [PMID: 30786766 PMCID: PMC6388412 DOI: 10.1177/1363459318809405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Involving and engaging the public are crucial for effective prioritisation, dissemination and implementation of research about the complex interactions between environments and health. Involvement is also important to funders and policy makers who often see it as vital for building trust and justifying the investment of public money. In public health research, ‘the public’ can seem an amorphous target for researchers to engage with, and the short-term nature of research projects can be a challenge. Technocratic and pedagogical approaches have frequently met with resistance, so public involvement needs to be seen in the context of a history which includes contested truths, power inequalities and political activism. It is therefore vital for researchers and policy makers, as well as public contributors, to share best practice and to explore the challenges encountered in public involvement and engagement. This article presents a theoretically informed case study of the contributions made by the Health and Environment Public Engagement Group to the work of the National Institute for Health Research (NIHR) Health Protection Research Unit in Environmental Change and Health (HPRU-ECH). We describe how Health and Environment Public Engagement Group has provided researchers in the HPRU-ECH with a vehicle to support access to public views on multiple aspects of the research work across three workshops, discussion of ongoing research issues at meetings and supporting dissemination to local government partners, as well as public representation on the HPRU-ECH Advisory Board. We conclude that institutional support for standing public involvement groups can provide conduits for connecting public with policy makers and academic institutions. This can enable public involvement and engagement, which would be difficult, if not impossible, to achieve in individual short-term and unconnected research projects.
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Affiliation(s)
| | | | - Jo Poland
- Health and Environment Public Engagement (HEPE), UK
| | | | | | | | | | | | - Andrew Green
- Health and Environment Public Engagement (HEPE), UK
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Odebeatu CC, Taylor T, Fleming LE, Osborne NJ. Correction to: Phthalates and asthma in children and adults: US NHANES 2007-2012. Environ Sci Pollut Res Int 2020; 27:11459. [PMID: 32026183 PMCID: PMC7645458 DOI: 10.1007/s11356-020-07869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The correct presentation name of the 4th Author is shown in this paper.
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Affiliation(s)
- Chinonso Christian Odebeatu
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, University of Exeter Medical School, Truro, Cornwall TR1 3HD UK
| | - Timothy Taylor
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, University of Exeter Medical School, Truro, Cornwall TR1 3HD UK
| | - Lora E. Fleming
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, University of Exeter Medical School, Truro, Cornwall TR1 3HD UK
| | - Nicholas J. Osborne
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, University of Exeter Medical School, Truro, Cornwall TR1 3HD UK
- School of Public Health and Community Medicine, University of New South Wales, Kensington, Sydney, 2052 Australia
- School of Public Health, The University of Queensland, Herston, Queensland 4006 Australia
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Alcock I, White MP, Pahl S, Duarte-Davidson R, Fleming LE. Associations between pro-environmental behaviour and neighbourhood nature, nature visit frequency and nature appreciation: Evidence from a nationally representative survey in England. Environ Int 2020; 136:105441. [PMID: 31927464 DOI: 10.1016/j.envint.2019.105441] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
Progress on changing human behaviour to meet the challenges of regional and global sustainability has been slow. Building on theory as well as small-scale survey and experimental evidence that exposure to nature may be associated with greater pro-environmentalism, the aim of the current study was to quantify relationships between exposure to nature (operationalised as neighbourhood greenspace, coastal proximity, and recreational nature visits) as well as appreciation of the natural world, and self-reported pro-environmental behaviour for the adult population of England. Using data from a nationally representative sample (N = 24,204), and controlling for potential confounders, a structural equation model was used to estimate relationships. Indirect effects of neighbourhood exposures via nature visits and nature appreciation were accounted for. We found positive relationships between both recreational nature visits and nature appreciation and pro-environmental behaviour across both the whole sample and key socio-demographic groups. The more individuals visited nature for recreation and the more they appreciated the natural world, the more pro-environmental behaviour they reported. Although rural and coastal dwellers tended to also be more pro-environmental on average, patterns were complex, potentially reflecting situational constraints and opportunities. Importantly, positive associations between pro-environmental behaviours and high neighbourhood greenspace and coastal proximity were present for both high and low socio-economic status households. Improving access to, and contact with, nature, e.g., through better urban planning, may be one approach for meeting sustainability targets.
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Affiliation(s)
- Ian Alcock
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - Sabine Pahl
- School of Psychology (Faculty of Health and Human Sciences), University of Plymouth, B219, 22 Portland Square, Drake Circus, Plymouth, Devon PL4 8AA, UK.
| | - Raquel Duarte-Davidson
- Public Health England Centre for Radiation, Chemical and Environmental Hazards (CRCE), Chilton, Didcot, Oxfordshire OX11 0RQ, UK.
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
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Sharpe RA, Machray KE, Fleming LE, Taylor T, Henley W, Chenore T, Hutchcroft I, Taylor J, Heaviside C, Wheeler BW. Household energy efficiency and health: Area-level analysis of hospital admissions in England. Environ Int 2019; 133:105164. [PMID: 31518939 PMCID: PMC6853278 DOI: 10.1016/j.envint.2019.105164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Fuel poverty affects up to 35% of European homes, which represents a significant burden on society and healthcare systems. Draught proofing homes to prevent heat loss, improved glazing, insulation and heating (energy efficiency measures) can make more homes more affordable to heat. This has prompted significant investment in energy efficiency upgrades for around 40% of UK households to reduce the impact of fuel poverty. Despite some inconsistent evidence, household energy efficiency interventions can improve cardiovascular and respiratory health outcomes. However, the health benefits of these interventions have not been fully explored; this is the focus of this study. METHODS In this cross sectional ecological study, we conducted two sets of analyses at different spatial resolution to explore population data on housing energy efficiency measures and hospital admissions at the area-level (counts grouped over a 3-year period). Housing data were obtained from three data sets covering housing across England (Household Energy Efficiency Database), Energy Performance Certificate (EPC) and, in the South West of England, the Devon Home Analytics Portal. These databases provided data aggregated to Lower Area Super Output Area and postcode level (Home Analytics Portal only). These datasets provided measures of both state (e.g. EPC ratings) and intervention (e.g. number of boiler replacements), aggregated spatially and temporally to enable cross-sectional analyses with health outcome data. Hospital admissions for adult (over 18 years) asthma, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) were obtained from the Hospital Episode Statistics database for the national (1st April 2011 to 31st March 2014) and Devon, South West of England (1st April 2014 to 31st March 2017) analyses. Descriptive statistics and regression models were used to describe the associations between small area household energy efficiency measures and hospital admissions. Three main analyses were undertaken to investigate the relationships between; 1) household energy efficiency improvements (i.e. improved glazing, insulation and boiler upgrades); 2) higher levels of energy efficiency ratings (measured by Energy Performance Certificate ratings); 3) energy efficiency improvements and ratings (i.e. physical improvements and rating assessed by the Standard Assessment Procedure) and hospital admissions. RESULTS In the national analyses, household energy performance certificate ratings ranged from 37 to 83 (mean 61.98; Standard Deviation 5.24). There were a total of 312,837 emergency admissions for asthma, 587,770 for COPD and 839,416 for CVD. While analyses for individual energy efficiency metrics (i.e. boiler upgrades, draught proofing, glazing, loft and wall insulation) were mixed; a unit increase in mean energy performance rating was associated with increases of around 0.5% in asthma and CVD admissions, and 1% higher COPD admission rates. Admission rates were also influenced by the type of dwelling, tenure status (e.g. home owner versus renting), living in a rural area, and minimum winter temperature. DISCUSSION Despite a range of limitations and some mixed and contrasting findings across the national and local analyses, there was some evidence that areas with more energy efficiency improvements resulted in higher admission rates for respiratory and cardiovascular diseases. This builds on existing evidence highlighting the complex relationships between health and housing. While energy efficiency measures can improve health outcomes (especially when targeting those with chronic respiratory illness), reduced household ventilation rates can impact indoor air quality for example and increase the risk of diseases such as asthma. Alternatively, these findings could be due to the ecological study design, reverse causality, or the non-detection of more vulnerable subpopulations, as well as the targeting of areas with poor housing stock, low income households, and the lack of "whole house approaches" when retrofitting the existing housing stock. CONCLUSION To be sustainable, household energy efficiency policies and resulting interventions must account for whole house approaches (i.e. consideration of the whole house and occupant lifestyles). These must consider more alternative 'greener' and more sustainable measures, which are capable of accounting for variable lifestyles, as well as the need for adequate heating and ventilation. Larger natural experiments and more complex modelling are needed to further investigate the impact of ongoing dramatic changes in the housing stock and health. STUDY IMPLICATIONS This study supports the need for more holistic approaches to delivering healthier indoor environments, which must consider a dynamic and complex system with multiple interactions between a range of interrelated factors. These need to consider the drivers and pressures (e.g. quality of the built environment and resident behaviours) resulting in environmental exposures and adverse health outcomes.
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Affiliation(s)
- R A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom; Public Health, Cornwall Council, 1E, New County Hall, Truro TR1 3AY, United Kingdom
| | - K E Machray
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom
| | - L E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom
| | - T Taylor
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom
| | - W Henley
- Health Statistics Research Group, Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, United Kingdom
| | - T Chenore
- NHS NEW Devon Clinical Commissioning Group, County Hall, Exeter EX2 4QD, United Kingdom
| | - I Hutchcroft
- Regen, Bradninch Court, Castle Street, Exeter EX4 3PL and Energiesprong UK Limited, National Energy Centre, Davy Avenue, Knowlhill, Milton Keynes MK5 8NG, United Kingdom
| | - J Taylor
- UCL Institute for Environmental Design and Engineering, UCL, 14 Upper Woburn Plc, London WC1H 0NN, United Kingdom
| | - C Heaviside
- Environmental Change Institute, University of Oxford, South Parks Road, Oxford OX1 3QY, Oxford, United Kingdom
| | - B W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom.
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Garrett JK, Clitherow TJ, White MP, Wheeler BW, Fleming LE. Coastal proximity and mental health among urban adults in England: The moderating effect of household income. Health Place 2019; 59:102200. [PMID: 31582294 DOI: 10.1016/j.healthplace.2019.102200] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/16/2019] [Accepted: 08/22/2019] [Indexed: 12/23/2022]
Abstract
After adjusting for covariates, self-reported general health in England is higher among populations living closer to the coast, and the association is strongest amongst more deprived groups. We explored whether similar findings were present for mental health using cross-sectional data for urban adults in the Health Survey for England (2008-2012, N ≥25,963). For urban adults, living ≤1 km from the coast, in comparison to >50 km, was associated with better mental health as measured by the GHQ12. Stratification by household income revealed this was only amongst the lowest-earning households, and extended to ≤5 km. Our findings support the contention that, for urban adults, coastal settings may help to reduce health inequalities in England.
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Affiliation(s)
- Joanne K Garrett
- European Centre for Environment and Human Health, European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital Treliske, Truro, Cornwall, TR1 3HD, UK.
| | - Theodore J Clitherow
- European Centre for Environment and Human Health, European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital Treliske, Truro, Cornwall, TR1 3HD, UK
| | - Mathew P White
- European Centre for Environment and Human Health, European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital Treliske, Truro, Cornwall, TR1 3HD, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital Treliske, Truro, Cornwall, TR1 3HD, UK
| | - Lora E Fleming
- European Centre for Environment and Human Health, European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital Treliske, Truro, Cornwall, TR1 3HD, UK
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Odebeatu CC, Taylor T, Fleming LE, J. Osborne N. Phthalates and asthma in children and adults: US NHANES 2007-2012. Environ Sci Pollut Res Int 2019; 26:28256-28269. [PMID: 31368075 PMCID: PMC6791917 DOI: 10.1007/s11356-019-06003-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/16/2019] [Indexed: 04/12/2023]
Abstract
Environmental exposure to phthalates may contribute to an increased risk of asthma in children and adults. We aimed to assess the direction and strength of the association between urinary phthalates metabolites and current asthma in children and adults that participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2012. Data on ten urinary phthalate metabolites, self-reported questionnaires, spirometry measures, and covariates were obtained from 7765 participants (28.1% were children aged 6-17 years) taking part in the NHANES 2007-2012. Asthma was assessed using self-reported questionnaires for children and adults, and via spirometry measures for adults alone. We used crude and adjusted logistic regression models to estimate the odds ratios (ORs) and 95% confidence interval (CI) per one log10 unit change in the concentration of phthalate metabolites. We further modeled the effect modification by sex. Out of 10 metabolites, only mono-benzyl phthalate (MBzP) was positively associated with the prevalence of self-reported asthma in children, after adjusting for a range of potential confounders (odds ratio 1.54; 95% confidence interval 1.05-2.27). No significant relationship was observed for adults. The association of mono-ethyl phthalate (MEP) was modified by sex, with significantly increased odds of asthma among males [boys (2.00; 1.14-3.51); adult males (1.32; 1.04-1.69)]. While no other phthalates showed a positive relationship with current asthma in males, mono-(carboxynonyl) phthalate (MCNP) and mono-(3-carboxylpropyl) phthalate (MCPP) were inversely associated with spirometrically defined asthma in adult females. A sex-specific relationship in adults was evident when spirometry, but not self-reported measures were used to define asthma. We found no clear association between exposure to phthalates and current asthma, except for a significant relationship between MBzP metabolites and self-reported asthma in children. As a result, exposure to phthalates and asthma development and/or exacerbations remains controversial, suggesting a need for a well-designed longitudinal study.
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Affiliation(s)
- Chinonso Christian Odebeatu
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, University of Exeter Medical School, Truro, Cornwall, TR1 3HD UK
| | - Timothy Taylor
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, University of Exeter Medical School, Truro, Cornwall, TR1 3HD UK
| | - Lora E. Fleming
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, University of Exeter Medical School, Truro, Cornwall, TR1 3HD UK
| | - Nicholas J. Osborne
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, University of Exeter Medical School, Truro, Cornwall, TR1 3HD UK
- School of Public Health and Community Medicine, University of New South Wales, Kensington, Sydney, 2052 Australia
- School of Public Health, The University of Queensland, Herston, Queensland 4006 Australia
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Abstract
Our future health and wellbeing depend on the oceans
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Affiliation(s)
- Michael H Depledge
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
| | - Bruce Maycock
- School of Public Health, Curtin University, Perth, Australia
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
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White MP, Alcock I, Grellier J, Wheeler BW, Hartig T, Warber SL, Bone A, Depledge MH, Fleming LE. Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Sci Rep 2019; 9:7730. [PMID: 31197192 PMCID: PMC6565732 DOI: 10.1038/s41598-019-44097-3] [Citation(s) in RCA: 264] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/08/2019] [Indexed: 02/07/2023] Open
Abstract
Spending time in natural environments can benefit health and well-being, but exposure-response relationships are under-researched. We examined associations between recreational nature contact in the last seven days and self-reported health and well-being. Participants (n = 19,806) were drawn from the Monitor of Engagement with the Natural Environment Survey (2014/15-2015/16); weighted to be nationally representative. Weekly contact was categorised using 60 min blocks. Analyses controlled for residential greenspace and other neighbourhood and individual factors. Compared to no nature contact last week, the likelihood of reporting good health or high well-being became significantly greater with contact ≥120 mins (e.g. 120-179 mins: ORs [95%CIs]: Health = 1.59 [1.31-1.92]; Well-being = 1.23 [1.08-1.40]). Positive associations peaked between 200-300 mins per week with no further gain. The pattern was consistent across key groups including older adults and those with long-term health issues. It did not matter how 120 mins of contact a week was achieved (e.g. one long vs. several shorter visits/week). Prospective longitudinal and intervention studies are a critical next step in developing possible weekly nature exposure guidelines comparable to those for physical activity.
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Affiliation(s)
- Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK.
| | - Ian Alcock
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - James Grellier
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Terry Hartig
- Institute for Housing and urban Research, Uppsala University, Box 514, SE-75120, Uppsala, Sweden
| | - Sara L Warber
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Angie Bone
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Michael H Depledge
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
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Djennad A, Lo Iacono G, Sarran C, Lane C, Elson R, Höser C, Lake IR, Colón-González FJ, Kovats S, Semenza JC, Bailey TC, Kessel A, Fleming LE, Nichols GL. Seasonality and the effects of weather on Campylobacter infections. BMC Infect Dis 2019; 19:255. [PMID: 30866826 PMCID: PMC6417031 DOI: 10.1186/s12879-019-3840-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/20/2019] [Indexed: 01/08/2023] Open
Abstract
Background Campylobacteriosis is a major public health concern. The weather factors that influence spatial and seasonal distributions are not fully understood. Methods To investigate the impacts of temperature and rainfall on Campylobacter infections in England and Wales, cases of Campylobacter were linked to local temperature and rainfall at laboratory postcodes in the 30 days before the specimen date. Methods for investigation included a comparative conditional incidence, wavelet, clustering, and time series analyses. Results The increase of Campylobacter infections in the late spring was significantly linked to temperature two weeks before, with an increase in conditional incidence of 0.175 cases per 100,000 per week for weeks 17 to 24; the relationship to temperature was not linear. Generalized structural time series model revealed that changes in temperature accounted for 33.3% of the expected cases of Campylobacteriosis, with an indication of the direction and relevant temperature range. Wavelet analysis showed a strong annual cycle with additional harmonics at four and six months. Cluster analysis showed three clusters of seasonality with geographic similarities representing metropolitan, rural, and other areas. Conclusions The association of Campylobacteriosis with temperature is likely to be indirect. High-resolution spatial temporal linkage of weather parameters and cases is important in improving weather associations with infectious diseases. The primary driver of Campylobacter incidence remains to be determined; other avenues, such as insect contamination of chicken flocks through poor biosecurity should be explored. Electronic supplementary material The online version of this article (10.1186/s12879-019-3840-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdelmajid Djennad
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, 61, Colindale Avenue, London, NW9 5EQ, UK.
| | | | | | | | - Richard Elson
- National Infection Service, Public Health England, London, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, London, UK
| | - Christoph Höser
- Institute for Hygiene and Public Health, GeoHealth Centre, University of Bonn, Bonn, Germany
| | | | | | - Sari Kovats
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Anthony Kessel
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, 61, Colindale Avenue, London, NW9 5EQ, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | | | - Gordon L Nichols
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, 61, Colindale Avenue, London, NW9 5EQ, UK.,University of Exeter, Exeter, UK.,University of Thessaly, Larissa, Thessaly, Greece
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38
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Diaz RE, Friedman MA, Jin D, Beet A, Kirkpatrick B, Reich A, Kirkpatrick G, Ullmann SG, Fleming LE, Hoagland P. Neurological illnesses associated with Florida red tide (Karenia brevis) blooms. Harmful Algae 2019; 82:73-81. [PMID: 30928012 PMCID: PMC9933543 DOI: 10.1016/j.hal.2018.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/07/2018] [Accepted: 07/07/2018] [Indexed: 05/12/2023]
Abstract
Human respiratory and gastrointestinal illnesses can result from exposures to brevetoxins originating from coastal Florida red tide blooms, comprising the marine alga Karenia brevis (K. brevis). Only limited research on the extent of human health risks and illness costs due to K. brevis blooms has been undertaken to date. Because brevetoxins are known neurotoxins that are able to cross the blood-brain barrier, it is possible that exposure to brevetoxins may be associated with neurological illnesses. This study explored whether K. brevis blooms may be associated with increases in the numbers of emergency department visits for neurological illness. An exposure-response framework was applied to test the effects of K. brevis blooms on human health, using secondary data from diverse sources. After controlling for resident population, seasonal and annual effects, significant increases in emergency department visits were found specifically for headache (ICD-9 784.0) as a primary diagnosis during proximate coastal K. brevis blooms. In particular, an increased risk for older residents (≥55 years) was identified in the coastal communities of six southwest Florida counties during K. brevis bloom events. The incidence of headache associated with K. brevis blooms showed a small but increasing association with K. brevis cell densities. Rough estimates of the costs of this illness were developed for hypothetical bloom occurrences.
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Affiliation(s)
- Roberto Efrain Diaz
- Department of Health Management and Policy, University of Miami, Coral Gables, FL, USA
| | | | - Di Jin
- Marine Policy Center, Woods Hole Oceanographic Institution, Woods Hole, MA, USA
| | - Andrew Beet
- Marine Policy Center, Woods Hole Oceanographic Institution, Woods Hole, MA, USA
| | - Barbara Kirkpatrick
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA; Mote Marine Laboratory, Sarasota, FL, USA
| | - Andrew Reich
- Aquatic Toxins Program, Bureau of Epidemiology, Florida Department of Health, Tallahassee, FL, USA
| | | | - Steven G Ullmann
- Department of Health Management and Policy, University of Miami, Coral Gables, FL, USA.
| | - Lora E Fleming
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA; European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
| | - Porter Hoagland
- Marine Policy Center, Woods Hole Oceanographic Institution, Woods Hole, MA, USA
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39
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Sharpe RA, Taylor T, Fleming LE, Morrissey K, Morris G, Wigglesworth R. Making the Case for "Whole System" Approaches: Integrating Public Health and Housing. Int J Environ Res Public Health 2018; 15:E2345. [PMID: 30355973 PMCID: PMC6267345 DOI: 10.3390/ijerph15112345] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/13/2018] [Accepted: 10/18/2018] [Indexed: 11/30/2022]
Abstract
Housing conditions have been an enduring focus for public health activity throughout the modern public health era. However, the nature of the housing and health challenge has changed in response to an evolution in the understanding of the diverse factors influencing public health. Today, the traditional public health emphasis on the type and quality of housing merges with other wider determinants of health. These include the neighbourhood, community, and "place" where a house is located, but also the policies which make access to a healthy house possible and affordable for everyone. Encouragingly, these approaches to policy and action on housing have the potential to contribute to the "triple win" of health and well-being, equity, and environmental sustainability. However, more effective housing policies (and in public health in general) that adopt more systemic approaches to addressing the complex interactions between health, housing, and wider environment are needed. This paper illustrates some of the key components of the housing and health challenge in developed countries, and presents a conceptual model to co-ordinate activities that can deliver the "triple win." This is achieved by offering a perspective on how to navigate more effectively, inclusively and across sectors when identifying sustainable housing interventions.
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Affiliation(s)
- Richard A Sharpe
- Public Health, Cornwall Council, Truro TR1 3AY, UK.
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Truro TR1 3HD, UK.
| | - Tim Taylor
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Truro TR1 3HD, UK.
| | - Lora E Fleming
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Truro TR1 3HD, UK.
| | - Karyn Morrissey
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Truro TR1 3HD, UK.
| | - George Morris
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Truro TR1 3HD, UK.
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40
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Cherrie MPC, Nichols G, Iacono GL, Sarran C, Hajat S, Fleming LE. Pathogen seasonality and links with weather in England and Wales: a big data time series analysis. BMC Public Health 2018; 18:1067. [PMID: 30153803 PMCID: PMC6114700 DOI: 10.1186/s12889-018-5931-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 08/02/2018] [Indexed: 01/15/2023] Open
Abstract
Background Many infectious diseases of public health importance display annual seasonal patterns in their incidence. We aimed to systematically document the seasonality of several human infectious disease pathogens in England and Wales, highlighting those organisms that appear weather-sensitive and therefore may be influenced by climate change in the future. Methods Data on infections in England and Wales from 1989 to 2014 were extracted from the Public Health England (PHE) SGSS surveillance database. We conducted a weekly, monthly and quarterly time series analysis of 277 pathogen serotypes. Each organism’s time series was forecasted using the TBATS package in R, with seasonality detected using model fit statistics. Meteorological data hosted on the MEDMI Platform were extracted at a monthly resolution for 2001–2011. The organisms were then clustered by K-means into two groups based on cross correlation coefficients with the weather variables. Results Examination of 12.9 million infection episodes found seasonal components in 91/277 (33%) organism serotypes. Salmonella showed seasonal and non-seasonal serotypes. These results were visualised in an online Rshiny application. Seasonal organisms were then clustered into two groups based on their correlations with weather. Group 1 had positive correlations with temperature (max, mean and min), sunshine and vapour pressure and inverse correlations with mean wind speed, relative humidity, ground frost and air frost. Group 2 had the opposite but also slight positive correlations with rainfall (mm, > 1 mm, > 10 mm). Conclusions The detection of seasonality in pathogen time series data and the identification of relevant weather predictors can improve forecasting and public health planning. Big data analytics and online visualisation allow the relationship between pathogen incidence and weather patterns to be clarified. Electronic supplementary material The online version of this article (10.1186/s12889-018-5931-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark P C Cherrie
- Centre for Research on Environment, Society and Health (CRESH), University of Edinburgh, Edinburgh, Scotland, EH8 9XP, UK.
| | | | | | | | - Shakoor Hajat
- London School of Hygiene and Tropical Medicine, London, England
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, England
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41
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Abo-Zaid G, Sharpe RA, Fleming LE, Depledge M, Osborne NJ. Association of Infant Eczema with Childhood and Adult Asthma: Analysis of Data from the 1958 Birth Cohort Study. Int J Environ Res Public Health 2018; 15:ijerph15071415. [PMID: 29976870 PMCID: PMC6069479 DOI: 10.3390/ijerph15071415] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022]
Abstract
The influence of early life exposures on later life disease has for some time provided clues to modifiable risk factors of disease. The “atopic march” is thought to play a role in the progression of allergic diseases and may offer an opportunity to lower asthma’s health and socioeconomic burden, although evidence remains controversial. We aimed to examine the relationship between early life eczema and asthma later in life. Using the National Child Development Study, we examined infant eczema and childhood and adult asthma. Data related to asthma or wheezing bronchitis were available for 13,503 (73%; 95% CI 72–74), 11,503 (61%; 95% CI 60–61), 12,524 (68%; 95% CI 67–69), 11,194 (60%; 95% CI 60–60), 9377 (51%; 95% CI 51–51), and 9760 (53%; 95% CI 52–53) subjects at ages 11, 16, 23, 33, 44, and 50 years, respectively. Logistic regression models were fitted to examine each wave separately before and after adjusting for a range of potential confounders. Generalised estimating equation (GEE) methods were undertaken to examine the associations after pooling all data from questionnaires. The prevalence of self-reported asthma in those that had previously reported infant eczema ranged from 1.0%; 95% CI 0.9–1.4 (age 44 years) to 2.2%; 95% CI 2.1–2.3 (age 33 years). Participants with infant eczema had a 2–3-fold increased risk of reporting asthma in childhood and adulthood; this was 1.6 times at age 44 years when using spirometry measures. Similar effect sizes were observed in the GEE models when considering all participants (OR 2.9; 95% CI 2.6–3.2). Childhood and adult asthma were consistently associated with infant eczema both by using the self-reported data and lung measures.
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Affiliation(s)
- Ghada Abo-Zaid
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
- Department of Mathematics and Statistics, Ain Shams University, Khalifa El-Maamon St, Abbasiya Sq., Cairo 11566, Egypt.
| | - Richard A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
- Public Health, Cornwall Council, New County Hall, Truro, Cornwall, TR1 3AY, UK.
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - Michael Depledge
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
- School of Public Health and Community Medicine, University of New South Wales, Kensington, Sydney 2052, Australia.
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42
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Hinchliffe S, Jackson MA, Wyatt K, Barlow AE, Barreto M, Clare L, Depledge MH, Durie R, Fleming LE, Groom N, Morrissey K, Salisbury L, Thomas F. Healthy publics: enabling cultures and environments for health. Palgrave Commun 2018; 4:57. [PMID: 29862036 PMCID: PMC5978671 DOI: 10.1057/s41599-018-0113-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/19/2018] [Indexed: 05/22/2023]
Abstract
Despite extraordinary advances in biomedicine and associated gains in human health and well-being, a growing number of health and well-being related challenges have remained or emerged in recent years. These challenges are often 'more than biomedical' in complexion, being social, cultural and environmental in terms of their key drivers and determinants, and underline the necessity of a concerted policy focus on generating healthy societies. Despite the apparent agreement on this diagnosis, the means to produce change are seldom clear, even when the turn to health and well-being requires sizable shifts in our understandings of public health and research practices. This paper sets out a platform from which research approaches, methods and translational pathways for enabling health and well-being can be built. The term 'healthy publics' allows us to shift the focus of public health away from 'the public' or individuals as targets for intervention, and away from the view that culture acts as a barrier to efficient biomedical intervention, towards a greater recognition of the public struggles that are involved in raising health issues, questioning what counts as healthy and unhealthy and assembling the evidence and experience to change practices and outcomes. Creating the conditions for health and well-being, we argue, requires an engaged research process in which public experiments in building and repairing social and material relations are staged and sustained even if, and especially when, the fates of those publics remain fragile and buffeted by competing and often more powerful public formations.
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Affiliation(s)
- Stephen Hinchliffe
- Department of Geography, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Mark A Jackson
- Department of History, College of Humanities, University of Exeter, Exeter, UK
| | - Katrina Wyatt
- Child Health and Health Complexity, Institute for Health Research, University of Exeter Medical School, Exeter, UK
| | | | - Manuela Barreto
- Department of Psychology, University of Exeter, Exeter, UK
- Lisbon University Institute (CIS/ISCTE-IUL), Lisbon, Portugal
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Michael H Depledge
- European Centre for the Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Robin Durie
- Department of Politics and International relations, University of Exeter, Exeter, UK
| | - Lora E Fleming
- European Centre for the Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Nick Groom
- Department of English, University of Exeter, Exeter, UK
| | - Karyn Morrissey
- European Centre for the Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Laura Salisbury
- Department of English and Film, University of Exeter, Exeter, UK
| | - Felicity Thomas
- University of Exeter Medical School, Exeter, UK
- College of Humanities, University of Exeter, Exeter, UK
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Caban-Martinez AJ, Moore KJ, Clarke TC, Davila EP, Clark JD, Lee DJ, Fleming LE. Health Promotion at the Construction Work Site: The Lunch Truck Pilot Study. Workplace Health Saf 2018; 66:571-576. [PMID: 29701118 DOI: 10.1177/2165079918764189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The transient nature of construction work makes it difficult to conduct longitudinal worksite-based health promotion activities. As part of a workplace health assessment pilot study, we worked with a commercial lunch truck company to disseminate four types of health education materials including cancer screening, workplace injury prevention, fruit and vegetable consumption, and smoking cessation to construction workers purchasing food items from the truck during their job breaks. Two weeks following the worksite assessment, we followed up with these workers to ascertain their use of the health promotion materials. Of the 54 workers surveyed, 83% reported reviewing and sharing the cancer screening materials with their families, whereas 44% discussed the cancer screening materials with coworkers. Similar proportions of workers reviewed, shared, and discussed the other health promotion materials with their family. Lunch trucks may be an effective strategy and delivery method for educating construction workers on healthy behaviors and injury prevention practices.
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Djennad A, Lo Iacono G, Sarran C, Fleming LE, Kessel A, Haines A, Nichols GL. A comparison of weather variables linked to infectious disease patterns using laboratory addresses and patient residence addresses. BMC Infect Dis 2018; 18:198. [PMID: 29703153 DOI: 10.1186/s12879-018-3106-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/20/2018] [Indexed: 03/31/2024] Open
Abstract
BACKGROUND To understand the impact of weather on infectious diseases, information on weather parameters at patient locations is needed, but this is not always accessible due to confidentiality or data availability. Weather parameters at nearby locations are often used as a proxy, but the accuracy of this practice is not known. METHODS Daily Campylobacter and Cryptosporidium cases across England and Wales were linked to local temperature and rainfall at the residence postcodes of the patients and at the corresponding postcodes of the laboratory where the patient's specimen was tested. The paired values of daily rainfall and temperature for the laboratory versus residence postcodes were interpolated from weather station data, and the results were analysed for agreement using linear regression. We also assessed potential dependency of the findings on the relative geographic distance between the patient's residence and the laboratory. RESULTS There was significant and strong agreement between the daily values of rainfall and temperature at diagnostic laboratories with the values at the patient residence postcodes for samples containing the pathogens Campylobacter or Cryptosporidium. For rainfall, the R-squared was 0.96 for the former and 0.97 for the latter, and for maximum daily temperature, the R-squared was 0.99 for both. The overall mean distance between the patient residence and the laboratory was 11.9 km; however, the distribution of these distances exhibited a heavy tail, with some rare situations where the distance between the patient residence and the laboratory was larger than 500 km. These large distances impact the distributions of the weather variable discrepancies (i.e. the differences between weather parameters estimated at patient residence postcodes and those at laboratory postcodes), with discrepancies up to ±10 °C for the minimum and maximum temperature and 20 mm for rainfall. Nevertheless, the distributions of discrepancies (estimated separately for minimum and maximum temperature and rainfall), based on the cases where the distance between the patient residence and the laboratory was within 20 km, still exhibited tails somewhat longer than the corresponding exponential fits suggesting modest small scale variations in temperature and rainfall. CONCLUSION The findings confirm that, for the purposes of studying the relationships between meteorological variables and infectious diseases using data based on laboratory postcodes, the weather results are sufficiently similar to justify the use of laboratory postcode as a surrogate for domestic postcode. Exclusion of the small percentage of cases where there is a large distance between the residence and the laboratory could increase the precision of estimates, but there are generally strong associations between daily weather parameters at residence and laboratory.
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Affiliation(s)
- Abdelmajid Djennad
- Public Health England, London, UK. .,Statistics, Modelling and Economics Department, National Infection Service, Public Health England, 61, Colindale Avenue, London, NW9 5EQ, UK.
| | - Giovanni Lo Iacono
- School of Veterinary Medicine, University of Surrey, Guildford, UK.,Centre for Radiation Chemical and Environmental Hazards, Public Health England, Harwell, Didcot, UK
| | | | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter, Exeter, UK
| | | | - Andy Haines
- London School of Hygiene and Tropical Medicine, London, UK
| | - Gordon L Nichols
- Public Health England, London, UK.,Centre for Radiation Chemical and Environmental Hazards, Public Health England, Harwell, Didcot, UK.,European Centre for Environment and Human Health, University of Exeter, Exeter, UK.,University of East Anglia, Norwich, UK
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45
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Osborne NJ, Alcock I, Wheeler BW, Hajat S, Sarran C, Clewlow Y, McInnes RN, Hemming D, White M, Vardoulakis S, Fleming LE. Pollen exposure and hospitalization due to asthma exacerbations: daily time series in a European city. Int J Biometeorol 2017; 61:1837-1848. [PMID: 28500390 PMCID: PMC5643363 DOI: 10.1007/s00484-017-1369-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/17/2017] [Accepted: 04/27/2017] [Indexed: 05/03/2023]
Abstract
Exposure to pollen can contribute to increased hospital admissions for asthma exacerbation. This study applied an ecological time series analysis to examine associations between atmospheric concentrations of different pollen types and the risk of hospitalization for asthma in London from 2005 to 2011. The analysis examined short-term associations between daily pollen counts and hospital admissions in the presence of seasonal and long-term patterns, and allowed for time lags between exposure and admission. Models were adjusted for temperature, precipitation, humidity, day of week, and air pollutants. Analyses revealed an association between daily counts (continuous) of grass pollen and adult hospital admissions for asthma in London, with a 4-5-day lag. When grass pollen concentrations were categorized into Met Office pollen 'alert' levels, 'very high' days (vs. 'low') were associated with increased admissions 2-5 days later, peaking at an incidence rate ratio of 1.46 (95%, CI 1.20-1.78) at 3 days. Increased admissions were also associated with 'high' versus 'low' pollen days at a 3-day lag. Results from tree pollen models were inconclusive and likely to have been affected by the shorter pollen seasons and consequent limited number of observation days with higher tree pollen concentrations. Future reductions in asthma hospitalizations may be achieved by better understanding of environmental risks, informing improved alert systems and supporting patients to take preventive measures.
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Affiliation(s)
- Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK.
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Ian Alcock
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
| | - Shakoor Hajat
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Rachel N McInnes
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
- Met Office Hadley Centre, Fitzroy Road, Exeter, EX1 3PB, UK
| | | | - Mathew White
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
| | - Sotiris Vardoulakis
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
- London School of Hygiene and Tropical Medicine, London, UK
- Environmental Change Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Oxon, OX11 0RQ, UK
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK
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Abstract
OBJECTIVE This study reviewed the news media coverage of statins, seeking to identify specific trends or differences in viewpoint between media outlets and examine common themes. DESIGN The study is a content analysis of the frequency and content of the reporting of statins in a selection of the British newsprint media. It involved an assessment of the number, timing and thematic content of articles followed by a discourse analysis examining the underlying narratives. The sample was the output of four UK newspapers, covering a broad-spectrum readership, over a six month timeframe 1 October 2013 to 31 March 2014. RESULTS A total of 67 articles included reference to statins. The majority (39, 58%) were reporting or responding to publication of a clinical study. The ratio of negative to positive coverage was greater than 2:1 overall. In the more politically right-leaning newspapers, 67% of coverage was predominantly negative (30/45 articles); 32% in the more left-leaning papers (7/22 articles). Common themes were the perceived 'medicalisation' of the population; the balance between lifestyle modification and medical treatments in the primary prevention of heart disease; side effects and effectiveness of statins; pharmaceutical sponsorship and implications for the reliability of evidence; trust between the public and government, institutions, research organisations and the medical profession. CONCLUSIONS Newsprint media coverage of statins was substantially influenced by the publication of national guidance and by coverage in the medical journals of clinical studies and comment. Statins received a predominantly negative portrayal, notably in the more right-leaning press. There were shared themes: concern about the balance between medication and lifestyle change in the primary prevention of heart disease; the adverse effects of treatment; and a questioning of the reliability of evidence from research institutions, scientists and clinicians in the light of their potential allegiances and funding.
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Affiliation(s)
- Julia Chisnell
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Tom Marshall
- Department of Public Health and Epidemiology, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chris Hyde
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Zhivko Zhelev
- PenCLAHRC, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Lora E Fleming
- European Centre for Environment & Human Health, University of Exeter Medical School, Exeter, UK
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Grellier J, White MP, Albin M, Bell S, Elliott LR, Gascón M, Gualdi S, Mancini L, Nieuwenhuijsen MJ, Sarigiannis DA, van den Bosch M, Wolf T, Wuijts S, Fleming LE. BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe's blue spaces. BMJ Open 2017; 7:e016188. [PMID: 28615276 PMCID: PMC5726080 DOI: 10.1136/bmjopen-2017-016188] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Proximity and access to water have long been central to human culture and accordingly deliver countless societal benefits. Over 200 million people live on Europe's coastline, and aquatic environments are the top recreational destination in the region. In terms of public health, interactions with 'blue space' (eg, coasts, rivers, lakes) are often considered solely in terms of risk (eg, drowning, microbial pollution). Exposure to blue space can, however, promote health and well-being and prevent disease, although underlying mechanisms are poorly understood. AIMS AND METHODS The BlueHealth project aims to understand the relationships between exposure to blue space and health and well-being, to map and quantify the public health impacts of changes to both natural blue spaces and associated urban infrastructure in Europe, and to provide evidence-based information to policymakers on how to maximise health benefits associated with interventions in and around aquatic environments. To achieve these aims, an evidence base will be created through systematic reviews, analyses of secondary data sets and analyses of new data collected through a bespoke international survey and a wide range of community-level interventions. We will also explore how to deliver the benefits associated with blue spaces to those without direct access through the use of virtual reality. Scenarios will be developed that allow the evaluation of health impacts in plausible future societal contexts and changing environments. BlueHealth will develop key inputs into policymaking and land/water-use planning towards more salutogenic and sustainable uses of blue space, particularly in urban areas. ETHICS AND DISSEMINATION Throughout the BlueHealth project, ethics review and approval are obtained for all relevant aspects of the study by the local ethics committees prior to any work being initiated and an ethics expert has been appointed to the project advisory board. So far, ethical approval has been obtained for the BlueHealth International Survey and for community-level interventions taking place in Spain, Italy and the UK. Engagement of stakeholders, including the public, involves citizens in many aspects of the project. Results of all individual studies within the BlueHealth project will be published with open access. After full anonymisation and application of any measures necessary to prevent disclosure, data generated in the project will be deposited into open data repositories of the partner institutions, in line with a formal data management plan. Other knowledge and tools developed in the project will be made available via the project website (www.bluehealth2020.eu). Project results will ultimately provide key inputs to planning and policy relating to blue space, further stimulating the integration of environmental and health considerations into decision-making, such that blue infrastructure is developed across Europe with both public health and the environment in mind.
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Affiliation(s)
- James Grellier
- European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Truro, UK
- Faculty of Medicine, School of Public Health, Imperial College, London, UK
| | - Mathew P White
- European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Truro, UK
- Psychology Applied to Health (PAtH), University of Exeter Medical School, Exeter, UK
| | - Maria Albin
- Occupational and Environmental Medicine (OEM), Department of Laboratory Medicine, University of Lund, Lund, Sweden
- Institute of Environmental Medicine (IMM), Karolinska Institute, Stockholm, Sweden
| | - Simon Bell
- Department of Landscape Architecture, Estonian University of Life Sciences, Tartu, Estonia
- OPENspace, Edinburgh College of Art, University of Edinburgh, Edinburgh, Scotland
| | - Lewis R Elliott
- European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Truro, UK
- Psychology Applied to Health (PAtH), University of Exeter Medical School, Exeter, UK
| | - Mireia Gascón
- Centre for International Health Research (CRESIB), Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centre for Research in Environmental Epidemiology (CREAL), Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Silvio Gualdi
- Fondazione Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC), Bologna, Italy
| | | | - Mark J Nieuwenhuijsen
- Centre for International Health Research (CRESIB), Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centre for Research in Environmental Epidemiology (CREAL), Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Matilda van den Bosch
- Department of Forest and Conservation Sciences, Faculty of Forestry, University of British Columbia, Vancouver, BC, Canada
- WHO European Centre for Environment and Health, WHO Regional Office for Europe, Bonn, Germany
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tanja Wolf
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Susanne Wuijts
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Lora E Fleming
- European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Truro, UK
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Huntley SR, Lee DJ, LeBlanc WG, Arheart KL, McClure LA, Fleming LE, Caban-Martinez AJ. Acute joint pain in the emerging green collar workforce: Evidence from the linked National Health Interview Survey and Occupational Information Network (O*NET). Am J Ind Med 2017; 60:518-528. [PMID: 28514025 DOI: 10.1002/ajim.22710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Green jobs are a rapidly emerging category of very heterogeneous occupations that typically involve engagement with new technologies and changing job demands predisposing them to physical stressors that may contribute to the development of joint pain. METHODS We estimated and compared the prevalence of self-reported acute (past 30 days) joint pain between green and non-green collar workers using pooled 2004-2012 National Health Interview Survey (NHIS) data linked to the Occupational Information Network Database (O*NET). RESULTS Green collar workers have a higher prevalence of acute joint pain as compared to non-green collar workers. Green collar workers with pain in the upper extremity joints were significantly greater than in the non-green collar workforce, for example, right shoulder [23.2% vs 21.1%], right elbow [13.7% vs 12.0%], left shoulder [20.1% vs 18.2%], and left elbow [12.0% vs 10.7%]. CONCLUSIONS Acute joint pain reported by the emerging green collar workforce can assist in identifying at risk worker subgroups for musculoskeletal pain interventions.
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Affiliation(s)
- Samuel R Huntley
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.,Department of Orthopaedics and Rehabilitation, Miami Center for Orthopaedic Research and Education (CORE), Miller School of Medicine, University of Miami, Miami, Florida
| | - David J Lee
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - William G LeBlanc
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Kristopher L Arheart
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Laura A McClure
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Lora E Fleming
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.,European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, University of Exeter Medical School, Truro, Cornwall, United Kingdom
| | - Alberto J Caban-Martinez
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
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Lo Iacono G, Armstrong B, Fleming LE, Elson R, Kovats S, Vardoulakis S, Nichols GL. Challenges in developing methods for quantifying the effects of weather and climate on water-associated diseases: A systematic review. PLoS Negl Trop Dis 2017; 11:e0005659. [PMID: 28604791 PMCID: PMC5481148 DOI: 10.1371/journal.pntd.0005659] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/22/2017] [Accepted: 05/23/2017] [Indexed: 11/19/2022] Open
Abstract
Infectious diseases attributable to unsafe water supply, sanitation and hygiene (e.g. Cholera, Leptospirosis, Giardiasis) remain an important cause of morbidity and mortality, especially in low-income countries. Climate and weather factors are known to affect the transmission and distribution of infectious diseases and statistical and mathematical modelling are continuously developing to investigate the impact of weather and climate on water-associated diseases. There have been little critical analyses of the methodological approaches. Our objective is to review and summarize statistical and modelling methods used to investigate the effects of weather and climate on infectious diseases associated with water, in order to identify limitations and knowledge gaps in developing of new methods. We conducted a systematic review of English-language papers published from 2000 to 2015. Search terms included concepts related to water-associated diseases, weather and climate, statistical, epidemiological and modelling methods. We found 102 full text papers that met our criteria and were included in the analysis. The most commonly used methods were grouped in two clusters: process-based models (PBM) and time series and spatial epidemiology (TS-SE). In general, PBM methods were employed when the bio-physical mechanism of the pathogen under study was relatively well known (e.g. Vibrio cholerae); TS-SE tended to be used when the specific environmental mechanisms were unclear (e.g. Campylobacter). Important data and methodological challenges emerged, with implications for surveillance and control of water-associated infections. The most common limitations comprised: non-inclusion of key factors (e.g. biological mechanism, demographic heterogeneity, human behavior), reporting bias, poor data quality, and collinearity in exposures. Furthermore, the methods often did not distinguish among the multiple sources of time-lags (e.g. patient physiology, reporting bias, healthcare access) between environmental drivers/exposures and disease detection. Key areas of future research include: disentangling the complex effects of weather/climate on each exposure-health outcome pathway (e.g. person-to-person vs environment-to-person), and linking weather data to individual cases longitudinally.
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Affiliation(s)
- Giovanni Lo Iacono
- Chemical and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, United Kingdom
| | - Ben Armstrong
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
| | - Richard Elson
- Gastrointestinal Infections, National Infection Service, Public Health England, London, United Kingdom
| | - Sari Kovats
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sotiris Vardoulakis
- Chemical and Environmental Effects Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, United Kingdom
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
- Institute of Occupational Medicine, Edinburgh, United Kingdom
| | - Gordon L. Nichols
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
- Gastrointestinal Infections, National Infection Service, Public Health England, London, United Kingdom
- University of East Anglia, Norwich, United Kingdom
- University of Thessaly, Larissa, Thessaly, Greece
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White MP, Pahl S, Wheeler BW, Depledge MH, Fleming LE. Natural environments and subjective wellbeing: Different types of exposure are associated with different aspects of wellbeing. Health Place 2017; 45:77-84. [PMID: 28319857 DOI: 10.1016/j.healthplace.2017.03.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 01/30/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
Abstract
Despite growing interest in the relationships between natural environments and subjective wellbeing (SWB), previous studies have various methodological and theoretical limitations. Focusing on urban/peri-urban residents (n=7272) from a nationally representative survey of the English population, we explored the relationships between three types of exposure: i) 'neighbourhood exposure', ii) 'visit frequency', and iii) 'specific visit'; and four components of SWB: i) evaluative, ii) eudaimonic, iii) positive experiential and iv) negative experiential. Controlling for area and individual level socio-demographics and other aspects of SWB, visit frequency was associated with eudaimonic wellbeing and a specific visit with positive experiential wellbeing. People who visited nature regularly felt their lives were more worthwhile, and those who visited nature yesterday were happier. The magnitude of the association between weekly nature visits and eudaimonic wellbeing was similar to that between eudaimonic wellbeing and life circumstances such as marital status. Findings are relevant for policies to protect and promote public access to natural environments.
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Affiliation(s)
- Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, UK.
| | - Sabine Pahl
- European Centre for Environment and Human Health, University of Exeter Medical School, UK; Department of Psychology, Plymouth University, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
| | - Michael H Depledge
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
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