The Effects of Historical Housing Policies on Resident Exposure to Intra-Urban Heat: A Study of 108 US Urban Areas

Social disparities in neighborhood heat in the Northeast United States

Upward trends in ground-level warming are expected to intensify, affecting the health of human populations. Specific to the United States, the Northeast (NE) region is one of the most vulnerable to these warming trends. Previous research has found social disparities in the distribution of heat, while recent studies have examined associations between metropolitan racial/ethnic segregation and heat exposures. We advance upon previous research by including a novel measure of neighborhood-level racial/ethnic diversity in our examination of social inequalities in heat for NE neighborhoods (census tracts). We paired data derived from the United States Geological Survey on mean land surface temperature (LST) for the summer months of 2013-2017 with sociodemographic data from the American Community Survey (5-year estimates, 2013-2017). We use multivariable generalized estimating equations (GEEs) that adjust for geographic clustering. Findings reveal heat exposure disparities across NE neighborhoods. Neighborhoods with higher proportions of racial/ethnic minorities, people of lower socioeconomic status, households without access to an automobile, and greater diversity experience higher temperatures. Diversity was more strongly related to increased heat in neighborhoods with lower Latinx and lower Black composition suggesting that neighborhood homogeneity confers a differentially greater cooling effect based on higher White composition. The social groups that carry the unequal thermal burdens are also those who are most vulnerable. Interventions to reduce heat risks in the NE should therefore prioritize reducing the burden on historically disadvantaged communities.

Resident Experiences With a Place-Based Collaboration to Address Health and Social Inequities: A Survey of Visitors to the East Harlem Neighborhood Health Action Center

In 2016 and 2017, the New York City Department of Health and Mental Hygiene established Neighborhood Health Action Centers (Action Centers) in disinvested communities of color as part of a place-based model to advance health equity. This model includes co-located partners, a referral and linkage system, and community space and programming. In 2018, we surveyed visitors to the East Harlem Action Center to provide a more comprehensive understanding of visitors’ experiences. The survey was administered in English, Spanish, and Mandarin. Respondents were racially diverse and predominantly residents of East Harlem. The majority had been to the East Harlem Action Center previously. Most agreed that the main service provider for their visit made them feel comfortable, treated them with respect, spoke in a way that was easy to understand, and that they received the highest quality of service. A little more than half of returning visitors reported engaging with more than one Action Center program in the last 6 months. Twenty-one percent of respondents reported receiving at least one referral at the Action Center. Two thirds were aware that the Action Center offered a number of programs and services and half were aware that referrals were available. Additional visits to the Action Center were associated with increased likelihood of engaging with more than one program and awareness of the availability of programs and referral services. Findings suggest that most visitors surveyed had positive experiences, and more can be done to promote the Action Center and the variety of services it offers.

Climate Change and State of the Science for Children's Health and Environmental Health Equity

INTRODUCTION

Climate change is impacting the physical and mental health of children and families. This is a state of the science update regarding the impacts of climate change for pediatric-focused health care providers and advanced practice registered nurses.

METHOD

Using an equity lens, the authors reviewed and synthesized current literature regarding the adverse impacts of climate change.

RESULTS

The poor and communities of color are disproportionately impacted by climate change. Physical health impacts include increased vector and water-born infectious diseases, increases in asthma and respiratory infections, and undernutrition. Social disruptions lead to human trafficking. Climate change is associated with mental health concerns, including anxiety and posttraumatic stress after natural disasters.

DISCUSSION

As clinicians, pediatric-focused providers, and advanced practice registered nurses should use multipronged and interdisciplinary approaches to address or prevent the adverse impacts of climate change. Advocacy at all government levels is necessary to safeguard children and vulnerable populations.

High ambient temperature and child emergency and hospital visits in New York City

BACKGROUND

Emerging literature has documented heat-related impacts on child health, yet few studies have evaluated the effects of heat among children of different age groups and comparing emergency department (ED) and hospitalisation risks.

OBJECTIVES

To examine the differing associations between high ambient temperatures and risk of ED visits and hospitalisations among children by age group in New York City (NYC).

METHODS

We used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0-18 years admitted to NYC EDs (n = 2,252,550) and hospitals (n = 228,006) during the warm months (May-September) between 2005 and 2011. Using a time-stratified, case-crossover design, we estimated the risk of ED visits and hospitalisations associated with daily maximum temperature (Tmax) for children of all ages and by age group.

RESULTS

The average Tmax over the study period was 80.3°F (range 50°, 104°F). Tmax conferred the greatest risk of ED visits for children aged 0-4, with a 6-day cumulative excess risk of 2.4% (95% confidence interval [CI] 1.7, 3.0) per 13°F (ie interquartile range) increase in temperature. Children and adolescents 5-12 years (0.8%, 95% CI 0.1, 1.6) and 13-18 years (1.4%, 95% CI 0.6, 2.3) are also sensitive to heat. For hospitalisations, only adolescents 13-18 years had increased heat-related risk, with a cumulative excess risk of 7.9% (95% CI 2.0, 14.2) per 13°F increase in Tmax over 85°F.

CONCLUSIONS

This urban study in NYC reinforces that young children are particularly vulnerable to effects of heat, but also demonstrates the sensitivity of older children and adolescents as well. These findings underscore the importance of focussing on children and adolescents in targeting heat illness prevention and emergency response activities, especially as global temperatures continue to rise.

Overlapping heat and COVID-19 risk in New York City

New York City, the most populated urban center in the United States, is exposed to a variety of natural hazards. These range from extratropical storms and coastal flooding to extreme heat and cold temperatures, and have been shown to unevenly impact the various vulnerable groups in the city. As the COVID-19 pandemic hit in March 2020 and the city became an early epicenter, disparities in exposure led to widely uneven infection and mortality rates. This study maps the overlapping heat and COVID-19 risks in New York City with a multi-hazard risk framework during Summer 2020. To do so, we simulate neighborhood scale temperatures using the Weather Research and Forecasting model coupled with a multi-layer urban parameterization. Simulation outputs were combined with zipcode-scale COVID-19 and sociodemographic data to compute a multi-hazard risk index. Our results highlight several regions where high social vulnerability, COVID-19 infection rates, and heat coincide. Moreover, we use the local indicators of spatial association technique to map regions of spatially correlated high multi-hazard risk in the NYC boroughs of The Bronx and parts of Brooklyn and Queens. These high risk locations account for nearly a quarter of the city's population, with households earning less than half than those in the lowest risk zones.

OUP accepted manuscript

Background

Methods

Results

Conclusion

Health outcomes in redlined versus non-redlined neighborhoods: A systematic review and meta-analysis

BACKGROUND

Redlining was a racialized zoning practice in the U.S. that blocked fair access to home loans during the 1930s, and recent research is illuminating health problems in the current residents of these historically redlined areas. However, this work has not yet been holistically summarized. Here, we present the first systematic review and meta-analysis comparing health outcomes in redlined versus non-redlined neighborhoods in U.S. cities.

METHODS

We extracted relevant articles in PubMed, Web of Science, Cochrane and Science Direct databases published from January 2010 to September 2021.

RESULTS

The search revealed 12 studies on preterm births (n = 3), gunshot-related injuries (n = 2), cancer (n = 1), asthma (n = 1), self-rated health (n = 1), multiple health outcomes (n = 2), heat-related outcomes (n = 1) and COVID-19 incidence and mortality (n = 1). A meta-analysis of three studies found the odds of having preterm birth was significantly higher (OR = 1.41, 95% CI: 1.05, 1.88; p = 0.02) among women living in redlined areas compared to those in non-redlined areas. Review of other outcomes revealed that gunshot-related injuries, asthma, heat-related outcomes, and multiple chronic conditions were worse in redlined areas, while associations with cancer varied by cancer type. In terms of cause-specific mortality, one study revealed no link between residential redlining and infant mortality rate, while one study on COVID-19 outcomes was inconclusive.

CONCLUSIONS

Overall, this review presents evidence that living in historically redlined areas is associated with increased risk of multiple serious adverse health outcomes. Further research on mechanisms, remediation, and neighborhood-level interventions is needed to strengthen the understanding of the impacts of redlining on health.

Implications of climate change for tourism and outdoor recreation: an Indiana, USA, case study

In this case study, we examine a broad range of impacts on tourism and recreation based on projected changes to Indiana's climate. The direct impacts of climate change on Indiana include increases in the number of hot and extremely hot days each summer, fewer mild days, more rain, and less snow. Each direct impact will affect tourism and recreation. Additionally, a range of indirect impacts are anticipated, including climate-related changes in health issues, new infrastructure needs, changes in forests and other recreational areas, and shifting consumer attitudes toward travel and recreation. Although direct impacts are predictable, indirect impacts on the complex tourism system are harder to anticipate, and the tourism and recreation industry must build resilience to respond to future change. The paper concludes with recommendations for future study.

Multi-Level Socioenvironmental Contributors to Childhood Asthma in New York City: a Cluster Analysis

Childhood asthma exacerbation remains the leading cause of pediatric emergency department visits and hospitalizations and disproportionately affects Latinx and Black children, compared to non-Latinx White children in NYC. Environmental exposures and socioeconomic factors may jointly contribute to childhood asthma exacerbations; however, they are often studied separately. To better investigate the multiple contributors to disparities in childhood asthma, we compiled data on various individual and neighborhood level socioeconomic and environmental factors, including education, race/ethnicity, income disparities, gentrification, housing characteristics, built environment, and structural racism, from the NYC Department of Health's KIDS 2017 survey and the US Census' American Community Survey. We applied cluster analysis and logistic regression to first identify the predominant patterns of social and environmental factors experienced by children in NYC and then estimate whether children experiencing specific patterns are more likely to experience asthma exacerbations. We found that housing and built environment characteristics, such as density and age of buildings, were the predominant features to differentiate the socio-environmental patterns observed in New York City. Children living in neighborhoods with greater proportions of rental housing, high-density buildings, and older buildings were more likely to experience asthma exacerbations than other children. These findings add to the literature about childhood asthma in urban environments, and can assist efforts to target actionable policies and practices that promote health equity related to childhood asthma.

Measuring the Biological Embedding of Racial Trauma Among Black Americans Utilizing the RDoC Approach

The NIMH Research Domain Criteria (RDoC) initiative aims to understand the mechanisms influencing psychopathology through a dimensional approach. Limited research thus far has considered potential racial/ethnic differences in RDoC constructs that are influenced by developmental and contextual processes. A growing body of research has demonstrated that racial trauma is a pervasive chronic stressor that impacts the health of Black Americans across the life course. In this review article, we examine the ways that an RDOC framework could allow us to better understand the biological embedding of racial trauma among Black Americans. We also specifically examine the Negative Valence System domain of RDoC to explore how racial trauma is informed by and can help expand our understanding of this domain. We end the review by providing some additional research considerations and future research directives in the area of racial trauma that build on the RDoC initiative.

Climate change projections for sustainable and healthy cities

The ambition to develop sustainable and healthy cities requires city-specific policy and practice founded on a multidisciplinary evidence base, including projections of human-induced climate change. A cascade of climate models of increasing complexity and resolution is reviewed, which provides the basis for constructing climate projections-from global climate models with a typical horizontal resolution of a few hundred kilometres, through regional climate models at 12-50 km to convection-permitting models at 1 km resolution that permit the representation of urban induced climates. Different approaches to modelling the urban heat island (UHI) are also reviewed-focusing on how climate model outputs can be adjusted and coupled with urban canopy models to better represent UHI intensity, its impacts and variability. The latter can be due to changes induced by urbanisation or to climate change itself. City interventions such as greater use of green infrastructure also have an effect on the UHI and can help to reduce adverse health impacts such as heat stress and the mortality associated with increasing heat. Examples for the Complex Urban Systems for Sustainability and Health (CUSSH) partner cities of London, Rennes, Kisumu, Nairobi, Beijing and Ningbo illustrate how cities could potentially make use of more detailed models and projections to develop and evaluate policies and practices targeted at their specific environmental and health priorities.

PRACTICE RELEVANCE

Large-scale climate projections for the coming decades show robust trends in rising air temperatures, including more warm days and nights, and longer/more intense warm spells and heatwaves. This paper describes how more complex and higher resolution regional climate and urban canopy models can be combined with the aim of better understanding and quantifying how these larger scale patterns of change may be modified at the city or finer scale. These modifications may arise due to urbanisation and effects such as the UHI, as well as city interventions such as the greater use of grey and green infrastructures.There is potential danger in generalising from one city to another-under certain conditions some cities may experience an urban cool island, or little future intensification of the UHI, for example. City-specific, tailored climate projections combined with tailored health impact models contribute to an evidence base that supports built environment professionals, urban planners and policymakers to ensure designs for buildings and urban areas are fit for future climates.

A 1-km hourly air-temperature model for 13 northeastern U.S. states using remotely sensed and ground-based measurements

BACKGROUND

Accurate and precise estimates of ambient air temperatures that can capture fine-scale within-day variability are necessary for studies of air temperature and health.

METHOD

We developed statistical models to predict temperature at each hour in each cell of a 927-m square grid across the Northeast and Mid-Atlantic United States from 2003 to 2019, across ~4000 meteorological stations from the Integrated Mesonet, using inputs such as elevation, an inverse-distance-weighted interpolation of temperature, and satellite-based vegetation and land surface temperature. We used a rigorous spatial cross-validation scheme and spatially weighted the errors to estimate how well model predictions would generalize to new cell-days. We assess the within-county association of temperature and social vulnerability in a heat wave as an example application.

RESULTS

We found that a model based on the XGBoost machine-learning algorithm was fast and accurate, obtaining weighted root mean square errors (RMSEs) around 1.6 K, compared to standard deviations around 11.0 K. We found similar accuracy when validating our model on an external dataset from Weather Underground. Assessing predictions from the North American Land Data Assimilation System-2 (NLDAS-2), another hourly model, in the same way, we found it was much less accurate, with RMSEs around 2.5 K. This is likely due to the NLDAS-2 model's coarser spatial resolution, and the dynamic variability of temperature within its grid cells. Finally, we demonstrated the health relevance of our model by showing that our temperature estimates were associated with social vulnerability across the region during a heat wave, whereas the NLDAS-2 showed a much weaker association.

CONCLUSION

Our high spatiotemporal resolution air temperature model provides a strong contribution for future health studies in this region.

Mapping supply of and demand for ecosystem services to assess environmental justice in New York City

Livability, resilience, and justice in cities are challenged by climate change and the historical legacies that together create disproportionate impacts on human communities. Urban green infrastructure has emerged as an important tool for climate change adaptation and resilience given their capacity to provide ecosystem services such as local temperature regulation, stormwater mitigation, and air purification. However, realizing the benefits of ecosystem services for climate adaptation depend on where they are locally supplied. Few studies have examined the potential spatial mismatches in supply and demand of urban ecosystem services, and even fewer have examined supply-demand mismatches as a potential environmental justice issue, such as when supply-demand mismatches disproportionately overlap with certain socio-demographic groups. We spatially analyzed demand for ecosystem services relevant for climate change adaptation and combined results with recent analysis of the supply of ecosystem services in New York City (NYC). By quantifying the relative mismatch between supply and demand of ecosystem services across the city we were able to identify spatial hot- and coldspots of supply-demand mismatch. Hotspots are spatial clusters of census blocks with a higher mismatch and coldspots are clusters with lower mismatch values than their surrounding blocks. The distribution of mismatch hot- and coldspots was then compared to the spatial distribution of socio-demographic groups. Results reveal distributional environmental injustice of access to the climate-regulating benefits of ecosystem services provided by urban green infrastructure in NYC. Analyses show that areas with lower supply-demand mismatch tend to be populated by a larger proportion of white residents with higher median incomes, and areas with high mismatch values have lower incomes and a higher proportion of people of color. We suggest that urban policy and planning should ensure that investments in "nature-based" solutions such as through urban green infrastructure for climate change adaptation do not reinforce or exacerbate potentially existing environmental injustices.

School Parks as a Community Health Resource: Use of Joint-Use Parks by Children before and during COVID-19 Pandemic

Parks are settings for physical activity that can support the physical and mental health of children during the COVID-19 pandemic. We determined the impact of the pandemic on the use of joint-use parks outside of school hours by children in Austin, TX, United States. In autumn of 2019 and autumn of 2020 (i.e., before and during the COVID-19 pandemic), we used an adapted version of the System for Observing Play and Recreation in Communities to observe whether children aged 1-12 participated in physical activity (i.e., sedentary, light and moderate, vigorous) at three parks located at schools serving mostly economically disadvantaged Latinx families. In 2020, we also observed whether children maintained social distance and wore face coverings. Results of negative binomial regression modeling revealed the pandemic was associated with a 46% [95% CI: 20-63%] and 62% [95% CI: 39-76%] decrease in the number of girls and boys at parks, respectively, and a 42% [95% CI: 16-59%] and 60% [95% CI: 36-75%] decrease in the number of girls and boys engaging in physical activity, respectively (p < 0.01). In total, 60.6% of girls and 73.6% of boys were not social distancing, and 91.8% of the time no children wore masks. Interventions should be considered to safely reintroduce children to parks for health benefits during pandemics.

A Satellite-Based Model for Estimating Latent Heat Flux From Urban Vegetation

The impacts of extreme heat events are amplified in cities due to unique urban thermal properties. Urban greenspace mitigates high temperatures through evapotranspiration and shading; however, quantification of vegetative cooling potential in cities is often limited to simple remote sensing greenness indices or sparse, in situ measurements. Here, we develop a spatially explicit, high-resolution model of urban latent heat flux from vegetation. The model iterates through three core equations that consider urban climatological and physiological characteristics, producing estimates of latent heat flux at 30-m spatial resolution and hourly temporal resolution. We find strong agreement between field observations and model estimates of latent heat flux across a range of ecosystem types, including cities. This model introduces a valuable tool to quantify the spatial heterogeneity of vegetation cooling benefits across the complex landscape of cities at an adequate resolution to inform policies addressing the effects of extreme heat events.

Racial Disparities in Incidence of Legionnaires' Disease and Social Determinants of Health: A Narrative Review

OBJECTIVES

Racial and socioeconomic disparities in the incidence of Legionnaires' disease have been documented for the past 2 decades; however, the social determinants of health (SDH) that contribute to these disparities are not well studied. The objective of this narrative review was to characterize SDH to inform efforts to reduce disparities in the incidence of Legionnaires' disease.

METHODS

We conducted a narrative review of articles published from January 1979 through October 2019 that focused on disparities in the incidence of Legionnaires' disease and pneumonia (inclusive of bacterial pneumonia and/or community-acquired pneumonia) among adults and children (excluding articles that were limited to people aged <18 years). We identified 220 articles, of which 19 met our criteria: original research, published in English, and examined Legionnaires' disease or pneumonia, health disparities, and SDH. We organized findings using the Healthy People 2030 SDH domains: economic stability, education access and quality, social and community context, health care access and quality, and neighborhood and built environment.

RESULTS

Of the 19 articles reviewed, multiple articles examined disparities in incidence of Legionnaires' disease and pneumonia related to economic stability/income (n = 13) and comorbidities (n = 10), and fewer articles incorporated SDH variables related to education (n = 3), social support (none), health care access (n = 1), and neighborhood and built environment (n = 6) in their analyses.

CONCLUSIONS

Neighborhood and built-environment factors such as housing, drinking water infrastructure, and pollutant exposures represent critical partnership and research opportunities. More research that incorporates SDH and multilevel, cross-sector interventions is needed to address disparities in Legionnaires' disease incidence.

Perceptions of Canadian Federal Policy Responses to COVID-19 among People with Disabilities and Chronic Health Conditions

This study examines how people with disabilities and chronic health conditions-members of a large and diverse group often overlooked by Canadian public policy-are making sense of the Canadian federal government's response to COVID-19. Using original national online survey data collected in June 2020 (N = 1,027), we investigate how members of this group view the government's overall response. Although survey results show broad support for the federal government's pandemic response, findings also indicate fractures based on disability type and specific health condition, political partisanship, region, and experiences with COVID-19. Among these, identification with the Liberal party and receipt of CERB stand out as associated with more positive views. Further examination of qualitative responses shows that these views are also linked to differing perspectives surrounding government benefits and spending, partisan divisions, and other social and cultural cleavages.

A pediatrician's guide to climate change-informed primary care

Despite the urgency of the climate crisis and mounting evidence linking climate change to child health harms, pediatricians do not routinely engage with climate change in the office. Each primary care visit offers opportunities to screen for and support children burdened with risks to health that are increasingly intense due to climate change. Routine promotion of healthy behaviors also aligns with some needed-and powerful-solutions to the climate crisis. For some patients, including those engaged in athletics, those with asthma and allergies, or those with complex healthcare needs, preparedness for environmental risks and disasters worsened by climate change is a critical component of disease prevention and management. For all patients, anticipatory guidance topics that are already mainstays of pediatric best practices are related closely to needed guidance to keep children safe and promote health in the setting of compounding risks due to climate change. By considering climate change in routine care, pediatricians will be updating practice to align with evidence-based literature and better serving patients. This article provides a framework for pediatricians to provide climate-informed primary care during the structure of pediatric well child and other visits.

Compounding Risks Caused by Heat Exposure and COVID-19 in New York City: A Review of Policies, Tools, and Pilot Survey Results

The Coronavirus Disease 2019 (COVID-19) pandemic changed many social, economic, environmental, and healthcare determinants of health in New York City (NYC) and worldwide. COVID-19 potentially heightened the risk of heat-related health impacts in NYC, particularly on the most vulnerable communities, who often lack equitable access to adequate cooling mechanisms such as air conditioning (AC) and good quality green space. Here, we review some of the policies and tools which have been developed to reduce vulnerability to heat in NYC. We then present results from an online pilot survey of members of the environmental justice organization WE ACT for Environmental Justice (WE ACT) between July 11 and August 8, 2020, which asked questions to evaluate how those in Northern Manhattan coped with elevated summer heat in the midst of the COVID-19 pandemic. We also make some policy recommendations based on our initial findings. Results of our pilot survey suggest that people stayed indoors more due to COVID-19 and relied more on AC units to stay cool. Survey responses also indicated that some avoided visiting green spaces due to concerns around overcrowding and did not regularly frequent them due to the distance from their homes. The responses also demonstrate a potential racial disparity in AC access; AC ownership and access was highest amongst white and lowest amongst Latino/a/x and Black respondents. The impacts of COVID-19 have highlighted the need to accelerate efforts to improve preparedness for extreme heat like the City of New York's AC and cooling center programs, heat ventilation and air conditioning (HVAC) retrofitting, equitable green space expansion, and stronger environmental justice community networks and feedback mechanisms to hear from affected residents. Conducting a survey of this kind annually may provide an additional effective component of evaluating cooling initiatives in NYC.

The driving influences of human perception to extreme heat: A scoping review

Prior research demonstrates a link between heat risk perception and population response to a heat warning. Communicating a precise and understandable definition of "heat" or "heatwaves" can affect how a population perceives and responds to extreme heat. Still, little is known about how heat perception affects behavior changes to heat and heat communication across diverse populations. This scoping review aims to identify and describe the main themes and findings of recent heat perception research globally and map critical research gaps and priorities for future studies. Results revealed risk perception influences a person's exposure to and behavioral response to excessive heat. Risk perception varied geographically along the rural-urban continuum and was typically higher among vulnerable subgroups, including populations who were low-income, minority, and in poor health. A more integrated approach to refining risk communication strategies that result in a behavioral change and incorporates the individual, social, and cultural components of impactful group-based or community-wide interventions is needed. Research employing longitudinal or quasi-experimental designs and advanced statistical techniques are required to tease apart the independent and interacting factors that causally influence risk communication, heat perception, and adaptive behaviors. We advance a framework to conceptualize the structural, environmental, personal, and social drivers of population heat risk perception and how they interact to influence heat perception and adaptive behaviors. Our findings map future research priorities needed for heat perception and a framework to drive future research design.

The intersection of pediatrics, climate change, and structural racism: Ensuring health equity through climate justice

Understanding and intervening at the intersection of climate change and child health disparities require pediatric providers to broaden their competency with structural determinants of health - even in the clinic. The environmental effects of climate change at the community level intersect in complex ways with structural racism and social influences of health. Climate injustice is further evident in policies and practices that disproportionately affect low-income communities and communities of color through exposure to harmful pollutants from industrial plants, heavy vehicular traffic, and flooding waterways, as well as to harm from degraded civic infrastructure such as leaking water lines and unsafe bridges. To support child health, pediatric providers must recognize the environmental health harms posed to children and multiplied by climate change as well as identify opportunities to center the voices of families and communities to dismantle these inequities. In this article, three case examples demonstrate the links between structural racism, climate change and child health. We then use a healing centered engagement approach to offer specific suggestions for how pediatric providers can actively promote health and resilience, advocate for patient needs, and contribute to efforts to change structural racism in existing practices and institutions.

Disproportionate exposure to urban heat island intensity across major US cities

Urban heat stress poses a major risk to public health. Case studies of individual cities suggest that heat exposure, like other environmental stressors, may be unequally distributed across income groups. There is little evidence, however, as to whether such disparities are pervasive. We combine surface urban heat island (SUHI) data, a proxy for isolating the urban contribution to additional heat exposure in built environments, with census tract-level demographic data to answer these questions for summer days, when heat exposure is likely to be at a maximum. We find that the average person of color lives in a census tract with higher SUHI intensity than non-Hispanic whites in all but 6 of the 175 largest urbanized areas in the continental United States. A similar pattern emerges for people living in households below the poverty line relative to those at more than two times the poverty line.

Urban greenspace as a climate change adaptation strategy for subtropical Asian cities: A comparative study across cities in three countries

Interest in nature-based approaches for climate change adaptation in cities is growing. Whilst there is a growing field of scholarship in a European and North America setting, research on the policy and governance of urban greenspace for climate adaptation in subtropical Asia is limited. Given the different development patterns, environmental characteristics and governance arrangements in subtropical cities, plus their comparatively large population and high climate risk, this is a significant knowledge gap. In response, this paper evaluates competences - skill sets, capabilities, and supporting policy and legislation - to enact adaptation through greenspace across different governance contexts; and assesses how international rhetoric on nature-based adaptation becomes localised to subtropical Asian city settings. We conduct interviews with stakeholders, plus review of relevant policy and city-specific research, for three cities with different governance and development contexts: Hanoi (Vietnam); Taipei (Taiwan); and Fukuoka (Japan). Across all three cases, we find that institutional structures and processes for connecting different remits and knowledge systems are a bigger challenge than a lack of appropriate policy or individuals with the required technical knowledge. However, opportunities for civil society participation and consideration of justice issues vary between the cities according to the socio-political context. These findings illustrate the value of individuals and organisations able to work across institutional boundaries in linking greenspace and adaptation agendas for subtropical Asian cities; and the importance of competence in collaboration with developers and civil society so that the rapid development or regeneration seen in subtropical Asian contexts does not tend towards green climate gentrification. More broadly, our findings show that the diverse nature of subtropical Asian cities means the role of greenspace in climate adaptation is likely to be context-specific, and thus that caution must be exercised against uncritically importing best practices from exemplar cases elsewhere.

Social Inequities in Urban Heat and Greenspace: Analyzing Climate Justice in Delhi, India

Climate change and rapid urbanization currently pose major challenges for equitable development in megacities of the Global South, such as Delhi, India. This study considers how urban social inequities are distributed in terms of burdens and benefits by quantifying exposure through an urban heat risk index (UHRI), and proximity to greenspace through the normalized difference vegetation index (NDVI), at the ward level in Delhi. Landsat derived remote sensing imagery for May and September 2011 is used in a sensitivity analysis of varying seasonal exposure. Multivariable models based on generalized estimating equations (GEEs) reveal significant statistical associations (p < 0.05) between UHRI/NDVI and several indicators of social vulnerability. For example, the proportions of children (β = 0.922, p = 0.024) and agricultural workers (β = 0.394, p = 0.016) are positively associated with the May UHRI, while the proportions of households with assets (β = -1.978, p = 0.017) and households with electricity (β = -0.605, p = 0.010) are negatively associated with the May UHRI. In contrast, the proportions of children (β = 0.001, p = 0.633) and agricultural workers (β = 0.002, p = 0.356) are not significantly associated with the May NDVI, while the proportions of households with assets (β = 0.013, p = 0.010) and those with electricity (β = 0.008, p = 0.006) are positively associated with the May NDVI. Our findings emphasize the need for future research and policies to consider how socially vulnerable groups are inequitably exposed to the impact of climate change-related urban heat without the mitigating effects of greenspace.

The tree cover and temperature disparity in US urbanized areas: Quantifying the association with income across 5,723 communities

Urban tree cover provides benefits to human health and well-being, but previous studies suggest that tree cover is often inequitably distributed. Here, we use National Agriculture Imagery Program digital ortho photographs to survey the tree cover inequality for Census blocks in US large urbanized areas, home to 167 million people across 5,723 municipalities and other Census-designated places. We compared tree cover to summer land surface temperature, as measured using Landsat imagery. In 92% of the urbanized areas surveyed, low-income blocks have less tree cover than high-income blocks. On average, low-income blocks have 15.2% less tree cover and are 1.5⁰C hotter than high-income blocks. The greatest difference between low- and high-income blocks was found in urbanized areas in the Northeast of the United States, where low-income blocks in some urbanized areas have 30% less tree cover and are 4.0⁰C hotter. Even after controlling for population density and built-up intensity, the positive association between income and tree cover is significant, as is the positive association between proportion non-Hispanic white and tree cover. We estimate, after controlling for population density, that low-income blocks have 62 million fewer trees than high-income blocks, equal to a compensatory value of $56 billion ($1,349/person). An investment in tree planting and natural regeneration of $17.6 billion would be needed to close the tree cover disparity, benefitting 42 million people in low-income blocks.

The legacy of structural racism: Associations between historic redlining, current mortgage lending, and health

Structural racism, which is embedded in past and present operations of the U.S. housing market, is a fundamental cause of racial health inequities. We conducted an ecologic study to 1) examine historic redlining in relation to current neighborhood lending discrimination and three key indicators of societal health (mental health, physical health, and infant mortality rate (IMR)) and 2) investigate sustained lending disinvestment as a determinant of current neighborhood health in one of the most hypersegregated metropolitan areas in the United States, Milwaukee, Wisconsin. We calculated weighted historic redlining scores from the proportion of 1930s Home Owners' Loan Corporation residential security grades contained within 2010 census tract boundaries. We combined two lending indicators from 2018 Home Mortgage Disclosure Act data to capture current neighborhood lending discrimination: low lending occurrence and high cost loans (measured via loan rate spread). Using historic redlining score and current lending discrimination, we created a 4-level hierarchical measure of lending trajectory. In Milwaukee neighborhoods, greater historic redlining was associated with current lending discrimination (OR = 1.73, 95%CI: 1.16, 2.58) and increased prevalence of poor physical health (β = 1.34, 95%CI: 0.40, 2.28) and poor mental health (β = 1.26, 95%CI: 0.51, 2.01). Historic redlining was not associated with neighborhood IMR (β = -0.48, 95%CI: -2.12, 1.15). A graded association was observed between lending trajectory and health: neighborhoods with high sustained disinvestment had worse physical and mental health than neighborhoods with high investment (poor physical health: β = 5.33, 95%CI: 3.05, 7.61; poor mental health: β = 4.32, 95%CI: 2.44, 6.20). IMR was highest in 'disinvested' neighborhoods (β = 5.87, 95%CI: 0.52, 11.22). Our findings illustrate ongoing legacies of government sponsored historic redlining. Structural racism, as manifested in historic and current forms of lending disinvestment, predicts poor health in Milwaukee's hypersegregated neighborhoods. We endorse equity focused policies that dismantle and repair the ways racism is entrenched in America's social fabric.

Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research

Anthropogenic climate change is adversely impacting people and contributing to suffering and increased costs from climate-related diseases and injuries. In responding to this urgent and growing public health crisis, mitigation strategies are in place to reduce future greenhouse gas emissions (GHGE) while adaptation strategies exist to reduce and/or alleviate the adverse effects of climate change by increasing systems' resilience to future impacts. While these strategies have numerous positive benefits on climate change itself, they also often have other positive externalities or health co-benefits. This knowledge can be harnessed to promote and improve global public health, particularly for the most vulnerable populations. Previous conceptual models in mitigation and adaptation studies such as the shared socioeconomic pathways (SSPs) considered health in the thinking, but health outcomes were not their primary intention. Additionally, existing guidance documents such as the World Health Organization (WHO) Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities is designed primarily for public health professionals or healthcare managers in hospital settings with a primary focus on resilience. However, a detailed cross sectoral and multidisciplinary conceptual framework, which links mitigation and adaptation strategies with health outcomes as a primary end point, has not yet been developed to guide research in this area. In this paper, we briefly summarize the burden of climate change on global public health, describe important mitigation and adaptation strategies, and present key health benefits by giving context specific examples from high, middle, and low-income settings. We then provide a conceptual framework to inform future global public health research and preparedness across sectors and disciplines and outline key stakeholders recommendations in promoting climate resilient systems and advancing health equity.

Linking History to Contemporary State-Sanctioned Slow Violence through Cultural and Structural Racism

Environmental scientists started documenting the racial inequities of environmental exposures (e.g., proximity to waste facilities or to industrial pollution) in the 1970s and 1980s. Since then, research has documented inequities in exposures to nearly every studied environmental hazard, showing that American society delivers racial violence toward non-White families. Through cultural racism, a resilient social hierarchy is set where the lives of some groups of people are considered more valuable than others; then, through structural racism, institutions unequally mete and dole environmental benefits and burdens to these groups. We argue that the "slow violence" of environmental racism is linked to other forms of racial violence that have been enacted throughout history. We discuss the meaning of cultural racism as it pertains to the hierarchy of groups of people whose lives are valued unequally and its link to structural racism. To remedy this environmental racial violence, we propose shifts in the empirical research on environmental inequities that are built upon, either implicitly or explicitly, the interconnected concepts of cultural and structural racism that link historical to contemporary forms of racial violence.

Biophilia beyond the Building: Applying the Tools of Urban Biodiversity Planning to Create Biophilic Cities

In response to the widely recognized negative impacts of urbanization on biodiversity, many cities are reimagining urban design to provide better biodiversity support. Some cities have developed urban biodiversity plans, primarily focused on improving biodiversity support and ecosystem function within the built environment through habitat restoration and other types of urban greening projects. The biophilic cities movement seeks to reframe nature as essential infrastructure for cities, seamlessly integrating city and nature to provide abundant, accessible nature for all residents and corresponding health and well-being outcomes. Urban biodiversity planning and biophilic cities have significant synergies in their goals and the means necessary to achieve them. In this paper, we identify three key ways by which the urban biodiversity planning process can support biophilic cities objectives: engaging the local community; identifying science-based, quantitative goals; and setting priorities for action. Urban biodiversity planning provides evidence-based guidance, tools, and techniques needed to design locally appropriate, pragmatic habitat enhancements that support biodiversity, ecological health, and human health and well-being. Developing these multi-functional, multi-benefit strategies that increase the abundance of biodiverse nature in cities has the potential at the same time to deepen and enrich our biophilic experience in daily life.

Thermal Inequity in Richmond, VA: The Effect of an Unjust Evolution of the Urban Landscape on Urban Heat Islands

The urban heat island (UHI) effect is caused by intensive development practices in cities and the diminished presence of green space that results. The evolution of these phenomena has occurred over many decades. In many cities, historic zoning and redlining practices barred Black and minority groups from moving into predominately white areas and obtaining financial resources, a practice that still affects cities today, and has forced these already disadvantaged groups to live in some of the hottest areas. In this study, we used a new dataset on the spatial distribution of temperature during a heat wave in Richmond, Virginia to investigate potential associations between extreme heat and current and historical demographic, socioeconomic, and land use factors. We assessed these data at the census block level to determine if blocks with large differences in temperature also had significant variation in these covariates. The amount of canopy cover, percent impervious surface, and poverty level were all shown to be strong correlates of UHI when analyzed in conjunction with afternoon temperatures. We also found strong associations of historical policies and planning decisions with temperature using data from the University of Richmond’s Digital Scholarship Lab’s “Mapping Inequality” project. Finally, the Church Hill area of the city provided an interesting case study due to recent data suggesting the area’s gentrification. Differences in demographics, socioeconomic factors, and UHI were observed between north and (more gentrified) south Church Hill. Both in Church Hill and in Richmond overall, our research found that areas occupied by people of low socioeconomic status or minority groups disproportionately experienced extreme heat and corresponding impacts on health and quality of life.

Dimensions of Thermal Inequity: Neighborhood Social Demographics and Urban Heat in the Southwestern U.S

Exposure to heat is a growing public health concern as climate change accelerates worldwide. Different socioeconomic and racial groups often face unequal exposure to heat as well as increased heat-related sickness, mortality, and energy costs. We provide new insight into thermal inequities by analyzing 20 Southwestern U.S. metropolitan regions at the census block group scale for three temperature scenarios (average summer heat, extreme summer heat, and average summer nighttime heat). We first compared average temperatures for top and bottom decile block groups according to demographic variables. Then we used spatial regression models to investigate the extent to which exposure to heat (measured by land surface temperature) varies according to income and race. Large thermal inequities exist within all the regions studied. On average, the poorest 10% of neighborhoods in an urban region were 2.2 °C (4 °F) hotter than the wealthiest 10% on both extreme heat days and average summer days. The difference was as high as 3.3-3.7 °C (6-7 °F) in California metro areas such as Palm Springs and the Inland Empire. A similar pattern held for Latinx neighborhoods. Temperature disparities at night were much smaller (usually ~1 °F). Disparities for Black neighborhoods were also lower, perhaps because Black populations are small in most of these cities. California urban regions show stronger thermal disparities than those in other Southwestern states, perhaps because inexpensive water has led to more extensive vegetation in affluent neighborhoods. Our findings provide new details about urban thermal inequities and reinforce the need for programs to reduce the disproportionate heat experienced by disadvantaged communities.

Integrating Diverse Perspectives for Managing Neighborhood Trees and Urban Ecosystem Services in Portland, OR (US)

Municipalities worldwide are increasingly recognizing the importance of urban green spaces to mitigate climate change’s extreme effects and improve residents’ quality of life. Even with extensive earlier research examining the distribution of tree canopy in cities, we know little about human perceptions of urban forestry and related ecosystem services. This study aims to fill this gap by examining the variations in socioeconomic indicators and public perceptions by asking how neighborhood trees and socioeconomic indicators mediate public perceptions of ecosystem services availability. Using Portland, Oregon (USA) as our case study, we assessed socioeconomic indicators, land cover data, and survey responses about public perceptions of neighborhood trees. Based on over 2500 survey responses, the results indicated a significant correlation among tree canopy, resident income, and sense of ownership for urban forestry. We further identified the extent to which the absence of trees amplifies environmental injustices and challenges for engaging communities with landscape management. The results suggested that Portland residents are aware of tree maintenance challenges, and the inclusion of cultural ecosystem services can better address existing environmental injustices. Our assessment of open-ended statements suggested the importance of conducting public outreach to identify specific priorities for a community-based approach to urban forestry.

Effects of trees, gardens, and nature trails on heat index and child health: design and methods of the Green Schoolyards Project

BACKGROUND

Latinx children in the United States are at high risk for nature-deficit disorder, heat-related illness, and physical inactivity. We developed the Green Schoolyards Project to investigate how green features-trees, gardens, and nature trails-in school parks impact heat index (i.e., air temperature and relative humidity) within parks, and physical activity levels and socioemotional well-being of these children. Herein, we present novel methods for a) observing children's interaction with green features and b) measuring heat index and children's behaviors in a natural setting, and a selection of baseline results.

METHODS

During two September weeks (high temperature) and one November week (moderate temperature) in 2019, we examined three joint-use elementary school parks in Central Texas, United States, serving predominantly low-income Latinx families. To develop thermal profiles for each park, we installed 10 air temperature/relative humidity sensors per park, selecting sites based on land cover, land use, and even spatial coverage. We measured green features within a geographic information system. In a cross-sectional study, we used an adapted version of System for Observing Play and Recreation in Communities (SOPARC) to assess children's physical activity levels and interactions with green features. In a cohort study, we equipped 30 3rd and 30 4th grade students per school during recess with accelerometers and Global Positioning System devices, and surveyed these students regarding their connection to nature. Baseline analyses included inverse distance weighting for thermal profiles and summing observed counts of children interacting with trees.

RESULTS

In September 2019, average daily heat index ranged 2.0 °F among park sites, and maximum daily heat index ranged from 103.4 °F (air temperature = 33.8 °C; relative humidity = 55.2%) under tree canopy to 114.1 °F (air temperature = 37.9 °C; relative humidity = 45.2%) on an unshaded playground. 10.8% more girls and 25.4% more boys interacted with trees in September than in November.

CONCLUSIONS

We found extreme heat conditions at select sites within parks, and children positioning themselves under trees during periods of high heat index. These methods can be used by public health researchers and practitioners to inform the redesign of greenspaces in the face of climate change and health inequities.

Redlines and Greenspace: The Relationship between Historical Redlining and 2010 Greenspace across the United States

INTRODUCTION

Redlining, a racist mortgage appraisal practice of the 1930s, established and exacerbated racial residential segregation boundaries in the United States. Investment risk grades assigned >80y ago through security maps from the Home Owners' Loan Corporation (HOLC) are associated with current sociodemographics and adverse health outcomes. We assessed whether historical HOLC investment grades are associated with 2010 greenspace, a health-promoting neighborhood resource.

OBJECTIVES

We compared 2010 normalized difference vegetation index (NDVI) across previous HOLC neighborhood grades using propensity score restriction and matching.

METHODS

Security map shapefiles were downloaded from the Mapping Inequality Project. Neighborhood investment risk grades included A (best, green), B (blue), C (yellow), and D (hazardous, red, i.e., redlined). We used 2010 satellite imagery to calculate the average NDVI for each HOLC neighborhood. Our main outcomes were 2010 annual average NDVI and summer NDVI. We assigned areal-apportioned 1940 census measures to each HOLC neighborhood. We used propensity score restriction, matching, and targeted maximum likelihood estimation to limit model extrapolation, reduce confounding, and estimate the association between HOLC grade and NDVI for the following comparisons: Grades B vs. A, C vs. B, and D vs. C.

RESULTS

Across 102 urban areas (4,141 HOLC polygons), annual average ±standard deviation (SD) 2010 NDVI was 0.47 (±0.09), 0.43 (±0.09), 0.39 (±0.09), and 0.36 (±0.10) in Grades A-D, respectively. In analyses adjusted for current ecoregion and census region, 1940s census measures, and 1940s population density, annual average NDVI values in 2010 were estimated at -0.039 (95% CI: -0.045, -0.034), -0.024 (95% CI: -0.030, -0.018), and -0.026 (95% CI: -0.037, -0.015) for Grades B vs. A, C vs. B, and D vs. C, respectively, in the 1930s.

DISCUSSION

Estimates adjusted for historical characteristics indicate that neighborhoods assigned worse HOLC grades in the 1930s are associated with reduced present-day greenspace. https://doi.org/10.1289/EHP7495.

Protecting health in dry cities: from evidence to action

Cities in the US and beyond are increasingly claiming heat readiness as the climate crisis escalates, while starting to recognize its disproportionate burden on poorer residents. But are their plans sufficient, and can they implement them fast enough? Mara Kardas-Nelson reports

Food Insecurity in the Post-Hurricane Harvey Setting: Risks and Resources in the Midst of Uncertainty

Food insecurity is of heightened concern during and after natural disasters; higher prevalence is typically reported in post-disaster settings. The current study examines food insecurity prevalence and specific risk/resource variables that may act as barriers or advantages in accessing food in such a setting. Using a modified quota sample (n = 316), Hurricane Harvey survivors participated in face-to-face interviews and/or online surveys that assessed health, social and household factors, and sociodemographic characteristics. Using logistic regression analyses we find that social vulnerabilities, circumstantial risk, and social and psychological resources are important in determining the odds of food insecurity. Hispanic and/or Nonwhite survivors, renters, and those persons displaced during the natural disaster have higher food insecurity odds. Survivors with stronger social ties, higher levels of mastery, and a greater sense of connectedness to their community are found to have lower food insecurity odds. A more nuanced analysis of circumstantial risk finds that while the independent effects of displacement and home ownership are important, so too is the intersection of these two factors, with displaced-renters experiencing significantly higher odds than any other residence and displacement combinations, and particularly those who are homeowners not displaced during the disaster. Strategies for addressing differential risks, as well as practical approaches for implementation and education programming related to disaster recovery, are discussed.

SI: Survivability under Overheating: The Impact of Regional and Global Climate Change on the Vulnerable and Low-Income Population

The present special issue discusses three significant challenges of the built environment, namely regional and global climate change, vulnerability, and survivability under the changing climate. Synergies between local climate change, energy consumption of buildings and energy poverty, and health risks highlight the necessity to develop mitigation strategies to counterbalance overheating impacts. The studies presented here assess the underlying issues related to urban overheating. Further, the impacts of temperature extremes on the low-income population and increased morbidity and mortality have been discussed. The increasing intensity, duration, and frequency of heatwaves due to human-caused climate change is shown to affect underserved populations. Thus, housing policies on resident exposure to intra-urban heat have been assessed. Finally, opportunities to mitigate urban overheating have been proposed and discussed.

Disparities in Sleep Health and Potential Intervention Models: A Focused Review

Disparities in sleep health are important but underrecognized contributors to health disparities. Understanding the factors contributing to sleep heath disparities and developing effective interventions are critical to improving all aspects of heath. Sleep heath disparities are impacted by socioeconomic status, racism, discrimination, neighborhood segregation, geography, social patterns, and access to health care as well as by cultural beliefs, necessitating a cultural appropriateness component in any intervention devised for reducing sleep health disparities. Pediatric sleep disparities require innovative and urgent intervention to establish a foundation of lifelong healthy sleep. Tapping the vast potential of technology in improving sleep health access may be an underutilized tool to reduce sleep heath disparities. Identifying, implementing, replicating, and disseminating successful interventions to address sleep disparities have the potential to reduce overall disparities in health and quality of life.

Association of Summer Heat Waves and the Probability of Preterm Birth in Minnesota: An Exploration of the Intersection of Race and Education

Preterm birth (PTB) is common and has negative impacts on infant health. While some maternal risk factors have been identified, including age under 20 or over 40, substance abuse, low BMI, and racism, less is known about the impact of environmental exposures like high heat. We combined 154,157 records of live births occurring in Minnesota between 2009 and 2015 with hourly weather records collected from the Minneapolis–St. Paul airport. We tested if maternal heat wave exposure (a seven-day period with a mean daily high temp of 37 °C) immediately prior to birth leads to a higher risk of preterm birth. Additional covariates included maternal age, race/ethnicity, educational status, and residence in the seven-county Minneapolis–St. Paul metro area. Pregnant women exposed to a seven-day heat wave of 37 °C or higher experienced a higher relative risk of PTB compared to women who did not experience a heat wave (1.14 risk ratio (RR), 1.0–1.3 95% confidence interval (CI)). The result is robust to controls for a woman’s age, race/ethnicity, educational attainment, place of residence, and year of the birth. Children born to Black women with college degrees who are exposed to heat waves experience a higher relative risk of PTB compared to White women with college degrees in a heat wave (2.97 RR, 1.5–6.1 95% CI). Summer heat waves are associated with higher risk of PTB in late-term pregnancies in Minnesota.

Associations between historical redlining and birth outcomes from 2006 through 2015 in California

BACKGROUND

Despite being one of the wealthiest nations, disparities in adverse birth outcomes persist across racial and ethnic lines in the United States. We studied the association between historical redlining and preterm birth, low birth weight (LBW), small-for-gestational age (SGA), and perinatal mortality over a ten-year period (2006-2015) in Los Angeles, Oakland, and San Francisco, California.

METHODS

We used birth outcomes data from the California Office of Statewide Health Planning and Development between January 1, 2006 and December 31, 2015. Home Owners' Loan Corporation (HOLC) Security Maps developed in the 1930s assigned neighborhoods one of four grades that pertained to perceived investment risk of borrowers from that neighborhood: green (grade A) were considered "Best", blue (grade B) "Still Desirable", yellow (grade C) "Definitely Declining", and red (grade D, hence the term "redlining") "Hazardous". Geocoded residential addresses at the time of birth were superimposed on HOLC Security Maps to assign each birth a HOLC grade. We adjusted for potential confounders present at the time of Security Map creation by assigning HOLC polygons areal-weighted 1940s Census measures. We then employed propensity score matching methods to estimate the association of historical HOLC grades on current birth outcomes. Because tracts graded A had almost no propensity of receiving grade C or D and because grade B tracts had low propensity of receiving grade D, we examined birth outcomes in the three following comparisons: B vs. A, C vs. B, and D vs. C.

RESULTS

The prevalence of preterm birth, SGA and mortality tended to be higher in worse HOLC grades, while the prevalence of LBW varied across grades. Overall odds of mortality and preterm birth increased as HOLC grade worsened. Propensity score matching balanced 1940s census measures across contrasting groups. Logistic regression models revealed significantly elevated odds of preterm birth (odds ratio (OR): 1.02, 95% confidence interval (CI): 1.00-1.05), and SGA (OR: 1.03, 95% CI: 1.00-1.05) in the C vs. B comparison and significantly reduced odds of preterm birth (OR: 0.93, 95% CI: 0.91-0.95), LBW (OR: 0.94-95% CI: 0.92-0.97), and SGA (OR: 0.94, 95% CI: 0.92-0.96) in the D vs. C comparison. Results differed by metropolitan area and maternal race.

CONCLUSION

Similar to prior studies on redlining, we found that worsening HOLC grade was associated with adverse birth outcomes, although this relationship was less clear after propensity score matching and stratifying by metropolitan area. Higher odds of preterm birth and SGA in grade C versus grade B neighborhoods may be caused by higher-stress environments, racial segregation, and lack of access to resources, while lower odds of preterm birth, SGA, and LBW in grade D versus grade C neighborhoods may due to population shifts in those neighborhoods related to gentrification.

Intersecting vulnerabilities in human biology: Synergistic interactions between climate change and increasing obesity rates

OBJECTIVES

Increasing obesity rates and accelerating climate change represent two global health challenges shaped by lifestyle change and human environmental modifications. Yet, few studies have considered how these issues may interact to exacerbate disease risk.

METHODS

In this theory article, we explore evidence that obesity-related disease and climatic changes share socio-ecological drivers and may interact to increase human morbidity and mortality risks. Additionally, we consider how obesity-climate change interactions may disproportionately affect vulnerable populations and how anthropological research can be applied to address this concern.

RESULTS

Interactions between heat stress and cardiometabolic disease represent an important pathway through which climate change and obesity-related morbidities may jointly impair health. For example, individuals with higher body fatness and obesity-related metabolic conditions (eg, type 2 diabetes) exhibit a reduced ability to dissipate heat. The risk of poor health resulting from these interactions is expected to be heterogeneous, with low- and middle-income countries, individuals of lower socioeconomic status, and minority populations facing a greater disease burden due to relative lack of resource access (eg, air conditioning). Moreover, older adults are at higher risk due to aging-associated changes in body composition and loss of thermoregulation capabilities.

CONCLUSIONS

Few policy makers appear to be considering how interventions can be designed to simultaneously address the medical burden posed by increasing obesity rates and climate change. Anthropological research is well situated to address this need in a nuanced and culturally-sensitive way; producing research that can be used to support community resilience, promote holistic well-being, and improve health outcomes.

Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013-2017

Objectives. To assess if historical redlining, the US government's 1930s racially discriminatory grading of neighborhoods' mortgage credit-worthiness, implemented via the federally sponsored Home Owners' Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth (< 37 weeks gestation).Methods. We analyzed 2013-2017 birth certificate data for all singleton births in New York City (n = 528 096) linked by maternal residence at time of birth to (1) HOLC grade and (2) current census tract social characteristics.Results. The proportion of preterm births ranged from 5.0% in grade A ("best"-green) to 7.3% in grade D ("hazardous"-red). The odds ratio for HOLC grade D versus A equaled 1.6 and remained significant (1.2; P < .05) in multilevel models adjusted for maternal sociodemographic characteristics and current census tract poverty, but was 1.07 (95% confidence interval = 0.92, 1.20) after adjustment for current census tract racialized economic segregation.Conclusions. Historical redlining may be a structural determinant of present-day risk of preterm birth.Public Health Implications. Policies for fair housing, economic development, and health equity should consider historical redlining's impacts on present-day residential segregation and health outcomes.

Google Street View Derived Built Environment Indicators and Associations with State-Level Obesity, Physical Activity, and Chronic Disease Mortality in the United States

Previous studies have demonstrated that there is a high possibility that the presence of certain built environment characteristics can influence health outcomes, especially those related to obesity and physical activity. We examined the associations between select neighborhood built environment indicators (crosswalks, non-single family home buildings, single-lane roads, and visible wires), and health outcomes, including obesity, diabetes, cardiovascular disease, and premature mortality, at the state level. We utilized 31,247,167 images collected from Google Street View to create indicators for neighborhood built environment characteristics using deep learning techniques. Adjusted linear regression models were used to estimate the associations between aggregated built environment indicators and state-level health outcomes. Our results indicated that the presence of a crosswalk was associated with reductions in obesity and premature mortality. Visible wires were associated with increased obesity, decreased physical activity, and increases in premature mortality, diabetes mortality, and cardiovascular mortality (however, these results were not significant). Non-single family homes were associated with decreased diabetes and premature mortality, as well as increased physical activity and park and recreational access. Single-lane roads were associated with increased obesity and decreased park access. The findings of our study demonstrated that built environment features may be associated with a variety of adverse health outcomes.