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Lakes T, Schmitz T, Füller H. Pathogenic built environment? Reflections on modeling spatial determinants of health in urban settings considering the example of COVID-19 studies. Front Public Health 2025; 13:1502897. [PMID: 40165988 PMCID: PMC11955651 DOI: 10.3389/fpubh.2025.1502897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 02/27/2025] [Indexed: 04/02/2025] Open
Abstract
The triad of host, agent, and environment has become a widely accepted framework for understanding infectious diseases and human health. While modern medicine has traditionally focused on the individual, there is a renewed interest in the role of the environment. Recent studies have shifted from an early-twentieth-century emphasis on individual factors to a broader consideration of contextual factors, including environmental, climatic, and social settings as spatial determinants of health. This shifted focus has been particularly relevant in the context of the COVID-19 pandemic, where the built environment in urban settings is increasingly recognized as a crucial factor influencing disease transmission. However, operationalizing the complexity of associations between the built environment and health for empirical analyses presents significant challenges. This study aims to identify key caveats in the operationalization of spatial determinants of health for empirical analysis and proposes guiding principles for future research. We focus on how the built environment in urban settings was studied in recent literature on COVID-19. Based on a set of criteria, we analyze 23 studies and identify explicit and implicit assumptions regarding the health-related dimensions of the built environment. Our findings highlight the complexities and potential pitfalls, referred to as the 'spatial trap,' in the current approaches to spatial epidemiology concerning COVID-19. We conclude with recommendations and guiding questions for future studies to avoid falsely attributing a built environment impact on health outcomes and to clarify explicit and implicit assumptions regarding the health-related dimensions.
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Affiliation(s)
- Tobia Lakes
- Department of Geography, Faculty of Mathematics and Natural Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Integrative Research Institute on Transformations of Human Environment Systems (IRI THESys), Berlin, Germany
| | - Tillman Schmitz
- Department of Geography, Faculty of Mathematics and Natural Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henning Füller
- Department of Geography, Faculty of Mathematics and Natural Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
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2
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Bolte G, Moebus S, Fehr R. [Urban Epidemiology as an Integrative Approach to Sustainable and Healthy Urban Development]. DAS GESUNDHEITSWESEN 2023; 85:S287-S295. [PMID: 37972600 DOI: 10.1055/a-2156-4305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Understanding the complex relationships between the physical and social environment and health in urban areas is essential for the development of appropriate measures of health promotion, disease prevention, and health protection. This article aims to characterize the comparatively new approach of urban epidemiology with its relevance for research and practice of urban health. Research in urban epidemiology provides important data and methodological foundations for integrated reporting, health impact assessments, and evaluation of interventions. Current challenges and solutions are outlined and initial recommendations for research, practice, and education and training are presented for discussion. Methods and findings of urban epidemiology can contribute in many ways to health-promoting, sustainable urban development.
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Affiliation(s)
- Gabriele Bolte
- Institut für Public Health und Pflegeforschung, Abt. Sozialepidemiologie, Universität Bremen, Bremen, Germany
| | - Susanne Moebus
- Institute for Urban Public Health, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Germany
| | - Rainer Fehr
- Sustainable Environmental Health Sciences, Medizinische Fakultät OWL, Universität Bielefeld, Bielefeld, Germany
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3
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Hofer-Fischanger K, Tuttner S, Amort FM, Helms K, Unger J, Hödl J, Strüver A, van Poppel MNM. Promoting active transport in rural communities through infrastructural modifications: the PABEM needs assessment tool. Health Promot Int 2023; 38:daab186. [PMID: 34849929 DOI: 10.1093/heapro/daab186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The design of the built environment in communities influences active transport and physical activity levels of citizens. Existing instruments for quantitatively assessing built environments were developed for use in urban areas and mainly by experts. Participative assessment of built environment modifications (PABEM) is a needs assessment tool that involves citizens and community decision-makers within a structured process for identifying needed changes to promote walking and cycling in rural areas. This article describes the development of the PABEM process and evaluates its initial use in three rural towns in Austria. PABEM consists of the following seven steps: (i) qualitative interviews; (ii) expert assessment of the built environment; (iii) citizen assessment of the built environment; (iv) social media interaction; (v) household questionnaire; (vi) participatory workshop; and (vii) evaluation and scoring workshop. The main modifications identified as necessary in rural towns were the revitalization of existing walking and cycling facilities and the construction of new barrier-free and safe sidewalks. In addition cycling routes to schools, to public transport facilities and to central public places as well as cleaner and inviting seating, a car-free school environment, speed reduction in town centres, more crosswalks and improved cleanliness in public places were also deemed necessary modifications. PABEM's provisions to ensure collaborative participation of citizens and local decision-makers fostered a continuous dialogue about the requirements of the built environment, user needs and opportunities for realization throughout the whole process.
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Affiliation(s)
- Kathrin Hofer-Fischanger
- Institute of Health and Tourism Management, FH JOANNEUM University of Applied Sciences, Kaiser-Franz-Josef Straße 24, Bad Gleichenberg 8344, Austria
| | - Silvia Tuttner
- Institute of Health and Tourism Management, FH JOANNEUM University of Applied Sciences, Kaiser-Franz-Josef Straße 24, Bad Gleichenberg 8344, Austria
| | - Frank M Amort
- Institute of Health and Tourism Management, FH JOANNEUM University of Applied Sciences, Kaiser-Franz-Josef Straße 24, Bad Gleichenberg 8344, Austria
| | - Katja Helms
- Institute of Construction Design and Economics, FH JOANNEUM University of Applied Sciences, Alte Poststraße 154, Graz 8020, Austria
| | - Julia Unger
- Institute of Occupational Therapy, FH JOANNEUM University of Applied Sciences, Kaiser-Franz-Josef Straße 24, Bad Gleichenberg 8344, Austria
| | - Josef Hödl
- Institute of Social Work, FH JOANNEUM University of Applied Sciences, Eggenberger Allee 11, Graz 8020, Austria
| | - Anke Strüver
- Institute of Geography and Regional Sciences, University of Graz, Heinrichstraße 36, Graz 8010, Austria
| | - Mireille N M van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, Graz 8010, Austria
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Röhrbein H, Hilger-Kolb J, Heinrich K, Kairies H, Hoffmann K. An Iterative, Participatory Approach to Developing a Neighborhood-Level Indicator System of Health and Wellbeing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1456. [PMID: 36674211 PMCID: PMC9859574 DOI: 10.3390/ijerph20021456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Despite increased awareness of the essential role of neighborhood characteristics for residents' health and wellbeing, the development of neighborhood-level indicator systems has received relatively little attention to date. To address this gap, we describe the participatory development process of a small-area indicator system that includes information on local health needs in a pilot neighborhood in the German city of Mannheim. To identify relevant indicators, we partnered with representatives of the city's public health department and used an iterative approach that included multiple Plan-Do-Check-Act cycles with ongoing feedback from local key stakeholders. The described process resulted in a web-based indicator system with a total of 86 indicators. Additionally, 123 indicators were perceived as relevant by stakeholders but could not be included due to data unavailability. Overall, stakeholders evaluated the participatory approach as useful. Even though the onset of the COVID-19 pandemic and the lack of some data elements hindered instrument development, close collaboration with public health partners facilitated the process. To identify and target sub-national health inequalities, we encourage local public health stakeholders to develop meaningful and useful neighborhood-level indicator systems, building on our experiences from the applied development process and considering identified barriers and facilitators.
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Affiliation(s)
- Hannah Röhrbein
- Center for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Jennifer Hilger-Kolb
- Center for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Kathrin Heinrich
- Youth Welfare Office and Public Health Department, Division for Youth Welfare Planning and Public Health Planning, 68161 Mannheim, Germany
| | - Holger Kairies
- Youth Welfare Office and Public Health Department, Division for Youth Welfare Planning and Public Health Planning, 68161 Mannheim, Germany
| | - Kristina Hoffmann
- Center for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
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Pomeroy-Stevens A, Goldman B, Grattan K. Participatory Systems Mapping for Municipal Prioritization and Planning. J Urban Health 2022; 99:738-748. [PMID: 35798924 PMCID: PMC9263058 DOI: 10.1007/s11524-022-00654-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 01/31/2023]
Abstract
Rapidly growing cities face new and compounding health challenges, leading governments and donors to seek innovative ways to support healthier, more resilient urban growth. One such approach is the systems mapping process developed by Engaging Inquiry (EI) for the USAID-funded Building Healthy Cities project (BHC) in four cities in Asia. This paper provides details on the theory and methods of the process. While systems mapping is not new, the approach detailed in this paper has been uniquely adapted to the purpose of municipal planning. Strategic stakeholder engagement, including participatory workshops with a diverse group of stakeholders, is at the core of this approach and led to deeper insights, greater buy-in, and shared understanding of the city's unique opportunities and challenges. This innovative mapping process is a powerful tool for defining municipal priorities within growing cities across the globe, where the situation is rapidly evolving. It can be used to provide evidence-based information on where to invest to gain the biggest impact on specific goals. This paper is part of a collection in this issue providing a detailed accounting of BHC's systems mapping approach across four project cities.
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Affiliation(s)
- Amanda Pomeroy-Stevens
- Building Healthy Cities Project, JSI Research & Training Institute, Inc, Arlington, VA, USA.
| | - Bailey Goldman
- Building Healthy Cities Project, Engaging Inquiry LLC, Durham, NC, USA
| | - Karen Grattan
- Building Healthy Cities Project, Engaging Inquiry LLC, Durham, NC, USA
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Jia B, Chen Y, Wu J. Bibliometric Analysis and Research Trend Forecast of Healthy Urban Planning for 40 Years (1981-2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189444. [PMID: 34574368 PMCID: PMC8464861 DOI: 10.3390/ijerph18189444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022]
Abstract
The history of healthy city planning can be traced back to the beginning of the 19th century. Since the industrialization period, the harsh living conditions of cities and the outbreak of infectious diseases have promoted the coordinated development of urban planning and public health, and people have gradually realized the importance of urban design and planning to the health of residents. After searching keywords related to health city and urban planning, and excluding repeated, non-English, and unrelated papers, this work retrieved 2582 documents as the basic data (timespan is 1 January 1981–31 December 2020, retrieval time is 28 January 2021). Additionally, CiteSpace was used to analyze document co-citation, cooperation network, and topic co-occurrence. Subsequently, random forest algorithm was used to predict the probability of citation. Overall, this work found that the hot spots of healthy urban planning are physical activity, green space, urban green space, and mental health. It also shows the diversification of themes and the development trend of cross-fields in the field of healthy urban planning. In addition, the article found that two factors, namely, the average number of citations of the first author and whether the article belongs to the field of environmental research, have a great impact on the number of citations of the article. This work is of practical significance to relevant practitioners and researchers, because it provides guidance for hot topics and future research directions in the field of healthy urban planning.
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Freudenberg N. Preparing the Urban Public Health Workforce. Am J Public Health 2021; 111:e1-e3. [PMID: 34191550 PMCID: PMC8493164 DOI: 10.2105/ajph.2021.306327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Nicholas Freudenberg
- Nicholas Freudenberg is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY
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Pineo H, Zhou K, Niu Y, Hale J, Willan C, Crane M, Zimmermann N, Michie S, Liu Q, Davies M. Evidence-informed urban health and sustainability governance in two Chinese cities. BUILDINGS & CITIES 2021; 2:550-567. [PMID: 34853832 PMCID: PMC7612054 DOI: 10.5334/bc.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sustainable development is best supported by intersectoral policies informed by a range of evidence and knowledge types (e.g. scientific and lay). Given China's rapid urbanisation, scale and global importance in climate mitigation, this study investigates how evidence is perceived and used to inform urban health and sustainability policies at central and local levels. Well-informed senior professionals in government/scientific agencies (12 in Beijing and 11 in Ningbo) were interviewed. A thematic analysis is presented using deductive and inductive coding. Government agency participants described formal remits and processes determining the scope and use of evidence by different tiers of government. Academic evidence was influential when commissioned by government departments. Public opinion and economic priorities were two factors that also influenced the use or weight of evidence in policymaking. This study shows that scientific evidence produced or commissioned by government was routinely used to inform urban health and sustainability policy. Extensive and routine data collection is regularly used to inform cyclical policy processes, which improves adaptive capacity. This study contributes to knowledge on the 'cultures of evidence use'. Environmental governance can be further improved through increased data-sharing and use of diverse knowledge types.
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Affiliation(s)
- Helen Pineo
- UCL Institute for Environmental Design and Engineering, The Bartlett School of Environment Energy and Resources, University College London (UCL), London, UK
| | - Ke Zhou
- UCL Institute for Environmental Design and Engineering, The Bartlett School of Environment Energy and Resources, University College London (UCL), London, UK
| | - Yanlin Niu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Joanna Hale
- Centre for Behaviour Change, University College London (UCL), London, UK
| | - Catherine Willan
- Bartlett Faculty of the Built Environment, University College London (UCL), London, UK
| | - Melanie Crane
- The Australian Prevention Partnership Centre, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Nici Zimmermann
- UCL Institute for Environmental Design and Engineering, The Bartlett School of Environment Energy and Resources, University College London (UCL), London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Qiyong Liu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Michael Davies
- UCL Institute for Environmental Design and Engineering, The Bartlett School of Environment Energy and Resources, University College London (UCL), London, UK
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Freitas Â, Rodrigues TC, Santana P. Assessing Urban Health Inequities through a Multidimensional and Participatory Framework: Evidence from the EURO-HEALTHY Project. J Urban Health 2020; 97:857-875. [PMID: 32860097 PMCID: PMC7454139 DOI: 10.1007/s11524-020-00471-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Urban health inequities often reflect and follow the geographic patterns of inequality in the social, economic and environmental conditions within a city-the so-called determinants of health. Evidence of patterns within these conditions can support decision-making by identifying where action is urgent and which policies and interventions are needed to mitigate negative impacts and enhance positive impacts. Within the scope of the EU-funded project EURO-HEALTHY (Shaping EUROpean policies to promote HEALTH equitY), the City of Lisbon was selected as a case study to apply a multidimensional and participatory assessment approach of urban health whose purpose was to inform the evaluation of policies and interventions with potential to address local health gaps. In this paper, we present the set of indicators identified as drivers of urban health inequities within the City of Lisbon, exploring the added value of using a spatial indicator framework together with a participation process to orient a place-based assessment and to inform policies aimed at reducing health inequities. Two workshops with a panel of local stakeholders from health and social care services, municipal departments (e.g. urban planning, environment, social rights and education) and non-governmental and community-based organizations were organized. The aim was to engage local stakeholders to identify locally critical situations and select indicators of health determinants from a spatial equity perspective. To support the analysis, a matrix of 46 indicators of health determinants, with data disaggregated at the city neighbourhood scale, was constructed and was complemented with maps. The panel identified critical situations for urban health equity in 28 indicators across eight intervention axes: economic conditions, social protection and security; education; demographic change; lifestyles and behaviours; physical environment; built environment; road safety and healthcare resources and performance. The geographical distribution of identified critical situations showed that all 24 city neighbourhoods presented one or more problems. A group of neighbourhoods systematically perform worse in most indicators from different intervention axes, requiring not only priority action but mainly a multi- and intersectoral policy response. The indicator matrices and maps have provided a snapshot of urban inequities across different intervention axes, making a compelling argument for boosting intersectoral work across municipal departments and local stakeholders in the City of Lisbon. This study, by integrating local evidence in combination with social elements, pinpoints the importance of a place-based approach for assessing urban health equity.
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Affiliation(s)
- Ângela Freitas
- CEGOT-UC, Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal.
| | - Teresa C Rodrigues
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Paula Santana
- CEGOT-UC, Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
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