Urban health: an example of a "health in all policies" approach in the context of SDGs implementation

Planetary health and its relevance in the modern era: A topical review

Planetary health is a relatively new concept that has gained traction in recent years due to the urgent need to address the health of our planet and its inhabitants. It refers to the interdependent health of both humans and the environment, recognizing that the two are inseparable and that the health of one is intricately linked to the health of the other. This article aims to advocate changes in how health care for both the environment and humans is envisaged, and aligned with sustainable development goals using ethically sound, solution-oriented, and practical approaches to education. Rapid industrialization, urbanization, and population growth led to environmental degradation and climate change in this era. These factors have profound implications for human health, with the World Health Organization estimating that 23% of global deaths are linked to environmental factors. Climate change and extreme weather events are exacerbating existing health problems. Air pollution, water pollution, and toxic chemicals are additional environmental factors that add to it and lead to health issues, including non-communicable diseases and death. A collaborative and interdisciplinary approach is needed to address planetary health challenges, including working across sectors and investing in research to understand better the complex interactions between human health and the environment. By promoting sustainable development and protecting the planet's health and inhabitants, we can ensure a healthy future for generations.

The urban political ecology of antimicrobial resistance: A critical lens on integrative governance

The objective of this paper is to integrate Urban Political Ecology (UPE) as a theory for identifying under-exposed urban dimensions of Antimicrobial Resistance (AMR). A UPE lens allows us to conceptualize urbanization as a ubiquitous socio-ecological process and an interpretive frame that could inform AMR governance strategies across related contexts by: a) situating AMR risks in relation to urbanization processes shaping social and political co-determinants of such systemic threats as climate change; b) aligning UPE scholarship with One Health (OH) approaches that address AMR to reveal the under-exposed link of AMR to environmental threats and broader structural dimensions that influence these threats; and c) identifying shared AMR and environmental governance pathways that inform the rationale for more equitable governance arrangements. We delineate a context in which the speed and scale of human activity in the larger context of urbanization, driven by global market integration strategies, impacts human-animal-environmental health threats such as AMR. We demonstrate how UPE scholarship can be leveraged to offer theoretical depth to approaches considering the interdependencies of AMR and climate change threats. We then propose a strategic approach focused on identifying shared governance pathways and intersectoral accountability frameworks to address upstream structural drivers of AM-Environmental threats. The co-benefits of a UPE-informed framework to human-animal-environmental health that leverages enabling policy environments to foster a more collaborative, equitable and sustainable approach to address systemic global health threats are clarified. Just as the concept of "health in all policies" emphasized taking health implications into account in all public policy development, the integration of UPE in AMR governance arrangements would emphasize the need to take other sectors into account through an intersectoral whole-of-government approach that fosters shared AMR - climate change governance pathways.

Exploring the Threefold Viewpoint on Children's Oral Health in a Cross-Sectional Study

Oral health is situated within the framework of the global health agenda, addressing facets pertaining to well-being and quality of life. The research is based on the need to address variables at the community level to improve schoolchildren's oral health and promote healthy behaviors and aims to carry out an in-depth analysis from the perspective of the factors that influence children's oral health. Step 1, designed by the World Health Organization, was utilized. An easy-to-use web interface was created for data collection. The statistical analysis consisted of using multinomial and binominal logistic regression models. The level of education of the adult has a high probability of influencing the consumption of unhealthy or healthy foods, it has a significant probability of exerting influence on social or medical problems and a correlation was found between the level of academic education and the pattern of dental visits. The development of health-promoting behaviors begins in childhood and involves parents, who have an essential role in the education of their children. Oral health promotion programs in schools need to target the child-adult-teacher-dentist relationships. Taking into consideration the aforementioned, a threefold viewpoint is necessary for the development of a national program aimed at promoting the oral health of schoolchildren in Romania.

The Urban Environment and Cardiometabolic Health

Urban environments contribute substantially to the rising burden of cardiometabolic diseases worldwide. Cities are complex adaptive systems that continually exchange resources, shaping exposures relevant to human health such as air pollution, noise, and chemical exposures. In addition, urban infrastructure and provisioning systems influence multiple domains of health risk, including behaviors, psychological stress, pollution, and nutrition through various pathways (eg, physical inactivity, air pollution, noise, heat stress, food systems, the availability of green space, and contaminant exposures). Beyond cardiometabolic health, city design may also affect climate change through energy and material consumption that share many of the same drivers with cardiometabolic diseases. Integrated spatial planning focusing on developing sustainable compact cities could simultaneously create heart-healthy and environmentally healthy city designs. This article reviews current evidence on the associations between the urban exposome (totality of exposures a person experiences, including environmental, occupational, lifestyle, social, and psychological factors) and cardiometabolic diseases within a systems science framework, and examines urban planning principles (eg, connectivity, density, diversity of land use, destination accessibility, and distance to transit). We highlight critical knowledge gaps regarding built-environment feature thresholds for optimizing cardiometabolic health outcomes. Last, we discuss emerging models and metrics to align urban development with the dual goals of mitigating cardiometabolic diseases while reducing climate change through cross-sector collaboration, governance, and community engagement. This review demonstrates that cities represent crucial settings for implementing policies and interventions to simultaneously tackle the global epidemics of cardiovascular disease and climate change.

Toward Heart-Healthy and Sustainable Cities: A Policy Statement From the American Heart Association

Nearly 56% of the global population lives in cities, with this number expected to increase to 6.6 billion or >70% of the world's population by 2050. Given that cardiometabolic diseases are the leading causes of morbidity and mortality in people living in urban areas, transforming cities and urban provisioning systems (or urban systems) toward health, equity, and economic productivity can enable the dual attainment of climate and health goals. Seven urban provisioning systems that provide food, energy, mobility-connectivity, housing, green infrastructure, water management, and waste management lie at the core of human health, well-being, and sustainability. These provisioning systems transcend city boundaries (eg, demand for food, water, or energy is met by transboundary supply); thus, transforming the entire system is a larger construct than local urban environments. Poorly designed urban provisioning systems are starkly evident worldwide, resulting in unprecedented exposures to adverse cardiometabolic risk factors, including limited physical activity, lack of access to heart-healthy diets, and reduced access to greenery and beneficial social interactions. Transforming urban systems with a cardiometabolic health-first approach could be accomplished through integrated spatial planning, along with addressing current gaps in key urban provisioning systems. Such an approach will help mitigate undesirable environmental exposures and improve cardiovascular and metabolic health while improving planetary health. The purposes of this American Heart Association policy statement are to present a conceptual framework, summarize the evidence base, and outline policy principles for transforming key urban provisioning systems to heart-health and sustainability outcomes.

Shaping urban environments to improve respiratory health: recommendations for research, planning, and policy

Urban areas carry a large burden of acute (infectious) and chronic respiratory diseases due to environmental conditions such as high levels of air pollution and high population densities. Car-dominated cities often lack walkable areas, which reduces opportunities for physical activity that are fundamentally important for healthy lungs. The already restricted amount of green space available-with often poorly selected plants-could produce pollen and subsequently provoke or worsen allergic diseases. Less affluent neighbourhoods often carry a larger respiratory disease burden. A multisectoral approach with more diverse policy measures and urban innovations is needed to reduce air pollution (eg, low emission zones), to increase public space for walking and cycling (eg, low traffic neighbourhoods, superblocks, 15-minute cities, and car-free cities), and to develop green cities (eg, planting of low-allergy trees). Stricter EU air quality guidelines can push these transformations to improve the respiratory health of citizens. Advocacy by medical respiratory societies can also make an important contribution to such changes.

'That is because we are alone': A relational qualitative study of socio-spatial inequities in maternal and newborn health programme coverage in rural Uttar Pradesh, India

This qualitative study was conducted in Uttar Pradesh state, India to explore how interrelated socio-economic position and spatial characteristics of four diverse villages may have influenced equity in coverage of community-based maternal and newborn health (MNH) services. We conducted social mapping and three focus group discussions in each village, among women of lower and higher socio-economic position who recently gave birth, and with community health workers (n = 134). Data were analysed in NVivo 11.0 using thematic framework analysis. The extent of socio-economic hierarchies and spatial disparateness within the village, combined with distance to larger centers, together shaped villages' level of socio-spatial remoteness. Disadvantaged socio-economic groups expressed being more often spatially isolated, with less access to infrastructure, resources or services, which was heightened if the village was physically distant from larger centers. In more socio-spatially remote villages, inequities in coverage of MNH services that disadvantaged lower socio-economic position groups were compounded as these groups more often experienced ASHA vacancies, as well as greater distance to and poorer perceived quality of health services nearest the village. The results inform a conceptual framework of 'socio-spatial remoteness' that can guide public health research and programmes to more comprehensively address health inequities within India and beyond.

Social participation in the city: exploring the moderating effect of walkability on the associations between active mobility, neighborhood perceptions, and social activities in urban adults

BACKGROUND

Living in urban environments is associated with several health risks (e.g., noise, and air pollution). However, there are also beneficial aspects such as various opportunities for social activities, which might increase levels of social participation and (physically) active mobility that in turn have positive effects on health and well-being. However, how aspects of the environment, active mobility, and social participation are associated is not well established. This study investigates the moderating effect of low vs. high walkability neighborhoods on the associations between active mobility, and social participation and integrates individuals' subjective perception of the neighborhood environment they are living in.

METHODS

Cross-sectional data from 219 adults (48% female, mean age = 46 ± 3.8 years) from 12 urban neighborhoods (six low, six high walkability) were analyzed: First, social participation, active mobility, and subjective neighborhood perceptions were compared between people living in a low vs. high walkability neighborhood via t-tests. Second, multigroup path analyses were computed to explore potential differences in the associations between these variables in low vs. high walkability neighborhoods.

RESULTS

Social participation, active mobility, and subjective neighborhood perceptions didn't differ in low vs. high walkability neighborhoods (p: 0.37 - 0.71). Active mobility and subjective neighborhood perceptions were significantly stronger related to social participation in low vs. high walkability neighborhoods (active mobility in low: ß = 0.35, p < .01 vs. high: ß = 0.09, p = .36; subjective neighborhood perceptions in low: ß = 0.27, p < .01 vs. high: ß = 0.15, p = .18).

CONCLUSIONS

Despite living in neighborhoods with objectively different walkability, participants rated social participation and active mobility equally and perceived their neighborhoods similarly. However, zooming into the interrelations of these variables reveals that social participation of residents from low walkability neighborhoods depends stronger on active mobility and perceiving the environment positively. Positive perceptions of the environment and active mobility might buffer the objectively worse walkability. Future research should focus on underlying mechanisms and determinants of subjective neighborhood perceptions and active mobility, especially in low walkability neighborhoods.

The contribution of the exposome to the burden of cardiovascular disease

Large epidemiological and health impact assessment studies at the global scale, such as the Global Burden of Disease project, indicate that chronic non-communicable diseases, such as atherosclerosis and diabetes mellitus, caused almost two-thirds of the annual global deaths in 2020. By 2030, 77% of all deaths are expected to be caused by non-communicable diseases. Although this increase is mainly due to the ageing of the general population in Western societies, other reasons include the increasing effects of soil, water, air and noise pollution on health, together with the effects of other environmental risk factors such as climate change, unhealthy city designs (including lack of green spaces), unhealthy lifestyle habits and psychosocial stress. The exposome concept was established in 2005 as a new strategy to study the effect of the environment on health. The exposome describes the harmful biochemical and metabolic changes that occur in our body owing to the totality of different environmental exposures throughout the life course, which ultimately lead to adverse health effects and premature deaths. In this Review, we describe the exposome concept with a focus on environmental physical and chemical exposures and their effects on the burden of cardiovascular disease. We discuss selected exposome studies and highlight the relevance of the exposome concept for future health research as well as preventive medicine. We also discuss the challenges and limitations of exposome studies.

A Single-Center Study of the Impact of the COVID-19 Pandemic on the Organization of Healthcare Service Delivery to Patients with Head and Neck Cancer

The aim of this study was to identify and assess the impact of the COVID-19 pandemic on the diagnosis and treatment of head and neck cancer (HNC) patients of the Department of Otolaryngology, Head and Neck Surgery of the 4th Military Teaching Hospital in Wroclaw for whom oncological treatment was planned by a cancer case board between March 2018 and February 2022. We analysed the medical records of 625 patients. In order to verify whether the relationships between the analysed features were statistically significant, the chi-square test of independence and the Student's t-test for independent samples were used (p < 0.05). Our analysis showed that the impact of the pandemic on the organization of health service delivery to HNC patients was not uniform. The largest difference in the number of formulated treatment plans was observed at the beginning of the pandemic (22.1% reduction compared with the year before the pandemic). During the pandemic, the proportion of patients admitted on the basis of a DILO (diagnosis and oncological treatment) card issued by a primary care physician, instead of a regular referral to hospital, issued also by a primary care physician, was significantly higher compared with the that during the pre-pandemic period. The majority of cancer patients with a oncological treatment planned during the pandemic lived in urban areas. During the pandemic, the number of patients with more-advanced-stage cancer, assessed on the basis of the type of planned treatment (radical vs. palliative), did not increase compared with that during the pre-pandemic period. However, our follow-up period was quite short. It is necessary to intensify activities aimed at promoting health and increasing health awareness in people living in rural areas and setting long-term priorities and objectives for health policies at the national, regional and local levels, with particular focus on this group of people.

The global fatty liver disease Sustainable Development Goal country score for 195 countries and territories

BACKGROUND AND AIMS

Fatty liver disease is highly prevalent, resulting in overarching wellbeing and economic costs. Addressing it requires comprehensive and coordinated multisectoral action. We developed a fatty liver disease Sustainable Development Goal (SDG) country score to provide insights into country-level preparedness to address fatty liver disease through a whole-of-society lens.

APPROACH AND RESULTS

We developed 2 fatty liver disease-SDG score sets. The first included 6 indicators (child wasting, child overweight, noncommunicable disease mortality, a universal health coverage service coverage index, health worker density, and education attainment), covering 195 countries and territories between 1990 and 2017. The second included the aforementioned indicators plus an urban green space indicator, covering 60 countries and territories for which 2017 data were available. To develop the fatty liver disease-SDG score, indicators were categorized as "positive" or "negative" and scaled from 0 to 100. Higher scores indicate better preparedness levels. Fatty liver disease-SDG scores varied between countries and territories (n = 195), from 14.6 (95% uncertainty interval: 8.9 to 19.4) in Niger to 93.5 (91.6 to 95.3) in Japan; 18 countries and territories scored > 85. Regionally, the high-income super-region had the highest score at 88.8 (87.3 to 90.1) in 2017, whereas south Asia had the lowest score at 44.1 (42.4 to 45.8). Between 1990 and 2017, the fatty liver disease-SDG score increased in all super-regions, with the greatest increase in south Asia, but decreased in 8 countries and territories.

CONCLUSIONS

The fatty liver disease-SDG score provides a strategic advocacy tool at the national and global levels for the liver health field and noncommunicable disease advocates, highlighting the multisectoral collaborations needed to address fatty liver disease, and noncommunicable diseases overall.

Urban Governance, Multisectoral Action, and Civic Engagement for Population Health, Wellbeing, and Equity in Urban Settings: A Systematic Review

Objectives: To identify the validated and reliable indicators and tools to assess good governance for population health, wellbeing, and equity in urban settings, and assess processes of multisectoral action and civic engagement as reported by peer-reviewed articles. Methods: We conducted a systematic review searching six databases for observational studies reporting strategies of either urban health, multisectoral action or civic engagement for wellbeing, health, or equity. Results: Out of 8,154 studies initially identified we included 17. From the included studies, 14 presented information about high-income countries. The general population was the main target in most studies. Multisectoral action was the most frequently reported strategy (14 studies). Three studies used Urban Health Equity Assessment and Response Tool (Urban HEART). Health indicators were the most frequently represented (6 studies). Barriers and facilitators for the implementation of participatory health governance strategies were reported in 12 studies. Conclusion: Data on the implementation of participatory health governance strategies has been mainly reported in high-income countries. Updated and reliable data, measured repeatedly, is needed to closely monitor these processes and further develop indicators to assess their impact on population health, wellbeing, and equity.

Air Pollution, Built Environment, and Early Cardiovascular Disease

As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.

Relationship between the Social Development Index and Self-Reported Periodontal Conditions

Inequalities in oral health are influenced by the social strata of the population. Few studies have focused on the multitude of factors related to social development as indicators of living conditions and periodontal health status. The aim of this study is to evaluate the association between self-reported periodontal conditions and the Social Development Index (SDI). A cross-sectional validated questionnaire was carried out among 1294 Mexican adults. Descriptive statistics and multivariate logistic regression models were used to identify the best predictors of self-reported periodontal conditions. Bone loss reporting was used as a proxy for the presence of periodontal disease. We found that higher global scores on the SDI and quality and available space in the home (QASH) increase the probability of having bone loss. Global SDI (OR = 7.27) and higher QASH (OR = 3.66) were indeed the leading societal factors related to periodontal disease. These results have pointed out how SDI and its indicators, in particular QASH, can be used to further explore inequities related to privileged access to dental care in the context of periodontal diseases.

Examining Place-Based Neighborhood Factors in a Multisite Peer-Led Healthy Lifestyle Effectiveness Trial for People with Serious Mental Illness

People with severe mental illness (SMI) experience significantly higher obesity-related comorbidities and premature mortality rates than healthy populations. The physical and social characteristics of neighborhoods where people with SMI reside can play an important role in promoting or hindering healthy eating and physical activity. However, this is seldom considered when designing and testing health behavior interventions for these populations. This study used baseline data from an obesity control trial for low-income, minority people with SMI to demonstrate the utility of assessing neighborhood- and city-level place-based factors within the context of lifestyle interventions. GIS was used to create a zip-code-level social and built environment geodatabase in New York City and Philadelphia, where the trial occurred. Chi-square and t-tests were used to assess differences in the spatial distribution of health-related built and social environment characteristics between and within cities and diet and physical activity outcomes. All types of neighborhood characteristics showed significant environmental differences between and within cities. Several neighborhood characteristics were associated with participants' baseline healthy eating and physical activity behaviors, emphasizing that place-based factors may moderate lifestyle interventions for SMI patients. Future behavioral interventions targeting place-dependent behaviors should be powered and designed to assess potential moderation by place-based factors.

The approaching pilot for One Health governance index

BACKGROUND

One Health approach advocates realizing the best health and harmonious symbiosis of human, animal and natural environment through cross-border, multi-sectoral and interdisciplinary cooperation. The good governance model is the leading factor for the performance of One Health governance. In order to tackle the complex problems in the One Health governance at the global level, the variation of One Health governance in different countries was analyzed by a set of indicators within the One Health system.

METHOD

The capacity of One Health governance was assessed after establishment of a set of indicators for the One Health governance index (OHGI) following the methodology of the global One Health index. The data to calculate OHGI was collected from various database sources, including the Food and Agriculture Organization, the World Health Organization, the World Organization for Animal Health, and official health-related institutions of various countries. Eight indicators (including 19 sub-indicators) were employed in the OHGI system to comprehensively evaluate the capacity of One Health governance in 146 countries of the world.

RESULTS

Among the 146 countries scored in the OHGI system, the average score was 34.11, with a median score of 31.49, ranged from 8.50 to 70.28. Most countries with higher OHGI scores come from Europe and Central Asia, East Asia and the Pacific and North America, while countries with the lower OHGI scores are almost from sub-Saharan Africa. Six countries scored more than 65 points, including Australia, Sweden, Germany, Netherlands, the United States of America and Finland, indicating that these countries are relatively mature in most aspects of One Health governance. However, there were some developing countries with OHGI scored lower than 15. Therefore, the gap between countries with higher OHGI scores and those with lower OHGI scores is more than 60.

CONCLUSIONS

Good governance on One Health is an important indicator to measure One Health's governance capacity. The political stability, the level of rule of law and economic conditions in different regions are significantly correlated with the One Health governance capacity. Actions need to be taken urgently to close the gap of One Health governance between different regions.

Measuring accessibility to public services and infrastructure criticality for disasters risk management

Component criticality analysis of infrastructure systems has traditionally focused on physical networks rather than infrastructure services. As an example, a key objective of transport infrastructure is to ensure mobility and resilient access to public services, including for the population, service providers, and associated supply chains. We introduce a new user-centric measure for estimating infrastructure criticality and urban accessibility to critical public services - particularly healthcare facilities without loss of generality - and the effects of disaster-induced infrastructure disruptions. Accessibility measures include individuals' choices of all services in each sector. The approach is scalable and modular while preserving detailed features necessary for local planning decisions. It relies on open data to simulate various disaster scenarios, including floods, seismic, and compound shocks. We present results for Lima, Peru, and Manila, Philippines, to illustrate how the approach identifies the most affected areas by shocks, underserved populations, and changes in accessibility and critical infrastructure components. We capture the changes in people's choices of health service providers under each scenario. For Lima, we show that the floods of 2020 caused an increase in average access times to all health services from 33 minutes to 48 minutes. We identify specific critical road segments for ensuring access under each scenario. For Manila, we locate the 22% of the population who lost complete access to all higher health services due to flooding of over 15 cm. The approach is used to identify and prioritize targeted measures to strengthen the resilience of critical public services and their supporting infrastructure systems, while putting the population at the center of decision-making.

Implementation of Health Impact Assessment in the Healthcare System of the Republic of Kazakhstan

The Health Impact Assessment (hereinafter referred to as HIA) is an effective method for predicting potential health impacts from decisions. Little is known about the implementation of the HIA in the Republic of Kazakhstan (further, RK). In addition, the Russian language literature has not yet been reviewed in terms of HIA-related knowledge. By conducting a literature review of enabling factors, including Russian language literature, on the implementation of the HIA and studying governance systems in RK, we aim to suggest an implementation process to implement the HIA in RK. After careful analysis of the governance system, we suggest set up of a HIA support unit under the National Scientific Center for Health Development and discuss the possible benefits. The proposed center should guide the implementation of the HIA in RK.

Perceived barriers to physical activity behaviour among patients with diabetes and hypertension in Kosovo: a qualitative study

Background

In a cohort of primary health care users across Kosovo (KOSCO cohort), high rates and poor control  of diabetes and hypertension were observed. These conditions can be prevented and better controlled by adapting to a healthy lifestyle. Physical activity is an important target, as inactivity and related obesity were very prevalent in the KOSCO cohort. This qualitative study aims to identify individual and structural barriers to physical activity perceived by patients with diabetes and/or hypertension so as to inform health care providers and policy-makers in Kosovo on strategies for promoting physical activity.

Methods

Interviews were conducted from July to October 2020 with 26 public primary health care users from five municipalities of Kosovo (Mitrovica, Vushtrri, Fushe Kosova, Gjakova, and Malisheva). The qualitative study was nested into the KOSCO cohort. KOSCO was implemented in 2019 and recruited consecutive patients visiting the public primary health care centres in these municipalities. Participants of this qualitative sub-study were selected if they had a doctor’s diagnosis of diabetes and/or hypertension. The interview guide consisted of questions related to physical activity barriers these patients are facing, despite having received motivational counselling sessions in primary healthcare centres. Data were analysed using a framework methodology.

Results

Three main themes moderating physical activity behaviour were identified: 1) neighbourhood built environment, 2) health-related problems, and 3) social support. The barriers to physical activity related to the first theme were structural features of the neighbourhoods such as: crowded sidewalks, lack of green spaces, lack of proper lighting in public spaces, as well as dense traffic. In regards to the second theme, the main health reasons for study participants to delay physical activity were related to: physical discomfort as well as stress, worry, and lack of energy. An additional barrier to exercise was lack of social support specifically from friends.

Conclusion

The study identifies structural and individual targets for integrated and inter-sectoral physical activity promotion efforts.

Preventive health resource allocation decision-making processes and the use of economic evidence in an Australian state government—A mixed methods study

Context

Recommended best practice for resource allocation decisions by governments include a stepwise process guided by economic evidence. However, the use of economic evidence in preventive health decision-making, which often impacts on multiple sectors of government, is under-researched. This study aimed to explore the resource allocation decision-making processes for preventive health interventions in the New South Wales (NSW) Government in Australia, and specifically examined the barriers and facilitators to the use of economic evidence from the perspective of multiple government departments.

Methods

This mixed methods study was conducted using semi-structured interviews with NSW Treasury representatives (n = 4), a focus group of NSW Ministry of Health representatives (n = 9), and a quantitative questionnaire of all participants. The schedule for the interviews and focus group was based on resource allocation guidance documents from Australian government agencies. Deductive content analysis was undertaken, guided by the Multiple Streams Framework.

Findings

NSW Treasury participants believed that decision-making processes where economic efficiency was the key guiding principle was the ideal approach. However, the NSW Ministry of Health participants identified that for preventive health decision-making, economic evidence was not used to inform their own choices but was typically only used to convince other agencies of the merits of proposed initiatives when seeking approval. The key barriers to the use of economic evidence were the lack of capacity within the NSW Ministry of Health to understand and undertake economic evaluations; a lack of collaboration between NSW Treasury and preventive health decision-makers within the NSW Ministry of Health; and deficient processes and governance mechanisms that do not facilitate or incentivise effective inter-sectoral decision-making.

Conclusions

Institutional structures for resource allocation decision-making regarding preventive health result in processes that contrast with best practice recommendations. The multiple challenges to collaborative decision-making across agencies require organisational change to promote a whole-of-government approach.

The systematic analysis and 10-year prediction on disease burden of childhood cancer in China

Background

There is a lack of in-depth analysis regarding the disease burden of childhood cancer in China. Indeed, this is the first time the topic has been addressed in detail. Drawing on population-based data for the past 30 years, this study systematically analyzes the composition and long-term trend of this disease burden in China.

Methods

GBD 2019 contained population-based data from 1990 to 2019 and was prepared using Microsoft Excel 2016. We used AAPC and ARIMA models for trend analysis and prediction formulation.

Results

In 2019, there were 45,601 new cases, 9,156 cancer deaths, and 782,530 DALYs in China. From 1990 to 2019, leukemia, together with brain and CNS cancer, invariably ranked highest in terms of new cases, cancer deaths, and DALYs. Leukemia accounted for more than 50%, but decreased over time. By contrast, the proportions for brain and CNS cancer increased. There were significant decreases in the overall incidence, mortality, and DALY rates in China, but these were still higher than the corresponding global average levels. Considering all types of childhood cancer, the incidence rate of testicular cancer showed the biggest increase, and the mortality and DALY rates of leukemia showed the largest decrease. In terms of different age groups, the overall incidence rate of childhood cancers increased in 0 to 4 age group, but it decreased in 5 to 14 age groups. The overall mortality and DALY rates of childhood cancers decreased in all four age groups. Over the next 10 years, the overall incidence rate of childhood cancer will increase, but the overall mortality and DALY rates will decrease. The increase in malignant skin melanoma will comprise the largest rise in the incidence, while the decrease for leukemia will be the largest fall in the incidence, cancer deaths, and DALYs.

Conclusion

The disease burden of all childhood cancers in China remains highly serious, especially for certain types of cancer and certain age groups. China should focus more emphatically on the incidence of childhood cancer in future, and it must consistently strengthen investment in the relevant research and medical resources to reduce the disease burden in this field.

Active and healthy ageing in urban environments: laying the groundwork for solution-building through citizen science

Urban age-friendly initiatives strive to promote active and healthy ageing by addressing urban influences that impact individuals as they age. Collaborative community partnerships with multi-level stakeholders are crucial for fostering age-friendly initiatives that can transform urban community health. Employing a citizen social science (CSS) approach, this study aimed to engage older adults and stakeholders in Birmingham, UK, to (i) identify key urban barriers and facilitators to active and healthy ageing, and (ii) facilitate collaboration and knowledge production to lay the groundwork for a citizen science project. Older adults (n = 16; mean age = 72(7.5 SD); 11 female) and community stakeholders (n = 11; 7 female) were engaged in six online group discussions, with audio recordings transcribed and thematically analysed to present key urban barrier and facilitator themes. Ageism, winter, technology and safety were barriers identified by both groups. Outdoor spaces and infrastructure, transportation, community facilities, and Covid-19 pandemic were identified as barriers and/or facilitators. Older adults identified the ageing process as a barrier and diversity of the city, health and mobility and technology as facilitators. For stakeholders, barriers were deprivation and poverty, gender differences, and ethnicity, whereas age-inclusive activities were a facilitator. Organic and active opportunities for older adults and stakeholders to connect, co-produce knowledge on urban environments and share resources presented foundations of solution-building and future collaboration. CSS effectively facilitated a range of stakeholders across local urban spaces to collaborate and co-produce ideas and solutions for enhancing local urban environments to promote active and healthy ageing.

Exposure to surrounding greenness and natural-cause and cause-specific mortality in the ELAPSE pooled cohort

BACKGROUND

The majority of studies have shown higher greenness exposure associated with reduced mortality risks, but few controlled for spatially correlated air pollution and traffic noise exposures. We aim to address this research gap in the ELAPSE pooled cohort.

METHODS

Mean Normalized Difference Vegetation Index (NDVI) in a 300-m grid cell and 1-km radius were assigned to participants' baseline home addresses as a measure of surrounding greenness exposure. We used Cox proportional hazards models to estimate the association of NDVI exposure with natural-cause and cause-specific mortality, adjusting for a number of potential confounders including socioeconomic status and lifestyle factors at individual and area-levels. We further assessed the associations between greenness exposure and mortality after adjusting for fine particulate matter (PM2.5), nitrogen dioxide (NO2) and road traffic noise.

RESULTS

The pooled study population comprised 327,388 individuals who experienced 47,179 natural-cause deaths during 6,374,370 person-years of follow-up. The mean NDVI in the pooled cohort was 0.33 (SD 0.1) and 0.34 (SD 0.1) in the 300-m grid and 1-km buffer. In the main fully adjusted model, 0.1 unit increment of NDVI inside 300-m grid was associated with 5% lower risk of natural-cause mortality (Hazard Ratio (HR) 0.95 (95% CI: 0.94, 0.96)). The associations attenuated after adjustment for air pollution [HR (95% CI): 0.97 (0.96, 0.98) adjusted for PM2.5; 0.98 (0.96, 0.99) adjusted for NO2]. Additional adjustment for traffic noise hardly affected the associations. Consistent results were observed for NDVI within 1-km buffer. After adjustment for air pollution, NDVI was inversely associated with diabetes, respiratory and lung cancer mortality, yet with wider 95% confidence intervals. No association with cardiovascular mortality was found.

CONCLUSIONS

We found a significant inverse association between surrounding greenness and natural-cause mortality, which remained after adjusting for spatially correlated air pollution and traffic noise.

From Health in All Policies to Health for All Policies

Worldwide responses to the COVID-19 pandemic have shown that it is possible for politicians to come together across departmental boundaries. To this end, in many countries, heads of government and their health ministers work closely with all other ministries, departments, and sectors, including social affairs, internal affairs, foreign affairs, research and education, transport, agriculture, business, and state aid. In this Viewpoint, we ask if and how the Sustainable Development Goals (SDGs) can support intersectoral collaboration to promote health, since governments have already committed to achieving them. We contend that SDGs can do so, ultimately advancing health while offering co-benefits across society.

Health impact assessment of local policies: methodology and tools

The aim of this work was to design some tools and a procedure for performing the Health Impact Assessment of municipal policies. A working group made up of municipal and public health specialists from the Valencian Community (Spain) was set up. After reviewing the tools used in other contexts, the Fem Salut? questionnaire for the simplified Health Impact Assessment of regional policies was adapted for use at the local level. A pilot study was carried out in six municipalities and local initiatives promoted by different sectors were analysed. Two workshops were held per municipality (with specialists and with citizens) and participatory techniques were used to identify the possible impacts on the social determinants of health, the population groups more particularly affected and the proposals for improvement. The feasibility of the methodology and the difficulties involved in carrying it out were discussed. A procedure was defined for the Health Impact Assessment of local initiatives in six steps: Describe (the municipality and the project), Extract (screening phase), Co-produce (participatory workshops), Integrate (the scientific evidence with the qualitative information obtained), Disseminate (to politicians, specialists and community) and Evaluate (direct and indirect results) (DECIDE). A guide was developed to facilitate its application at the local level along with two complementary tools (a questionnaire and worksheets). The technical group rated the process as simple and flexible, as well as being easy to adapt to the characteristics of the municipality and project. In addition to the cross-sectoral approach, the incorporation of citizen participation in the process is an important added value.

Energy Efficiency through the Implementation of an AI Model to Predict Room Occupancy Based on Thermal Comfort Parameters

Room occupancy prediction based on indoor environmental quality may be the breakthrough to ensure energy efficiency and establish an interior ambience tailored to each user. Identifying whether temperature, humidity, lighting, and CO2 levels may be used as efficient predictors of room occupancy accuracy is needed to help designers better utilize the readings and data collected in order to improve interior design, in an effort to better suit users. It also aims to help in energy efficiency and saving in an ever-increasing energy crisis and dangerous levels of climate change. This paper evaluated the accuracy of room occupancy recognition using a dataset with diverse amounts of light, CO2, and humidity. As classification algorithms, K-nearest neighbors (KNN), hybrid Adam optimizer–artificial neural network–back-propagation network (AO–ANN (BP)), and decision trees (DT) were used. Furthermore, this research is based on machine learning interpretability methodologies. Shapley additive explanations (SHAP) improve interpretability by estimating the significance values for each feature for classifiers applied. The results indicate that the KNN performs better than the DT and AO-ANN (BP) classification models have 99.5%. Though the two classifiers are designed to evaluate variations in interpretations, we must ensure that they have accurate detection. The results show that SHAP provides successful implementation following these metrics, with differences detected amongst classifier models that support the assumption that model complexity plays a significant role when predictability is taken into account.

The Adoption of Digital Technologies and Artificial Intelligence in Urban Health: A Scoping Review

As more people live in cities, the impact of urban settings on population health has been increasing. One of the main strategies to cope with urbanization is adopting artificial intelligence (AI) and new digital technologies to develop new urban services that improve citizens’ health and well-being. The aim of this study is to review urban interventions and adopting digital technologies and AI-based algorithms to improve population health. A scoping review of the literature was conducted by querying MEDLINE, Web of Science, and Scopus databases. The included studies were categorized into one urban health area, suggested by the WHO, according to the type of intervention investigated. Out of 3733 records screened, 12 papers met all inclusion criteria. Four studies investigated the “outdoor and indoor pollution” area, one “climate change”, one “housing”, two “health and social services” and four “urban transport” areas. Only one article used a comprehensive approach to public health, investigating the use of AI and digital technologies both to characterize exposure conditions to health determinants and to monitor population health effects, while the others were limited to characterizing exposure conditions to health determinants, thus employing a preliminary public health perspective. From this point of view, countries should foster synergy for the development of research on digital technologies to address the determinants of health in the urban context. From a global health perspective, sharing results with the scientific community would also allow other countries to use those technologies that have been shown to be effective, paving the way for more sustainable living conditions worldwide.

Awareness of initiative practice for health in the Chinese population: A questionnaire survey based on a network platform

BACKGROUND

In 2016, the Chinese government issued the Healthy China 2030 plan, which also produced the initiative practice for health (IPFH) concept. However, people’s knowledge and awareness of the IPFH are unclear.

AIM

To investigate awareness of IPFH in the Chinese population and explore the relevant influential factors.

METHODS

An internet-based self-designed questionnaire survey was used to collect respondents’ demographic characteristics and awareness of health and the IPFH from March 26 to April 18, 2020. IPFH consciousness was assessed by the scores for different related questions. The Student’s t test, the Chi-square test, and multiple logistic regression analysis were performed to analyze the differences and influencing factors.

RESULTS

A total of 2678 valid questionnaires were collected. Of the respondents, 973 (36.3%) had heard of the IPFH concept. In addition, 89.5% of participants agreed with the view that the IPFH is beneficial to improving quality of life, and over half thought that a regular schedule, a reasonable diet, tobacco and alcohol control, a cheerful mood, specific life goals and plans, taking the initiative to accept health-related education and implement health knowledge, good interpersonal relationships, and regular physical examinations were closely related to the IPFH. The majority of respondents paid attention to their health and usually obtained health-related knowledge via social media and were also willing to promote the IPFH. Most of the participants underestimated the role of hospitals, family doctors, and health managers in promoting the IPFH. Age, monthly income, and medical-related work experience were the influencing factors for IPFH awareness.

CONCLUSION

The Chinese population has limited knowledge of the IPFH. People with strong IPFH awareness are older, earn more, and have medical-related work experience.

Estimating risk factor attributable burden - challenges and potential solutions when using the comparative risk assessment methodology

Background

Burden of disease analyses quantify population health and provide comprehensive overviews of the health status of countries or specific population groups. The comparative risk assessment (CRA) methodology is commonly used to estimate the share of the burden attributable to risk factors. The aim of this paper is to identify and address some selected important challenges associated with CRA, illustrated by examples, and to discuss ways to handle them. Further, the main challenges are addressed and finally, similarities and differences between CRA and health impact assessments (HIA) are discussed, as these concepts are sometimes referred to synonymously but have distinctly different applications.

Results

CRAs are very data demanding. One key element is the exposure-response relationship described e.g. by a mathematical function. Combining estimates to arrive at coherent functions is challenging due to the large variability in risk exposure definitions and data quality. Also, the uncertainty attached to this data is difficult to account for. Another key issue along the CRA-steps is to define a theoretical minimal risk exposure level for each risk factor. In some cases, this level is evident and self-explanatory (e.g., zero smoking), but often more difficult to define and justify (e.g., ideal consumption of whole grains). CRA combine all relevant information and allow to estimate population attributable fractions (PAFs) quantifying the proportion of disease burden attributable to exposure. Among many available formulae for PAFs, it is important to use the one that allows consistency between definitions, units of the exposure data, and the exposure response functions. When combined effects of different risk factors are of interest, the non-additive nature of PAFs and possible mediation effects need to be reflected. Further, as attributable burden is typically calculated based on current exposure and current health outcomes, the time dimensions of risk and outcomes may become inconsistent. Finally, the evidence of the association between exposure and outcome can be heterogeneous which needs to be considered when interpreting CRA results.

Conclusions

The methodological challenges make transparent reporting of input and process data in CRA a necessary prerequisite. The evidence for causality between included risk-outcome pairs has to be well established to inform public health practice.

Examining Intersectoral Action as an Approach to Implementing Multistakeholder Collaborations to Achieve the Sustainable Development Goals

Objectives: The Sustainable Development Goals (SDGs) re-orient action towards improving the social and ecological determinants of health and equity. SDG 17 calls for enhanced policy and institutional coherence and strong multi-stakeholder partnerships. Intersectoral action (IA) has a promising history in public health, including health promotion and global health. Some experts see IA as crucial to the SDGs. Yet less is known about how IA is conceptualized and what promising models exist with relevance to the SDGs. We sought to investigate how IA is understood conceptually and empirically.

Methods: We conducted a narrative review of global public health and political science literatures and grey literature on the SDGs to identify theoretical models, case studies and reviews of IA research.

Results: Multiple competing conceptualizations of IA exist. Research has focused on case studies in high-income countries. More conceptual clarity, analyses of applications in LMICs, and explorations of political and institutional factors affecting IA are needed, as is attention to power dynamics between sectors.

Conclusion: IA is required to collaborate on the SDGs and address equity. New models for successful implementation merit exploration.

Quest for a Tool Measuring Urban Quality of Life: ISO 37120 Standard Sustainable Development Indicators

Humanity is exceeding planetary boundaries, and it seems that it is unlikely to meet internationally agreed sustainable development goals. Current trends and challenges in the domain of urban sustainability assessment have proven that measuring and interpreting results regarding quality of life requires a complex analysis. The aim of this paper is to investigate the possibility of comparing, in a transparent way, urban quality of life using sustainable development indicators based on the ISO 37120 standard, taking as case studies seven selected cities: Amsterdam, Buenos Aires, Dubai, Gdynia, London, Los Angeles and Zagreb. The hypothesis reads as follows: the ISO 37120 indicators, converted into partial and total utility value, then grouped within sustainable development dimensions (environmental, economic and social) may be used to measure the level of urban quality of life. Research results indicate that there are some significant and interesting differences between the compared cities within the environmental, economic and social pillars. The analysis, conducted with the use of utility method, may facilitate taking the right decisions on urban management, planning and investment. Thus, this tool may be useful for decision makers and help cities and communities of all sizes to become more safe, resilient, prosperous, inclusive, smart and sustainable.

The Incorporation of the 2030 Agenda in the Design of Local Policies for Social Transformation in Disadvantaged Urban Areas

According to the United Nations, the current COVID-19 crisis is threatening decades of development gains. This situation is aggravated in disadvantaged urban areas where 25% of the world’s population lives. Such concentration has aggravated the multidimensional problem that requires an integrated policy approach. Internationally, this approach has materialized in the formulation of global policies such as the 2030 Agenda. However, many doubts remain about the extent to which global policy such as the 2030 Agenda is able to inspire the formulation of local policies from the multidimensional perspective proposed by the Sustainable Development Goals (SDGs). To answer this question, in this contribution we rely on a comparative case study of two public policies aimed at promoting the social inclusion of the most vulnerable groups in the urban context: the “Andalusian Regional Strategy for Social Cohesion and Inclusion. Intervention in disadvantaged areas” (ERACIS) and the “Barcelona Strategy for Inclusion and Reduction of Social Inequalities 2017–2027”. The results show how the government sphere, the logic of intervention, and other aspects of policy design influence the incorporation of the principles of the 2030 Agenda in local policies, highlighting both risks and potentials of such policy transfer, crucial to the effective achievement of the SDGs.

Building Resilient Cities: Climate Change and Health Interlinkages in the Planning of Public Spaces

Greenhouse gases emissions resulting from the combustion of fossil fuels are worsening air quality and affecting the climate system. While climate change impacts on meteorological variables affects air quality by altering the concentration and distribution of pollutants, air pollution significantly influences the climate, leading to negative impacts on human health. Due to the combination of high temperatures, air pollution, and high population density, cities are particularly vulnerable to climate change impacts. The planning and design of public spaces aimed at climate change mitigation and adaptation can result in multiple co-benefits for human health, while reducing social inequalities. To address the major research gaps in the communication between health and planning experts, and the lack of capacity among public sectors and policy makers, it is necessary to promote capacity building and knowledge sharing between the planning and health sectors. The purpose of this article is to develop preliminary recommendations for a process that allows a comprehensive assessment of the interlinkages between climate and health, social, environmental, and economic vulnerabilities, and the quality of the urban spaces, to support local governments, policymakers, and education institutions in making informed decisions for public spaces. The methods applied were a literature review and interviews with experts.

A sustainable development goal framework to guide multisectoral action on NAFLD through a societal approach

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent condition that requires a comprehensive and coordinated response across sectors and disciplines.

AIMS

In the absence of a multisectoral framework to tackle this condition, we developed one using the sustainable development goals (SDGs) as the basis for converging thinking about the design and delivery of public health responses.

METHODS

A multidisciplinary group identified the SDG targets and indicators for inclusion in the new framework through a two-stage process. Firstly, a core team of three researchers independently reviewed the 169 targets and 231 indicators of the SDGs to select a shortlist. Over two Delphi rounds, a multidisciplinary group of 12 experts selected which of the shortlisted targets and indicators to include. Respondents also provided written feedback on their selection. Targets and indicators with 75% or greater agreement were included in the final framework.

RESULTS

The final framework comprises 16 targets-representing 9% of all targets and 62% (16/26) of the shortlisted targets-and seven indicators, accounting for 50% (7/14) of the shortlisted indicators and 3% of all indicators. The selected targets and indicators cover a broad range of factors, from health, food and nutrition to education, the economy, and the built environment.

CONCLUSIONS

Addressing the challenge of NAFLD will require a re-envisioning of the liver health landscape, with greater focus on joined-up systems thinking and action. This new framework can help guide this process, including by outlining the stakeholders with whom the liver health community needs to engage.

Cities and neuroscience research: A systematic literature review

BACKGROUND

Cities are becoming the socio-economic hubs for most of the world's population. Understanding how our surroundings can mentally affect everyday life has become crucial to integrate environmental sustainability into urban development. The present review aims to explore the empirical studies investigating neural mechanisms underlying cognitive and emotional processes elicited by the exposure to different urban built and natural spaces. It also tries to identify new research questions and to leverage neurourbanism as a framework to achieve healthier and sustainable cities.

METHODS

By following the PRISMA framework, we conducted a structured search on PubMed, ProQuest, Web of Science, and Scopus databases. Only articles related to how urban environment-built or natural-affects brain activity through objective measurement (with either imaging or electrophysiological techniques) were considered. Further inclusion criteria were studies on human adult populations, peer-reviewed, and in English language.

RESULTS

Sixty-two articles met the inclusion criteria. They were qualitatively assessed and analyzed to determine the main findings and emerging concepts. Overall, the results suggest that urban built exposure (when compared to natural spaces) elicit activations in brain regions or networks strongly related to perceptual, attentional, and (spatial) cognitive demands. The city's-built environment also triggers neural circuits linked to stress and negative affect. Convergence of these findings was observed across neuroscience techniques, and for both laboratory and real-life settings. Additionally, evidence also showed associations between neural social stress processing with urban upbringing or current city living-suggesting a mechanistic link to certain mood and anxiety disorders. Finally, environmental diversity was found to be critical for positive affect and individual well-being.

CONCLUSION

Contemporary human-environment interactions and planetary challenges imply greater understanding of the neurological underpinnings on how the urban space affects cognition and emotion. This review provides scientific evidence that could be applied for policy making on improved urban mental health. Several studies showed that high-quality green or blue spaces, and bio-diverse urban areas, are important allies for positive neural, cognitive, and emotional processes. Nonetheless, the spatial perception in social contexts (e.g., city overcrowding) deserves further attention by urban planners and scientists. The implications of these observations for some theories in environmental psychology and research are discussed. Future work should take advantage of technological advancements to better characterize behavior, brain physiology, and environmental factors and apply them to the remaining complexity of contemporary cities.

Methods for Evaluating Environmental Health Impacts at Different Stages of the Policy Process in Cities

PURPOSE OF REVIEW

Evaluating the environmental health impacts of urban policies is critical for developing and implementing policies that lead to more healthy and equitable cities. This article aims to (1) identify research questions commonly used when evaluating the health impacts of urban policies at different stages of the policy process, (2) describe commonly used methods, and (3) discuss challenges, opportunities, and future directions.

RECENT FINDINGS

In the diagnosis and design stages of the policy process, research questions aim to characterize environmental problems affecting human health and to estimate the potential impacts of new policies. Simulation methods using existing exposure-response information to estimate health impacts predominate at these stages of the policy process. In subsequent stages, e.g., during implementation, research questions aim to understand the actual policy impacts. Simulation methods or observational methods, which rely on experimental data gathered in the study area to assess the effectiveness of the policy, can be applied at these stages. Increasingly, novel techniques fuse both simulation and observational methods to enhance the robustness of impact evaluations assessing implemented policies. The policy process consists of interdependent stages, from inception to end, but most reviewed studies focus on single stages, neglecting the continuity of the policy life cycle. Studies assessing the health impacts of policies using a multi-stage approach are lacking. Most studies investigate intended impacts of policies; focusing also on unintended impacts may provide a more comprehensive evaluation of policies.

Healthy City Project: An application of data envelopment analysis

Purpose

The importance of Korea’s Healthy City Project has recently increased due to the growth of the elderly population and chronic diseases. Consequently, local governments are expanding the project to manage health at the local level; however, because local government resources are limited, efficient business operation is required. Thus, the purpose of this study is to present a plan for effective project management by developing a strategy for a Healthy City Project that is suitable for the scale of local governments.

Methods

For efficiency analysis, data were collected from the homepages of 90 local governments that are implementing the Healthy City Project in Korea, and data envelopment analysis (DEA) was conducted using both the CCR model and the BCC model. The input variables for the DEA included budget, manpower, organization, planned projects, and research education. In addition, we selected program, network, and project performance as output variables.

Results

Analysis results indicated that the CCR model identified 22 (out of 90) municipalities in which Healthy City Projects are implemented efficiently, while 68 are inefficient. The BCC model identified many more efficient regions than the CCR model; however, the difference was insignificant. Thus, the budget, manpower, planned projects, and network must be increased to improve efficiency.

Conclusion

First, to improve the efficiency of the Healthy City Project, a sufficient budget must be secured during its implementation. Second, long- and short-term plans are needed to expand the Healthy City Program. Third, networks must be created for local governments to benchmark Healthy City Projects.

'Health in All Policies'-A Key Driver for Health and Well-Being in a Post-COVID-19 Pandemic World

Policy in all sectors affects health, through multiple pathways and determinants. Health in all policies (HiAP) is an approach that seeks to identify and influence the health and equity impacts of policy decisions, to enhance health benefits and avoid harm. This usually involves the use of health impact assessment or health lens analysis. There is growing international experience in these approaches, and some countries have cross-sectoral governance structures that prioritize the assessment of the policies that are most likely to affect health. The fundamental elements of HiAP are inter-sectoral collaboration, policy influence, and holistic consideration of the range of health determinants affected by a policy area or proposal. HiAP requires public health professionals to invest time to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity. With commitment, political will and tools such as the health impact assessment, it provides a powerful approach to integrated policymaking that promotes health, well-being, and equity. The COVID-19 pandemic has raised the profile of public health and highlighted the links between health and other policy areas. This paper describes the rationale for, and principles underpinning, HiAP mechanisms, including HIA, experiences, challenges and opportunities for the future.

Heart healthy cities: genetics loads the gun but the environment pulls the trigger

The world's population is estimated to reach 10 billion by 2050 and 75% of this population will live in cities. Two-third of the European population already live in urban areas and this proportion continues to grow. Between 60% and 80% of the global energy use is consumed by urban areas, with 70% of the greenhouse gas emissions produced within urban areas. The World Health Organization states that city planning is now recognized as a critical part of a comprehensive solution to tackle adverse health outcomes. In the present review, we address non-communicable diseases with a focus on cardiovascular disease and the urbanization process in relation to environmental risk exposures including noise, air pollution, temperature, and outdoor light. The present review reports why heat islands develop in urban areas, and how greening of cities can improve public health, and address climate concerns, sustainability, and liveability. In addition, we discuss urban planning, transport interventions, and novel technologies to assess external environmental exposures, e.g. using digital technologies, to promote heart healthy cities in the future. Lastly, we highlight new paradigms of integrative thinking such as the exposome and planetary health, challenging the one-exposure-one-health-outcome association and expand our understanding of the totality of human environmental exposures.

WITHDRAWN: The role of medical and health policies in the health risk management system

Ahead of Print article withdrawn by publisher.

Stakeholders' Perspectives on the Unmet Needs and Health Priorities of the Urban Poor in South-East Nigeria

Relatively little is known about readiness of urban health systems to address health needs of the poor. This study explored stakeholders' perception of health needs and strategies for improving health of the urban poor using qualitative analysis. Focus group discussions (n = 5) were held with 26 stakeholders drawn from two Nigerian states during a workshop. Urban areas are characterised by double burden of diseases. Poor housing, lack of basic amenities, poverty, and poor access to information are determinants of health of the urban poor. Shortage of health workers, stock-out of medicines, high cost of care, lack of clinical practice guidelines, and dual practice constrain access to primary health services. An overarching strategy, that prioritises community-driven urban planning, health-in-all policies, structured linkages between informal and formal providers, financial protection schemes, and strengthening of primary health care system, is required to address health needs of the urban poor.

Evolution of Vehicle Emission Factors in a Megacity Affected by Extensive Biofuel Use: Results of Tunnel Measurements in São Paulo, Brazil

Since 2001, four emission measurement campaigns have been conducted in multiple traffic tunnels in the megacity of São Paulo, Brazil, an area with a fleet of more than 7 million vehicles running on fuels with high biofuel contents: gasoline + ethanol for light-duty vehicles (LDVs) and diesel + biodiesel for heavy-duty vehicles (HDVs). Emission factors for LDVs and HDVs were calculated using a carbon balance method, the pollutants considered including nitrogen oxides (NO_x), carbon monoxide (CO), and sulfur dioxide, as well as carbon dioxide and ethanol. From 2001 to 2018, fleet-average emission factors for LDVs and HDVs, respectively, were found to decrease by 4.9 and 5.1% per year for CO and by 5.5 and 4.2% per year for NO_x. These reductions demonstrate that regulations for vehicle emissions adopted in Brazil in the last 30 years improved air quality in the megacity of São Paulo significantly, albeit with a clear delay. These findings, especially those for CO, indicate that official emission inventories underestimate vehicle emissions. Here, we demonstrated that the adoption of emission factors calculated under real-world conditions can dramatically improve air quality modeling in the region.

Environmental exposure during travel: A research review and suggestions forward

Daily travel through the urban fabric exposes urban dwellers to a range of environmental conditions that may have an impact on their health and wellbeing. Knowledge about exposures during travel, their associations with travel behavior, and their social and health outcomes are still limited. In our review, we aim to explain how the current environmental exposure research addresses the interactions between human and environmental systems during travel through their spatial, temporal and contextual dimensions. Based on the 104 selected studies, we identify significant recent advances in addressing the spatiotemporal dynamics of exposure during travel. However, the conceptual and methodological framework for understanding the role of multiple environmental exposures in travel environments is still in an early phase, and the health and wellbeing impacts at individual or population level are not well known. Further research with greater geographical balance is needed to fill the gaps in the empirical evidence, and linking environmental exposures during travel with the causal health and wellbeing outcomes. These advancements can enable evidence-based urban and transport planning to take the next step in advancing urban livability.

How can we analyze environmental health resilience and vulnerability? A joint analysis with composite indices applied to the north of France

In environmental health, vulnerability reflecting the cumulative harmful constraints and nuisances to which populations are subjected and resilience defined as the capacity of a territory to cope with health inequalities have been little extensively investigated together with the same importance. Besides the diversity of factors involved, there is no consensual framework to develop composite indices, one recognized methodology to deal with a multifaceted issue. Therefore, this research aims to establish a new transferable approach to assess the spatial heterogeneity of territorial inequalities. This new strategy relies on the simultaneous evaluation of resilience and vulnerability and the joint analysis based on the cross-interpretation of the spatialized composite indices of resilience and vulnerability. A case study was conducted to demonstrate the feasibility of this methodology, using the municipality as a spatial unit of analysis within a region in the north of France. To provide the most holistic description possible of the 3817 studied municipalities, 50 variables related to the economic, environment, policy, health, services and social dimensions were used to develop the composite indices. The vulnerability Index has a median value of 0.151 with an IQR of [0.126-0.180] and the Resilience Index has a median value of 0.341 with an IQR of [0.273-0.401]. The joint analysis was conducted to classify each municipality among four defined typologies: 1687 municipalities (44.2%) belong to the "To monitor" category, 1646 (43.1%) to the "Resilient" category, 329 (8.6%) to the "Have resources" category and 155 (4.1%) to the "Territorial blackspot" category. The methodology herein may be a diagnostic tool to identify and prioritize municipalities that could benefit from the implementation of specifically tailored public health policies.

Sociological modeling of smart city with the implementation of UN sustainable development goals

The COVID-19 pandemic before mass vaccination can be restrained only by the limitation of contacts between people, which makes the digital economy a key condition for survival. More than half of the world's population lives in urban areas, and many cities have already transformed into "smart" digital/virtual hubs. Digital services ensure city life safe without an economy lockout and unemployment. Urban society strives to be safe, sustainable, well-being, and healthy. We set the task to construct a hybrid sociological and technological concept of a smart city with matched solutions, complementary to each other. Our modeling with the elaborated digital architectures and with the bionic solution for ensuring sufficient data governance showed that a smart city in comparison with the traditional city is tightly interconnected inside like a social "organism". Society has entered a decisive decade during which the world will change by moving closer towards SDGs targets 2030 as well as by the transformation of cities and their digital infrastructures. It is important to recognize the large vector of sociological transformation as smart cities are just a transition phase to human-centered personal space or smart home. The "atomization" of the world urban population raises the gap problem in achieving SDGs because of different approaches to constructing digital architectures for smart cities or smart homes in countries. The strategy of creating smart cities should bring each citizen closer to SDGs at the individual level, laying in the personal space the principles of sustainable development and wellness of personality.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11625-020-00889-5.

Transdisciplinary Research Priorities for Human and Planetary Health in the Context of the 2030 Agenda for Sustainable Development

Human health and wellbeing and the health of the biosphere are inextricably linked. The state of Earth's life-support systems, including freshwater, oceans, land, biodiversity, atmosphere, and climate, affect human health. At the same time, human activities are adversely affecting natural systems. This review paper is the outcome of an interdisciplinary workshop under the auspices of the Future Earth Health Knowledge Action Network (Health KAN). It outlines a research agenda to address cross-cutting knowledge gaps to further understanding and management of the health risks of these global environmental changes through an expert consultation and review process. The research agenda has four main themes: (1) risk identification and management (including related to water, hygiene, sanitation, and waste management); food production and consumption; oceans; and extreme weather events and climate change. (2) Strengthening climate-resilient health systems; (3) Monitoring, surveillance, and evaluation; and (4) risk communication. Research approaches need to be transdisciplinary, multi-scalar, inclusive, equitable, and broadly communicated. Promoting resilient and sustainable development are critical for achieving human and planetary health.

Selecting Indicators to Monitor and Assess Environmental Health in a Portuguese Urban Setting: A Participatory Approach

Environmental health (EH) is influenced by complex interactions between health and the built and natural environments, there being little research on its specificities in urban settings. The use of suitable indicators to monitor and assess EH is fundamental in informing evidence-based interventions at the local level. A participatory approach to selecting indicators to inform the monitoring and assessment of EH in Lisbon is herein considered. Evidence derived from a systematic review of literature and data from Lisbon and Portuguese databases were analyzed by 12 Portuguese experts in individual semi-structured interviews. The interviews aimed at identifying relevant indicators and important emerging issues in the Lisbon urban setting. The outputs from the interviews were validated by a two-round Web-Delphi process in which panelists (22 experts) from different areas of expertise expressed their views regarding the relevance of the indicators for the analysis of EH in urban settings. Seventeen indicators were validated in the Web-Delphi process. High participation achieved along this process supports the view that this participatory approach was useful for validation. Results from the adopted participatory approach point out gaps in the collection of noise and mobility indicators data and raise emerging issues on housing indicators that require further research. The results also suggest the need for local action to improve indicators and tools in order to help the monitorization of EH in urban contexts. The adopted participatory approach can be replicated for other Portuguese and European urban settings.

The inter-relationship between depressed mood, functional decline and disability over a 10-year observational period within the Longitudinal Urban Cohort Ageing Study (LUCAS)

Background

The WHO defines ‘healthy ageing’ as ‘the process of developing and maintaining the functional ability’. Late-life depression and frailty compromise well-being and independence of older people. To date, there exists little research on the interaction of the dynamic processes of frailty and depression and only a few studies were longitudinal. Conclusions about the direction of effects remained uncertain.

Methods

Data were obtained from each of the last six biyearly waves (2007–2017) of the Longitudinal Urban Cohort Ageing Study (LUCAS) in Hamburg, Germany, a prospective observational cohort study of manifold aspects of ageing. Screening of predictor and event variables: depressed mood: one question from the 5-item Mental Health Inventory Screening Test; frailty: LUCAS Functional Ability Index, status ‘frail’; disability: one question on need for human help with basic activities of daily living. Kaplan-Meier curves and Cox’s proportional hazards regression were used for time-to-event analyses with shifting baseline.

Results

Sample size in 2007 was 2012, average age 76.2 years; ±6.5. Main results were as follows: (1) depression significantly increased the hazard of subsequent frailty (HR=1.581; 95% CI 1.257 to 1.988; p<0.001); (2) frailty significantly increased the hazard of subsequent depression (HR=2.324; 95% CI 1.703 to 3.172; p<0.001); (3) depression significantly increased the hazard of subsequent disability (HR=2.589; 95% CI 1.885 to 3.557; p<0.001) and (4) disability did not significantly increase the hazard of subsequent depression (HR=1.540; 95% CI 0.917 to 2.579; p=0.102).

Conclusion

Our results suggest an interdependence of the processes of depression and frailty/disability rather than unidirectional dependencies. These observable processes may be representative of underlying unobservable profound life changes. Obviously, there is a need for early screening to initiate appropriate interventions.