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Vine MM, Mulligan K, Harris R, Dean JL. The Impact of Health Geography on Public Health Research, Policy, and Practice in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6735. [PMID: 37754595 PMCID: PMC10531040 DOI: 10.3390/ijerph20186735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
The link between geography and health means that the places we occupy-where we are born, where we live, where we work, and where we play-have a direct impact on our health, including our experiences of health. A subdiscipline of human geography, health geography studies the relationships between our environments and the impact of factors that operate within those environments on human health. Researchers have focused on the social and physical environments, including spatial location, patterns, causes of disease and related outcomes, and health service delivery. The work of health geographers has adopted various theories and philosophies (i.e., positivism, social interactionism, structuralism) and methods to collect and analyze data (i.e., quantitative, qualitative, spatial analysis) to examine our environments and their relationship to health. The field of public health is an organized effort to promote the health of its population and prevent disease, injury, and premature death. Public health agencies and practitioners develop programs, services, and policies to promote healthy environments to support and enable health. This commentary provides an overview of the recent landscape of health geography and makes a case for how health geography is critically important to the field of public health, including examples from the field to highlight these links in practice.
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Affiliation(s)
- Michelle M. Vine
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Kate Mulligan
- Canadian Institute for Social Prescribing, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
| | - Rachel Harris
- Independent Researcher, Hamilton, ON L8P 1H6, Canada;
| | - Jennifer L. Dean
- School of Planning, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
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Lilly K, Kean B, Hallett J, Robinson S, Selvey LA. Factors of the policy process influencing Health in All Policies in local government: A scoping review. Front Public Health 2023; 11:1010335. [PMID: 36844855 PMCID: PMC9949293 DOI: 10.3389/fpubh.2023.1010335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Objectives This review aimed to identify factors in the policymaking environment that influence a Health in all Policies approach in local government, how these vary across different municipal contexts, and the extent that theories of the policy process are applied. Methods A scoping review was conducted to include sources published in English, between 2001 and 2021 in three databases, and assessed for inclusion by two blind reviewers. Results Sixty-four sources were included. Sixteen factors of the policy process were identified, expanding on previously reported literature to include understanding and framing of health, use of evidence, policy priority, and influence of political ideology. Eleven sources applied or referred to theories of the policy process and few reported findings based on different local government contexts. Conclusion There are a range of factors influencing a Health in All Policies approach in local government, although a limited understanding of how these differ across contexts. A theory-informed lens contributed to identifying a breadth of factors, although lack of explicit application of theories of the policy process in studies makes it difficult to ascertain meaningful synthesis of the interconnectedness of these factors.
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Affiliation(s)
- Kara Lilly
- School of Health, University of the Sunshine Coast, Maroochydore, QLD, Australia
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Bridie Kean
- School of Health, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Jonathan Hallett
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Suzanne Robinson
- School of Population Health, Curtin University, Perth, WA, Australia
- Deakin Health Economics, Faculty of Health Sciences, Deakin University, Burwood, VIC, Australia
| | - Linda A. Selvey
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Lilly K, Hallett J, Robinson S, Selvey LA. Insights into local health and wellbeing policy process in Australia. Health Promot Int 2020; 35:925-934. [PMID: 31504496 DOI: 10.1093/heapro/daz082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To investigate factors that enable or challenge the initiation and actioning of health and wellbeing policy in Australian local governments using political science frameworks. An online survey was distributed to staff and elected members of Australian local governments. The survey sought responses to a range of variables as informed by political science frameworks. Data were analysed using descriptive statistics and results were compared between local governments of different geographical sizes and locations using Kruskal-Wallis non-parametric testing. There were 1825 survey responses, including 243 CEOs, representing 45% of Australian local governments. Enablers for local government policy initiation and action included the high priority given to health and wellbeing (44%), local leadership (56%) and an organizational (70%) and personal obligation (68%) to the community to act. Less true is a favourable legislative environment (33%), leadership from higher levels of government (29%) and sufficient financial capacity (22%). Cities are better positioned to initiate and action health policy, regardless of the broader legislative environment. Health and wellbeing is a high priority for Australian local governments, despite lack of funding and limited lobbying and support from other sectors and higher levels of government. The insights from political science frameworks assist to understand the policy process, including the interrelatedness of enablers and challenges to initiating and actioning health and wellbeing policy. Further understanding the policy drivers would support practitioners and researchers advocating to influence local health and wellbeing policy.
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Affiliation(s)
- Kara Lilly
- School of Health and Sport Science, University of the Sunshine Coast, Sunshine Coast, Australia.,School of Public Health, Curtin University, Perth, Australia
| | | | | | - Linda A Selvey
- School of Public Health, University of Queensland, Brisbane, Australia
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Urban Green Space and the Pursuit of Health Equity in Parts of the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111432. [PMID: 29165367 PMCID: PMC5708071 DOI: 10.3390/ijerph14111432] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 12/29/2022]
Abstract
Research has demonstrated that inequitable access to green space can relate to health disparities or inequalities. This commentary aims to shift the dialogue to initiatives that have integrated green spaces in projects that may promote health equity in the United States. Specifically, we connect this topic to factors such as community revitalization, affordable housing, neighborhood walkability, food security, job creation, and youth engagement. We provide a synopsis of locations and initiatives in different phases of development along with characteristics to support effectiveness and strategies to overcome challenges. The projects cover locations such as Atlanta (GA), Los Angeles (CA), the District of Columbia (Washington D.C.), South Bronx (NY), and Utica (NY). Such insight can develop our understanding of green space projects that support health equity and inform the dialogue on this topic in ways that advance research and advocacy.
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Canadian policy perspectives on promoting physical activity across age-friendly communities: lessons for advocacy and action. AGEING & SOCIETY 2017. [DOI: 10.1017/s0144686x17000939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTPopulation ageing combined with physical inactivity has critical implications for the public health of communities in the twenty-first century. In the last decade, the World Health Organization launched the age-friendly cities agenda, aiming to address population ageing through whole-systems, rights-based, health equity-focused approaches. An important intervention for age-friendly communities is modifying built environments to support population-level physical activity. Physical activity can help mitigate impacts of chronic diseases and social isolation on older adults. Need for advocacy and action in this area raises questions of how to develop supportive environments for physical activity across age-friendly community types. In Canada, a substantial proportion of older adults live outside large urban municipalities, for which scant research exists on fostering age-friendly built environments. To this end, we conducted qualitative research involving semi-structured interviews with 21 municipal policy influencers in Alberta, Canada to gather perspectives on development and early implementation of an age-friendly policy framework in the small urban and rural context. Our findings are organised by three main themes providing key lessons for advocacy and action, namelypursuing comprehensive planning,promoting public engagementandprioritising the needs of older adults. This research informs advocacy and action priorities in promoting built environment modification for routine physical activity as part of an age-friendliness agenda for small urban and rural regions of Canada and other countries.
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Andermann A, Pang T, Newton JN, Davis A, Panisset U. Evidence for Health III: Making evidence-informed decisions that integrate values and context. Health Res Policy Syst 2016; 14:16. [PMID: 26976393 PMCID: PMC4791763 DOI: 10.1186/s12961-016-0085-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
Making evidence-informed decisions with the aim of improving the health of individuals or populations can be facilitated by using a systematic approach. While a number of algorithms already exist, and while there is no single ‘right’ way of summarizing or ordering the various elements that should be involved in making such health-related decisions, an algorithm is presented here that lays out many of the key issues that should be considered, and which adds a special emphasis on balancing the values of individual patients and entire populations, as well as the importance of incorporating contextual considerations. Indeed many different types of evidence and value judgements are needed during the decision-making process to answer a wide range of questions, including (1) What is the priority health problem? (2) What causes this health problem? (3) What are the different strategies or interventions that can be used to address this health problem? (4) Which of these options, as compared to the status quo, has an added benefit that outweighs the harms? (5) Which options would be acceptable to the individuals or populations involved? (6) What are the costs and opportunity costs? (7) Would these options be feasible and sustainable in this specific context? (8) What are the ethical, legal and social implications of choosing one option over another? (9) What do different stakeholders stand to gain or lose from each option? and (10) Taking into account the multiple perspectives and considerations involved, which option is most likely to improve health while minimizing harms? This third and final article in the ‘Evidence for Health’ series will go through each of the steps in the algorithm in greater detail to promote more evidence-informed decisions that aim to improve health and reduce inequities.
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Affiliation(s)
- Anne Andermann
- Department of Family Medicine and Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada.
| | - Tikki Pang
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
| | - John N Newton
- Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, England
| | | | - Ulysses Panisset
- Department of Preventive and Social Medicine-Health Policy, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Evidence Informed Policy Network (EVIPNet) Steering Group, World Health Organization, Geneva, Switzerland
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Abstract
INTRODUCTION Realist methods are increasingly being used to investigate complex public health problems. Despite the extensive evidence base clarifying the built environment as a determinant of health, there is limited knowledge about how and why land-use planning systems take on health concerns. Further, the body of research related to the wider determinants of health suffers from not using political science knowledge to understand how to influence health policy development and systems. This 4-year funded programme of research investigates how the land-use planning system in New South Wales, Australia, incorporates health and health equity at multiple levels. METHODS AND ANALYSIS The programme uses multiple qualitative methods to develop up to 15 case studies of different activities of the New South Wales land-use planning system. Comparison cases from other jurisdictions will be included where possible and useful. Data collection includes publicly available documentation and purposively sampled stakeholder interviews and focus groups of up to 100 participants across the cases. The units of analysis in each case are institutional structures (rules and mandates constraining and enabling actors), actors (the stakeholders, organisations and networks involved, including health-focused agencies), and ideas (policy content, information, and framing). Data analysis will focus on and develop propositions concerning the mechanisms and conditions within and across each case leading to inclusion or non-inclusion of health. Data will be refined using additional political science and sociological theory. Qualitative comparative analysis will compare cases to develop policy-relevant propositions about the necessary and sufficient conditions needed to include health issues. ETHICS AND DISSEMINATION Ethics has been approved by Sydney University Human Research Ethics Committee (2014/802 and 2015/178). Given the nature of this research we will incorporate stakeholders, often as collaborators, throughout. We outline our research translation strategies following best practice approaches.
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Affiliation(s)
- Patrick Harris
- Menzies Centre for Health Policy, University of Sydney / Australian National University, Australia
| | - Sharon Friel
- Menzies Centre for Health Policy, University of Sydney / Australian National University, Australia
- REGNET, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney / Australian National University, Australia
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Morrison J, Pons-Vigués M, Díez E, Pasarin MI, Salas-Nicás S, Borrell C. Perceptions and beliefs of public policymakers in a Southern European city. Int J Equity Health 2015; 14:18. [PMID: 25890326 PMCID: PMC4343064 DOI: 10.1186/s12939-015-0143-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/20/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction Socio-economic inequalities in health are large in urban areas; however, local municipal governments may plan, manage and provide services and policies which can reduce these. The objective of this study was to describe the beliefs and perceptions of public policymakers in a European city, Barcelona. They are the key actors in designing and implementing urban public policies. Methods A qualitative research study describing policymakers’ beliefs on health inequalities. The study population were twelve policymakers. These were politicians or officers from the city council. Informant profiles were selected using a theoretical sample. Semi-structured individual interviews were performed to collect the data and a thematic content analysis was carried out. Results Politicians were aware of health inequalities in their city and identified diverse social causes. They viewed reducing inequalities as a priority for the city’s government. Officers were less knowledgeable and described less efforts in addressing health inequalities. It was stated by some that reducing inequalities in non-health sectors helped to reduce health inequalities indirectly and there was some collaboration between two sectors. The most frequent barriers encountered when implementing policies were funding and the cities’ limited authority. Conclusions Officers and policymakers had different levels of awareness and access to information on health and its socials determinants. Officers referred to specific causes of health inequalities and policies which related to their sectors and politicians were more familiar with upstream determinants and policies. Some participants explained that policies and programmes needed to be evaluated and very little intersectoral action was said to be carried out. More efforts should be made to provide all policymakers with information on the social determinants of health inequalities. Research on health inequalities and policy should engage with policymakers and promote health as a cross cutting issue in the city council in liaison with the third sector.
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Affiliation(s)
- Joana Morrison
- Department of Epidemiology and Public Health, University College London, London, UK. .,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Agència de Salut Pública de Barcelona, Barcelona, Spain.
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. .,Universitat de Girona, Girona, Spain.
| | - Elia Díez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Agència de Salut Pública de Barcelona, Barcelona, Spain. .,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Maria Isabel Pasarin
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Agència de Salut Pública de Barcelona, Barcelona, Spain. .,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | | | - Carme Borrell
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Agència de Salut Pública de Barcelona, Barcelona, Spain. .,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain. .,Universitat Pompeu Fabra, Barcelona, Spain.
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Lemon SC, Goins KV, Schneider KL, Brownson RC, Valko CA, Evenson KR, Eyler AA, Heinrich KM, Litt J, Lyn R, Reed HL, Tompkins NO, Maddock J. Municipal Officials' Participation in Built Environment Policy Development in the United States. Am J Health Promot 2014; 30:42-9. [PMID: 25372234 DOI: 10.4278/ajhp.131021-quan-536] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study examined municipal officials' participation in built environment policy initiatives focused on land use design, transportation, and parks and recreation. DESIGN Web-based cross-sectional survey. SETTING Eighty-three municipalities with 50,000 or more residents in eight states. SUBJECTS Four hundred fifty-three elected and appointed municipal officials. MEASURES Outcomes included self-reported participation in land use design, transportation, and parks and recreation policy to increase physical activity. Independent variables included respondent position; perceptions of importance, barriers, and beliefs regarding physical activity and community design and layout; and physical activity partnership participation. ANALYSIS Multivariable logistic regression models. RESULTS Compared to other positions, public health officials had lower participation in land use design (78.3% vs. 29.0%), transportation (78.1% vs. 42.1%), and parks and recreation (67.1% vs. 26.3%) policy. Perceived limited staff was negatively associated with participation in each policy initiative. Perceptions of the extent to which physical activity was considered in community design and physical activity partnership participation were positively associated with participation in each. Perceived lack of collaboration was associated with less land use design and transportation policy participation, and awareness that community design affects physical activity was associated with more participation. Perceived lack of political will was associated with less parks and recreation policy participation. CONCLUSION Public health officials are underrepresented in built environment policy initiatives. Improving collaborations may improve municipal officials' policy participation.
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Social change or business as usual at city hall? Examining an urban municipal government's response to neighbourhood-level health inequities. Soc Sci Med 2014; 133:366-73. [PMID: 25245453 DOI: 10.1016/j.socscimed.2014.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/26/2014] [Accepted: 09/11/2014] [Indexed: 11/22/2022]
Abstract
There is a renewed interest in the potential of municipal governments working collaboratively with local communities to address health inequities. A growing body of literature has also highlighted the benefits and limitations of participatory approaches in neighbourhood interventions initiated by municipal governments. However, few studies have investigated how neighbourhood interventions tackling health inequities work in real-time and in context, from the perspectives of Community Developers (CDs) who promote community participation. This study uses a process evaluation approach and semi-structured interviews with CDs to explore the challenges they face in implementing a community development, participatory process in the City of Hamilton's strategy to reduce health inequities - Neighbourhood Action. Findings demonstrate that municipal government can facilitate and suppress community participation in complex ways. CDs serve as significant but conflicted intermediaries as they negotiate and navigate power differentials between city and community actors, while also facing structural challenges. We conclude that community participation is important to bottom-up, resident-led social change, and that CDs are central to this work.
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Morrison J, Pons-Vigués M, Bécares L, Burström B, Gandarillas A, Domínguez-Berjón F, Diez È, Costa G, Ruiz M, Pikhart H, Marinacci C, Hoffmann R, Santana P, Borrell C. Health inequalities in European cities: perceptions and beliefs among local policymakers. BMJ Open 2014; 4:e004454. [PMID: 24871536 PMCID: PMC4039864 DOI: 10.1136/bmjopen-2013-004454] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe the knowledge and beliefs of public policymakers on social inequalities in health and policies to reduce them in cities from different parts of Europe during 2010 and 2011. DESIGN Phenomenological qualitative study. SETTING 13 European cities. PARTICIPANTS 19 elected politicians and officers with a directive status from 13 European cities. MAIN OUTCOME Policymaker's knowledge and beliefs. RESULTS Three emerging discourses were identified among the interviewees, depending on the city of the interviewee. Health inequalities were perceived by most policymakers as differences in life-expectancy between population with economic, social and geographical differences. Reducing health inequalities was a priority for the majority of cities which use surveys as sources of information to analyse these. Bureaucracy, funding and population beliefs were the main barriers. CONCLUSIONS The majority of the interviewed policymakers gave an account of interventions focusing on the immediate determinants and aimed at modifying lifestyles and behaviours in the more disadvantaged classes. More funding should be put towards academic research on effective universal policies, evaluation of their impact and training policymakers and officers on health inequalities in city governments.
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Affiliation(s)
- Joana Morrison
- Department of Epidemiology and Public Health, University College London, London, UK
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat de Girona, Girona, Spain
| | - Laia Bécares
- School of Social Sciences, University of Manchester, Manchester, UK
| | | | - Ana Gandarillas
- Subdirección General de Promoción de la Salud y Prevención. Consejería de Sanidad. Comunidad de Madrid (Subdirectorate-General for Health Promotion and Prevention. Madrid Regional Health Authority), Spain
| | - Felicitas Domínguez-Berjón
- Subdirección General de Promoción de la Salud y Prevención. Consejería de Sanidad. Comunidad de Madrid (Subdirectorate-General for Health Promotion and Prevention. Madrid Regional Health Authority), Spain
| | - Èlia Diez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Giuseppe Costa
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Milagros Ruiz
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Chiara Marinacci
- Epidemiology Department, Local Health Unit TO3, Turin, Italy
- Ministry of Health, Italy, Rome, Italy
| | | | - Paula Santana
- Centro de Estudos de Geografia e Ordenamento do Território (CEGOT), Departamento de Geografia, Universidade de Coimbra, Coimbra , Portugal
| | - Carme Borrell
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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