He Kainga Oranga: reflections on 25 years of measuring the improved health, wellbeing and sustainability of healthier housing.

This paper reflects on the influences and outcomes of He Kainga Oranga/Housing and Health Research Programme over 25 years, and their impact on housing and health policy in Aotearoa and internationally. Working in partnership particularly with Maori and Pasifika communities, we have conducted randomised control trials which have shown the health and broad co-benefits of retrofitted insulation, heating and remediation of home hazards, which have underpinned government policy in the Warm Up NZ-Heat Smart programme and the Healthy Homes Standards for rental housing. These trials have been included as evidence in the WHO Housing and Health Guidelines and led to our designation as a WHO Collaborating Centre on Housing and Wellbeing. We are increasingly explicitly weaving Maori frameworks, values and processes with traditional Western science.

Evaluating natural experiments to measure the co-benefits of urban policy interventions to reduce carbon emissions in New Zealand.

Finding effective policy interventions for addressing the Sustainable Development Goals, such as reducing carbon emissions (SDG 13), which can also enhance good health and wellbeing (SDG 3), is urgent. Many promising interactions occur between sustainable cities and communities (SDG 11), clean water and sanitation (SDG 6) and affordable and clean energy (SDG 7), which sit at the centre of integrated urban planning and regeneration. In this paper, we consider the framing and findings of four policies we have evaluated as natural experiments, all of which have important co-benefits, which were not always the focus of the initial policies. These policies are: the installation of cycleways and walkways in existing suburbs; a central government measure to recentralise employment after the 2011 Christchurch earthquakes; the streamlining of housing developments by reducing land-use regulation; and ongoing changes of policy about public housing investment. We show that having a clear understanding of the benefits of increased physical activity for health, for example, could accelerate the reduction of carbon emissions. Also, decisions about infrastructure, housing and job locations can generate health and environmental gains if supported by broader public transport investments. Cycling and walking are also more likely to substitute for short habitual car trips. Similarly, measuring the co-benefits of differential residential models, relating to land-use and renewable energy, provides a framework that can facilitate learning from policy interventions, enabling wider and potentially more rapid generalisation of policies, including those for climate change mitigation.

Emissions from the road transport sector of New Zealand: key drivers and challenges.

The transport sector is the fastest growing greenhouse gas-emitting sector in the world and it is also a major source of emissions in New Zealand. Greenhouse gas (GHG) emissions from road transport increased by 84.3% between 1990 and 2016. This increase in GHG emissions was the highest among the different energy sub-sectors of New Zealand. Increasing energy consumption and GHG emissions are due to the gradual increase in population, car-dependent low-density development, lack of integrated public transport networks, inappropriate policy interventions and so on. These factors are making it difficult to reduce emissions from this sector. This study investigates (i) major drivers of transport sector emissions, including how drivers differ from those affecting other developed countries; (ii) a mitigation policy roadmap to achieve future emissions reduction targets; and (iii) mitigation policy initiatives by the government, and policy gaps. To identify the key drivers from a set of drivers, this study uses a vector error correction model (VECM). The Granger causality test reveals that the fuel economy of the New Zealand passenger vehicle fleet has a significant causal relationship with transport emissions. Introduction of a number of policies such as a feebate scheme and/or a high minimum fuel economy standard could effectively alter this causal relationship in the short term, along with other measures such as urban planning changes for medium-term impact. This study aims to help policy makers identify the most tractable factors driving transport emissions and alternative policy options suitable for emissions mitigation.

A Cost Benefit Analysis of an Active Travel Intervention with Health and Carbon Emission Reduction Benefits.

Active travel (walking and cycling) is beneficial for people’s health and has many co-benefits, such as reducing motor vehicle congestion and pollution in urban areas. There have been few robust evaluations of active travel, and very few studies have valued health and emissions outcomes. The ACTIVE before-and-after quasi-experimental study estimated the net benefits of health and other outcomes from New Zealand’s Model Communities Programme using an empirical analysis comparing two intervention cities with two control cities. The Programme funded investment in cycle paths, other walking and cycling facilities, cycle parking, ‘shared spaces’, media campaigns and events, such as ‘Share the Road’, and cycle-skills training. Using the modified Integrated Transport and Health Impacts Model, the Programme’s net economic benefits were estimated from the changes in use of active travel modes. Annual benefits for health in the intervention cities were estimated at 34.4 disability-adjusted life years (DALYs) and two lives saved due to reductions in cardiac disease, diabetes, cancer, and respiratory disease. Reductions in transport-related carbon emissions were also estimated and valued. Using a discount rate of 3.5%, the estimated benefit/cost ratio was 11:1 and was robust to sensitivity testing. It is concluded that when concerted investment is made in active travel in a city, there is likely to be a measurable, positive return on investment.

How Economic Analysis Can Contribute to Understanding the Links between Housing and Health.

An economic analysis of housing's linkages to health can assist policy makers and researchers to make better decisions about which housing interventions and policies are the most cost-beneficial. The challenge is to include cobenefits. The adoption in 2015 of the UN Sustainable Development Goals underscores the importance of understanding how policies interact, and the merit of comprehensively evaluating cobenefits. We explain our approach to the empirical assessment of such cobenefits in the housing and health context, and consider lessons from empirical economic appraisals of the impact of housing on health outcomes. Critical assumptions relating to cobenefits are explicitly examined. A key finding is that when wider policy outcome measures are included, such as mental health impacts and carbon emission reductions, it is important that effects of assumptions on outcomes are considered. Another is that differing values underlie appraisal, for example, the weight given to future generations through the discount rate. Cost-benefit analyses (CBAs) can better facilitate meaningful debate when they are based on explicit assumptions about values. In short, the insights drawn from an economic framework for housing-and-health studies are valuable, but nonetheless contingent. Given that housing interventions typically have both health and other cobenefits, and incorporate social value judgements, it is important to take a broad view but be explicit about how such interventions are assessed.

Understanding the systemic nature of cities to improve health and climate change mitigation.

Understanding cities comprehensively as systems is a costly challenge and is typically not feasible for policy makers. Nevertheless, focusing on some key systemic characteristics of cities can give useful insights for policy to advance health and well-being outcomes. Moreover, if we take a coevolutionary systems view of cities, some conventional assumptions about the nature of urban development (e.g. the growth in private vehicle use with income) may not stand up. We illustrate this by examining the coevolution of urban transport and land use systems, and institutional change, giving examples of policy implications. At a high level, our concern derives from the need to better understand the dynamics of urban change, and its implications for health and well-being. At a practical level, we see opportunities to use stylised findings about urban systems to underpin policy experiments. While it is now not uncommon to view cities as systems, policy makers appear to have made little use so far of a systems approach to inform choice of policies with consequences for health and well-being. System insights can be applied to intelligently anticipate change - for example, as cities are subjected to increasing natural system reactions to climate change, they must find ways to mitigate and adapt to it. Secondly, systems insights around policy cobenefits are vital for better informing horizontal policy integration. Lastly, an implication of system complexity is that rather than seeking detailed, 'full' knowledge about urban issues and policies, cities would be well advised to engage in policy experimentation to address increasingly urgent health and climate change issues.

Increasing active travel: results of a quasi-experimental study of an intervention to encourage walking and cycling.

BACKGROUND: There is increased interest in the effectiveness and co-benefits of measures to promote walking and cycling, including health gains from increased physical activity and reductions in fossil fuel use and vehicle emissions. This paper analyses the changes in walking and cycling in two New Zealand cities that accompanied public investment in infrastructure married with programmes to encourage active travel. METHOD: Using a quasi-experimental two-group pre-post study design, we estimated changes in travel behaviour from baseline in 2011 to mid-programme in 2012, and postprogramme in 2013. The intervention and control cities were matched in terms of sociodemographic variables and baseline levels of walking and cycling. A face-to-face survey obtained information on walking and cycling. We also drew from the New Zealand Travel Survey, a national ongoing survey of travel behaviour, which was conducted in the study areas. Estimates from the two surveys were combined using meta-analysis techniques. RESULTS: The trips and physical activity were evaluated. Relative to the control cities, the odds of trips being by active modes (walking or cycling) increased by 37% (95% CI 8% to 73%) in the intervention cities between baseline and postintervention. The net proportion of trips made by active modes increased by about 30%. In terms of physical activity levels, there was little evidence of an overall change. DISCUSSION: Comparing the intervention cities with the matched controls, we found substantial changes in walking and cycling, and conclude that the improvements in infrastructure and associated programmes appear to have successfully arrested the general decline in active mode use evident in recent years.

Increasing active travel: aims, methods and baseline measures of a quasi-experimental study.

BACKGROUND: Policy advisers are seeking robust evidence on the effectiveness of measures, such as promoting walking and cycling, that potentially offer multiple benefits, including enhanced health through physical activity, alongside reductions in energy use, traffic congestion and carbon emissions. This paper outlines the 'ACTIVE' study, designed to test whether the Model Communities Programme in two New Zealand cities is increasing walking and cycling. The intervention consists of the introduction of cycle and walkway infrastructure, along with measures to encourage active travel. This paper focuses on the rationale for our chosen study design and methods. METHOD: The study design is multi-level and quasi-experimental, with two intervention and two control cities. Baseline measures were taken in 2011 and follow-up measures in 2012 and 2013. Our face-to-face surveys measured walking and cycling, but also awareness, attitudes and habits. We measured explanatory and confounding factors for mode choice, including socio-demographic and well-being variables. Data collected from the same households on either two or three occasions will be analysed using multi-level models that take account of clustering at the household and individual levels. A cost-benefit analysis will also be undertaken, using our estimates of carbon savings from mode shifts. The matching of the intervention and control cities was quite close in terms of socio-demographic variables, including ethnicity, and baseline levels of walking and cycling. DISCUSSION: This multidisciplinary study provides a strong design for evaluating an intervention to increase walking and cycling in a developed country with relatively low baseline levels of active travel. Its strengths include the use of data from control cities as well as intervention cities, an extended evaluation period with a reasonable response rate from a random community survey and the availability of instrumental variables for sensitivity analyses.

Accelerated Biodegradation of Veterinary Antibiotics in Agricultural Soil following Long-Term Exposure, and Isolation of a Sulfamethazine-degrading sp.

The World Health Organization has identified antibiotic resistance as one of the top three threats to global health. There is concern that the use of antibiotics as growth promoting agents in livestock production contributes to the increasingly problematic development of antibiotic resistance. Many antibiotics are excreted at high rates, and the land application of animal manures represents a significant source of environmental exposure to these agents. To evaluate the long-term effects of antibiotic exposure on soil microbial populations, a series of field plots were established in 1999 that have since received annual applications of a mixture of sulfamethazine (SMZ), tylosin (TYL), and chlortetracycline (CTC). During the first 6 yr (1999-2004) soils were treated at concentrations of 0, 0.01 0.1, and 1.0 mg kg soil, in subsequent years at concentrations of 0, 0.1, 1.0, and 10 mg kg soil. The lower end of this concentration range is within that which would result from an annual application of manure from medicated swine. Following ten annual applications, the fate of the drugs in the soil was evaluated. Residues of SMZ and TYL, but not CTC were removed much more rapidly in soil with a history of exposure to 10 mg/kg drugs than in untreated control soil. Residues of C-SMZ were rapidly and thoroughly mineralized to CO in the historically treated soils, but not in the untreated soil. A SMZ-degrading sp. was isolated from the treated soil. Overall, these results indicate that soil bacteria adapt to long-term exposure to some veterinary antibiotics resulting in sharply reduced persistence. Accelerated biodegradation of antibiotics in matrices exposed to agricultural, wastewater, or pharmaceutical manufacturing effluents would attenuate environmental exposure to antibiotics, and merits investigation in the context of assessing potential risks of antibiotic resistance development in environmental matrices.

Warm homes for older people: aims and methods of a randomised community-based trial for people with COPD.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is of increasing importance with about one in four people estimated to be diagnosed with COPD during their lifetime. None of the existing medications for COPD has been shown to have much effect on the long-term decline in lung function and there have been few recent pharmacotherapeutic advances. Identifying preventive interventions that can reduce the frequency and severity of exacerbations could have important public health benefits. The Warm Homes for Elder New Zealanders study is a community-based trial, designed to test whether a NZ$500 electricity voucher paid into the electricity account of older people with COPD, with the expressed aim of enabling them to keep their homes warm, results in reduced exacerbations and hospitalisation rates. It will also examine whether these subsidies are cost-beneficial. METHODS: Participants had a clinician diagnosis of COPD and had either been hospitalised or taken steroids or antibiotics for COPD in the previous three years; their median age was 71 years. Participants were recruited from three communities between 2009 to early 2011. Where possible, participants' houses were retrofitted with insulation. After baseline data were received, participants were randomised to either 'early' or 'late' intervention groups. The intervention was a voucher of $500 directly credited to the participants' electricity company account. Early group participants received the voucher the first winter they were enrolled in the study, late participants during the second winter. Objective measures included spirometry and indoor temperatures and subjective measures included questions about participant health and wellbeing, heating, medication and visits to health professionals. Objective health care usage data included hospitalisation and primary care visits. Assessments of electricity use were obtained through electricity companies using unique customer numbers. DISCUSSION: This community trial has successfully enrolled 522 older people with COPD. Baseline data showed that, despite having a chronic respiratory illness, participants are frequently cold in their houses and economise on heating. TRIAL REGISTRATION: The clinical trial registration is http://NCT01627418.

Improving health and energy efficiency through community-based housing interventions.

OBJECTIVES: Houses designed for one climate and cultural group may not be appropriate for other places and people. Our aim is to find cost-effective ways to improve the characteristics of older homes, ill-fitted for New Zealand's climate, in order to improve the occupants' health. METHOD: We have carried out two community randomised trials, in partnership with local communities, which have focused on retrofitted insulation and more effective heating and have two other studies under way, one which focuses on electricity vouchers and the other on housing hazard remediation. RESULTS: The Housing, Insulation and Health Study showed that insulating 1,350 houses, built before insulation was required, improved the occupants' health and well being as well as household energy efficiency. In the Housing, Heating and Health Study we investigated the impact of installing more effective heating in insulated houses for 409 households, where there was a child with doctor-diagnosed asthma. Again, the study showed significant results in the intervention group; indoor temperatures increased and levels of NO(2) were halved. Children reported less poor health, lower levels of asthma symptoms and sleep disturbances by wheeze and dry cough. Children also had fewer days off school. CONCLUSION: Improving the energy efficiency of older housing leads to health improvements and energy efficiency improvements. Multidisciplinary studies of housing interventions can create compelling evidence to support policies for sustainable housing developments which improve health.

Analysis of common bean expressed sequence tags identifies sulfur metabolic pathways active in seed and sulfur-rich proteins highly expressed in the absence of phaseolin and major lectins.

BACKGROUND: A deficiency in phaseolin and phytohemagglutinin is associated with a near doubling of sulfur amino acid content in genetically related lines of common bean (Phaseolus vulgaris), particularly cysteine, elevated by 70%, and methionine, elevated by 10%. This mostly takes place at the expense of an abundant non-protein amino acid, S-methyl-cysteine. The deficiency in phaseolin and phytohemagglutinin is mainly compensated by increased levels of the 11S globulin legumin and residual lectins. Legumin, albumin-2, defensin and albumin-1 were previously identified as contributing to the increased sulfur amino acid content in the mutant line, on the basis of similarity to proteins from other legumes. RESULTS: Profiling of free amino acid in developing seeds of the BAT93 reference genotype revealed a biphasic accumulation of gamma-glutamyl-S-methyl-cysteine, the main soluble form of S-methyl-cysteine, with a lag phase occurring during storage protein accumulation. A collection of 30,147 expressed sequence tags (ESTs) was generated from four developmental stages, corresponding to distinct phases of gamma-glutamyl-S-methyl-cysteine accumulation, and covering the transitions to reserve accumulation and dessication. Analysis of gene ontology categories indicated the occurrence of multiple sulfur metabolic pathways, including all enzymatic activities responsible for sulfate assimilation, de novo cysteine and methionine biosynthesis. Integration of genomic and proteomic data enabled the identification and isolation of cDNAs coding for legumin, albumin-2, defensin D1 and albumin-1A and -B induced in the absence of phaseolin and phytohemagglutinin. Their deduced amino acid sequences have a higher content of cysteine than methionine, providing an explanation for the preferential increase of cysteine in the mutant line. CONCLUSION: The EST collection provides a foundation to further investigate sulfur metabolism and the differential accumulation of sulfur amino acids in seed of common bean. Identification of sulfur-rich proteins whose levels are elevated in seed lacking phaseolin and phytohemagglutinin and sulfur metabolic genes may assist the improvement of protein quality.

Fate of the antifungal drug clotrimazole in agricultural soil.

Clotrimazole is a broad-spectrum antimycotic drug used for the treatment of dermatological and gynecological infections; it is incompletely broken down during sewage treatment and could potentially reach agricultural land through the application of municipal biosolids or wastewater. In the absence of any environmental fate data, we evaluated the persistence and dissipation pathways of (3)H-clotrimazole during laboratory incubations of agricultural soils. Clotrimazole was removed from a loam (time to dissipate 50% = 68 d), a sandy loam (time to dissipate 50% = 36 d), and a clay loam (time to dissipate 50% = 55 d), with formation of nonextractable residues being the major sink for (3) H. Their parent compound had no significant mineralization, as evidenced by the lack of formation of (3) H(2) O. Up to 15% of the applied radioactivity was recovered in the form of [(3)H]-(2-chlorophenyl)diphenyl methanol. The rate of clotrimazole dissipation in the loam soil did not vary with moisture content, but it was slower at a lower temperature (number of days to dissipate 50% = 275.6 d at 4°C). Addition of municipal biosolids to the loam soil did not vary the clotrimazole dissipation rate. In summary, the present study has established that clotrimazole is dissipated in soil, at rates that varied with soil texture and temperature. Clotrimazole dissipation was accompanied by the formation of nonextractable residues and detectable extractable residues of the transformation product (2-chlorophenyl)diphenyl methanol.

Fate of the antiretroviral drug tenofovir in agricultural soil.

Tenofovir (9-(R)-(2-phosphonylmethoxypropyl)-adenine) is an antiretroviral drug widely used for the treatment of human immunodeficiency virus (HIV-1) and Hepatitis B virus (HBV) infections. Tenofovir is extensively and rapidly excreted unchanged in the urine. In the expectation that tenofovir could potentially reach agricultural lands through the application of municipal biosolids or wastewater, and in the absence of any environmental fate data, we evaluated its persistence in selected agricultural soils. Less than 10% of [adenine-8-(14)C]-tenofovir added to soils varying widely in texture (sand, loam, clay loam) was mineralized in a 2-month incubation under laboratory conditions. Tenofovir was less readily extractable from clay soils than from a loam or a sandy loam soil. Radioactive residues of tenofovir were removed from the soil extractable fraction with DT(50)s ranging from 24±2 to 67+22days (first order kinetic model) or 44+9 to 127+55days (zero order model). No extractable transformation products were detectable by HPLC. Tenofovir mineralization in the loam soil increased with temperature (range 4°C to 30°C), and did not occur in autoclaved soil, suggesting a microbial basis. Mineralization rates increased with soil moisture content, ranging from air-dried to saturated. In summary, tenofovir was relatively persistent in soils, there were no extractable transformation products detected, and the response of [adenine-8-(14)C]-tenofovir mineralization to soil temperature and heat sterilization indicated that the molecule was biodegraded by aerobic microorganisms. Sorption isotherms with dewatered biosolids suggested that tenofovir residues could potentially partition into the particulate fraction during sewage treatment.

Proteomic analysis of common bean seed with storage protein deficiency reveals up-regulation of sulfur-rich proteins and starch and raffinose metabolic enzymes, and down-regulation of the secretory pathway.

A deficiency in major seed storage proteins is associated with a nearly two-fold increase in sulfur amino acid content in genetically related lines of common bean (Phaseolus vulgaris). Their mature seed proteome was compared by an approach combining label-free quantification by spectral counting, 2-DE, and analysis of selective extracts. Lack of phaseolin, phytohemagglutinin and arcelin was mainly compensated by increases in legumin, alpha-amylase inhibitors and mannose lectin FRIL. Along with legumin, albumin-2, defensin and albumin-1 were major contributors to the elevated sulfur amino acid content. Coordinate induction of granule-bound starch synthase I, starch synthase II-2 and starch branching enzyme were associated with minor alteration of starch composition, whereas increased levels of UDP-glucose 4-epimerase were correlated with a 30% increase in raffinose content. Induction of cell division cycle protein 48 and ubiquitin suggested enhanced ER-associated degradation. This was not associated with a classical unfolded protein response as the levels of ER HSC70-cognate binding protein were actually reduced in the mutant. Repression of rab1 GTPase was consistent with decreased traffic through the secretory pathway. Collectively, these results have implications for the nutritional quality of common bean, and provide information on the pleiotropic phenotype associated with storage protein deficiency in a dicotyledonous seed.