Urban health advantage and penalty in aging populations: a comparative study across major megacities in China.

Background: Urban living is linked to better health outcomes due to a combination of enhanced access to healthcare, transportation, and human development opportunities. However, spatial inequalities lead to disparities, resulting in urban health advantages and penalties. Understanding the relationship between health and urban development is needed to generate empirical evidence in promoting healthy aging populations. This study provides a comparative analysis using epidemiological evidence across diverse major Chinese cities, examining how their unique urban development trajectories over time have impacted the health of their aging residents. Methods: We tracked changes in air pollution (NO2, PM2.5, O3), green space (measured by NDVI), road infrastructure (ring road areas), and nighttime lighting over 20 years in six major cities in China. We followed a longitudinal cohort of 4992 elderly participants (average age 87.8 years) over 16,824 person-years. We employed Cox proportional hazard regression to assess longevity, assessing 14 variables, including age, sex, ethnicity, marital status, residence, household income, occupation, education, smoking, alcohol consumption, exercise, and points of interest (POI) count of medicine-related facilities, sports, and leisure service-related places, and scenic spots within a 5 km-radius buffer. Findings: Geographic proximity to points of interest significantly improves survival. Elderly living in proximity of the POI-rich areas had a 34.6%-35.6% lower mortality risk compared to those in POI-poor areas, for the highest compared to the lowest quartile. However, POI-rich areas had higher air pollution levels, including PM2.5 and NO2, which was associated with a 21% and 10% increase in mortality risk for increase of 10 µg/m3, respectively. The benefits of urban living had higher effect estimates in monocentric cities, with clearly defined central areas, compared to polycentric layouts, with multiple satellite city centers. Interpretation: Spatial inequalities create urban health advantages for some and penalties for others. Proximity to public facilities and economic activities is associated with health benefits, and may counterbalance the negative health impacts of lower green space and higher air pollution. Our empirical evidence show optimal health gains for age-friendly urban environments come from a balance of infrastructure, points of interest, green spaces, and low air pollution. Funding: Natural Science Foundation of Beijing (IS23105), National Natural Science Foundation of China (82250610230, 72061137004), World Health Organization (2024/1463606-0), Research Fund Vanke School of Public Health Tsinghua University (2024JC002), Beijing TaiKang YiCai Public Welfare Foundation, National Key R&D Program of China (2018YFC2000400).

China's public health initiatives for climate change adaptation.

China's health gains over the past decades face potential reversals if climate change adaptation is not prioritized. China's temperature rise surpasses the global average due to urban heat islands and ecological changes, and demands urgent actions to safeguard public health. Effective adaptation need to consider China's urbanization trends, underlying non-communicable diseases, an aging population, and future pandemic threats. Climate change adaptation initiatives and strategies include urban green space, healthy indoor environments, spatial planning for cities, advance location-specific early warning systems for extreme weather events, and a holistic approach for linking carbon neutrality to health co-benefits. Innovation and technology uptake is a crucial opportunity. China's successful climate adaptation can foster international collaboration regionally and beyond.

Integrating street view images and deep learning to explore the association between human perceptions of the built environment and cardiovascular disease in older adults.

Understanding how built environment attributes affect health remains important. While many studies have explored the objective characteristics of built environments that affect health outcomes, few have examined the role of human perceptions of built environments on physical health. Baidu Street View images and computer vision technological advances have helped researchers overcome the constraints of traditional methods of measuring human perceptions (e.g., these methods are laborious, time-consuming, and costly), allowing for large-scale measurements of human perceptions. This study estimated human perceptions of the built environment (e.g., beauty, boredom, depression, safety, vitality, and wealth) by adopting Baidu Street View images and deep learning algorithms. Negative binomial regression models were employed to analyze the relationship between human perceptions and cardiovascular disease in older adults (e.g., ischemic heart disease and cerebrovascular disease). The results indicated that wealth perception is negatively related to the risk of cardiovascular disease. However, depression and vitality perceptions are positively associated with the risk of cardiovascular disease. Furthermore, we found no relationship between beauty, boredom, safety perceptions, and the risk of cardiovascular disease. Our findings highlight the importance of human perceptions in the development of healthy city planning and facilitate a comprehensive understanding of the relationship between built environment characteristics and health outcomes in older adults. They also demonstrate that street view images have the potential to provide insights into this complicated issue, assisting in the formulation of refined interventions and health policies.

Does healthy city construction facilitate green growth in China? Evidence from 279 cities.

In the face of the challenge of balancing urban economic development and environmental protection, the concept of a healthy city has emerged as a promising model for sustainable urban development. This study empirically investigates the impact of healthy city construction on green growth by utilizing a difference-in-difference model estimation on a panel dataset of 279 Chinese prefecture-level cities from 2007 to 2019. The findings reveal that healthy city construction significantly contributes to green growth, particularly in pilot cities, and this effect is observed across cities of different sizes and economic bases. Additionally, we identify two channels through which healthy city construction promotes green growth: enhancing innovation capacity and enriching human resources. These findings have implications not only for Chinese cities navigating the path towards green growth but also for other developing nations striving for economic transformation and environmentally sustainable development.

Assessing the construction of a Healthy City in China: a conceptual framework and evaluation index system.

OBJECTIVES: COVID-19 has brought challenges to the health of all mankind. It is particularly important to promote the construction of a 'Healthy China' and build a 'healthy community'. The aims of this study were to construct a reasonable conceptual framework for the Healthy City concept and to assess Healthy City construction in China. STUDY DESIGN: This study combined qualitative and quantitative research. METHODS: This study proposes the concept model of 'nature-human body-Healthy City' and accordingly constructs an evaluation index system for the construction of a Healthy City that integrates five dimensions, namely, the medical level, economic basis, cultural development, social services, and ecological environment to explore the spatial and temporal heterogeneity of Healthy City construction in China. Finally, the influencing factors of Healthy City construction patterns are explored using GeoDetector. RESULTS: (1) The pace of Healthy City construction is generally on the rise; (2) the construction of Healthy Cities exhibits significant global spatial autocorrelation and gradually increasing agglomeration. The spatial distribution of cold hotspot areas was relatively stable; (3) medical and health progress is an important factor; the level of economic development is the leading support; the endowment of resources and environment is the basic condition; public service support provides important support; and scientific and technological innovation capabilities provide technical support for the construction of a Healthy City. CONCLUSIONS: The spatial heterogeneity of Healthy City construction in China is evident, and the state of spatial distribution is relatively stable. The spatial pattern of Healthy City construction is shaped by a combination of factors. Our research will provide a scientific basis for promoting the construction of Healthy Cities and helping to implement the Health China Strategy.

Built environment and schizophrenia re-hospitalization risk in China: A cohort study.

BACKGROUND: Built environment exposure, characterized by ubiquity and changeability, has the potential to be the prospective target of public health policy. However, little research has been conducted to explore its impact on schizophrenia. This study aimed to investigate the association between built environmentand and schizophrenia rehospitalization by simultaneously considering substantial built environmental exposures. METHODS: We recruited eligible schizophrenia patients from Hefei, Anhui Province, China between 2017 and 2019. The main outcome for this study was the time interval until the first recurrent hospital admission occurred within one year after discharge. For each included subject, we estimated the built environment exposures, including population density, walkability, land use mix, green and blue space, public transportation accessibility and road traffic indicator. Lasso (Least Absolute Shrinkage and Selection Operator) analysis was used to select the key variables. Multivariable Cox regression model was applied to obtain hazard ratio (HR) and its corresponding 95% confidence intervals (CI). Further, we also evaluated the joint effects of built environment characteristics on rehospitalization for schizophrenia by Quantile g-computation model. RESULTS: A total of 1564 hospitalized schizophrenia patients were enrolled, with 347 patients (22.2%) had a rehospitalization within one-year after discharge. Multivariable Cox regression analysis indicated that the re-hospitalization rate for schizophrenia would be higher in areas with a high population density (HR: 1.10, 95%CI: 1.04-1.16). Nonetheless, compared to the reference (Q1), participants who lived in a neighborhood with the highest walkability and NDVI (Normalized Difference Vegetation Index) (Q4) had a 76% and 47% lower risk of re-hospitalization within one year (HR:0.24, 95%CI: 0.13-0.45; and 0.53, 95%CI:0.32-0.85), respectively. Moreover, quantile-based g-computation analyses revealed that increased walkability and green space significantly eliminated the adverse effects of population density increases on schizophrenia patients, with a HR ratio of 0.61 (95%CI:0.48,0.79) per one quartile change at the same time. CONCLUSION: Our study provides scientific evidence for the significant role of built environment in schizophrenia rehospitalization, suggesting that optimizing the built environment is required in designing and building a healthy city.

Healthy City Community Space-Oriented Structural Planning and Management Optimization under COVID-19.

This work studies ways of Healthy City Construction (HCC) and Urban Governance Optimization (UGO) during the COVID-19 pandemic. The specific urban community space planning structure is proposed following a literature review on the healthy city's theoretical basis and historical development. Then, the proposed HCC-oriented community space structure is tested by surveying residents' physical and mental health and infectious risk using a questionnaire survey and Particle Swarm Optimization (PSO). Specifically, the particle fitness is calculated according to the original data conditions, and the community space with the highest fitness is determined. Based on the calculation, the community space's neighbors are investigated from different aspects through a questionnaire survey on patients' daily activities and community health security coverage. The results showed that: (1) The score of daily activities of community patients with respiratory diseases was 2312 before the implementation of the proposed community structure and 2715 after the implementation. Therefore, the service quality of residents increases after implementation. (2) The proposed HCC-oriented community space structure improves the physical self-control ability of chronic patients and helps them reduce their pain. This work aims to create a people-oriented healthy city community space, improve the city's "immune system," and regenerate the energy and environmental sustainability of the urban living environment.

Older people's out-of-home mobility and wellbeing in Australia: Personal, built environment, and transportation factors associated with unmet mobility needs.

Out-of-home mobility is fundamental to older people's wellbeing and quality of life. Understanding the unmet mobility needs of older people is a necessary starting point for determining how they can be supported to be mobile. This study estimates the extent of unmet mobility needs among older Australians and identifies the characteristics of those most likely to report unmet mobility needs. Analysis was conducted on nationally representative data of 6,685 older Australians drawn from the 2018 Survey of Disability, Aging and Carers conducted by the Australian Bureau of Statistics. Twelve predictor variables from two conceptual frameworks on older people's mobility were included in the multiple logistic regression model. Twelve percent (n = 799) of participants had unmet mobility needs, and associated factors significant in multivariable models included being among the "young-old", having a lower income, having lower levels of self-rated health, having a long-term condition, being limited in everyday physical activities, experiencing a higher level of distress, being unlicensed, having decreased public transport ability, and residing in major cities. Efforts to support older people's mobility must make equity an explicit consideration, reject a one-size-fits-all approach, and prioritize the accessibility of cities and communities.

Perspectives on urban mobility in promoting physical activity in the context of commuting in Brazil / Perspectivas sobre mobilidade urbana na promoção da atividade física no contexto dos deslocamentos no Brasil

Despite Brazil's important advances in regulatory aspects related to city planning, the disorder-ly growth of Brazilian cities makes it difficult to implement changes that would result in greater opportunities for the active commuting of the population. This essay was designed to reflect on opportunities for improvement in the urban environment to promote physical activity in the context of commuting in Brazil. From this perspective, the study identified policies that promote orderly growth and support active commuting in cities. It also suggested the use of indicators to evaluate and monitor development, with a particular emphasis on active commuting. Furthermore, it is essential to adapt and improve the urban planning process to meet the needs of Brazilian municipalities and foster closer collaboration with civil society. Thus, it will be possible to verify the changes in the urban environment and their impact on the active commuting, promoting the development of healthy and sustainable cities

Apesar do Brasil apresentar importante avanço em aspectos regulatórios relacionados ao planejamento das cidades, o crescimento desordenado das cidades brasileiras dificulta a realização de mudanças que reflitam em maiores oportunidades no deslocamento ativo da população. Este ensaio foi elaborado com objetivo de refletir sobre as oportunidades para melhorias no ambiente urbano para a promoção da atividade física no contexto do deslocamento no Brasil. Nessa perspectiva, o estudo identificou políticas que permitem o crescimento ordenado e favoreça o deslocamento ativo nas cidades, além de sugerir o uso de indicadores para avaliação e monitoramento do desenvolvimento, com especial foco no deslocamento ativo. Ademais, é imprescindível que o processo de planejamento urbano seja adaptado e aprimorado considerando as necessidades dos municípios brasileiros e com aproximação da sociedade civil. Assim, será possível verificar as modificações no ambiente urbano e seu impacto no deslocamento ativo da população, estimulando a criação de cidades saudáveis e sustentáveis

Impact of Built Environment and Neighborhood on Promoting Mental Health, Well-being, and Social Participation in Older People: an Umbrella Review.

Background: The built environment, especially in the context of the neighborhood, affects older people's health. This umbrella review aims to summarize the associations between factors and interventions in the built environment as regards modifying or improving mental health, well-being, social inclusion and participation in the elderly. Methods: We searched articles in the following databases: PubMed, Embase, Cochrane Library, Scopus, Avery Index, Sage, Web of Science, Health Evidence, and Google Scholar, without any time limits. The factors and interventions examined have been classified into three categories (urban infrastructure, green infrastructure, built environment), and we have assessed their relationships with each of the health outcomes. Results: Eight reviews have been included. The results show a positive association between factors and interventions and health outcomes, even though this tends to differ with respect to some of the elements (study design, sample size, built environment and health outcome measurements, and the quality of the primary studies included in the reviews) in the selected studies. Conclusions: In conclusion, the present study suggests and confirms that acting on the built environment has a positive impact on mental health and social inclusion.

Pressupostos epistemológicos das cidades amigas das pessoas idosas: revisão de escopo / Presupuestos epistemológicos de las ciudades amigables con las personas mayores: revisión de alcance / Epistemological assumptions of age-friendly cities: a scoping review

Resumo Objetivo Identificar os conceitos e perspectivas teóricas que fundamentam os estudos sobre Cidade Amiga da Pessoa Idosa. Métodos Revisão de escopo utilizando seis bancos de dados para identificar estudos publicados em revistas indexadas entre 2007 e 2021 usando as palavras-chave 'age-friendly' OR 'age friendly' OR 'cidade amiga'. Resultados Foram encontrados 2.975 estudos que após aplicação de critérios de exclusão resultaram em 227. Observou-se ampla variação no conceito do termo, porém muitos autores o fizeram replicando a OMS, sendo que em 59,5% dos estudos não houve menção de nenhuma perspectiva teórica. A teoria ecológica foi o referencial mais frequente (26%), sendo o termo usado como um equivalente a envelhecimento ativo. Autores de quatro países respondem pela maioria dos artigos (61%). Conclusão É necessário articular o conceito de Cidade Amiga da Pessoa Idosa com uma abordagem teórica e cultural para compreender mais profundamente as perspectivas do urbano e do social sob a lógica do envelhecimento populacional principalmente para a América Latina. A análise teórica nestes estudos e na gerontologia favorecerão discussões mais críticas sobre o envelhecimento, o idadismo e a crescente desigualdade social em curso.

Resumen Objetivo Identificar los conceptos y perspectivas teóricas que fundamentan los estudios sobre Cuidades Amigables con las Personas Mayores. Métodos Revisión de alcance utilizando seis bancos de datos para identificar estudios publicados en revistas indexadas entre 2007 y 2021, con las palabras clave 'age-friendly' OR 'age friendly' OR 'ciudad amigable'. Resultados Se encontraron 2975 estudios que, luego de aplicar los criterios de exclusión, quedaron 227. Se observó una amplia variación del concepto del término, aunque muchos autores replicaron a la OMS. En el 59,5 % de los estudios no se mencionó ninguna perspectiva teórica. La teoría ecológica fue la referencia más frecuente (26 %), y el término se usó como un equivalente al envejecimiento activo. La mayoría de los artículos (61 %) son de autores de cuatro países. Conclusión Es necesario unir el concepto de Cuidades Amigables con las Personas Mayores con un enfoque teórico y cultural para comprender más profundamente las perspectivas de lo urbano y lo social de acuerdo con la lógica del envejecimiento poblacional, principalmente en América Latina. El análisis teórico en estos estudios y en la gerontología permitirán discusiones más críticas sobre el envejecimiento, el edadismo y la creciente desigualdad social en curso.

Abstract Objective To identify the concepts and theoretical perspectives that underlie studies on age-friendly city. Methods This is a scoping review using six databases to identify studies published in indexed journals between 2007 and 2021 using the keywords 'age-friendly' OR 'age friendly' OR 'cidade amiga'. Results A total of 2,975 studies were found, which, after applying the exclusion criteria, resulted in 227. There was wide variation in the concept of the term, but many authors did so by replicating the WHO, and in 59.5% of studies there was no mention of any theoretical perspective. The ecological theory was the most frequent reference (26%), the term being used as an equivalent to active aging. Authors from four countries account for most articles (61%). Conclusion It is necessary to articulate the concept of age-friendly city with a theoretical and cultural approach to understand more deeply the urban and social perspectives under the logic of population aging, mainly for Latin America. Theoretical analysis in these studies and in gerontology will favor more critical discussions about aging, ageism and the growing social inequality in progress.

Mobilidade urbana e determinação social da saúde, uma reflexão / Urban mobility and social determination of health, a reflection

Resumo Compreender as relações entre mobilidade urbana e o processo saúde-doença requer perceber que a mobilidade urbana está diretamente relacionada ao tipo de cidade e sociedade onde ela ocorre. Assim, as diferentes condições de mobilidade nas cidades, um fenômeno subjacente à qualidade física e social do espaço urbano, pode implicar em iniquidades em saúde, em especial em países do capitalismo periférico. No Brasil, o modelo de mobilidade associado à precariedade da infraestrutura para pedestres e ciclistas, às longas distâncias a serem percorrida, ao tempo de viagem e à insuficiência e falta de qualidade dos sistemas coletivos de transporte, potencializa os efeitos deletérios sobre a saúde humana. Isso nos permite inferir sobre a mobilidade urbana como uma determinação social da saúde. Este ensaio busca lançar reflexões acerca da mobilidade urbana para além de um utilitarismo positivista a partir de um devir de justiça social alicerçado pela Promoção da Saúde e tendo como estratégia principal o fortalecimento das intersetorialidades.

Abstract Understanding the relationships between urban mobility and the health-disease process requires realizing that urban mobility is directly related to the type of city and society where it occurs. Thus, the different mobility conditions in cities, a phenomenon underlying the physical and social quality of urban space, may imply health inequities, especially in peripheral capitalist countries. In Brazil, the mobility model associated with precarious infrastructure for pedestrians and cyclists, long distances to be travelled, travel times, and the insufficiency and low quality of collective transport systems potentiates the deleterious effects on human health. This leads us to infer on urban mobility as a social determinant of health. This essay seeks to launch reflections on urban mobility beyond a positivist utilitarianism from a development of social justice based on Health Promotion and having as main strategy the strengthening of intersectorialities.

Identifying Challenges, Enabling Practices, and Reviewing Existing Policies Regarding Digital Equity and Digital Divide Toward Smart and Healthy Cities: Protocol for an Integrative Review.

BACKGROUND: Digital equity denotes that all individuals and communities have equitable access to the information technology required to participate in digital life and can fully capitalize on this technology for their individual and community gain and benefits. Recent research highlighted that COVID-19 heightened the existing structural inequities and further exacerbated the technology-related social divide, especially for racialized communities, including new immigrants, refugees, and ethnic minorities. The intersection of challenges associated with racial identity (eg, racial discrimination and cultural differences), socioeconomic marginalization, and age- and gender-related barriers affects their access to health and social services, education, economic activity, and social life owing to digital inequity. OBJECTIVE: Our aim is to understand the current state of knowledge on digital equity and the digital divide (which is often considered a complex social-political challenge) among racialized communities in urban cities of high-income countries and how they impact the social interactions, economic activities, and mental well-being of racialized city dwellers. METHODS: We will conduct an integrative review adapting the Whittemore and Knafl methodology to summarize past empirical or theoretical literature describing digital equity issues pertaining to urban racialized communities. The context will be limited to studies on multicultural cities in high-income countries (eg, Calgary, Alberta) in the last 10 years. We will use a comprehensive search of 8 major databases across multiple disciplines and gray literature (eg, Google Scholar), using appropriate search terms related to digital "in/equity" and "divide." A 2-stage screening will be conducted, including single citation tracking and a hand search of reference lists. Results will be synthesized using thematic analysis guidelines. RESULTS: As of August 25, 2022, we have completed a systematic search of 8 major academic databases from multiple disciplines, gray literature, and citation or hand searching. After duplicate removal, we identified 8647 articles from all sources. Two independent reviewers are expected to complete the 2-step screening (title, abstract, and full-text screening) using Covidence followed by data extraction and analysis in 4 months (by December 2022). Data will be extracted regarding digital equity-related initiatives, programs, activities, research findings, issues, barriers, policies, recommendations, etc. Thematic analysis will reveal how barriers and facilitators of digital equity affect or benefit racialized population groups and what social, material, and systemic issues need to be addressed to establish digital equity for racialized communities in the context of a multicultural city. CONCLUSIONS: This project will inform public policy about digital inequity alongside conventional systemic inequities (eg, education and income levels); promote digital equity by exploring and examining the pattern, extent, and determinants and barriers of digital inequity across sociodemographic variables and groups; and analyze its interconnectedness with spatial dimensions and variations of the urban sphere (geographic differences). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40068.

A Systematic Review with Framework Synthesis of the Ways That Urban Environments Influence Opportunities for Healthy and Sustainable Mobility in Older Age.

Supporting older people's use of sustainable transport is important for both population health and sustainable development, especially in the context of global population ageing. This systematic review identifies individual and environmental factors that influence older people's sustainable transport use and synthesises findings using a framework approach. Factors influencing older people's walking (n = 10 studies), bus use (n = 11), community transport use (n = 1), bicycling (n = 1), and e-bicycling (n = 1) were found to be physical, geographical, facility-based, economic, time-based, fear-based, space-based, information-based, or interpersonal. Many factors were common across transport modes. One reason for this is that environmental features designed to facilitate the use of one particular transport mode also influenced the use of other modes (e.g., bus shelters influence not only bus use but also walking as they provide pedestrian seating). Thus, environments need to be considered from the perspective of multiple, different types of road users. Another reason is that many factors related to the ways individuals experienced their environment (e.g., finding information guiding behaviour in public spaces to be unclear), regardless of any specific transport mode. This review highlights the important need for greater cross-sectoral action and input from older people.

How to Design Greenway on Urban Land Utilization: Linking Place Preference, Perceived Health Benefit, and Environmental Perception.

The rapid urbanization and over-crowded urban environment have caused a serious public health crisis. Numerous studies have found that public green spaces can benefit human health and well-being. Therefore, a short supply or an inappropriate planning of public green spaces would exaggerate the health crisis. For all these reasons, how to create health-promoting greenways in urban areas becomes a critical and pressing challenge for urban sustainability. To address this challenge, we conducted a photograph-survey study of a greenway to examine the relationship between place preference, perceived health benefit, and environmental perception. Through a set of linear regression analysis, we found that: place preference is significantly and positively associated with six specific perceptions, including relaxation when walking alone, cheering of one's mood, being away from daily life, traffic safety, recovery from stress, and mental fascination. Furthermore, we identified the important environmental perception elements that have significant positive or negative associations with each identified perception; these were carefully planned. This study is an initial effort to examine a critical urban land-use issue: appropriate planning of greenways in the city to promote public health and well-being. The research findings provide strong and clear guidance on planning strategies for urban greenways and shed light on future studies.

Review of the impact of urban parks and green spaces on residence prices in the environmental health context.

Urban parks have consistently played an important role in people's living environment, reflecting house prices and the extent of the people's attention. Although many studies have been conducted in this filed, the consolidated related research has not been discussed often. Therefore, related papers on the impact of urban park green spaces on housing prices in recent years should be sorted out. Different choices of urban parks and green areas will undoubtedly influence research methods, housing preferences and the nature of the effects. Consequently, a logical framework of previous studies must be constructed. This study will review the literature from four aspects: (i) review of research methods on how park green spaces affect home prices (i.e., Research techniques, such as hedonic price analysis methods, geographically weighted regression models and neural network models, are frequently used in studies, and methodological advancements have helped the field advance); (ii) examining the varying effects of the same or similar types of parkland on home values; (iii) review of studies on the subject, analyzing variations in the scope and degree of the effects of various parks on home values in terms of such factors as park size, accessibility and serving size and (iv) review of innovative research perspectives, translating the issue of impact of parklands on housing prices into a study of the capitalization and amenity of parklands.

How to Evaluate Health in All Policies at the Local Level: Methodological Insights Within Municipalities From the WHO French Healthy Cities Network.

BACKGROUND: This article proposes a method for analysing the degree of maturity of Health in All Policies (HiAP) among World Health Organization-French Healthy Cities Network (WHO-FHCN) as part of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project. We focused on the creation or enhancement of health-promoting environments, and more specifically, public green spaces. METHODS: We conducted a cross-sectional quantitative study guided by the evaluative framework of the HiAP maturity level developed by Storm et al mixed with a qualitative interpretation. A self-administered questionnaire was sent to elected officials and health department officers in the 85 member cities of the WHO-FHCN in 2017. Subsequently 58 cities were included in the analysis, which was based on a multiple correspondence analysis (MCA) and a hierarchical ascending classification (HAC). RESULTS: Thirty-two criteria among a total of 100 were identified and were used to organize the cities into 8 groups which was then reduced to three profiles among the cities: a less advanced HiAP profile, an established HiAP profile and an advanced HiAP profile. This process allows us to identify 4 dimensions that make it possible to evaluate the level of maturity of cities in the HiAP process, namely: (1) the consideration of social inequalities in health and/or health issues in the policies/actions of the sector studied, (2) occasional intersectoral collaboration, ie, one-off initiatives between the health department and others sectors, (3) the existence of joint projects, ie, common projects between two or more sectors, (4) the existence of intersectoral bodies, in this case on the theme of urban green spaces including an intersectoral committee and/or working groups. CONCLUSION: Four dimensions which allow to the measurement of the degree of progress in implementing health-all-policies are proposed. With a view to integrating knowledge into public action, this study carried out under real conditions offers a realistic method to evaluate HiAP.

An N-Shaped Association between Population Density and Abdominal Obesity.

Abdominal obesity is a threat to public health and healthy cities. Densification may reduce abdominal obesity, but current evidence of the relationship between population density and abdominal obesity is not conclusive. The aim of this study was to disentangle the nonlinear association between population density and abdominal obesity. Data came from the 2004-2015 China Health and Nutrition Survey, which included 36,422 adults aged between 18 and 65 years. Generalized additive models (GAMs) were applied to explore how population density was associated with objectively measured waist circumference (WC) and waist-to-height ratio (WHtR), after controlling for other built environmental attributes, socioeconomic characteristics, and regional and year fixed effects. We found that population density had N-shaped associations with both WC and WHtR, and the two turning points were 12,000 and 50,000 people/km2. In particular, population density was positively correlated with abdominal obesity when it was below 12,000 people/km2. Population density was negatively associated with abdominal obesity when it was between 12,000 and 50,000 people/km2. Population density was also positively related to abdominal obesity when it was greater than 50,000 people/km2. Therefore, densification is not always useful to reduce abdominal obesity. Policy-makers need to pay more attention to local density contexts before adopting densification strategies.

The Associations Between Urban Form and Major Non-communicable Diseases: a Systematic Review.

In the current century, non-communicable diseases (NCDs), particularly cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, are the most important cause of mortality all over the world. Given the effect of the built environment on people's health, the present study seeks to conduct a systematic review in order to investigate the relationship between urban form and these four major NCDs as well as their main risk factors. Two independent reviewers in November 2020 after an extensive search through PubMed and Scopus identified 77 studies. Studies published in English were included if they addressed one or more attributes of urban form in relation to any major NCDs and their main risk factors. Publication date, country, geographical scale, study design, methods of built environment measurement, and findings of the relationships among variables were extracted from eligible studies. The findings suggest that the elements of urban form (density, transportation and accessibility, characteristics of building and streetscape, land use, spatial layouts and configuration) could increase or inhibit these diseases through their effect on physical activity, diet, air pollution, blood pressure, and obesity. However, there are study shortages, contradictions, and ambiguities in these relationships which are mainly due to methodological and conceptual challenges. As a result, more in-depth research is needed to achieve solid and consistent results that could be made into clear guidelines for planning and designing healthier cities.