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.

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.

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.

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.

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

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

Very high-resolution remote sensing-based mapping of urban residential districts to help combat COVID-19.

Urban residential districts (URDs) are a major element in the formation of cities that are essential for urban planning. Regarding the COVID-19 virus, which remains variable in aerosols for several hours, airborne transmission tends to occur in areas of poor ventilation and high occupant density. Thus, ventilation capacity is an important factor influencing airborne transmission in URDs, which should be evaluated as part of efforts to fight COVID-19 and guide healthy city planning and implementation. Here, we develop and test systematic methods to map URDs in a typical city in northern China and quantify their ventilation capacity using very high-resolution remote sensing images. Four fundamental spatial forms of URD are identified in the research area: the point-group form, parallel form, enclosed form, and hybrid form. Our analyses indicate that the integrated ventilation capacities for well-designed URDs are nearly twice those of poorly designed URDs. Large variations in ventilation capacity are also observed within URDs, with up to 13.42 times difference between the buildings. Therefore, very high-resolution remote sensing data are fundamental for extracting building height and generating precise spatial forms, which can improve the micro-scale URD ventilation planning for the prevention of COVID-19.

[The municipal planning for the benefit of health].

The article, on the basis of analysis of scientific publications, presents brief overview of principles and technologies of development of cities considering impact on population health. The particular attention is paid to analysis of being built areas and careful use of available resources. The definition of the term "sustainable development of territory" and description of necessary measures for its application in practice are given. The actual trend of "coronavirus" transformation of architectural urban environment is presented, including availability for each family member of one's own space, room, house and flat with terrace, balcony, separate entrances (in case when apartment is located on the first floor), expanded house territory, life outside the city. At that, reduction of social relationships is established. To control effectiveness of city management corresponding indices are presented.

[Sustainability of the Healthy Municipalities strategy in GuatemalaSustentabilidade da estratégia de Municípios Saudáveis na Guatemala]. / Sostenibilidad de la estrategia Municipios Saludables en Guatemala.

OBJECTIVE: Evaluate the sustainability of the Healthy Municipalities strategy in Guatemala in order to have solid evidence to support decision-making. METHODS: A concurrent mixed-methods study was carried out in five phases: 1) theoretical-conceptual (based on a narrative review of the literature on sustainability, dimensions and categories were proposed for evaluation); (2) empirical (four municipalities were selected for convenience and 29 semi-structured interviews and four focus groups were conducted with key actors to explore sustainability; with this information, a score was assigned to each category and dimension); (3) analytical, by category and dimension (content analysis was performed for qualitative information, and totals and averages were calculated for quantitative information); (4) integrative (qualitative data were integrated into matrices by category and dimension, and quantitative data were supported by qualitative information); and 5) meta-inference (consideration was given to the context and its influence on the results). RESULTS: Ninety-two (92) informants participated. In operational terms, progress was observed in the transfer and use of results, and in rotations in leadership. In the legal and political sphere, accountability and local planning were highlighted. In the economic sphere, progressive investment in health, water and sanitation was emphasized, as well as insufficient investment in social determinants of health. In the social sphere, few mechanisms were observed to promote and strengthen social participation. CONCLUSIONS: In the municipalities that participated in the study, a fair level of sustainability was observed in the Healthy Municipalities strategy.

OBJETIVO: Avaliar a sustentabilidade da estratégia de Municípios Saudáveis na Guatemala para dispor de evidências sólidas para apoiar o processo decisório. MÉTODOS: Foi realizado um estudo de método misto concorrente em cinco fases: 1) fase teórica-conceitual em que foi feita a revisão narrativa da literatura em sustentabilidade a partir da qual foram propostas dimensões e categorias a serem avaliadas; 2) fase empírica em que foi feita a seleção por conveniência de quatro municípios, com 29 entrevistas semiestruturadas e quatro grupos de discussão com as principais partes interessadas para explorar a sustentabilidade; a partir das informações coletadas, foi dada uma pontuação a cada categoria e dimensão; 3) fase analítica, por categoria e dimensão, em que foi realizada a análise do conteúdo para os dados qualitativos e feito o cálculo de somatórias e médias para os dados quantitativos; 4) fase integrativa em que os dados qualitativos foram integrados em matrizes por categoria e dimensão e os dados quantitativos foram respaldados com a informação qualitativa e 5) metainferência em que foi analisado o contexto e sua influência nos resultados. RESULTADOS: O estudo incluiu 92 participantes. Na dimensão operacional, destacam-se os avanços na transferência e no uso de resultados, bem como a ênfase em liderança. Na dimensão jurídico-política, destacam-se a prestação de contas e os planos locais. Na dimensão econômica, destaca-se o investimento progressivo em saúde, água e saneamento, com investimento inadequado nos determinantes sociais da saúde. Na dimensão social, observam-se poucos mecanismos para incentivar e reforçar a participação social. CONCLUSÕES: Foi observado nos municípios participantes do estudo um nível constante de sustentabilidade da estratégia de Municípios Saudáveis.

Sustainability of the Healthy Municipalities Strategy in Guatemala.

OBJECTIVE: Evaluate the sustainability of the Healthy Municipalities strategy in Guatemala in order to have solid evidence to support decision-making. METHODS: A concurrent mixed-methods study was carried out in five phases: 1) theoretical-conceptual (based on a narrative review of the literature on sustainability, dimensions and categories were proposed for evaluation); 2) empirical (four municipalities were selected for convenience and 29 semi-structured interviews and four focus groups were conducted with key actors to explore sustainability; with this information, a score was assigned to each category and dimension); 3) analytical, by category and dimension (content analysis was performed for qualitative information, and totals and averages were calculated for quantitative information); 4) integrative (qualitative data were integrated into matrices by category and dimension, and quantitative data were supported by qualitative information); and 5) meta-inference (consideration was given to the context and its influence on the results). RESULTS: Ninety-two (92) informants participated. In operational terms, progress was observed in the transfer and use of results, and in rotations in leadership. In the legal and political sphere, accountability and local planning were highlighted. In the economic sphere, progressive investment in health, water and sanitation was emphasized, as well as insufficient investment in social determinants of health. In the social sphere, few mechanisms were observed to promote and strengthen social participation. CONCLUSIONS: In the municipalities that participated in the study, a fair level of sustainability was observed in the Healthy Municipalities strategy.

The convergences between the Sustainable Development Goals and national agendas: the Brazilian case.

One of the criticisms against the Sustainable Development Goals (SDGs) or 2030 Agenda is how they are decontextualized from national realities. To verify this, we worked to identify possible interfaces between the deliberations that took place at Brazilian national conferences and the 2030 Agenda, in the context of urban territories. A qualitative study was conducted using thematic analysis of the final documents produced by the national conferences on health, food and nutrition security, environment and solidarity economy (2013-2015). The study considered all 17 SDGs and the results are presented in the five Ps categories. (i) People: discussions related to this category presented more convergences than any other. (ii) Planet: water was discussed in terms of its rational use and preservation, and as a right. Patterns of consumption, production and climate change were linked to the debate on food. (iii) Partnerships: varying views were presented, some regarding them as a threat against guaranteed rights and others as a way to strengthen the national agenda. (iv) Prosperity: discussions focused on economic growth and industrialization associated to the redistribution of wealth and overcoming inequities. Cities were considered strategic in rural-urban relations. (v) Peace: the term was absent, but 'justice' was discussed in terms of rights, fair taxation and the inclusion of people in vulnerable situations. Our results demonstrated that the 2030 Agenda clearly converges with Brazil's social demands. They enabled contextualizing the SDGs and qualified the debates on their implementation, which indicate the adherence to principles of the health promotion field.

[Health Without Borders: Creating Healthy Cities].

Urbanization, a rapidly rising trend worldwide, is being felt particularly strongly in East Asia. The World Health Organization (WHO) launched a healthy-cities plan in 1986 as a platform to encourage cities around the world to eliminate the problems resulting from increasingly dense urban population densities. The health and quality of life of city residents are seriously affected by the problems associated with urbanization, including environmental pollution, traffic congestion, public insecurity, and inadequate infrastructure, which may exceed the scope of local government plans and expectations. Rather than dealing with these problems individually, urban planners must take a global approach to issue of urbanization. Public and private-sector inputs are critical to facilitating good urban planning and community development by local governments in order to help cities achieve a well-managed urban environment that gives citizens a good environment in which to live, work, and play. The promotion healthy-city plans in Taiwan will foster the creation of cities of health through the integration or cooperation of government health, urban-planning, environmental-protection, industrial-development, transportation, cultural-education, and other departments and agencies. Based on the vision of a healthy city, Taiwan's cities should gradually attain a sustainable, healthy society and healthy environment that promotes the holistic health of their residents. Therefore, we look forward to fulfilling the vision of "health without borders, creating healthy cities" through the implementation of the healthy city plan.

Prevalence of active transportation among adults in Latin America and the Caribbean: a systematic review of population-based studies.

OBJECTIVE: To describe the prevalence of "active" (self-propelled, human-powered) transportation in the Latin America and Caribbean (LAC) region over the past decade. METHODS: MEDLINE, Excerpta Medica (Embase), SportDiscus, Lilacs, MediCarib, Web of Science, OVID, CINAHL, Scopus, Google Scholar, National Transportation Library, and TRIS/TRID were searched for articles on active transportation published between January 2003 and December 2014 with (at least) a title and abstract in English, Portuguese, or Spanish. Research was included in the study if the two reviewing authors agreed it 1) was conducted in an adult sample (≥ 18 years old), 2) was designed to be representative of any LAC area, and 3) reported at least one measure of active transportation. Reference lists of included papers and retrieved reviews were also checked. A total of 129 key informants (87 scientific experts and 42 government authorities) were contacted to identify additional candidate publications. Two other authors extracted the data independently. RESULTS: A total of 10 459 unique records were found; the full texts of 143 were reviewed; and a total of 45 studies were included in the study, yielding estimates for 72 LAC settings, most of which were in Argentina, Brazil, and Colombia. No eligible studies were found for the years 2003-2004, resulting in a 10-year study time frame. Estimates were available for walking, cycling, or the combination of both, with a high degree of heterogeneity (heterogeneity index (I2) ≥ 99%). The median prevalence of active transportation (combining walking and cycling) was 12.0%, ranging from 5.1% (in Palmas, Brazil) to 58.9% (in Rio Claro, Brazil). Men cycled more than women in all regions for which information was available. The opposite was true for walking. CONCLUSIONS: Prevalence of active transportation in LAC varied widely, with great heterogeneity and uneven distribution of studies across countries, indicating the need for efforts to build comprehensive surveillance systems with standardized, timely, and detailed estimates of active transportation in order to support policy planning and evaluation.

Then and now: a revision of the city health profile of the city of Pécs, Hungary.

The City of Pécs, a founding member, has participated in the World Health Organization European Healthy Cities Network (WHO-EHCN) since 1986. Each WHO-EHCN city prepares a city health profile (CHP) through which it supports local health-related activities. The first CHP of Pécs was carried out in 1996. The aim of more recent research has been to implement a comprehensive review of the first CHP and to make a comparative analysis between the results of the former and the updated CHPs. The data were received from different databases and a telephone survey. The review showed improvement in those areas that can be influenced through the measures of the city authorities. The survey showed that both the ratio of smokers and the amount of cigarettes smoked had decreased so that the ratio of regular smokers became the lowest among the youngest age group. The number of alcohol consumers increased, while the amount of alcohol consumed dropped slightly, meaning that alcohol consumption per capita decreased overall. The comparative analysis highlighted unhealthy diets, insufficient sleep duration and physical inactivity becoming significant health risk factors. To avoid a 'reinventing the wheel' situation, it would be worth comparing the results of health and lifestyle surveys of other WHO-EHCN cities and eventually jointly devise the best solutions.

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).

How Green Space Justice in urban built-up areas affects public mental health: a moderated chain mediation model.

Background: Green and blue spaces, as crucial components of urban ecosystems, significantly impact the physical and mental health of residents. However, the mechanisms through which Green/Blue Space Justice influence residents' health remain unclear. Methods: This study aims to explore the impact of green spaces on public psychological responses, physical activity, and mental health from a justice perspective, and to examine the moderating role of blue spaces in this relationship. The research was conducted in selected communities within the Chang-Zhu-Tan urban agglomeration in Hunan Province, China. A total of 801 valid questionnaires were collected through field visits and online surveys. The study uses an improved Gaussian-based two-step floating catchment area (2SFCA) method to assess green space accessibility. Data were analyzed using structural equation modeling (SEM) and moderation effect analysis to reveal the relationships between variables. Results: The findings indicate that Green Space Justice has a significant positive impact on psychological responses, physical activity, and mental health; psychological responses and physical activity play crucial mediating roles between Green Space Justice and mental health; and Green Space Justice significantly affects mental health through a chain mediation path involving psychological responses and physical activity. Moreover, Blue Space Justice significantly moderates the impact of Green Space Justice on psychological responses and physical activity, but does not have a significant direct impact on mental health. Conclusion: This study enriches the theory of Green Space Justice by revealing the mechanisms through which it influences mental health via psychological responses and physical activity. It provides a scientific basis for the development of healthy cities. Additionally, it recommends that urban planning should prioritize the equitable distribution and high accessibility of both green and blue spaces to comprehensively enhance residents' physical and mental well-being. Policymakers should consider prioritizing the accessibility of high-quality green spaces for vulnerable communities during urban renewal and expansion processes to reduce social health inequalities and promote broader public health outcomes.

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.

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.

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.