Pathways to urban health and well-being: measuring and modelling of community services' in a medium size city.

Social and natural capital are fundamental to people's wellbeing, often within the context of local community. Developing communities and linking people together provide benefits in terms of mental well-being, physical activity and other associated health outcomes. The research presented here was carried out in Christchurch - Otautahi, New Zealand, a city currently re-building, after a series of devastating earthquakes in 2010 and 2011. Poor mental health has been shown to be a significant post-earthquake problem, and social connection has been postulated as part of a solution. By curating a disparate set of community services, activities and facilities, organised into a Geographic Information Systems (GIS) database, we created i) an accessibility analysis of 11 health and well-being services, ii) a mobility scenario analysis focusing on 4 general well-being services and iii) a location-allocation model focusing on 3 primary health care and welfare location optimisation. Our results demonstrate that overall, the majority of neighbourhoods in Christchurch benefit from a high level of accessibility to almost all the services; but with an urban-rural gradient (the further away from the centre, the less services are available, as is expected). The noticeable exception to this trend, is that the more deprived eastern suburbs have poorer accessibility, suggesting social inequity in accessibility. The findings presented here show the potential of optimisation modelling and database curation for urban and community facility planning purposes.

New Zealand Healthline call data used to measure the effect of travel time on the use of the emergency department.

Telephone triage is a health tool increasingly used to connect geographically distant populations. Such services are also utilised to address issues of Emergency Department (ED) overuse. New Zealand's tele-triage service, Healthline, has existed since 2001 but is yet to be the focus of analysis. This research sought to understand the role that travel time to ED had upon Healthline users' compliance with telephone advice. Additionally, the role of deprivation in Healthline (as a determinant of caller behaviour) was examined. Travel time to ED was found to influence the impact of Healthline advice upon callers but this was not confounded by deprivation. Those living closest to the ED were more likely to attend when advised to, and less likely to stay away if told to avoid the ED. Different time brackets showed stronger trends, suggesting that callers at varying distances from EDs may be more or less influenced by both travel time and Healthline advice.

Comprehensive clinical assessment of home-based older persons within New Zealand: an epidemiological profile of a national cross-section.

OBJECTIVE: Since 2012, all community care recipients in New Zealand have undergone a standardised needs assessment using the Home Care International Residential Assessment Instrument (interRAI-HC). This study describes the national interRAI-HC population, assesses its data quality and evaluates its ability to be matched. METHODS: The interRAI-HC instrument elicits information on 236 questions over 20 domains; conducted by 1,800+ trained health professionals. Assessments between 1 July 2012 and 30 June 2014 are reported here. Stratified by age, demographic characteristics were compared to 2013 Census estimates and selected health profiles described. Deterministic matching to the Ministry of Health's mortality database was undertaken. RESULTS: Overall, 51,232 interRAI-HC assessments were conducted, with 47,714 (93.1%) research consent from 47,236 unique individuals; including 2,675 Maori and 1,609 Pacific people. Apart from height and weight, data validity and reliability were high. A 99.8% match to mortality data was achieved. CONCLUSIONS: The interRAI-HC research database is large and ethnically diverse, with high consent rates. Its generally good psychometric properties and ability to be matched enhances its research utility. IMPLICATIONS: This national database provides a remarkable opportunity for researchers to better understand older persons' health and health care, so as to better sustain older people in their own homes.

Public health impacts of city policies to reduce climate change: findings from the URGENCHE EU-China project.

BACKGROUND: Climate change is a global threat to health and wellbeing. Here we provide findings of an international research project investigating the health and wellbeing impacts of policies to reduce greenhouse gas emissions in urban environments. METHODS: Five European and two Chinese city authorities and partner academic organisations formed the project consortium. The methodology involved modelling the impact of adopted urban climate-change mitigation transport, buildings and energy policy scenarios, usually for the year 2020 and comparing them with business as usual (BAU) scenarios (where policies had not been adopted). Carbon dioxide emissions, health impacting exposures (air pollution, noise and physical activity), health (cardiovascular, respiratory, cancer and leukaemia) and wellbeing (including noise related wellbeing, overall wellbeing, economic wellbeing and inequalities) were modelled. The scenarios were developed from corresponding known levels in 2010 and pre-existing exposure response functions. Additionally there were literature reviews, three longitudinal observational studies and two cross sectional surveys. RESULTS: There are four key findings. Firstly introduction of electric cars may confer some small health benefits but it would be unwise for a city to invest in electric vehicles unless their power generation fuel mix generates fewer emissions than petrol and diesel. Second, adopting policies to reduce private car use may have benefits for carbon dioxide reduction and positive health impacts through reduced noise and increased physical activity. Third, the benefits of carbon dioxide reduction from increasing housing efficiency are likely to be minor and co-benefits for health and wellbeing are dependent on good air exchange. Fourthly, although heating dwellings by in-home biomass burning may reduce carbon dioxide emissions, consequences for health and wellbeing were negative with the technology in use in the cities studied. CONCLUSIONS: The climate-change reduction policies reduced CO2 emissions (the most common greenhouse gas) from cities but impact on global emissions of CO2 would be more limited due to some displacement of emissions. The health and wellbeing impacts varied and were often limited reflecting existing relatively high quality of life and environmental standards in most of the participating cities; the greatest potential for future health benefit occurs in less developed or developing countries.

Residential exposure to visible blue space (but not green space) associated with lower psychological distress in a capital city.

As urbanisation escalates globally, urban neighbourhood features which may improve physical and mental health are of growing importance. Using a cross-sectional survey of adults and the application of novel geospatial techniques, this study investigated whether increased visibility of nature (green and blue space) was associated with lower psychological distress (K10 scores), in the capital city of Wellington, New Zealand. To validate, we also tested whether visibility of blue space was associated missing teeth in the same sample. Cluster robust, linear regression models were fitted to test the association between visibility of nature and K10 scores, adjusted for age, sex, personal income, neighbourhood population density, housing quality, crime and deprivation. Higher levels of blue space visibility were associated with lower psychological distress (ß=-0.28, p<0.001). Importantly, blue space visibility was not significantly associated with tooth loss. Further research is needed to confirm whether increased visibility of blue space could promote mental well-being and reduce distress in other cities.

Social and spatial inequalities in Rotaviral enteritis: a case for universally funded vaccination in New Zealand.

AIMS: Rotaviruses have long been recognised as the most common cause of diarrhoea-related childhood morbidity and mortality worldwide. The benefits of national rotavirus vaccination programmes have been proven, with estimates of the reduction in hospital stays ranging from 70% to 90%. Previous work has found spatial variation in rotaviral rates between areas in Australia and Germany. This study sought to identify spatial and spatio-temporal variation in clustering of high and low neighbourhood rates of paediatric hospital admissions for RV disease in Auckland, New Zealand for the period 2006-2011. METHODS: Annual clusters of rotavirus hospitalisations were identified using a Local Moran's I Index from ArcGIS. Spatio-temporal variation during the study period used a retrospective spatial variation in temporal trends scan statistic in SatScan. RESULTS: Annual clusters of high and low rotavirus rates were identified for each year of the study and the spatio-temporal scan statistic confirmed that spatial clustering of rotavirus rates had shifted significantly during the study period. CONCLUSIONS: This research suggests that targeted rotaviral intervention is inappropriate and supports the introduction of a fully funded rotavirus vaccine in New Zealand in 2014.

An ecological study of the relationship between socioeconomic isolation and mental health in the most deprived areas in Auckland, New Zealand.

International debate posits that when groups feel deprived relative to reference groups in society, there may be psychosocial impacts. Deprivation varies geographically and deprived areas may be proximal to advantaged areas. In theory, this leads to chronic stress and poor mental health. This research explored whether socioeconomically isolated deprived areas experience increased levels of anxiety/mental disorder treatment, compared to other deprived areas. We developed a spatial isolation measure to characterise deprived areas surrounded by advantaged areas in Auckland, New Zealand. We found that isolated areas were characterised by fewer Maori and Pacific people, high density and shorter travel time to General Practitioners. We found significantly higher rates of anxiety/mood disorder treatment in highly isolated versus non-isolated areas and a statistically significant relationship with anxiety/mood disorders for each isolation level, both before and after confounder adjustment. This evidence suggests that mental health within small areas may be sensitive to the neighbourhood interactions, through social comparison or discrimination which lead to psychosocial stress.

Deprived yet healthy: neighbourhood-level resilience in New Zealand.

Geographical inequalities in health are omnipresent with health and related behaviours typically worse in socioeconomically deprived places. However, this is not always true. Deprived places with unexpectedly good health outcomes, or what might be considered 'resilient' places, have been noted. Few studies have quantitatively examined resilience in neighbourhoods or investigated potential explanations for this resilience. This paper examines the paradox of low mortality despite high social deprivation in New Zealand neighbourhoods and considers possible neighbourhood characteristics that contribute to unanticipated positive health outcomes. Using area-level mortality (2005-2007) and socioeconomic data, we developed the Resilience Index New Zealand to quantify neighbourhood levels of resilience across the country. We then examined relationships between this measure and a suite of built, physical and social characteristics. We found that resilient places tended to be densely populated, urban areas. We observed gradients and increases/decreases in the most resilient groups in access to or levels of physical environment factors (environmental deprivation, safe drinking water, air quality) and unhealthy living infrastructure (alcohol and gambling outlets). Since these factors are amenable to change, these findings are the strongest evidence that such improvements may lower mortality in similarly deprived places. The social environment of resilient areas was characterised by high levels of incoming residents. We also found some surprising associations and observed U-shaped relationships for a number of the neighbourhood factors. Such findings suggest the need to develop a better proxy of community cohesion and a better understanding of the interactions between people and their neighbourhoods, rather than simply the presence of certain factors. We argue that this study has identified amenable neighbourhood characteristics and highlighted the importance of 'place-specific' resilience factors that may be effective in reducing mortality in some neighbourhoods, but be less effective in others.

Is particulate air pollution associated with health and health inequalities in New Zealand?

Air pollution can increase mortality risk and may also exacerbate socioeconomic inequalities in health outcomes. This New Zealand study investigated whether exposure to particulate air pollution (PM(10)) was associated with mortality and health inequalities. Annual mean PM(10) estimates for urban Census Area Units (CAUs) were linked to cause-specific mortality data. A dose-response relationship was found between PM(10) and respiratory disease mortality, including at concentrations below the existing annual average guideline value of 20µgm(-3). Establishing and enforcing a lower guideline value is likely to have population health benefits. However, socioeconomic inequalities in respiratory disease mortality were not significantly elevated with PM(10) exposure.

Improving health through policies that promote active travel: a review of evidence to support integrated health impact assessment.

BACKGROUND: Substantial policy changes to control obesity, limit chronic disease, and reduce air pollution emissions, including greenhouse gasses, have been recommended. Transportation and planning policies that promote active travel by walking and cycling can contribute to these goals, potentially yielding further co-benefits. Little is known, however, about the interconnections among effects of policies considered, including potential unintended consequences. OBJECTIVES AND METHODS: We review available literature regarding health impacts from policies that encourage active travel in the context of developing health impact assessment (HIA) models to help decision-makers propose better solutions for healthy environments. We identify important components of HIA models of modal shifts in active travel in response to transport policies and interventions. RESULTS AND DISCUSSION: Policies that increase active travel are likely to generate large individual health benefits through increases in physical activity for active travelers. Smaller, but population-wide benefits could accrue through reductions in air and noise pollution. Depending on conditions of policy implementations, risk tradeoffs are possible for some individuals who shift to active travel and consequently increase inhalation of air pollutants and exposure to traffic injuries. Well-designed policies may enhance health benefits through indirect outcomes such as improved social capital and diet, but these synergies are not sufficiently well understood to allow quantification at this time. CONCLUSION: Evaluating impacts of active travel policies is highly complex; however, many associations can be quantified. Identifying health-maximizing policies and conditions requires integrated HIAs.

The influence of road curvature on fatal crashes in New Zealand.

Bends in roads can cause crashes but a recent study in the UK found that areas with mostly curved roads had lower crash rates than areas with straighter roads. This present study aimed to replicate the previous research in a different country. Variations in the number of fatal road crashes occurring between 1996 and 2005 in 73 territorial local authorities across New Zealand were modelled against possible predictors. The predictors were traffic flow, population counts and characteristics, car use, socio-economic deprivation, climate, altitude and road characteristics including four measures of average road curvature. The best predictors of the number of fatal crashes on urban roads, rural state highways and other rural roads were traffic flow, speed limitation and socio-economic deprivation. Holding significant factors constant, there was no evidence that TLAs with the most curved roads had more crashes than elsewhere. Fatal crashes on urban roads were significantly and negatively related to two measures of road curvature: the ratio of road length to straight distance and the cumulative angle turned per kilometre. Weaker negative associations on rural state highways could have occurred by chance. These results offer limited support to the suggestion that frequently occurring road bends might be protective.