Improved human greenspace exposure equality during 21st century urbanization.

Greenspace plays a crucial role in urban ecosystems and has been recognized as a key factor in promoting sustainable and healthy city development. Recent studies have revealed a growing concern about urban greenspace exposure inequality; however, the extent to which urbanization affects human exposure to greenspace and associated inequalities over time remains unclear. Here, we incorporate a Landsat-based 30-meter time-series greenspace mapping and a population-weighted exposure framework to quantify the changes in human exposure to greenspace and associated equality (rather than equity) for 1028 global cities from 2000 to 2018. Results show a substantial increase in physical greenspace coverage and an improvement in human exposure to urban greenspace, leading to a reduction in greenspace exposure inequality over the past two decades. Nevertheless, we observe a contrast in the rate of reduction in greenspace exposure inequality between cities in the Global South and North, with a faster rate of reduction in the Global South, nearly four times that of the Global North. These findings provide valuable insights into the impact of urbanization on urban nature and environmental inequality change and can help inform future city greening efforts.

Contrasting inequality in human exposure to greenspace between cities of Global North and Global South.

The United Nations specified the need for "providing universal access to greenspace for urban residents" in the 11th Sustainable Development Goal. Yet, how far we are from this goal remains unclear. Here, we develop a methodology incorporating fine-resolution population and greenspace mappings and use the results for 2020 to elucidate global differences in human exposure to greenspace. We identify a contrasting difference of greenspace exposure between Global South and North cities. Global South cities experience only one third of the greenspace exposure level of Global North cities. Greenspace exposure inequality (Gini: 0.47) in Global South cities is nearly twice that of Global North cities (Gini: 0.27). We quantify that 22% of the spatial disparity is associated with greenspace provision, and 53% is associated with joint effects of greenspace provision and spatial configuration. These findings highlight the need for prioritizing greening policies to mitigate environmental disparity and achieve sustainable development goals.

Beyond green environments: Multi-scale difference in human exposure to greenspace in China.

Greenspace exposure metrics can allow for comparisons of green space supply across time, space, and population groups, and for inferring patterns of variation in opportunities for people to enjoy the health and recreational benefits of nearby green environments. A better understanding of greenspace exposure differences across various spatial scales is a critical requirement for lessening environmental health disparities. However, existing studies are typically limited to a single city or across selected cities, which severely limits the use of results in measuring systemic national and regional scale differences that might need policy at above individual city planning level. To close this knowledge gap, our study aims to provide a holistic assessment of multi-scale greenspace exposure across provinces, cities, counties, towns, and land parcels for the whole of China. We mapped the nationwide fractional greenspace coverage at 10 m with Sentinel-2 satellite imagery, and then modeled population-weighted greenspace exposure to examine variation of greenspace exposure across scales. Our results show a prominent scaling effect of greenspace exposure across multi-scale administrative divisions in China, suggesting, as expected, an increase in heterogeneity with finer spatial scales. We also identify an asymmetric pattern of the difference between greenspace exposure and greenspace coverage, across a geo-demographic demarcation boundary (i.e., along the Heihe-Tengchong Line). In general, the greenspace coverage rate will overestimate more realistic human exposure to greenspace in East China while underestimating in West China. We further found that, in China, more recently urbanized areas have much better greenspace exposure than older urban areas. Our study provides a spatially explicit greenspace exposure metric for discovering multi-scale greenspace exposure difference, which will enhance governments' capacity to quantify environmental justice, detect vulnerable greenspace exposure risk hotspots, prioritize greenspace management at the supra-city scale, and monitor the balance between greenspace supply and demand.

Community planning for a "healthy built environment" via a human-environment nexus? A multifactorial assessment of environmental characteristics and age-specific stroke mortality in Hong Kong.

With the prevalence of stroke rising due to both aging societies and more people getting strokes at a younger age, a comprehensive investigation into the relationship between urban characteristics and age-specific stroke mortality for the development of a healthy built environment is necessary. Specifically, assessment of various dimensions of urban characteristics (e.g. short-term environmental change, long-term environmental conditions) is needed for healthy built environment designs and protocols. A multifactorial assessment was conducted to evaluate associations between environmental and sociodemographic characteristics with age-stroke mortality in Hong Kong. We found that short-term (and temporally varying) daily PM10, older age and being female were more strongly associated with all types of stroke deaths compared to all-cause deaths in general. Colder days, being employed and being married were more strongly associated with hemorrhagic stroke deaths in general. Long-term (and spatially varying) regional-level air pollution were more strongly associated with non-hemorrhagic stroke deaths in general. These associations varied by age. Employment (manual workers) and low education were risk factors for stroke mortality at younger ages (age <65). Greenness and open space did not have a significant association with stroke mortality. Since a significant connection was expected, this leads to questions about the health-inducing efficacy of Hong Kong's compact open spaces (natural greenery being limited to steep slopes, and extensive impervious surfaces on public open spaces). In conclusion, urban plans and designs for stroke mortality prevention should implement age-specific health care to neighborhoods with particular population segments.

Examining the Multi-Scalar Unevenness of High-Quality Healthcare Resources Distribution in China.

Healthcare disparity is, to a large extent, ascribable to the uneven distribution of high-quality healthcare resources, which remains insufficiently examined, largely due to data unavailability. To overcome this barrier, we synthesized multiple sources of data, employed integrated methods and made a comprehensive analysis of government administrative structures and the socio-economic environment to build probably the most inclusive dataset of Chinese 3-A hospitals thus far. Calibrated on a sample of 379 hospitals rated by a reputable organization, we developed a realistic and viable evaluation framework for assessing hospital quality in China. We then calculated performance scores for 1246 3-A hospitals, which were aggregated and further analyzed at multiple scales (cities, provinces, regions, and economic zones) using general entropy indexes. This research shows that the fragmented governance and incoordination of "kuai" and "tiao" is rooted deeply in China's legacy of centrally-planned systems, and has had a far-reaching yet partially contradictory influence over the contemporary distribution and performance of healthcare resources. Additionally, the unevenness in the distribution of healthcare resources is related closely to a city's administrative rank and power. This study thus suggests that the policy design of healthcare systems should be coordinated with external socio-economic transformation in a sustainable manner.

Examining the interaction of fast-food outlet exposure and income on diet and obesity: evidence from 51,361 UK Biobank participants.

BACKGROUND: Household income (as a marker of socioeconomic position) and neighbourhood fast-food outlet exposure may be related to diet and body weight, which are key risk factors for non-communicable diseases. However, the research evidence is equivocal. Moreover, understanding the double burden of these factors is a matter of public health importance. The purpose of this study was to test associations of neighbourhood fast-food outlet exposure and household income, in relation to frequency of consumption of processed meat and multiple measures of adiposity, and to examine possible interactions. METHODS: We employed an observational, cross-sectional study design. In a cohort of 51,361 adults aged 38-72 years in Greater London, UK, we jointly classified participants based on household income (£/year, four groups) and GIS-derived neighbourhood fast-food outlet proportion (counts of fast-food outlets as a percentage of all food outlets, quartiles). Multivariable regression models estimated main effects and interactions (additive and multiplicative) of household income and fast-food outlet proportion on odds of self-reported frequent processed meat consumption (> 1/week), measured BMI (kg/m2), body fat (%), and odds of obesity (BMI ≥ 30). RESULTS: Income and fast-food proportion were independently, systematically associated with BMI, body fat, obesity and frequent processed meat consumption. Odds of obesity were greater for lowest income participants compared to highest (OR = 1.54, 95% CI: 1.41, 1.69) and for those most-exposed to fast-food outlets compared to least-exposed (OR = 1.51, 95% CI: 1.40, 1.64). In jointly classified models, lowest income and highest fast-food outlet proportion in combination were associated with greater odds of obesity (OR = 2.43, 95% CI: 2.09, 2.84), with relative excess risk due to interaction (RERI = 0.03). Results were similar for frequent processed meat consumption models. There was no evidence of interaction on a multiplicative scale between fast-food outlet proportion and household income on each of BMI (P = 0.230), obesity (P = 0.054) and frequent processed meat consumption (P = 0.725). CONCLUSIONS: Our study demonstrated independent associations of neighbourhood fast-food outlet exposure and household income, in relation to diet and multiple objective measures of adiposity, in a large sample of UK adults. Moreover, we provide evidence of the double burden of low income and an unhealthy neighbourhood food environment, furthering our understanding of how these factors contribute jointly to social inequalities in health.

Improving Mental Health Through the Regeneration of Deprived Neighborhoods: A Natural Experiment.

Neighborhood-level interventions provide an opportunity to better understand the impact of neighborhoods on health. In 2001, the Welsh Government, United Kingdom, funded Communities First, a program of neighborhood regeneration delivered to the 100 most deprived of the 881 electoral wards in Wales. In this study, we examined the association between neighborhood regeneration and mental health. Information on regeneration activities in 35 intervention areas (n = 4,197 subjects) and 75 control areas (n = 6,695 subjects) was linked to data on mental health from a cohort study with assessments made in 2001 (before regeneration) and 2008 (after regeneration). Propensity score matching was used to estimate the change in mental health in intervention neighborhoods versus control neighborhoods. Baseline differences between intervention and control areas were of similar magnitude as produced by paired randomization of neighborhoods. Regeneration was associated with an improvement in the mental health of residents in intervention areas compared with control neighborhoods (ß = 1.54, 95% confidence interval: 0.50, 2.59), suggesting a reduction in socioeconomic inequalities in mental health. There was a dose-response relationship between length of residence in regeneration neighborhoods and improvements in mental health (P-trend = 0.05). These results show that targeted regeneration of deprived neighborhoods can improve mental health.

The communities first (ComFi) study: protocol for a prospective controlled quasi-experimental study to evaluate the impact of area-wide regeneration on mental health and social cohesion in deprived communities.

INTRODUCTION: Recent systematic reviews have highlighted the dearth of evidence on the effectiveness of regeneration on health and health inequalities. 'Communities First' is an area-wide regeneration scheme to improve the lives of people living in the most deprived areas in Wales (UK). This study will evaluate the impact of Communities First on residents' mental health and social cohesion. METHODS AND ANALYSIS: A prospective controlled quasi-experimental study of the association between residence in Communities First regeneration areas in Caerphilly county borough and change in mental health and social cohesion. The study population is the 4226 residents aged 18-74 years who responded to the Caerphilly Health and Social Needs Study in 2001 (before delivery) and 2008 (after delivery of Communities First). Data on the location, type and cost of Communities First interventions will be extracted from records collected by Caerphilly county borough council. The primary outcome is the change in mental health between 2001 and 2008. Secondary outcomes are changes: in common mental disorder case status (using survey and general practice data), social cohesion and mental health inequalities. Multilevel models will examine change in mental health and social cohesion between Communities First and control areas, adjusting for individual and household level confounding factors. Further models will examine the effects of (1) different types of intervention, (2) contamination across areas, (3) length of residence in a Communities First area, and (4) population migration. We will carry out a cost-consequences analysis to summarise the outcomes generated for participants, as well as service utilisation and utility gains. ETHICS AND DISSEMINATION: This study has had approval from the Information Governance Review Panel at Swansea University (Ref: 0266 CF). Findings will be disseminated through peer-review publications, international conferences, policy and practice partners in local and national government, and updates on our study website (http://medicine.cardiff.ac.uk/clinical-study/communities-first-regeneration-programme/).

Urban built environment configuration and psychological distress in older men: results from the Caerphilly study.

BACKGROUND: Few studies have examined the impact of the built environment configuration upon mental health. The study examines the impact of objectively assessed land use and street network configuration upon psychological distress and whether this association is moderated by the natural environment and area-level deprivation. METHODS: In a community sample of 687 older men from the Caerphilly Prospective Study, built environment morphological metrics (morphometrics) were related to differences in psychological distress as measured by the General Health Questionnaire. Cross-sectional data were taken from the most recent (5th) phase. A multi-level analysis with individuals nested within census-defined neighbourhoods was conducted. Environmental measures comprised GIS-constructed land use and street network metrics, slope variability and a satellite derived measure of greenness. RESULTS: Reduced psychological distress was associated with residing in a terraced dwelling (OR=0.48, p=0.03), higher degrees of land-use mix (OR=0.42, p=0.03 for the high tertile) and having higher local-level street-network accessibility ('movement potential') (OR=0.54, p=0.03). Hillier topography with higher slope variability was associated with increased risks of psychological distress (OR=1.38, p=0.05). CONCLUSIONS: The findings support our hypothesis that built environment configuration is independently associated with psychological distress. The study underscores the need for effective intervention in the planning and design of residential built environment to achieve the goal of health-sustaining communities.

Poverty concentration and determinants in China's urban low-income neighbourhoods and social groups.

Based on a large-scale household survey conducted in 2007, this article reports on poverty concentration and determinants in China's low-income neighbourhoods and social groups. Three types of neighbourhood are recognized: dilapidated inner-city neighbourhoods, declining workers' villages and urban villages. Respondents are grouped into four categories: working, laid-off/unemployed and retired urban residents, together with rural migrants. We first measure poverty concentration across different types of neighbourhood and different groups. The highest concentrations are found in dilapidated inner-city neighbourhoods and among the laid-off/unemployed. Mismatches are found between actual hardships, sense of deprivation and distribution of social welfare provision. Second, we examine poverty determinants. Variations in institutional protection and market remuneration are becoming equally important in predicting poverty generation, but are differently associated with it in the different neighbourhoods and groups. As China's urban economy is increasingly shaped by markets, the mechanism of market remuneration is becoming a more important determinant of poverty patterns, especially for people who are excluded from state institutions, notably laid-off workers and rural migrants.

Risk management by early recognition of warning signs in patients in forensic psychiatric care.

PURPOSE: To clarify the concept of early recognition for the field of forensic nursing. The concept is based on the proposition that patient behavior deteriorating toward aggression is idiosyncratic but nevertheless reconstructable like a "signature." Once reconstructed, this signature can be used to detect "early signs" of deterioration and thus prevent violent behavior. CONCEPT: Early recognition is approached from the perspective of deteriorating behavior. Special attention is paid to the social and interpersonal factors related to the individual behaving violently. From this perspective, the thoughts, feelings, and behavior of the patient can indicate the onset of aggression, and early recognition of these warning signs can help thwart such deterioration. The aviation metaphor of a "black box" is used to emphasize the importance of attention to early warning signs. Patients in forensic care must draw upon their previous experiences (i.e., their own black boxes) to gain insight into their violent behavior and the warning signals for this. The emphasis is on the cooperation between the patient and the nurse in the application of risk management strategies. The Early Recognition Method provides an approach in which patients and nurses also gradually attune their perspectives on aggressive behavior. CONCLUSION: The concept of early recognition is important because it extends the idea of early intervention to include enabling patients to control their own behavior. Early recognition has strong practical implications for forensic nurses as it allows them to attenuate aggression by assisting patients with the detection of early warning signs.