Study of citizen satisfaction and loyalty in the urban area of Guayaquil: Perspective of the quality of public services applying structural equations.

This study investigates the satisfaction and adequacy of citizens through the expected quality and perceived quality in the areas of planning and territorial viability, experience in the provision of municipal services and citizen experience in environmental issues, in order to provide tools for territorial decision making for the citizens' well-being. In our research PLS software is used for the analysis of hypotheses. A questionnaire was delivered to a sample of 521 citizens, representing the spectrum of the population, and the statistical study of the responses yielded results on citizen satisfaction and loyalty. Our research includes the study of moderating effects on the causal ratio of perceived value and satisfaction in territorial planning and viability, the perceived quality in the provision of municipal services and the perceived quality in the citizen experience in the environmental management of the territory on the value relationship perceived by the citizen and general satisfaction. A second objective of the study is to see if there are significant differences in the hypotheses raised by gender by performing a multigroup analysis. This difference has been appreciated in two of the hypotheses. The study shows that the policies exercised by the territorial managers of the different areas have a significant influence on the value perceived by citizens, satisfaction and loyalty, which shape their general well-being. Areas for improvement in territorial policies and municipal services such as citizen security, air quality, public lighting and sports services have been identified. Knowing these shortcomings allows politicians to focus their efforts on improving the quality of life in cities.

Enhancing Sustainability and Resilience through Multi-Level Infrastructure Planning.

Resilient planning demands not only resilient actions, but also resilient implementation, which promotes adaptive capacity for the attainment of the planned objectives. This requires, in the case of multi-level infrastructure systems, the simultaneous pursuit of bottom-up infrastructure planning for the promotion of adaptive capacity, and of top-down approaches for the achievement of global objectives and the reduction of structural vulnerabilities and imbalances. Though several authors have pointed out the need to balance bottom-up flexibility with top-down hierarchical control for better plan implementation, very few methods have yet been developed with this aim, least of all with a multi-objective perspective. This work addressed this lack by including, for the first time, the mitigation of urban vulnerability, the improvement of road network condition, and the minimization of the economic cost as objectives in a resilient planning process in which both actions and their implementation are planned for a controlled, sustainable development. Building on Urban planning support system (UPSS), a previously developed planning tool, the improved planning support system affords a planning alternative over the Spanish road network, with the best multi-objective balance between optimization, risk, and opportunity. The planning process then formalizes local adaptive capacity as the capacity to vary the selected planning alternative within certain limits, and global risk control as the duties that should be achieved in exchange. Finally, by means of multi-objective optimization, the method reveals the multi-objective trade-offs between local opportunity, global risk, and rights and duties at local scale, thus providing deeper understanding for better informed decision-making.

Examining the distributional equity of urban tree canopy cover and ecosystem services across United States cities.

Examining the distributional equity of urban tree canopy cover (UTCC) has increasingly become an important interdisciplinary focus of ecologists and social scientists working within the field of environmental justice. However, while UTCC may serve as a useful proxy for the benefits provided by the urban forest, it is ultimately not a direct measure. In this study, we quantified the monetary value of multiple ecosystem services (ESD) provisioned by urban forests across nine U.S. cities. Next, we examined the distributional equity of UTCC and ESD using a number of commonly investigated socioeconomic variables. Based on trends in the literature, we predicted that UTCC and ESD would be positively associated with the variables median income and percent with an undergraduate degree and negatively associated with the variables percent minority, percent poverty, percent without a high school degree, percent renters, median year home built, and population density. We also predicted that there would be differences in the relationships between each response variable (UTCC and ESD) and the suite of socioeconomic predictor variables examined because of differences in how each response variable is derived. We utilized methods promoted within the environmental justice literature, including a multi-city comparative analysis, the incorporation of high-resolution social and environmental datasets, and the use of spatially explicit models. Patterns between the socioeconomic variables and UTCC and ESD did not consistently support our predictions, highlighting that inequities are generally not universal but rather context dependent. Our results also illustrated that although the variables UTCC and ESD had largely similar relationships with the predictor variables, differences did occur between them. Future distributional equity research should move beyond the use of proxies for environmental amenities when possible while making sure to consider that the use of ecosystem service estimates may result in different patterns with socioeconomic variables of interest. Based on our findings, we conclude that understanding and remedying the challenges associated with inequities requires an understanding of the local social-ecological system if larger sustainability goals are to be achieved.

Aging in Place in Gentrifying Neighborhoods: Implications for Physical and Mental Health.

Background and Objectives: In the United States, the older adult population and the proportion of neighborhoods experiencing gentrification are both growing. However, there is limited scholarship on the effects of gentrification on older adults, with most work focusing on those who leave rather than stay. This study examines the effects of remaining in a gentrifying neighborhood on older adults' self-rated health and mental health, with particular attention to outcomes for those who are economically vulnerable. Research Design and Methods: Data are from 6,810 community-dwelling respondents in metropolitan areas from the first wave of the National Health & Aging Trends Study combined with the 1970-2010 National Neighborhood Change Database. We estimate the effects of gentrification on self-rated health and mental health separately using a quasi-experimental approach and comparing two methods: matching design and linear regression. Results: Economically vulnerable older adults in gentrifying neighborhoods reported higher self-rated health than economically vulnerable older adults in low-income neighborhoods. Both economically vulnerable and higher-income older adults in gentrifying neighborhoods had more depression and anxiety symptoms than those living in more affluent areas. Higher-income older adults in gentrifying neighborhoods had poorer mental health than their counterparts in low-income neighborhoods. Discussion and Implications: Findings call attention to the complexity of gentrification, and the need for more research examining how the intersection of neighborhood and individual characteristics influences older adults' health. Results reinforce the need for neighborhood-level interventions as well as relocation support to promote health in later life and caution against an overemphasis on aging in place.

Short- and Long-Term Impacts of Neighborhood Built Environment on Self-Rated Health of Older Adults.

Background and Objectives: Proximity to health care, healthy foods, and recreation is linked to improved health in older adults while deterioration of the built environment is a risk factor for poor health. Yet, it remains unclear whether individuals prone to good health self-select into favorable built environments and how long-term exposure to deteriorated environments impacts health. This study uses a longitudinal framework to address these questions. Research Design and Methods: The study analyzes 3,240 Americans aged 45 or older from the Panel Study of Income Dynamics with good self-reported health at baseline, and follows them from 1999 to 2013. At each biennial survey wave, individual data are combined with data on services in the neighborhood of residence (defined as the zip code) from the Economic Census. The analysis overcomes the problem of residential self-selection by employing marginal structural models and inverse probability of treatment weights. Results: Logistic regression estimates indicate that long-term exposure to neighborhood built environments that lack health-supportive services (e.g., physicians, pharmacies, grocery stores, senior centers, and recreational facilities) and are commercially declined (i.e., have a high density of liquor stores, pawn shops, and fast food outlets) increases the risk of fair/poor self-rated health compared to more average neighborhoods. Short-term exposure to the same environments as compared to average neighborhoods has no bearing on self-rated health after adjusting for self-selection. Discussion and Implications: Results highlight the importance of expanding individuals' access to health-supportive services prior to their reaching old age, and expanding access for people unlikely to attain residence in service-dense neighborhoods.

[Health impact assessment methodology for urban planning projects in Andalusia (Spain)]. / Metodología de la valoración del impacto en salud de instrumentos de planeamiento urbanístico en Andalucía.

OBJECTIVE: To describe the tool developed in Andalusia (Spain) to conduct an analysis and prospective assessment of health impacts from urban planning projects as well as the process followed to design it. METHOD: On the one hand, direct and indirect relationships between urban setting and health were identified in light of the best scientific evidence available; and, on the other hand, methods and tools in impact assessment were reviewed. After the design of the tool, it was tested via both internal and external validation processes (meetings, workshops and interviews with key informants). RESULTS: The tool consists of seven phases, structured in two stages. A first descriptive stage shows how to obtain information about goals, objectives and general points pertaining the project and also to characterise the potentially affected population. The second one indicates, in several phases, how to identify and sort out potential impacts from the project using different supporting tools. CONCLUSIONS: Both in the testing phase and through its implementation since the entry into force of Andalusian Decree 169/2014 (16 June 2015) and forced all urban planning projects to be subjected to an Health Impact Assessment, this methodology has proved responsive, identifying major potential health impacts from the measures included in those projects. However, the tool has been shaped as a living tool and will be adapted in line with the experience acquired in its use.

Geospatial analysis and distribution patterns of home nursing care in a metropolitan area - a large-scale analysis.

AIMS: This study focuses on home nursing care distribution in an urban setting in Germany. BACKGROUND: A shortage of nursing care workforce is present in Germany. METHODS: A geospatial analysis was performed to examine distribution patterns at the district level in Frankfurt, Germany (n = 46 districts) and factors were analysed influencing the location choice of home nursing care providers (n = 151). Furthermore, within the analysis we focused on the population aged over 65 years to model the demand for nursing care. RESULTS: The analysis revealed a tendency of home nursing care providers to be located near the city centre (centripetal distribution pattern). However, the demand for care showed more inconsistent patterns. Still, a centripetal distribution pattern of demand could be stated. Compared with the control groups (e.g. acute hospitals and pharmacies) similar geographical distribution patterns were present. However, the location of home nursing care providers was less influenced by demand compared with the control groups. CONCLUSION: The supply of nursing care was unevenly distributed in this metropolitan setting, but still matched the demand for nursing care. IMPLICATION FOR NURSING MANAGEMENT: Due to the rapidly changing health care environments policy, regulations must be (re-)evaluated critically to improve the management and delivery of nursing care provision.

Associations between active living-oriented zoning and no adult leisure-time physical activity in the U.S.

Nearly one-third of adults report no leisure-time physical activity (LTPA). Governmental and authoritative bodies recognize the role that community design through zoning code changes can play in enabling LTPA. This study examined the association between zoning and no adult LTPA in the U.S. This study was conducted between 2012 and 2016, with analyses occurring in 2015-2016. Zoning codes effective as of 2010 were compiled for jurisdictions located in the 495 most populous U.S. counties and were evaluated for pedestrian-oriented code reform zoning, 11 active living-oriented provisions (e.g., sidewalks, bike-pedestrian connectivity, mixed use, bike lanes) and a summated zoning scale (max=12). Individual-level LTPA data were obtained from the 2012 CDC Behavioral Risk Factor Surveillance System (BRFSS). County-aggregated, population-weighted zoning variables were constructed for linking to BRFSS. Log-log multivariate regressions (N=147,517 adults), controlling for individual and county characteristics and with robust standard errors clustered on county, were conducted to examine associations between zoning and no LTPA. Relative risks (RR) compared predicted lack of LTPA at 0% and 100% county-level population exposure to each zoning predictor. Zoning code reforms were associated with a 13% lower probability of no LTPA (RR: 0.87, 95% CI: 0.82-0.92). Except for crosswalks, all zoning provisions were associated with an 11-16% lower probability of no LTPA. Having all 12 zoning provisions was associated with a 22% lower probability of no LTPA (RR: 0.78, 95% CI: 0.72-0.83). The results suggest that active living-oriented zoning is a policy lever available to communities seeking to reduce rates of no LTPA.

Measuring policy and related effects of a health impact assessment related to connectivity.

Health Impact Assessments are an important tool to help policymakers perceive the potential positive and negative contributions of decisions to public health. While they have been increasingly used in the United States, studies have not examined intermediate effects. Using key stakeholder interviews, this manuscript examines policy outcomes and other related effects of the HIA 21months after completing a Health Impact Assessment Report around connectivity policy. Further, it reflects on the measurement of these effects as part of the monitoring and evaluation stage of the Health Impact Assessment process.

Plan de acción Panamá ciudad sostenible: hacia una gestión moderna e integral de la planificación urbana / Panama sustainable city action plan: towards a modern and comprehensive management of urban planning

Este Plan de Acción, titulado "Panamá Ciudad Sostenible", es el resultado de un esfuerzo conjunto entre los responsables de la Alcaldía de la Ciudad de Panamá y la Iniciativa de Ciudades Emergentes y Sostenibles (ICES) del BID. La elaboración de este Plan también ha contado con la participación de representantes del Gobierno de la República de Panamá, de los alcaldes de los municipios que conforman el Área Metropolitana de Ciudad de Panamá, de actores privados, y de la sociedad civil de la ciudad, entre otros, sin cuya contribución no hubiese sido posible la realización de este trabajo. La implementación de la metodología ICES en el Área Metropolitana de Ciudad de Panamá representa una apuesta que hace el BID para una planificación sustentable, que se suma y complementa con otros procesos de planificación urbanos y sectoriales que se dan en la ciudad, tales como el Plan Integrado de Movilidad Urbana Sostenible (fases I y II) y la actualización del Plan Metropolitano. En consecuencia, este Plan de Acción construye sobre estos trabajos y otras iniciativas realizadas en el Área Metropolitana de Ciudad de Panamá, aportando nuevos insumos para la planificación integral y multisectorial, como el análisis del crecimiento histórico de la huella urbana y prospectiva de expansión futura, la valoración del territorio mediante diversos indicadores comparativos, y el conocimiento de las inquietudes y anhelos de los panameños a través de una encuesta de opinión pública, entre otros. Mediante el relato del trabajo desarrollado durante 12 meses en las distintas etapas de implementación de la metodología ICES, este documento resume los resultados del diagnóstico sectorial y territorial, plantea los principales retos para la sostenibilidad, y presenta las estrategias y acciones acordadas para abordar estos desafíos. El Municipio de Panamá y el BID esperan que este Plan de Acción se pueda constituir en una hoja de ruta de corto, mediano y largo plazo para el desarrollo sostenible de Ciudad de Panamá. La transformación positiva del territorio dependerá, sin embargo, del esfuerzo y la cooperación de los gobiernos municipales, sus ciudadanos, sus organizaciones de la sociedad civil, sus empresarios, junto al apoyo del Gobierno Nacional. El proceso de formulación del Plan de Acción ha buscado contribuir a ese proceso de diálogo, colaboración y coordinación entre diversos actores metropolitanos, que asumen cada vez con mayor fuerza el sentido de un futuro compartido.

Municipios, comunas y comunidades saludables: orientaciones técnicas / Healthy municipalities, communes and communities: technical guidelines

En el marco de las prioridades gubernamentales, la evidencia nacional e internacional de los determinantes sociales de la salud y el reimpulso de Salud en Todas las Políticas que señalan la importancia de abordar las causas que producen las inequidades en salud y teniendo en consideración que las intervenciones eficaces y costo efectivas son las que se enfocan en medidas estructurales, en las primeras etapas de la vida para alcanzar mejores resultados en salud, calidad de vida y equidad. Desde esta perspectiva, el Ministerio de Salud actualiza su compromiso con las Estrategias de Promoción de la Salud planteando desafíos y énfasis para los próximos años. Del mismo modo, considerando los resultados de estudios epidemiológicos, estadísticas vitales, monitoreo y evaluación de los planes comunales de Promoción de Salud, se han definido los énfasis para esta nueva etapa de consolidación de la estrategia de promoción de salud en el nivel comunal a través de la Estrategia de Municipios, Comunas y Comunidades Saludables como parte vital del plan de acción y reformulación del Programa de Promoción de la Salud en Chile. (1) El fortalecimiento de las funciones esenciales de salud pública: promoción de la salud y participación ciudadana, junto con las crecientes inequidades producto de las desigualdades, desafían a Chile a avanzar hacia una mirada profunda de la salud pública, que no sólo se centre en la reorientación de los servicios, sino que logre efectivamente impactar en las condiciones que generan y reproducen las inequidades en salud. Por lo tanto, el desafío es avanzar en un enfoque basado en el desarrollo comunitario, concordante con los principios básicos del enfoque de determinantes sociales de la salud y brechas de equidad persistentes En consecuencia, a través de la Estrategia Municipios, Comunas y Comunidades Saludables se propicia alcanzar el reconocimiento formal de la promoción de la salud en los Municipios, en base a la alianza de salud y desarrollo local donde los gobiernos comunales, junto a la comunidad, se empoderen con el fin de generar políticas públicas saludables para la población con pertinencia territorial y cultural, apuntado a lograr la construcción de entornos saludables donde las personas viven, trabajan, crean redes, establecen vínculos con otras personas y con el medio ambiente. Cabe destacar, que en el nivel local el propósito es contribuir al diseño de políticas públicas y programas intersectoriales, en la dirección de salud en todas las políticas que creen entornos saludables, a través de instrumentos de gestión territorial, tales como Planes de Desarrollo Comunal, Planos reguladores, presupuestos Municipales, ordenanzas municipales, decretos alcaldicios, entre otros, con intervenciones en los distintos componentes de salud pública. Asimismo, se promueve el fortalecimiento de la gestión pública participativa, mediante la capacitación de dirigentes sociales para el ejercicio de la ciudadanía en salud y la implementación de mecanismos de participación social, que permita la construcción colectiva y ejecución de un Plan Trienal de Municipios, Comunas y Comunidades Saludables.

Toward improved public health outcomes from urban nature.

There is mounting concern for the health of urban populations as cities expand at an unprecedented rate. Urban green spaces provide settings for a remarkable range of physical and mental health benefits, and pioneering health policy is recognizing nature as a cost-effective tool for planning healthy cities. Despite this, limited information on how specific elements of nature deliver health outcomes restricts its use for enhancing population health. We articulate a framework for identifying direct and indirect causal pathways through which nature delivers health benefits, and highlight current evidence. We see a need for a bold new research agenda founded on testing causality that transcends disciplinary boundaries between ecology and health. This will lead to cost-effective and tailored solutions that could enhance population health and reduce health inequalities.

The evolution of the sustainability assessment tool SBToolPT: from buildings to the built environment.

This paper analyses the current trends in sustainability assessment. After about 15 years from the launch of sustainability assessment tools, focused on buildings evaluation, the paradigm of sustainability assessment tools is changing from the building scale to the built environment scale. Currently European cities and cities around the world are concerned with sustainable development, as well as its evolution. Cities seek a way to adapt to contemporary changes, in order to meet the required needs and ensure population's well-being. Considering this, the new generations of sustainability assessment tools are being developed to be used to guide and help cities and urban areas to become more sustainable. Following the trend of the most important sustainability assessment tools, the sustainability assessment tool SBTool(PT) is also developing its version for assessing the sustainability of the built environment, namely, the urban planning projects and the urban regeneration projects, to be developed in Portugal, the SBTool(PT)-UP. The application of the methodology to three case studies will demonstrate its feasibility; at the same time this will identify the best practices which will serve as reference for new projects, thereby assisting the development of the tool.

Reconnecting urban planning with health: a protocol for the development and validation of national liveability indicators associated with noncommunicable disease risk behaviours and health outcomes.

AIM: Liveable communities create the conditions to optimise health and wellbeing outcomes in residents by influencing various social determinants of health - for example, neighbourhood walkability and access to public transport, public open space, local amenities, and social and community facilities. This study will develop national liveability indicators that are (a) aligned with state and federal urban policy, (b) developed using national data (where available), (c) standard and consistent over time, (d) suitable for monitoring progress towards creating more liveable, equitable and sustainable communities, (e) validated against selected noncommunicable disease risk behaviours and/or health outcomes, and (f) practical for measuring local, national and federal built environment interventions. STUDY TYPE: Protocol. METHOD: Over two years, the National Liveability Study, funded through The Australian Prevention Partnership Centre (TAPPC), will develop and validate a national set of spatially derived built environment liveability indicators related to noncommunicable disease risk behaviours and/or health outcomes, informed by a review of relevant policies in selected Australian state and territory governments. To create national indicators, we will compare measures developed using national data with finer-grained state-level data, which have been validated against a range of outcomes. Finally, we will explore the creation of a national database of built environment spatial indicators. RESULTS: A national advisory group comprising stakeholders in state and federal government, federal nongovernment organisations and state-based technical working groups located in the ACT, Victoria, NSW, Queensland and WA has been established; a policy analysis is under way and work programs are being prepared. CONCLUSION: This project seeks to build the capacity for built environment and health systems research by developing national indicators to monitor progress towards creating healthy and liveable communities. This ambition requires multisector engagement and an interdisciplinary research team.

Promoting active living in healthy cities of Europe.

Local governments in Europe have a vital role in promoting physical activity in the daily life of citizens. However, explicit investment in active living has been limited. One of the four core themes for Phase IV (2003-2008) of the World Health Organization (WHO) European Healthy Cities Network (WHO-EHCN) was to encourage local governments and their partners to implement programs in favor of active living. This study analyzes the performance of network cities during this period. Responses to a general evaluation questionnaire are analyzed by content according to a checklist, and categorized into themes and dimensions. Most cities viewed "active living" as an important issue for urban planning; to improve visual appeal, enhance social cohesion, create a more sustainable transport system to promote walkability and cyclability and to reduce inequalities in public health. Almost all member cities reported on existing policies that support the promotion of active living. However, only eight (of the 59) responding cities mentioned an integrated framework specific for active living. Many efforts to promote active living are nested in programs to prevent obesity among adults or children. Future challenges include establishing integrated policies specifically for active living, introducing a larger range of actions, as well as increasing funding and capacity to make a difference at the population level.

Urban planning for healthy cities. A review of the progress of the European Healthy Cities Programme.

The purpose of this paper is to evaluate the progress made by European cities in relation to Healthy Urban Planning (HUP) during Phase IV of the World Health Organization's Healthy Cities programme (2003-2008). The introduction sets out the general principle of HUP, identifying three levels or phases of health and planning integration. This leads on to a more specific analysis of the processes and substance of HUP, which provide criteria for assessment of progress. The assessment itself relies on two sources of data provided by the municipalities: the Annual Review Templates (ARTs) 2008 and the response to the Phase IV General Evaluation Questionnaire. The findings indicate that the evidence from different sources and questions in different sections are encouragingly consistent. The number of cities achieving a good level of understanding and activity in HUP has risen very substantially over the period. In particular, those achieving effective strategic integration of health and planning have increased. A key challenge for the future will be to develop planning frameworks which advance public health concerns in a spatial policy context driven often by market forces. A health in all policies approach could be valuable.

Investigating the impact of a smart growth community on the contexts of children's physical activity using Ecological Momentary Assessment.

This quasi-experimental research used Ecological Momentary Assessment with electronic surveys delivered through mobile phones to determine whether children change the type of contexts (i.e., settings) where they engage in physical activity after a recent move to a smart growth (SG) community in the U.S. as compared to children living in conventional low-to-medium density U.S. suburban communities (controls). SG vs. control children engaged in a greater proportion of physical activity bouts with friends, a few blocks from home, and at locations to which they walked. Over six months, the proportion of physical activity bouts reported at home (indoors) and in high traffic locations decreased among SG but not control children. Six-month increases in daily moderate-to-vigorous physical activity did not significantly differ by group. Children might have altered the type of contexts where they engage in physical activity after moving to SG communities, yet more time may be necessary for these changes to impact overall physical activity.

Page Avenue health impact assessment: building on diverse partnerships and evidence to promote a healthy community.

The Page Avenue health impact assessment (HIA) was focused on a redevelopment in Missouri. This case study describes a comprehensive HIA led by an interdisciplinary academic team with community partners, as well as compliance with North American HIA Practice Standards. Some of the key lessons learned included: (1) interdisciplinary teams are valuable but they require flexibility and organization; (2) engaging community stakeholders and decision-makers prior to, during, and following the HIA is critical to a successful HIA; and (3) HIA teams should not be too closely affiliated with decision-makers. It is hoped that this case study will inform future HIAs.