Environmental health, economy, and amenities interactively drive migration patterns among China's older people.

The increasing number of older adult migrants is rapidly changing regional demographic and social structures in China. There is an urgent need to understand the spatial patterns and factors that influence older adults to migrate, especially the role of environmental health. However, this issue has been under-studied. This study focused on intra-provincial and inter-provincial older adult migrants as research subjects, estimated their spatial concentration index based on the iterative proportional fitting approach, and explored the factors influencing their migration using the GeoDetector Model. The results showed the following: (1) In 2015, more than 76% of inter-provincial older adult migrants were distributed in Eastern China, and most intra-provincial older adult migrants were scattered in sub-provincial cities. (2) Compared to factors relating to economy and amenities, environmental health by itself played a relatively weak role in the migration of older adults, but the interaction among environmental health, economy, and amenities was a key driving force of older adult migration. (3) There were significant differences in the dominant environmental health factors between inter-provincial migration and intra-provincial migration, which were temperature and altitude, respectively. Our findings can help policymakers focus on the composition of older adult migrants based on urban environmental health characteristics and rationally optimize older adult care facilities to promote supply-demand matching.

Broadening the Environmental Lens to Include Social and Structural Determinants of Women's Health Disparities.

BACKGROUND: Due to the physical, metabolic, and hormonal changes before, during, and after pregnancy, women-defined here as people assigned female at birth-are particularly susceptible to environmental insults. Racism, a driving force of social determinants of health, exacerbates this susceptibility by affecting exposure to both chemical and nonchemical stressors to create women's health disparities. OBJECTIVES: To better understand and address social and structural determinants of women's health disparities, the National Institute of Environmental Health Sciences (NIEHS) hosted a workshop focused on the environmental impacts on women's health disparities and reproductive health in April 2022. This commentary summarizes foundational research and unique insights shared by workshop participants, who emphasized the need to broaden the definition of the environment to include upstream social and structural determinants of health. We also summarize current challenges and recommendations, as discussed by workshop participants, to address women's environmental and reproductive health disparities. DISCUSSION: The challenges related to women's health equity, as identified by workshop attendees, included developing research approaches to better capture the social and structural environment in both human and animal studies, integrating environmental health principles into clinical care, and implementing more inclusive publishing and funding approaches. Workshop participants discussed recommendations in each of these areas that encourage interdisciplinary collaboration among researchers, clinicians, funders, publishers, and community members. https://doi.org/10.1289/EHP12996.

Racism as a public health issue in environmental health disparities and environmental justice: working toward solutions.

BACKGROUND: Environmental health research in the US has shown that racial and ethnic minorities and members of low-socioeconomic groups, are disproportionately burdened by harmful environmental exposures, in their homes, workplace, and neighborhood environments that impact their overall health and well-being. Systemic racism is a fundamental cause of these disproportionate exposures and associated health effects. To invigorate and inform current efforts on environmental justice and to raise awareness of environmental racism, the National Institute of Environmental Health Sciences (NIEHS) hosted a workshop where community leaders, academic researchers, and NIEHS staff shared perspectives and discussed ways to inform future work to address health disparities. OBJECTIVES: To share best practices learned and experienced in partnerships between academic researchers and communities that are addressing environmental racism across the US; and to outline critical needs and future actions for NIEHS, other federal agencies, and anyone who is interested in conducting or funding research that addresses environmental racism and advances health equity for all communities. DISCUSSION: Through this workshop with community leaders and researchers funded by NIEHS, we learned that partnerships between academics and communities hold great promise for addressing environmental racism; however, there are still profound obstacles. To overcome these barriers, translation of research into plain language and health-protective interventions is needed. Structural changes are also needed in current funding mechanisms and training programs across federal agencies. We also learned the importance of leveraging advances in technology to develop creative solutions that can protect public health.

The effects of cool roofs on health, environmental, and economic outcomes in rural Africa: study protocol for a community-based cluster randomized controlled trial.

BACKGROUND: High ambient air temperatures in Africa pose significant health and behavioral challenges in populations with limited access to cooling adaptations. The built environment can exacerbate heat exposure, making passive home cooling adaptations a potential method for protecting occupants against indoor heat exposure. METHODS: We are conducting a 2-year community-based stratified cluster randomized controlled trial (cRCT) implementing sunlight-reflecting roof coatings, known as "cool roofs," as a climate change adaptation intervention for passive indoor home cooling. Our primary research objective is to investigate the effects of cool roofs on health, indoor climate, economic, and behavioral outcomes in rural Burkina Faso. This cRCT is nested in the Nouna Health and Demographic Surveillance System (HDSS), a population-based dynamic cohort study of all people living in a geographically contiguous area covering 59 villages, 14305 households and 28610 individuals. We recruited 1200 participants, one woman and one man, each in 600 households in 25 villages in the Nouna HDSS. We stratified our sample by (i) village and (ii) two prevalent roof types in this area of Burkina Faso: mud brick and tin. We randomized the same number of people (12) and homes (6) in each stratum 1:1 to receiving vs. not receiving the cool roof. We are collecting outcome data on one primary endpoint - heart rate, (a measure of heat stress) and 22 secondary outcomes encompassing indoor climate parameters, blood pressure, body temperature, heat-related outcomes, blood glucose, sleep, cognition, mental health, health facility utilization, economic and productivity outcomes, mosquito count, life satisfaction, gender-based violence, and food consumption. We followed all participants for 2 years, conducting monthly home visits to collect objective and subjective outcomes. Approximately 12% of participants (n = 152) used smartwatches to continuously measure endpoints including heart rate, sleep and activity. DISCUSSION: Our study demonstrates the potential of large-scale cRCTs to evaluate novel climate change adaptation interventions and provide evidence supporting investments in heat resilience in sub-Saharan Africa. By conducting this research, we will contribute to better policies and interventions to help climate-vulnerable populations ward off the detrimental effects of extreme indoor heat on health. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00023207. Registered on April 19, 2021.

The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments.

Environmental health remains a niche topic in bioethics, despite being a prominent social determinant of health. In this paper we argue that if bioethicists are to take the project of health justice as a serious one, then we have to address environmental injustices and the threats they pose to our bioethics principles, health equity, and clinical care. To do this, we lay out three arguments supporting prioritizing environmental health in bioethics based on bioethics principles including a commitment to vulnerable populations and justice. We also highlight and advocate for environmental law efforts that align with these priorities, focusing specifically on the need for a right to a healthy environment. Our intention is to draw attention to the legal and ethical concepts that underlie the importance of a healthy environment, and urge bioethicists to prioritize both legal and ethical advocacy against environmental injustices in their practice.

Integrated environmental health assessment: Proposed approaches to exposure during chemical incidents.

An integrated environmental health exposure assessment (IEHA) refers to the integration of human biomonitoring data (HBM) and environmental measurements and aims to optimize the exposure assessment process. Due to lack of data, this approach remains an issue during chemical incidents. This study aims to explore integrated exposure approaches for assessing human health risks during chemical incidents. Based on the Preferred Reporting Items of Systematic reviews and Meta-Analyses statement, a literature analysis was performed. A level of confidence ranging from 1 to 4 was established to define the quality and strength of data used to undertake an IEHA approach. Twenty-seven articles (n = 18) and texts (n = 9) from Europe (41%) and the United States (37%) were analyzed. Among the 18 scientific articles, 61% (n = 11) presented a quantitative approach and 17% (n = 3) presented a qualitative approach. Quantitative approaches must be based on accurate data, coupled with predictive models. Of all the scientific papers, 40% (n = 7) responded to a confidence level greater than or equal to 2. Uncertainties detected through the integrated exposure approaches were related to input data, analytical methods, and HBM reference value interpretations. During chemical incidents, direct measurements were the most relevant data. Few scientific studies have developed an integrated approach during emergency situations. However, when this was used, they presented a high level of confidence by defining levels of exposure that support decision-making processes. Despite the multiple approaches, there was a lack of guidelines allowing an integrated risk assessment to be performed during an emergency chemical exposure. Integr Environ Assess Manag 2024;20:481-497. © 2023 SETAC.

Political statement of the WHO European Healthy Cities Network: towards thriving societies - advancing health in the well-being economy

Cities are drivers of innovation across public and private sectors towards enabling an economy that works for everyone. The following Political Statement has been developed through consultation with member cities and WHO European Office for Investment for Health and Development and reflects commitment to the Health and Well-Being Economy Pilot initiated by the WHO European Healthy Cities Network. The pilot aims to bring expertise together to support action in cities towards well-being economies.

Moving Forward with Reporting Back Individual Environmental Health Research Results.

BACKGROUND: The practice of reporting back individual results to participants in environmental health research has evolved significantly over the past 20 years. Research findings support the potential of report-back to enhance the ethics, quality, and impact of environmental health research. Nonetheless, implementation of environmental health report-back practices is not yet routine. OBJECTIVES: We propose a framework for institutionalizing appropriate report-back to participants of their individual results across the environmental health research enterprise. We provide a brief overview of the rationales for report-back, social science research on report-back experiences over the past two decades, and recent efforts to synthesize guidance in this field. We also describe barriers to be addressed in moving toward widespread implementation of report-back. DISCUSSION: Report-back of individual results is increasingly recognized as an ethical responsibility and essential component of impactful environmental health research. Experience shows that when personal results are returned with appropriate contextual information, report-back can increase environmental health literacy, promote individual actions, and enhance engagement in policy change. Therefore, report-back can promote environmental justice and reduce disparities in access to science. Despite this evidence base, report-back is not widely implemented. We recommend the collaborative development of guidelines, training, and resources to build capacity for appropriate report-back to study participants across the environmental health research enterprise, and we identify research priorities to advance the field. Development of tools and shared infrastructure for report-back holds promise for reducing barriers while ensuring high-quality personalized reports. Disseminating successful case studies could also advance excellence. We recommend including diverse scientific disciplines, community partners, representatives of study populations, clinicians, institutional review boards (IRBs), legal experts, public health professionals, and government officials in further developing this critical aspect of environmental health research. https://doi.org/10.1289/EHP12463.

Assessing environmental health impacts of coal mining exploitation in Iran: A Rapid Impact Assessment Matrix (RIAM) approach for environmental protection.

Environmental Impact Assessment is the process of evaluating the effects caused by a project on the environment. The outcomes generated by this assessment can lead to a reduction of the negative effects and an increase in the positive effects caused by mine projects. The present study was conducted to evaluate the environmental impact assessment of the Goliran Coal Mine in northern Iran. In the descriptive-analytical study, to achieve the objectives, observatory surveys were conducted around the coal mine using a checklist, which was about the positive and negative effects of a coal mine. Then the data were entered into the RIAM and the positive and negative effects were ranked and the most important effects were determined. In RIAM, one point is assigned to each component. 17 important activities for environmental impacts were identified using a checklist. Among the activities carried out at the coal mine site, the major ones included tunnel excavation, construction of the rail line collection and disposal of coal mine effluent, coal transportation, collection and disposal of mine tailings, and technical defects and leakage. The scores of each environmental factor were based on the four environmental components: physical/chemical, biological/ecological, social/cultural, and economic/operational. The results of the present study showed that the most negatively affected environmental components are the physical/chemical components derived from three activities; the construction of the underground tunnel; the construction of a coal transport rail line; and the actual transportation of coal extracts. The scores of each environmental factor based on the four components at the Goliran coal mine in northern Iran indicate that the highest negative score was -64, corresponding to the physical/chemical component, and was assigned to air pollution. On the other hand, the highest positive score corresponds to the economic/operational component with +54, assigned to the income that employees earn from the mine. Overall results showed that the coal mine in northern Iran had negative effects on the environment but the effects were not severe. It is suggested that for future research, corrective measures should be taken in the form of an environmental management plan to reduce the negative effects caused by coal mining, and then prospective research should be done to check the extent of reducing the negative effects.

The economy-employment-environmental health transfer and embedded inequities of China's capital metropolitan area: a mixed-methods study.

BACKGROUND: Metropolitan areas have complex trade linkages internally and externally. This complexity stimulates the unequal spatial transfer of environmental health consequences, economy, and employment embodied in internal trade or trade with the outside regions, resulting in unequal exchange. Existing research has rarely discussed this issue at a refined scale, hindering targeted inequity alleviation policies. METHODS: We conducted a mixed-methods study, focusing on the most polluted metropolitan area in the world, the Beijing-Tianjin-Hebei region of China, and developed an integrated modelling framework to downscale the analysis of the trade-driven unequal transfer of PM2·5- related premature deaths, value added, and job opportunities to the city scale within Beijing-Tianjin-Hebei. The study couples a nested Multi-Regional Input-Output model table containing data from 13 Beijing-Tianjin-Hebei cities and 28 outer provinces in 2017 with a bottom-up emission inventory, value added and employment statistical data, the Weather Research and Forecasting-Comprehensive Air Quality Model with Extensions, the Global Exposure Mortality Model, and human capital methods. We also constructed two indices measuring unequal exchanges between PM2·5-related deaths and economic and employment gains embodied in trades between cities in Beijing-Tianjin-Hebei and trades with outside regions. FINDINGS: The Beijing-Tianjin-Hebei region as a single entity shifted 14 985 (95% CI 12 800-16 948) net deaths to regions outside the Beijing-Tianjin-Hebei through trade, most of which occurred in the central region of China. The industrial-based peripheral Beijing-Tianjin-Hebei cities suffered the most serious inequities when trading with other Beijing-Tianjin-Hebei cities and outside regions. While gaining equivalent local jobs, these industrial-based peripheral cities had 250% higher PM2·5-related deaths (10·2 PM2·5-related deaths for obtaining 1000 local jobs) than core cities (2·9 PM2·5-related deaths for obtaining 1000 local jobs) and 57·7% higher PM2·5-related deaths than agricultural-based peripheral cities (6·5 PM2·5-related deaths for obtaining 1000 local jobs). While gaining equivalent value added, industrial-based peripheral cities had 50·6% higher PM2·5-related deaths (¥13·9 of reduced human capital due to PM2·5-related premature deaths to obtain ¥1000 local value added) than core cities (¥9·2 of reduced human capital due to PM2·5-related premature deaths to obtain ¥1000 local value added) and 67·4% higher PM2·5-related deaths than agricultural-based peripheral cities (¥8·3 of reduced human capital due to PM2·5-related premature deaths to obtain ¥1000 local value added). INTERPRETATION: Treating metropolitan areas as a single entity obscured internal heterogeneity, potentially misleading policy makers into imposing strict regulations on the whole metropolitan area to alleviate the inequities it posed on outside regions. However, several peripheral Beijing-Tianjin-Hebei cities were disadvantaged in their trade with core Beijing-Tianjin-Hebei cities and outside regions. Therefore, policies should be tailored for particular cities within metropolitan areas. Future targeted policies should include, but not be limited to, making ecological compensations and incorporating the environment and health costs into the price of pollution-intensive goods and services. FUNDING: National Key Research and Devlopment Program of China, National Natural Science Foundation of China, and Jiangsu Natural Science Foundation.

Using the Doughnut Economics framework to structure whole-system thinking in socioecological wellbeing with multidisciplinary stakeholders: an applied case study in Glasgow, Scotland.

BACKGROUND: Human and environmental health are inseparable and interdependent. Doughnut Economics is a conceptual framework combining the Sustainable Development Goals with Planetary Boundaries, thereby simultaneously considering human and planetary wellbeing. The vision is to "meet the needs of all people within the means of the living planet, for the benefit of both current and future generations". Glasgow City Council has committed to becoming a Green Wellbeing Economy, with a socially just transition to Net Zero by 2030. Through our City-University partnership, we are exploring whether Doughnut Economics can drive transformative action towards a sustainable, healthy, and equitable future. METHODS: Glasgow is a pilot site for the C40 Cities' Thriving City Portrait methodology that downscales Doughnut Economics to cities. The Portrait process combined desk-based research and policy review (from January to April, 2022) with participatory workshops to enrich initial findings. The five participatory workshops took place between April, 2022, and February, 2023, and involved about 130 stakeholders. Participants included civil servants, politicians, scientists, community representatives, employees and representatives of private and third-sector organisations, and social enterprises, identified through an iterative stakeholder mapping process with City Council partners. Workshop aims were to create pluralistic definitions of what thriving means for each of the Doughnut's social and ecological dimensions. Ethics approval for the study was granted by The University of Glasgow, College of Medical Veterinary and Life Sciences. FINDINGS: The workshops produced a shared, holistic vision for Glasgow's future as a thriving city. The Doughnut demonstrated potential as a tool for both understanding the city's socioecological impacts, and as a compass by which the city might set its policy agenda. It allows the multiple goals and priorities of a city system to congregate around a cohesive goal. The Portrait process led to a widening of stakeholders' perspectives, applying systems thinking to policy priorities, cross-sector discussion and collaboration, and significant buy-in from a diverse range of changemakers. INTERPRETATION: The Doughnut framework offered a starting point for Public and Planetary Health researchers to understand connections, co-benefits and trade-offs across different parts of the policy and intervention system. Applying this framework in cities could generate support for whole-system interventions and sustainable solutions to the complex and interconnected climate and social challenges we face. One of the limitations is that we do not yet know whether stakeholders can translate support for this co-created framework into tangible whole-systems action. FUNDING: UKRI Natural Environment Research Council and University of Glasgow.

Optimizing cropping systems to close the gap between economic profitability and environmental health.

Supporting food security while maintaining ecosystem sustainability is one of the most important global challenges for humanity. Optimization of cropping systems is expected to promote the ecosystem services of agroecosystems. Yet, how and why cropping system influences the trade-offs between economic profitability and multiple ecosystem services remain poorly understood. We investigate the influence of six cropping systems on trade-offs between economic profitability and multiple ecosystem services after considering 36 agricultural ecosystem properties using field experiment data from 2020 to 2022. We show that designing cropping system is a critical tool to closing the gap between ecosystem sustainability and commercial profitability. Cropping system with three harvests within 2 yr had higher performance in overall ecosystem multiple services through enhancement of supporting, regulating, and economic performance without compromising provisioning compared with four other systems. These systems diminished the trade-off among multiple services, resulting in a 'win-win' situation for economics and multiple services. By contrast, the monoculture and double cropping systems lead to a strong trade-off between pairwise services including ecosystem health and profitability. Our work illustrates the substantial potential of rotation systems with three harvests within 2 yr in enforcing ecosystem services and closing the trade-offs among multiple agricultural ecosystem services.

Investing in Retail Food Safety: Assessing the NEHA-FDA Retail Flexible Funding Model Grant Program's Distribution Through an SDOH Lens.

Social Determinants of Health (SDOH) have a major impact on community health and quality of life. Healthy People 2030 has an increased focus on SDOH, given their contribution to health disparities and inequalities as a social phenomenon. Despite advances in food hygiene and sanitation, structural disparities related to SDOH leave food systems vulnerable. The Voluntary National Retail Food Regulatory Program Standards (VNRFRPS), otherwise known as the Retail Program Standards initiative is part of the Food and Drug Administration (FDA)'s strategy for prevention-based food safety to reduce foodborne illness. The National Environmental Health Association (NEHA) and the U.S. Food and Drug Administration (FDA) work in partnership to administer the NEHA-FDA Retail Flexible Funding Model (RFFM) Grant Program. The program provides funding to State, Local, Tribal, and Territorial (SLTT) retail food regulatory agencies as they achieve and advance conformance with the VNRFRPS. In its first year (Calendar Year 2022) of the 3-year cycle, the grant program awarded $6.87M in funding to over 200 jurisdictions nationwide. The research note shares preliminary findings of utilizing Geographic Information Systems (GIS) to map the first-year SLTT grant program awardees, with a selection of their jurisdiction's Social Determinants of Health (SDOH) metrics. Integration and analysis of program-specific grant funding and mapping with the relevant health determinants provide an opportunity to understand further the need for comprehensive program investments for greater impact and improvements in public health.