Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica.

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of mortality across the Caribbean and similar regions. Structural determinants include a marked increase in the dependency on food imports, and the proliferation of processed foods, including sugar-sweetened beverages (SSBs). We focused on Jamaica as a case study and the health challenge of SSBs, and situated contemporary actions, experiences and policies within their historical context to investigate underlying drivers of commercial determinants of health and attempts to counter them. We asked: how can a historical perspective of the drivers of high level SSB consumption in Jamaica contribute to an enhanced understanding of the context of public health policies aimed at reducing their intake? METHODS: An ethnographic approach with remote data collection included online semi-structured interviews and workshops with 22 local experts and practitioners of health, agriculture and nutrition in Jamaica and attending relevant regional public webinars on SSBs and NCD action in the Caribbean. Our analysis was situated within a review of historical studies of Caribbean food economies with focus on the twentieth century. Jamaican and UK-based researchers collected and ethnographically analysed the data, and discussed findings with the wider transdisciplinary team. RESULTS: We emphasise three key areas in which historical events have shaped contextual factors of SSB consumption. Trade privileged sugar as a cash crop over food production during Jamaica's long colonial history, and trade deregulation since the 1980s through structural adjustment opened markets to transnational companies. These changes increased Jamaican receptiveness to the mass advertisement and marketing of these companies, whilst long-standing power imbalances hampered taxation and regulation in contemporary public health actions. Civil society efforts were important for promoting structural changes to curb overconsumption of SSBs and decentring such entrenched power relations. CONCLUSION: The contemporary challenge of SSBs in Jamaica is a poignant case study of commercial determinants of health and the important context of global market-driven economies and the involvement of private sector interests in public health policies and governance. Historically contextualising these determinants is paramount to making sense of the sugar ecology in Jamaica today and can help elucidate entrenched power dynamics and their key actors.

Digital competence and psychological wellbeing in a social housing community: a repeated survey study.

BACKGROUND: Little is known about whether digital competence is related to psychological wellbeing, with most previous research focusing on students and elderly people. There is also limited evidence on seasonal changes in psychological wellbeing, particularly in specific groups. Social housing residents are an underserved and under-researched population. The objectives of this study were to explore associations between digital competence (assessed by general technology self-efficacy) and psychological wellbeing (assessed by mental wellbeing and life satisfaction), and to explore seasonal effects, in social housing residents. METHODS: A repeated survey design was used. The Happiness Pulse questionnaire with a bespoke digital module was sent via post or e-mail at four timepoints between July 2021 and July 2022 to 167 social housing residents in West Cornwall, England. There were 110 respondents in total; thirty completed all four questionnaires and 59 completed an autumn/winter and summer questionnaire. Data were analysed using descriptive and inferential methods including regression, repeated measures analysis of variance and panel analysis. RESULTS: Significant positive associations were found between digital self-efficacy and mental wellbeing, and between digital self-efficacy and life satisfaction. However, there were no significant seasonal changes in psychological wellbeing. CONCLUSIONS: The findings extend the existing literature beyond student and elderly populations and suggest that improving digital competence is a potential pathway to improving psychological wellbeing. Surveys with larger samples and qualitative studies are needed to elucidate the mechanisms involved.

The Physical Activity Wearables in the Police Force (PAW-Force) study: acceptability and impact.

BACKGROUND: Policing is a highly stressful and increasingly sedentary occupation. The study aim was to assess the acceptability and impact of a mobile health (mHealth) technology intervention (Fitbit® activity monitor and 'Bupa Boost' smartphone app) to promote physical activity (PA) and reduce sedentary time in the police force. METHODS: Single-group, pre-post, mixed methods pilot study. Police officers and staff (n = 180) were recruited from two police forces in South West England. Participants used the technology for 12 weeks (an 'individual' then 'social' phase) followed by 5 months of optional use. Data sources included Fitbit®-recorded objective step count, questionnaire surveys and semi-structured interviews (n = 32). Outcome assessment points were baseline (week 0), mid-intervention (week 6), post-intervention (week 12) and follow-up (month 8). Paired t-tests were used to investigate changes in quantitative outcomes. Qualitative analysis involved framework and thematic analysis. RESULTS: Changes in mean daily step count were non-significant (p > 0.05), but self-reported PA increased in the short term (e.g. + 465.4 MET-minutes/week total PA baseline to week 12, p = 0.011) and longer term (e.g. + 420.5 MET-minutes/week moderate-to-vigorous PA baseline to month 8, p = 0.024). The greatest impact on behaviour was perceived by less active officers and staff. There were no significant changes in sedentary time; the qualitative findings highlighted the importance of context and external influences on behaviour. There were no statistically significant changes (all p-values > 0.05) in any secondary outcomes (physical and mental health-related quality of life, perceived stress and perceived productivity), with the exception of an improvement in mental health-related quality of life (SF-12 mental component score + 1.75 points, p = 0.020) from baseline to month 8. Engagement with and perceived acceptability of the intervention was high overall, but a small number of participants reported negative physical (skin irritation) and psychological (feelings of guilt and anxiety) consequences of technology use. Individual app features (such as goal-setting and self-monitoring) were generally preferred to social components (social comparison, competitions and support). CONCLUSIONS: mHealth technology is an acceptable and potentially impactful intervention for increasing PA in the police force. The intervention was less useful for reducing sedentary time and the impact on secondary outcomes is unclear. TRIAL REGISTRATION: NCT03169179 (registered 30th May 2017).

Social cohesion, mental wellbeing and health-related quality of life among a cohort of social housing residents in Cornwall: a cross sectional study.

BACKGROUND: Research and policy have identified social cohesion as a potentially modifiable determinant of health and wellbeing that could contribute to more sustainable development. However, the function of social cohesion appears to vary between communities. The aim of this study was to analyse the levels of, and associations, between social cohesion, mental wellbeing, and physical and mental health-related quality of life among a cohort of social housing residents from low socioeconomic status communities in Cornwall, UK. Social housing is below market-rate rental accommodation made available to those in certain health or economic circumstances. These circumstances may impact on the form and function of social cohesion. METHODS: During recruitment, participants in the Smartline project completed the Short Warwick-Edinburgh Mental Wellbeing Scale, SF-12v2 and an eight item social cohesion scale. Cross sectional regression analyses of these data adjusted for gender, age, national identity, area socioeconomic status, rurality, education, employment, and household size were undertaken to address the study aim. RESULTS: Complete data were available from 305 (92.7%) participants in the Smartline project. Univariable analyses identified a significant association between social cohesion, mental wellbeing and mental health-related quality of life. Within fully adjusted multivariable models, social cohesion only remained significantly associated with mental wellbeing. Sensitivity analyses additionally adjusting for ethnicity and duration of residence, where there was greater missing data, did not alter the findings. CONCLUSIONS: Among a relatively homogeneous cohort, the reported level of social cohesion was only found to be significantly associated with higher mental wellbeing, not physical or mental health-related quality of life. The efforts made by social housing providers to offer social opportunities to all their residents regardless of individual physical or mental health state may support the development of a certain degree of social cohesion. Sense of control or safety in communities may be more critical to health than social cohesion. Additional observational research is needed before attempts are made to alter social cohesion to improve health.

The Lancet Countdown: tracking progress on health and climate change.

The Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be "the greatest global health opportunity of the 21st century". The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. These focus areas form the five thematic working groups of the Lancet Countdown and represent different aspects of the complex association between health and climate change. These thematic groups will provide indicators for a global overview of health and climate change; national case studies highlighting countries leading the way or going against the trend; and engagement with a range of stakeholders. The Lancet Countdown ultimately aims to report annually on a series of indicators across these five working groups. This paper outlines the potential indicators and indicator domains to be tracked by the collaboration, with suggestions on the methodologies and datasets available to achieve this end. The proposed indicator domains require further refinement, and mark the beginning of an ongoing consultation process-from November, 2016 to early 2017-to develop these domains, identify key areas not currently covered, and change indicators where necessary. This collaboration will actively seek to engage with existing monitoring processes, such as the UN Sustainable Development Goals and WHO's climate and health country profiles. The indicators will also evolve over time through ongoing collaboration with experts and a range of stakeholders, and be dependent on the emergence of new evidence and knowledge. During the course of its work, the Lancet Countdown will adopt a collaborative and iterative process, which aims to complement existing initiatives, welcome engagement with new partners, and be open to developing new research projects on health and climate change.

Telephone-Based Training Intervention for Using Digital Communication Technologies for Social Housing Residents During the COVID-19 Pandemic: Mixed Methods Feasibility and Acceptability Evaluation.

BACKGROUND: In an era in which digital communication technologies play a pivotal role in everyday life, social housing residents remain highly susceptible to digital exclusion. OBJECTIVE: This study aims to evaluate the feasibility and acceptability of a telephone-based training intervention designed to empower people to confidently use digital communication technologies (ie, video calls and web-based messaging). METHODS: Conducted in collaboration with a UK social housing association, the intervention was facilitated by a unitary authority's Digital Inclusion Team during the COVID-19 pandemic. A mixed methods approach was used, encompassing quantitative and qualitative data collection on demand, reach, implementation, and potential outcomes. Demographic and qualitative data on the reasons for undertaking or not undertaking the training were collected via telephone interviews during the recruitment process. Digital competency and well-being data were collected via a self-reported survey before and after the intervention. RESULTS: Among the 4485 residents who were offered training, 67 (1.49%) expressed interest, of whom 12 (18%) of the 67 completed the training. The findings indicate a demand for basic digital training among social housing residents. The key findings revolve around the substantial dropout rate among those who were interested in undertaking the training. Barriers were strongly influenced by socioeconomic and health circumstances, reflecting the sociodigital inequalities commonly found in this group. For the training participants, the intervention was acceptable and achieved its goals, demonstrating the potential of tailored, persistent training efforts in overcoming barriers. There were no changes in self-reported well-being or digital competency outcomes (but this was limited by the small sample size). CONCLUSIONS: Sociodigital inequalities impact the reach, implementation, and acceptability of telephone-based digital training for social housing residents. Barriers to reaching and training digitally excluded groups can be overcome through the use of trusted intermediaries, personalized recruitment approaches, the minimization of administrative barriers, and tailored and agile training programs. Recognizing the resource-intensive nature of such initiatives, this study calls for enhanced recognition of intermediary efforts in national digital inclusion policies.

Estimating the Impact of Relative Financial Circumstances in Childhood on Adult Mental Wellbeing: a Mediation Analysis.

Previous research has indicated that the role of childhood circumstances on adult mental health is primarily mediated through adult socioeconomic circumstances. Using linear regression models and mediation analysis this paper examines whether childhood financial circumstances is associated with adult mental wellbeing and to what extent any association is explained by adult financial circumstances. Adjusting for age and highest education attainment, we found that childhood financial circumstances predict wellbeing in adulthood. However, stratifying by age (respondents aged 18-40, 41-65 and 66 years plus), a more complicated pattern of associations emerged with potential cohort and age effects emerging. Only adult financial circumstances significantly impact adult wellbeing in our youngest group, while neither childhood nor adult financial circumstances are significantly associated with wellbeing in the oldest age group (66 years plus). However, both childhood and adult financial circumstances were significantly associated with wellbeing in middle age, and this effect was mostly direct (OR-1.09: CI 95%: -1.63, -0.17) rather than indirect (OR-0.08: CI 95%: -0.17, -0.01). This research adds to the evidence base that childhood is a critical period for wellbeing in middle age (41-65 years). Previous research has found that subjective wellbeing plays an important role in physical and mental health outcomes in adulthood. The impact of financial hardship in childhood on wellbeing in adulthood found in this study is particularly concerning as levels of child poverty increase in the UK.

Dynamic calibration with approximate Bayesian computation for a microsimulation of disease spread.

The global COVID-19 pandemic brought considerable public and policy attention to the field of infectious disease modelling. A major hurdle that modellers must overcome, particularly when models are used to develop policy, is quantifying the uncertainty in a model's predictions. By including the most recent available data in a model, the quality of its predictions can be improved and uncertainties reduced. This paper adapts an existing, large-scale, individual-based COVID-19 model to explore the benefits of updating the model in pseudo-real time. We use Approximate Bayesian Computation (ABC) to dynamically recalibrate the model's parameter values as new data emerge. ABC offers advantages over alternative calibration methods by providing information about the uncertainty associated with particular parameter values and the resulting COVID-19 predictions through posterior distributions. Analysing such distributions is crucial in fully understanding a model and its outputs. We find that forecasts of future disease infection rates are improved substantially by incorporating up-to-date observations and that the uncertainty in forecasts drops considerably in later simulation windows (as the model is provided with additional data). This is an important outcome because the uncertainty in model predictions is often overlooked when models are used in policy.

Understanding the links between human health, ecosystem health, and food systems in Small Island Developing States using stakeholder-informed causal loop diagrams.

Globalized food systems are a major driver of climate change, biodiversity loss, environmental degradation, and the increasing prevalence of overweight and obesity in society. Small Island Developing States (SIDS) are particularly sensitive to the negative effects of rapid environmental change, with many also exhibiting a heavy reliance on food imports and high burdens of nutrition-related disease, resulting in calls to (re)localize their food systems. Such a transition represents a complex challenge, with adaptation interventions in one part of the food system contingent on the success of interventions in other parts. To help address this challenge, we used group model-building techniques from the science of system dynamics to engage food system stakeholders in Caribbean and Pacific SIDS. Our aim was to understand the drivers of unhealthy and unsustainable food systems in SIDS, and the potential role that increased local food production could play in transformative adaptation. We present two causal loop diagrams (CLDs) considered helpful in designing resilience-enhancing interventions in local food systems. These CLDs represent 'dynamic hypotheses' and provide starting points that can be adapted to local contexts for identifying food system factors, understanding the interactions between them, and co-creating and implementing adaptation interventions, particularly in SIDS. The results can help guide understanding of complexity, assist in the co-creation of interventions, and reduce the risk of maladaptive consequences.

Sea swimming and snorkeling in tropical coastal blue spaces and mental well-being: Findings from Indonesian island communities during the COVID-19 pandemic.

The COVID-19 pandemic has considerable mental health impacts. Immersive nature-based interventions, such as swimming or snorkeling, may help mitigate the global mental health crisis caused by the pandemic. To investigate this, we collected cross-sectional data from residents of coastal villages (n = 308) in Kepulauan Selayar, Indonesia. Analysis of Covariance (ANCOVA) was used with mental well-being as the outcome variable, operationalized as the Mental Component Summary (MCS) scores from the SF-12 (12-item Short Form Health Survey). After adjusting for covariates, the activity of sea swimming or snorkeling was found to be significantly associated with better mental well-being (η2 = 0.036; p < 0.01). Predictive margins analysis revealed that those who engaged in sea swimming or snorkeling for one to three days a week gained a 2.7 increase in their MCS scores, compared to those who did not. A non-linear dose-response relationship was detected: for those swimming or snorkeling more than three days per week, there was only an increase of 1.7 MCS score compared to the 0-day. Overall this study contributes to the expanding of evidence base, showing that interactions with blue spaces can be beneficial for mental health, especially in a potentially stressful time such as the current pandemic. Management implications: The positive association between the activity of swimming or snorkeling in open seas and the mental well-being of rural coastal communities in Indonesia during the COVID-19 pandemic indicates that access to coastal blue spaces is important in a time of uncertainties and high stress. Ensuring that local communities have continuous access to these spaces is the key challenge for all relevant stakeholders, particularly in light of the growing privatization of the local coastal environment for the sake of tourism. However, considering the importance that these blue spaces hold for the mental well-being of local communities, intensive dialogue amongst these stakeholders must be pursued to ensure that the development of the area does not jeopardize the collective well-being of the people already living there.

Marine Protected Area Expansion and Country-Level Age-Standardized Adult Mortality.

Many countries have adopted targets to increase marine protected areas (MPAs) to limit the degradation of water bodies. Although there is evidence that MPAs can conserve marine life and promote biodiversity, there are limited data on the human health implications of MPAs. Using panel data from 1990, 2000, and 2014, we estimated the country-level associations between MPAs (i.e., percentage of territorial waters designated as marine reserves) and age-standardized mortality (i.e., age-standardized probability of dying between 15 and 60 years from all-causes among ages 15-60/100,000 population) by sex, among 110 countries. We fit mixed-effects linear regression models of mortality as a function of current MPA coverage, gross domestic product growth, year, the prior extent of MPA, electricity coverage, governance, and country-level random effects. We observed a significant inverse association between current MPA coverage and adult mortality. For each 5-percentage-point increase in current MPA coverage, a country had 0.982 times the geometric means of female and male mortality [geometric mean ratio: 0.982 (95% CI 0·976, 0·988)] conditional on past %MPA coverage and other modeled variables. The model showed no significant residual association of mortality with past %MPA conditional on current %MPA and other modeled variables. This is one of the first studies to show a positive association between increasing marine conservation and human health. This macro-level study suggests there may be important co-benefits for human health from expanding MPAs that merit further investigation.

Health and wellbeing implications of adaptation to flood risk.

Adaptation strategies to ameliorate the impacts of climate change are increasing in scale and scope around the world, with interventions becoming a part of daily life for many people. Though the implications of climate impacts for health and wellbeing are well documented, to date, adaptations are largely evaluated by financial cost and their effectiveness in reducing risk. Looking across different forms of adaptation to floods, we use existing literature to develop a typology of key domains of impact arising from interventions that are likely to shape health and wellbeing. We suggest that this typology can be used to assess the health consequences of adaptation interventions more generally and argue that such forms of evaluation will better support the development of sustainable adaptation planning.

The feasibility and acceptability of digital technology for health and wellbeing in social housing residents in Cornwall: A qualitative scoping study.

OBJECTIVE: The aim of this study was to explore the feasibility and acceptability of digital technology for improving health and wellbeing in social housing residents living in a deprived area in Cornwall, England. METHODS: Qualitative scoping study with focus groups and telephone interviews (23 participants in total). Focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: Levels of use and experience with digital technology were diverse in this group, ranging from 'willing and unable' to 'expert' on a self-perceived scale. Overall, participants had positive perceptions of technology and were keen to try new technologies. Five categories of factors influencing technology use were identified: functional, physical / health, psychological and attitudinal, technology-associated barriers, and privacy, safety and security. Preferred types of digital technology were wearable activity monitors (e.g. Fitbit®), virtual assistants (e.g. Amazon Alexa) and social messaging (e.g. WhatsApp). There was a strong consensus that technology should be easy to use and should have a clear purpose. There was a need to improve awareness, knowledge and confidence in technology use and participants desired further training and support. CONCLUSIONS: There is a need and desire to use digital technology to improve health, wellbeing and social connectedness in social housing residents in Cornwall. The findings will be used to inform a digital training and support programme for the participants of the Smartline project. This study also serves as a template for future research that seeks to scope the feasibility and acceptability of different digital interventions in similar populations.

Wellbeing and Social Network Characteristics in Rural Communities: Findings from a Cohort in Social Housing in Cornwall, United Kingdom.

The mental wellbeing of those living in resource poor and rural localities is a public health priority. Despite evidence of a link between social networks and mental wellbeing, little is known about this relationship in the context of rural and resource poor environments. The current study uses novel social network methodology to investigate the extent to which social network size and composition is related to mental wellbeing in a social housing community in rural England. Data come from 88 individuals living in social housing in Cornwall. These participants are part of a larger study of 329 social housing households surveyed in 2017 and 2018. Mental wellbeing was measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). A series of multivariable linear regression models were used to test associations between social network characteristics and mental wellbeing. Social network size was significantly associated with the SWEMWBS (b = 0.39, p < 0.01), such that individuals with larger networks reported better mental wellbeing, but after controlling for community social cohesion, this effect dissipated. Neither gender composition or talking with network members about health and wellbeing were significantly associated with the SWEMWBS. Findings suggest that both the quantity of social connections and perceptions of community cohesion are moderately associated with mental wellbeing in rural and resource poor localities. As such, efforts to improve mental wellbeing would benefit from targeting multiple aspects of social relationships, rather than focusing solely on increasing the size of individuals' social networks.

The Impact of Nutrition-Based Interventions on Nutritional Status and Metabolic Health in Small Island Developing States: A Systematic Review and Narrative Synthesis.

Small island developing states (SIDS) have a high burden of nutrition-related disease associated with nutrient-poor, energy-dense diets. In response to these issues, we assessed the effectiveness of nutrition-based interventions on nutritional status (under-nutrition) and metabolic health (over-nutrition) among persons in SIDS. We included SIDS-based nutrition studies with change in nutrition status (e.g., markers of anaemia) or metabolic status (e.g., markers of glycaemia) as outcomes. The PRISMA framework was applied and MEDLINE, Embase, CINAHL, OARE library, Web of Science, Scopus, ASSIA, EconLit, AGORA, AGRICOLA, AGRIS, WHO-EMRO, and LILACS were searched (2000−2020). Cochrane risk of bias (ROB) and Cochrane ROBINS-I tools assessed ROB for randomised and non-randomised studies, respectively. PROSPERO registration (CRD42021236396) was undertaken. We included 50 eligible interventions, involving 37,591 participants: 14 trials reported on nutritional status, 36 on metabolic health. Effective interventions, evaluated at the individual level, took a multifaceted approach for metabolic outcomes; while nutrition outcomes utilised supplements. Most intervention types were suitable for issues related to 'over' nutrition versus 'under' nutrition. Twenty-six studies (nutrition status (six); metabolic health (twenty)) were effective (p < 0.05). With the current rise of nutrition-related public health challenges, there is a need for further development and evaluation of these and related interventions at the population level.

Interventions in Small Island Developing States to improve diet, with a focus on the consumption of local, nutritious foods: a systematic review.

Introduction: Food security in Small Island Developing States (SIDS) is an international policy priority. SIDS have high rates of nutrition-related non-communicable diseases, including obesity and type 2 diabetes, micronutrient deficiencies and, in many, persistent childhood stunting. This is associated with an increasing reliance on imported processed food of poor nutritional quality. Calls have been made for strengthening local food systems, resilient to climate change, to increase the consumption of nutritious locally produced food. We aimed to systematically review interventions intended to improve diet in SIDS, and specifically explore whether these interventions applied a local food approach. Methods: The search strategy was applied to 11 databases, including in health, social science and agriculture. Screening of titles, abstracts and data extraction was undertaken in duplicate. Risk of bias was assessed using Cochrane tools. Narrative synthesis of the results was undertaken. The study protocol was registered (PROSPERO registration number: 2020CRD42020201274). Results: From 26 062 records, 154 full texts were reviewed and 24 were eligible. Included studies were from the Caribbean, Pacific, Mauritius and Singapore. Five were a randomised study design, one an interrupted time series analysis, eight controlled and ten uncontrolled pre-test and post-test. Nine studies included some aspect of a local food approach. Most interventions (n=15) included nutrition education, with evidence of effectiveness largely limited to those that also included practical skills training, such as vegetable gardening or food preparation. Three studies were considered low risk of bias, with the majority (n=13) of moderate risk. Conclusion: There is a lack of robust evidence on interventions to improve diet in SIDS. The evidence suggests that multifaceted approaches are likely to be the most effective, and local food approaches may promote effectiveness, through mechanisms of cultural and contextual relevance. Further development and evaluation of interventions is urgently required to increase the comparability of these studies, to help guide policy on improving nutrition in SIDS.

Scenarios of demographic distributional aspects of health co-benefits from decarbonising urban transport.

BACKGROUND: There is limited knowledge on the distribution of the health co-benefits of reduced air pollutants and carbon emissions in the transport sector across populations. METHODS: This Article describes a health impact assessment used to estimate the health co-benefits of alternative land passenger transport scenarios for the city of Beijing, China, testing the effect of five transport-based scenarios from 2020 to 2050 on health outcomes. New potential scenarios range from implementing a green transport infrastructure, to scenarios primarily based on the electrification of vehicle fleets and a deep decarbonisation scenario with near zero carbon emissions by 2050. The health co-benefits are disaggregated by age and sex and estimated in monetary terms. FINDINGS: The results show that all the alternative mitigation scenarios result in reduced PM2·5 and CO2 emissions compared to a business-as-usual scenario during 2020-50. The near zero scenario achieves the largest health co-benefits and economic benefits annually relative to the sole mitigation strategy, preventing 300 (95% CI 229-450) deaths, with health co-benefits and CO2 cost-saving an equivalent of 0·01% (0·00-0·03%) of Beijing's Gross domestic product in 2015 by 2050. Given Beijing's ageing population and higher mortality rate, individuals aged 50 years and older experience the greatest benefit from the mitigation scenarios. Regarding sex, the greatest health benefits occur in men. INTERPRETATION: This assessment provides estimates of the demographic distribution of benefits from the effects of combinations of green transport and decarbonising vehicles in transport futures. The results show that there are substantial positive health outcomes from decarbonising transport in Beijing. Policies aimed at encouraging active travel and use of public transport, increasing the safety of active travel, improving public transport infrastructure, and decarbonising vehicles lead to differential benefits. In addition, disaggregation by age and sex shows that the health impacts related to transport pollution disproportionately influence different age cohorts and genders. FUNDING: National Natural Science Foundation of China and FRIEND Project (through the National Research Foundation of Korea, funded by the Ministry of Science and ICT).