A project to identify the best practices and health performance objectives for building construction and renovation.

The 2014-2018 National Prevention Plan (NPP), in order to promote a correct relationship between health and the environment, indicated, among the central objectives, the definition of guidelines to promote the building hygiene codes in an eco-compatible way, but also to develop specific skills on the subject of confined environments and residential construction in the operators of the Regional Health Services. The CCM2015 Project has therefore set itself the goal of taking stock of the best health practices available today in terms of sustainability and eco-compatibility in the buildings' construction and renovation actions. All this in order to define updated health performance targets to be made available to the competent Authorities, to adapt the current legislation at national, regional and local level, and finally to define the contents of a continuing education (training courses) capable to support operators in risk assessment related to the built environment and in the definition of effective preventive measures.

Using laws to further public health causes: the Healthy Prisons Agenda.

In this commentary, we propose using laws in implementing the Healthy Prisons Agenda. We evaluate the efficacy of laws in tackling health inequalities in prisons, provide recommendations on how states can uphold their international commitments that safeguard prisoners' right to healthcare, and frame prisons as health-promoting settings. We also assess the challenges that can thwart this proposal, such as the non-binding nature of international obligations, global prison overcrowding and the dependency on prison governors and staff for implementation of the Agenda. The commentary concludes by recommending further evaluation of our proposal and testing its potential generalisability to other health-promotion agendas.

Building Road Safety Institutions in Low- and Middle-Income Countries: The Case of Argentina.

Traffic injuries remain a leading health concern in most low- and middle-income countries (LMICs). However, most LMICs have not established institutions that have the legislative mandate and financial resources necessary to coordinate large-scale interventions. Argentina provides a counterexample. Argentina is a federal country where the decentralization of authority to provincial governments was a key barrier to effective national interventions. In 2008, Argentina passed a law establishing a national road safety agency and subsequently received a World Bank loan to build the agency's capacity to coordinate actions. Although traffic injuries in Argentina have not yet begun to decline, these developments raise important questions:Why did Argentina come to view road safety as aproblem?Why was institutional reform the chosen solution? What was the political process for achieving reform? What are the broader implications for institutional reform in LMICs?We explore these questions using a descriptive case study (single-case, holistic design) of Argentina. The case illustrates that focusing events, like the Santa Fe tragedy that killed nine children, and advocacy groups are important for raising political attention and creating an opportunity for legislative reform. It highlights the importance of policy entrepreneurs who used the opportunity to push through new legislation. Though the political dynamic was predominantly local, international actors worked with local advocates to build demand for safety and develop solutions that could be deployed when the opportunity arose. Most important, the case emphasizes the importance of developing institutions with the resources and authority necessary for managing national road safety programs.

The contribution of smokefree outdoor areas in achieving New Zealand's Smokefree 2025 goal.

ISSUES ADDRESSED: With the adoption of Smokefree 2025, further commitment from local government to extend smokefree outdoor area policies is becoming increasingly important in the presence of high public support. The aim of this study was to identify local government commitment in the Canterbury/West Coast (CWC) region to the New Zealand Smokefree 2025 goal through provision of smokefree outdoor areas. METHODS: Document analysis of the different stages of council long-term plans (LTPs) was undertaken, including 239 draft LTP documents, 5926 public submissions on these documents and 13 final LTP documents. A comparison between the 2015 final document and the 2012 final document was undertaken. Following this, semi-structured telephone interviews were undertaken with council staff. RESULTS: No council had referred to Smokefree 2025 or smokefree community spaces in any 2015 LTP draft document. Each of the CWC councils received a number of smokefree-related submissions, with the main theme being the extension of current Smokefree Outdoor Area Policy. The final LTP documents showed that 5 councils had included a brief statement about Smokefree 2025. Smokefree issues were mentioned more often in the 2012 LTP compared to the 2015 LTP. CONCLUSIONS: This research highlights a need for more commitment by local government to achieving the Smokefree 2025 goal. So what? There are opportunities for health groups to work with councils to try and enhance their overall commitment to Smokefree 2025 and promote wellbeing.

Improving Pool Fencing Legislation in Queensland, Australia: Attitudes and Impact on Child Drowning Fatalities.

Four-sided, non-climbable pool fencing is an effective strategy for preventing children from drowning in home swimming pools. In 2009, the Queensland Government introduced legislation to improve the effectiveness of pool fencing. This study explores community attitudes towards the effectiveness of these legislative changes and examines child (<5 years) drowning deaths in pools. Data from the 2011 Queensland Computer-Assisted Telephone Interviewing (CATI) Social Survey include results from questions related to pool ownership and pool fencing legislation. Fatal child drowning cases between 1 January 2005 and 31 December 2015 were sourced from coronial data. Of the 1263 respondents, 26/100 households had a pool. A total of 58% believed tightening legislation would be effective in reducing child drowning deaths. Pool owners were more likely to doubt the effectiveness of legislation (p < 0.001) when compared to non-pool owners. Perceptions of effectiveness did not differ by presence of children under the age of five. There were 46 children who drowned in Queensland home pools (7.8/100,000 pools with children residing in the residence/annum) between 2005 and 2015. While pool owners were less likely to think that tightening the legislation would be effective, the number of children drowning in home swimming pools declined over the study period. Drowning prevention agencies have more work to do to ensure that the most vulnerable (young children in houses with swimming pools) are protected.

An exemplum and its road safety morals.

With the design of an existing bike-lane in mind I discuss several general issues: accident causation and its linkage to the formulation of prevention strategies; the myopia afflicting major studies of causation and their misleading 'the-driver-did-it' message; the question of who is responsible for what in the management of road safety; and the difficult position in which the professionals find themselves when the 'State' does not embrace its responsibility to road safety. I think that were the public aware of this state of affairs in North America it might insist on change.

Working with Policy and Regulatory Factors to Implement Universal Design in the Built Environment: The Australian Experience.

Built environments that are usable by all provide opportunities for engagement in meaningful occupations. However, enabling them in day to day design processes and practice is problematic for relevant professions. The purpose of this phenomenological study was to gain greater understanding of the policy and regulatory influences that promote or hinder the uptake of universal design in built environments, to inform better future design. Focus groups or telephone interviews were undertaken with 28 key building industry and disability stakeholders in Australia. Four themes were identified: the difficulties of definition; the push or pull of regulations and policy; the role of formal standards; and, shifting the focus of design thinking. The findings highlight the complexity of working within policy and regulatory contexts when implementing universal design. Occupational therapists working with colleagues from other professions must be aware of these influences, and develop the skills to work with them for successful practice.

A century of sprawl in the United States.

The urban street network is one of the most permanent features of cities. Once laid down, the pattern of streets determines urban form and the level of sprawl for decades to come. We present a high-resolution time series of urban sprawl, as measured through street network connectivity, in the United States from 1920 to 2012. Sprawl started well before private car ownership was dominant and grew steadily until the mid-1990s. Over the last two decades, however, new streets have become significantly more connected and grid-like; the peak in street-network sprawl in the United States occurred in ∼ 1994. By one measure of connectivity, the mean nodal degree of intersections, sprawl fell by ∼ 9% between 1994 and 2012. We analyze spatial variation in these changes and demonstrate the persistence of sprawl. Places that were built with a low-connectivity street network tend to stay that way, even as the network expands. We also find suggestive evidence that local government policies impact sprawl, as the largest increases in connectivity have occurred in places with policies to promote gridded streets and similar New Urbanist design principles. We provide for public use a county-level version of our street-network sprawl dataset comprising a time series of nearly 100 y.

The Cleveland-Cuyahoga County Food Policy Coalition: "we have evolved".

Several pieces of legislation passed in Cleveland, Ohio, from 2007 to 2011, focused on improving the city's food environment through urban agriculture initiatives. We used qualitative, case study methods, including interviews with 7 key informants, to examine the policy development process and investigate the role of the Cleveland-Cuyahoga County Food Policy Coalition in developing and implementing 4 pieces of legislation. In this article, we focus on 2 pieces of legislation: zoning designation of an urban garden and allowance of small farm animals and bees on residential property. Five key themes emerged: impetus for policy came from community needs; education and raising awareness helped mitigate barriers; a cultural shift took place among policy makers; social connections and individual champions were needed; and concerns over food access and health influenced policy decisions. Legislative actions are important tools to influence the nutrition environment, as long as they are based on local needs and context.

Fast-food fights: news coverage of local efforts to improve food environments through land-use regulations, 2001-2013. [corrected].

Zoning and other land-use policies are a promising but controversial strategy to improve community food environments. To understand how these policies are debated, we searched existing databases and the Internet and analyzed news coverage and legal documentation of efforts to restrict fast-food restaurants in 77 US communities in 2001 to 2013. Policies intended to improve community health were most often proposed in urban, racially diverse communities; policies proposed in small towns or majority-White communities aimed to protect community aesthetics or local businesses. Health-focused policies were subject to more criticism than other policies and were generally less successful. Our findings could inform the work of advocates interested in employing land-use policies to improve the food environment in their own communities.

Uses of research evidence in the state legislative process to promote active environments in Minnesota.

PURPOSE: To describe how research evidence and non-research-based information are used in testimony and other legislative documents used in arguments for and against physical activity-related bills in Minnesota. DESIGN: Content analysis. SETTING: Documents and oral testimony archived by the Minnesota State Legislature from 2007 to 2011. SUBJECTS: Not applicable. MEASURES: A coding instrument was developed to measure descriptive features of materials (e.g., length, document type) and the presence or absence of certain types of research evidence and non-research-based information. ANALYSIS: Frequencies of variables and measures of associations using Pearson χ (2) tests. RESULTS: Over a third (36%) of the sample contained research evidence, and 88% of the sample contained non-research-based information. Compared to materials related to physical activity, materials related to built environment were significantly less likely to reference research evidence. CONCLUSION: Despite an abundance of evidence, research evidence was present in only about one-third of the sample. There may be opportunities during legislative discussions on the built environment for obesity-related data to help make the case for sound policies.

Comparative study of European tunnel emergency-stop-area-wall protection measures.

Due to the increasing number of traffic accidents involving the collisions of vehicles with the emergency-stop-area head walls in tunnels, a comparative numerical analysis in accordance with the EN 1317 standard has been performed in order to assess the quality of the available protective safety barriers. Based on the simulation results, the values of the relevant injury criteria - the acceleration severity index (ASI), the theoretical head impact velocity (THIV) and the post-impact head deceleration (PHD) - were computed for several collision scenarios involving two different passenger vehicles colliding with two different safety barriers in various ways. The results show that due to the geometrical restrictions in the tunnel's emergency stop area none of the barriers can provide total protection for the occupants of the vehicle in the event of a collision. The installation of a steel-sheet-tube crash cushion was, however, found to provide the best possible protection within the given limitations. The results of the analysis were the basis for selecting a safety-barrier design for existing tunnel installations and for the proposed changes in regulations governing the geometry of the tunnel's emergency stop area.

Development by design in Colombia: making mitigation decisions consistent with conservation outcomes.

Mitigation policy and regulatory frameworks are consistent in their strong support for the mitigation hierarchy of: (1) avoiding impacts, (2) minimizing impacts, and then (3) offsetting/compensating for residual impacts. While mitigation frameworks require developers to avoid, minimize and restore biodiversity on-site before considering an offset for residual impacts, there is a lack of quantitative guidance for this decision-making process. What are the criteria for requiring impacts be avoided altogether? Here we examine how conservation planning can guide the application of the mitigation hierarchy to address this issue. In support of the Colombian government's aim to improve siting and mitigation practices for planned development, we examined five pilot projects in landscapes expected to experience significant increases in mining, petroleum and/or infrastructure development. By blending landscape-level conservation planning with application of the mitigation hierarchy, we can proactively identify where proposed development and conservation priorities would be in conflict and where impacts should be avoided. The approach we outline here has been adopted by the Colombian Ministry of Environment and Sustainable Development to guide licensing decisions, avoid piecemeal licensing, and promote mitigation decisions that maintain landscape condition.

Positioning soundscape research and management.

This paper is an outcome of a workshop that addressed the question how soundscape research can improve its impact on the local level. It addresses a number of topics by complementing existing approaches and practices with possible future approaches and practices. The paper starts with an analysis of the role of sound annoyance and suboptimal soundscapes on the lives of individuals and concludes that a good soundscape, or more generally a good sensescape, is at the same time pleasant as well as conducive for the adoption of healthy habits. To maintain or improve sensescape quality, urban planning needs improved design tools that allow for a more holistic optimization and an active role of the local stakeholders. Associated with this is a gradual development from government to governance in which optimization of the soundscape at a local (administrative or geographic) level is directly influenced by the users of spaces. The paper concludes that soundscape research can have a greater impact by helping urban planners design for health and pleasant experiences as well as developing tools for improved citizen involvement in local optimization.

Qualitative study to explore stakeholder perceptions related to road safety in Hyderabad, India.

The Bloomberg Philanthropies Global Road Safety Programme in India focuses on reduction of drink driving and increase in helmet usage in the city of Hyderabad. During the early stages of implementation, perceptions of stakeholders on road safety were explored as part of the monitoring and evaluation process for a better understanding of areas for improving road safety in Hyderabad. Fifteen in-depth interviews with government officials, subject experts, and road traffic injury victims, and four focus group discussions with trauma surgeons, medical interns, nurses, and taxi drivers were conducted, analysed manually, and presented as themes. Respondents found Hyderabad unsafe for road-users. Factors such as inadequate traffic laws, gaps in enforcement, lack of awareness, lack of political will, poor road engineering, and high-risk road users were identified as threats to road safety. The responsibility for road safety was assigned to both individual road-users and the government, with the former bearing the responsibility for safe traffic behaviour, and the latter for infrastructure provision and enforcement of regulations. The establishment of a lead agency to co-ordinate awareness generation, better road engineering, and stricter enforcement of traffic laws with economic and non-economic penalties for suboptimal traffic behaviour, could facilitate improved road safety in Hyderabad.