Towards a global framework for transport, health and health equity.

This study derives a generalised global framework for transport, health and health equity, based on a synthesis of 94 urban transport and health frameworks. The framework emphasises factors related to health equity, which are generally ignored in existing conceptual frameworks on the relationship between transport and health. While some factors such as travel behaviour were included in most reviewed frameworks, climate change and other macro-level factors were included in less than a quarter of frameworks, and health equity was included in less than 10%. We developed a framework that includes key framework components identified by a scoping review, as well as addressing important gaps. This framework can be utilized to inform work on transport, health and health equity by different agencies such as the World Health Organization. It can be used to guide health sector engagement with transport issues to lead to healthier and more equitable transport decision-making globally.

Systematic Review of the Health and Equity Impacts of Remediation and Redevelopment of Contaminated Sites.

(1) Background: Globally there is a vast legacy of contaminated sites from past industrial, commercial and military activity, waste disposal, and mineral extraction. This review examined the extent to which the remediation of contaminated sites reduces health risks to new and existing populations. (2) Methods: Standard academic databases were searched for papers that reported on health-related outcomes in humans following remediation and redevelopment of contaminated sites. Title/abstract screening, followed by full-text screening identified sixteen papers that met the eligibility criteria. (3) Results: Most studies were set in the United States of America and reported changes in blood lead concentrations in children, following soil remediation and, in some cases, public health campaigns to reduce exposure. Two further studies examined the impacts of remediation on soil contaminated with chromium and sediments contaminated with polychlorinated biphenyls (PCBs). (4) Conclusions: Overall, the evidence suggests that remediation via removal, capping, and replacing soil, and planting vegetation is effective at reducing concentrations of lead and chromium in blood and urine in children. There is also evidence that sediment dredging can reduce PCB concentrations in umbilical cords in infants. Study designs are relatively weak and some recommendations are provided for those wishing to examine the health impacts of remediation.

Pathways linking biodiversity to human health: A conceptual framework.

Biodiversity is a cornerstone of human health and well-being. However, while evidence of the contributions of nature to human health is rapidly building, research into how biodiversity relates to human health remains limited in important respects. In particular, a better mechanistic understanding of the range of pathways through which biodiversity can influence human health is needed. These pathways relate to both psychological and social processes as well as biophysical processes. Building on evidence from across the natural, social and health sciences, we present a conceptual framework organizing the pathways linking biodiversity to human health. Four domains of pathways-both beneficial as well as harmful-link biodiversity with human health: (i) reducing harm (e.g. provision of medicines, decreasing exposure to air and noise pollution); (ii) restoring capacities (e.g. attention restoration, stress reduction); (iii) building capacities (e.g. promoting physical activity, transcendent experiences); and (iv) causing harm (e.g. dangerous wildlife, zoonotic diseases, allergens). We discuss how to test components of the biodiversity-health framework with available analytical approaches and existing datasets. In a world with accelerating declines in biodiversity, profound land-use change, and an increase in non-communicable and zoonotic diseases globally, greater understanding of these pathways can reinforce biodiversity conservation as a strategy for the promotion of health for both people and nature. We conclude by identifying research avenues and recommendations for policy and practice to foster biodiversity-focused public health actions.

Are There Changes in Inequalities in Injuries? A Review of Evidence in the WHO European Region.

Decreases in injury rates globally and in Europe in the past decades, although encouraging, may mask previously reported social inequalities between and within countries that persist or even increase. European research on this issue has not been systematically reviewed, which is the aim of this article. Between and within-country studies from the WHO European Region that investigate changes in social inequalities in injuries over time or in recent decades were sought in PubMed, Scopus, and Web of Science. Of the 27 studies retained, seven were cross-country and 20 were country-specific. Twelve reported changes in inequalities over time and the remaining 15 shed light on other aspects of inequalities. A substantial downward trend in injuries is reported for all causes and cause-specific ones-alongside persisting inequalities between countries and, in a majority of studies, within countries. Studies investigate diverse questions in different population groups. Depending on the social measure and injury outcome considered, many report inequalities in injuries albeit to a varying degree. Despite the downward trends in risk levels, relative social inequalities in injuries remain a persisting public health issue in the European Region.

Incorporating Environmental Justice into Second Generation Indices of Multiple Deprivation: Lessons from the UK and Progress Internationally.

Second generation area-based indices of multiple deprivation have been extensively used in the UK over the last 15 years. They resulted from significant developments in political, technical, and conceptual spheres for deprivation data. We review the parallel development of environmental justice research and how and when environmental data was incorporated into these indices. We explain the transfer of these methods from the UK to Germany and assess the progress internationally in developing such indices. Finally, we illustrate how billions of pounds in the UK was allocated by using these tools to tackle neighbourhood deprivation and environmental justice to address the determinants of health.

Development of a quantitative methodology to assess the impacts of urban transport interventions and related noise on well-being.

Well-being impact assessments of urban interventions are a difficult challenge, as there is no agreed methodology and scarce evidence on the relationship between environmental conditions and well-being. The European Union (EU) project "Urban Reduction of Greenhouse Gas Emissions in China and Europe" (URGENCHE) explored a methodological approach to assess traffic noise-related well-being impacts of transport interventions in three European cities (Basel, Rotterdam and Thessaloniki) linking modeled traffic noise reduction effects with survey data indicating noise-well-being associations. Local noise models showed a reduction of high traffic noise levels in all cities as a result of different urban interventions. Survey data indicated that perception of high noise levels was associated with lower probability of well-being. Connecting the local noise exposure profiles with the noise-well-being associations suggests that the urban transport interventions may have a marginal but positive effect on population well-being. This paper also provides insight into the methodological challenges of well-being assessments and highlights the range of limitations arising from the current lack of reliable evidence on environmental conditions and well-being. Due to these limitations, the results should be interpreted with caution.

Wellbeing impacts of city policies for reducing greenhouse gas emissions.

To mitigate climate change, city authorities are developing policies in areas such as transportation, housing and energy use, to reduce greenhouse gas emissions. In addition to their effects on greenhouse gas emissions, these policies are likely to have consequences for the wellbeing of their populations for example through changes in opportunities to take physical exercise. In order to explore the potential consequences for wellbeing, we first explore what 'wellbeing' is and how it can be operationalised for urban planners. In this paper, we illustrate how wellbeing can be divided into objective and subjective aspects which can be measured quantitatively; our review of measures informs the development of a theoretical model linking wellbeing to policies which cities use to reduce greenhouse gas emissions. Finally, we discuss the extent to which the links proposed in the conceptual model are supported by the literature and how cities can assess wellbeing implications of policies.

The interactive effects of housing and neighbourhood quality on psychological well-being.

BACKGROUND: Many individuals are subject to the physically and mentally detrimental effects of living in substandard housing and inadequate neighbourhoods. We propose that better physical neighbourhood quality can partially offset some of the negative effects of poor housing quality on psychological well-being. METHODS: Interviews and questionnaires were used to collect data in a cross-sectional study of housing quality, the state of the surrounding environment, and individual health and well-being for 5605 European adults from the Large Analysis and Review of European housing and health Status conducted by WHO in eight European cities. Multilevel random coefficient modelling was used to statistically analyse the main and interactive effects of housing quality and neighbourhood quality on psychological well-being. Socioeconomic status, employment status, gender and marital status were included as statistical controls. RESULTS AND CONCLUSIONS: Substandard housing quality and poor neighbourhood quality each contribute to lower psychological well-being. Furthermore better neighbourhood quality buffers against the negative effects of poor housing quality on psychological well-being. These results fill a gap in research concerning the ability of neighbourhood quality to amplify or attenuate housing quality impacts on well-being.

Экологическое бремя болезней, связанных с неудовлетворительными жилищными условиями: методическое руководство по количественной оценке влияния на здоровье некоторых факторов риска, связанных с жилищными условиями, в Европейском регионе ВОЗ: резюме доклада

В настоящем резюме содержатся основные выводы доклада «Экологическое бремя болезней, связанных с неудовлетворительными жилищными условиями». B нем приводятся фактические данные, свидетельствующие о том, что неудовлетворительные жилищные условия грозят серьезными нарушениями здоровья. Улучшение жилищных условий, при котором устраняются или снижаются до минимума негативные воздействия на здоровье и безопасность людей и стимулируется создание здоровых условий жизни, благоприятно как для отдельных жителей, так и для всего общества. Снижение нагрузки на системы здравоохранения, связанной с необходимостью удовлетворения нужд населения, обусловленных плохими жилищными условиями, – это не только очевидный приоритет общественного здравоохранения, но и несомненный фактор экономической целесообразности. Изложенные в полном докладе результаты обосновывают принцип, согласно которому в основе жилищной политики должны лежать интересы здоровья. Создание здорового, доступного и экологически безопасного жилья должно стать первостепенной задачей всех специалистов и руководителей, занятых в сферах, связанных с различными аспектами жилищных условий и здоровья. Обе публикации предлагают им необходимые сведения для выполнения этой задачи.

Environmental burden of disease associated with inadequate housing: a method guide to the quantification of health effects of selected housing risks in the WHO European Region

This guide describes how to estimate the disease burden caused by inadequate housing conditions for the WHO European Region as well as for subregional and national levels. It contributes to the WHO series of guides that describe how to estimate the burden of disease caused by environmental and occupational risk factors. An introductory volume to the series outlines the general methodology. In this context, the WHO Regional Office for Europe took up the challenge to quantify the health effects of inadequate housing and convened an international working group to quantify the health impacts of selected housing risk factors, applying the environmental burden of disease (EBD) approach. The guide outlines, using European data, the evidence linking housing conditions to health and the methods for assessing housing impacts on population health. This is done for twelve housing risk factors in a practical step-by-step approach that can be adapted to local circumstances and knowledge. It also summarizes the recent evidence on the health implications of housing renewal and provides a national example on assessing the economic implications of inadequate housing. The findings confirm that housing is a significant public health issue. However, to realize the large health potential associated with adequate, safe and healthy homes, joint action of health and non-health sectors is required.

Environmental burden of disease associated with inadequate housing: a method guide to the quantification of health effects of selected housing risks in the WHO European Region: summary report

This summary report presents key findings of the report “Environmental burden of disease associated with inadequate housing”. It provides evidence that the health consequences of inadequate housing are substantial. Improving housing in a way that removes or minimizes the negative impact on health and safety and promotes a healthier living environment is good for the residents and beneficial for society. Reducing the burden of responding to the demands on the health system attributable to inadequate housing is an obvious public health priority, but also something that makes economic sense. The findings set out in the full report provide ample justification for the principle that health should be at the centre of housing policy. Making housing healthy, affordable and sustainable should be a prime objective of all professionals and policy-makers involved in any aspect of housing and of health. This summary and its sister publication provide the evidence they need to make it so.

Social inequities in environmental risks associated with housing and residential location--a review of evidence.

BACKGROUND: Housing conditions and environmental quality of residential areas are differentially distributed in the population. Less affluent population groups are more often affected by inadequate housing conditions and higher environmental burden in their residential neighbourhoods. A synthesis of the dispersed evidence on health-related housing characteristics and social status is needed to provide support for housing policies addressing social inequities. METHODS: The literature on social inequities and environmental risks related to housing and residential location was searched in health, environmental and geographical databases and reviewed to summarize the evidence. Household-level socio-economic status and income were considered as indicators of social status. The review was limited to European evidence. RESULTS: Adequate studies were only available for few countries. Most studies identified the less affluent population groups as most exposed to environmental risks in the place of residence. Inequities were reported for risks experienced within the dwelling (such as exposure to dampness, chemical contamination, noise, temperature problems and poor sanitation) and related to residential location (neighbourhood quality, traffic-related pollution, proximity to pollution sites). Increased exposure to environmental risks within more affluent population groups was rarely identified. CONCLUSIONS: The review indicates that social status and especially low income are strongly associated with increased exposure to environmental risks in the private home or related to residential location. However, due to the methodological variety of the available studies and the lack of data for many countries, it is not possible to provide a general assessment of the magnitude of inequity in Europe at the present time.