Perceptions and attitudes about antibiotic resistance in the general public and general practitioners in France.

BACKGROUND: During the last 20 years, France has taken important steps to tackle antibiotic resistance. These include national awareness campaigns for the general public, and supporting changes in terms of antibiotic prescription for healthcare practitioners. To prepare the upcoming 2022/2023 campaign, we conducted two surveys to assess (1) the general public's knowledge, attitudes and behaviours regarding antibiotics and (2) the perceptions and practices of general practitioners (GPs). METHODS: Two quantitative telephone surveys were conducted using the same methodology as that used in 2010 by the National Health Insurance Authority. The first was conducted in 2019 in a national representative quota sample of 1204 persons aged over 15 years living in metropolitan France, including an over-sample of 332 parents of children aged six years or under. The second was conducted in 2020 in a national representative sample of 388 GPs. RESULTS: Twenty-seven percent of respondents reported taking antibiotics during the previous year. Sixty-five percent of GPs declared prescribing fewer antibiotics during the previous five years. However, 33% of GPs reported they often had patients who put high pressure to get antibiotics. The pressure from elderly patients, especially those with comorbidities was notable. Three percent of respondent patients reported putting often pressure on their GP. All respondents expressed total trust in their GP irrespective of whether s/he had prescribed them antibiotics. Half knew that antibiotics act only on bacteria, and 38% said they understood precisely what antibiotic resistance is. CONCLUSION: Although antibiotic use is decreasing in France, patient pressure on GPs to prescribe antibiotics is very high. GPs are key ambassadors in reducing antibiotic use. Awareness campaigns must target elderly patients in particular.

How to Evaluate Health in All Policies at the Local Level: Methodological Insights Within Municipalities From the WHO French Healthy Cities Network.

BACKGROUND: This article proposes a method for analysing the degree of maturity of Health in All Policies (HiAP) among World Health Organization-French Healthy Cities Network (WHO-FHCN) as part of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project. We focused on the creation or enhancement of health-promoting environments, and more specifically, public green spaces. METHODS: We conducted a cross-sectional quantitative study guided by the evaluative framework of the HiAP maturity level developed by Storm et al mixed with a qualitative interpretation. A self-administered questionnaire was sent to elected officials and health department officers in the 85 member cities of the WHO-FHCN in 2017. Subsequently 58 cities were included in the analysis, which was based on a multiple correspondence analysis (MCA) and a hierarchical ascending classification (HAC). RESULTS: Thirty-two criteria among a total of 100 were identified and were used to organize the cities into 8 groups which was then reduced to three profiles among the cities: a less advanced HiAP profile, an established HiAP profile and an advanced HiAP profile. This process allows us to identify 4 dimensions that make it possible to evaluate the level of maturity of cities in the HiAP process, namely: (1) the consideration of social inequalities in health and/or health issues in the policies/actions of the sector studied, (2) occasional intersectoral collaboration, ie, one-off initiatives between the health department and others sectors, (3) the existence of joint projects, ie, common projects between two or more sectors, (4) the existence of intersectoral bodies, in this case on the theme of urban green spaces including an intersectoral committee and/or working groups. CONCLUSION: Four dimensions which allow to the measurement of the degree of progress in implementing health-all-policies are proposed. With a view to integrating knowledge into public action, this study carried out under real conditions offers a realistic method to evaluate HiAP.

Urban green spaces and cancer: a protocol for a scoping review.

INTRODUCTION: Green space in the built environment is an important topic on the health agenda today. Studies have shown that access to green spaces is associated with better mental and physical health, yet green spaces can also be detrimental to health if they are not managed appropriately. Despite the increasing interest in urban green spaces, little research has so far been conducted into the links between green spaces and cancer. OBJECTIVE: The purpose of this scoping review is therefore to map the literature available on the types of relationship between urban green spaces and cancer. METHOD AND ANALYSIS: We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guideline to report the protocol. To conduct this scoping review, we will use a structured search strategy based on controlled vocabulary and relevant key terms related to green space, urban space and cancer. We will search MEDLINE (PubMed), GreenFILE (EBSCOhost), Cumulative Index to Nursing and Allied Health Literature (EBSCOhost) and ScienceDirect as electronic database as well as hand-search publications for grey literature. This review will therefore provide evidence on this current topic, one which could have practical implications for policy-makers involved in choices which are more conducive to healthy living. ETHICS AND DISSEMINATION: No primary data will be collected since all data that will be presented in this review are based on published articles and publicly available documents, and therefore ethics committee approval is not a requirement. The findings of this review will be presented at workshops and conferences, and will be submitted for publication in a peer-reviewed journal.

Correction to: The GREENH-City interventional research protocol on health in all policies.

After publication of the article [1], it has been brought to our attention that in the original publication the third author's name was spelt incorrectly. The correct spelling is "Emmanuelle Faure". This was previously spelt as "Emmannuelle Faure". The original article has been revised to reflect this.

The GREENH-City interventional research protocol on health in all policies.

BACKGROUND: This paper presents the research protocol of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project funded by the National Institute for Cancer (Subvention N°2017-003-INCA). In France, health inequities have tended to increase since the late 1980s. Numerous studies show the influence of social, economic, geographic and political determinants on health inequities across the life course. Exposure to environmental factors is uneven across the population and may impact on health and health inequities. In cities, green spaces contribute to creating healthy settings which may help tackle health inequities. Health in All Policies (HiAP) represents one of the key strategies for addressing social and environmental determinants of health inequities. The objective of this research is to identify the most promising interventions to operationalize the HiAP approaches at the city level to tackle health inequities through urban green spaces. It is a participatory interventional research to analyze public policy in real life setting (WHO Healthy Cities). METHOD/DESIGN: It is a mixed method systemic study with a quantitative approach for the 80 cities and a comparative qualitative multiple case-studies of 6 cities. The research combines 3 different lens: 1/a political analysis of how municipalities apply HiAP to reduce social inequities of health through green space policies and interventions 2/a geographical and topological characterization of green spaces and 3/ on-site observations of the use of green spaces by the inhabitants. RESULTS: City profiles will be identified regarding their HiAP approaches and the extent to which these cities address social inequities in health as part of their green space policy action. The analysis of the transferability of the results will inform policy recommendations in the rest of the Health City Network and widely for the French municipalities. DISCUSSION/CONCLUSION: The study will help identify factors enabling the implementation of the HiAP approach at a municipal level, promoting the development of green spaces policies in urban areas in order to tackle the social inequities in health.

[Regular bike use in Nantes: a combined health and mobility approach]. / Pratiques quotidiennes du vélo à Nantes : approche croisée de la santé et de la mobilité.

The health benefits of regular physical activity have now been clearly established. Two initiatives developed in Nantes allowed estimation of the benefits as perceived by local authorities as well as the motivations of cyclists and the general population. The City Council and the metropolitan area of Greater Nantes used the HEAT tool, which identifies the economic health benefit of increasing active forms of transport at the population level. The number of deaths avoided and the economic benefits were calculated by using both current and 2030-projected cycling rates and mortality rates. HEAT shows that, at current cycling rates, the health benefits result in 120 deaths avoided over 10 years for the city of Nantes (260 for the metropolitan area) with an economic benefit of €461,000,000 (€1,005,000,000 for the metropolitan area). A study of bike usage carried out in Greater Nantes based on interviews of cyclists and the general population showed that health and well-being were the leading reasons cited for cycling. The study showed an overrepresentation of academically-qualified men amongst cyclists. This inter-sectorial approach reinforced the exchanges between politicians and staff in both the transport and health sectors. It also allowed sharing of objectives and joint actions notably in the form of the 2015-2020 Cycling Plan, which is designed to promote cycling among people not currently using this modality. .

European national healthy city networks: the impact of an elite epistemic community.

National healthy cities networks (NNs) were created 20 years ago to support the development of healthy cities within the WHO Europe Region. Using the concept of epistemic communities, the evolution and impact of NNs is considered, as is their future development. Healthy cities national networks are providing information, training and support to member cities. In many cases, they are also involved in supporting national public health policy development and disseminating out healthy city principles to other local authorities. National networks are a fragile but an extremely valuable resource for sharing public health knowledge.

Healthy Cities: facilitating the active participation and empowerment of local people.

Community participation and empowerment are key values underpinning the European WHO Healthy Cities initiative, now in its fifth phase. This paper provides a brief overview of the history, policy context, and theory relating to community participation and empowerment. Drawing on Phase IV evaluation data, it presents the findings in relation to the four quadrants of Davidson's Wheel of Participation--information, consultation, participation in decision making, and empowerment. The large majority of European Healthy Cities have mechanisms in place to provide information for and to consult with local people. Most also demonstrate a commitment to enabling community participation in decision-making and to empowering citizens. Within this context, the evaluation highlighted a diversity of approaches and revealed varied perspectives on how participation and empowerment can be integrated within city leadership and governance processes. The paper concludes by suggesting that there is a need to strengthen future evaluative research to better understand how and why the Healthy Cities approach makes a difference.

Incidence of stroke and socioeconomic neighborhood characteristics: an ecological analysis of Dijon stroke registry.

BACKGROUND AND PURPOSE: Studies have shown higher stroke incidence in areas with higher levels of deprivation. We aimed to determine the pattern of association between various area socioeconomic status (SES) indicators and stroke incidence in specific sex and age groups. METHODS: Data are from the Dijon stroke registry for the period 1995 to 2003. The analyses included 1255 cases aged older than 40 (median age, 76.8). Poisson regression was used to model stroke incidence according to the SES level of 61 small areas. RESULTS: Among women, stroke incidence was higher in neighborhoods with large income inequality (incidence rate ratio, 1.34; P=0.003), higher proportions of unemployed (1.24; P=0.02), of non-French nationals (1.21, P=0.02), and of rented housing (1.31; P=0.03). Areas with a higher proportion of people aged older than 60 were associated with lower stroke incidence (incidence rate ratio, 0.72; P=0.01). Analysis by specific age-groups showed stronger effects among the 60- to 74-year-olds. Among men, no associations between SES and stroke incidence were identified overall but analysis by age groups showed significant effect among the 40- to 59-year-olds. In this age group, incidence rate ratios were 1.47 for unemployment (P=0.01), 1.86 for no car ownership (P=0.02), and 1.56 for income inequality (P=0.01). Among stroke cases, no trend in vascular risk factors prevalence according to area SES was identified. CONCLUSIONS: Variations of stroke incidence were more marked for the SES indicators of wealth and of income inequality. They were apparent at an earlier age in men and showed a stronger gradient among women.

National networks of Healthy Cities in Europe.

National networks of Healthy Cities emerged in the late 1980s as a spontaneous reaction to a great demand by cities to participate in the Healthy Cities movement. Today, they engage at least 1300 cities in the European region and form the backbone of the Healthy Cities movement. This article provides an analysis of the results of the regular surveys of national networks that have been carried out principally since 1997. The main functions and achievements of national networks are presented alongside some of their most pressing challenges. Although networks have differing priorities and organizational characteristics, they do share common goals and strategic directions based on the Healthy Cities model (see other articles in this special edition of HPI). Therefore, it has been possible to identify a set of organizational and strategic factors that contribute to the success of networks. These factors form the basis of a set of accreditation criteria for national networks and provide guidance for the establishment of new national networks. Although national networks have made substantial achievements, they continue to face a number of dilemmas that are discussed in the article. Problems a national network must deal with include how to obtain sustainable funding, how to raise the standard of work in cities without creating exclusive participation criteria and how to balance the need to provide direct support to cities with its role as a national player. These dilemmas are similar to other public sector networks. During the last 15 years, the pooling of practical expertise in urban health has made Healthy Cities networks an important resource for national as well as local governments. Not only do they provide valuable support to their members but they often advise ministries and other national institutions on effective models to promote sustainable urban health development.

Community participation and empowerment in Healthy Cities.

Community participation and empowerment are core principles underpinning the Healthy Cities movement. By providing an overview of theory and presenting the relevant findings of evaluations, this article explores how cities in the WHO European Healthy Cities Network have integrated community participation and empowerment within their development. Reflecting the inclusion of public participation and empowerment within the designation criteria for project cities, the evaluation of Phase III in 2002 demonstrated that community participation continues to be a high priority in most project cities. One-third of cities regularly consulted with large parts of their populations and another third undertook occasional consultations. Nearly 80% of cities had mechanisms for community representatives to participate in decision-making; and more than two-thirds of cities had initiatives explicitly aimed at empowering local people. Subsequent research carried out during 2005 further highlighted the centrality of public participation to the Healthy Cities movement. It found that all project cities continued to support community involvement. Community participation is an essential part of the process of good local governance, and empowerment remains at the heart of effective health promotion. To be meaningful, these processes must be seen as fundamental values of Healthy Cities and so must be developed as an integral part of long-term strategic development.

Impact of social ties on self reported health in France: is everyone affected equally?

AIM: To examine the association of social ties and income with self reported health, in order to investigate if social ties have a greater impact on the health of people on low incomes compared to those financially better off. METHODS: A nationally representative cross-sectional study of 5205 French adults using data from questionnaires which asked about health, income and relationships with family and friends etc. RESULTS: Less than good self-rated health (SRH) is twice as frequently reported by people in the lowest income group than those in the highest income group. People with low incomes are also more likely to have felt alone on the previous day, received no phone call during the last week, have no friends, not be a member of a club, and to live alone. Socially isolated people report lower SRH. Likelihood ratio tests for interaction vs. main effect models were statistically significant for 2 of the measures of social ties, borderline for 2 others and non-significant for one. For 4 of the 5 indicators of social ties, larger odd ratios show that social isolation is more strongly associated with less than good SRH among people on low incomes compared to those with a higher income. CONCLUSION: Social isolation is associated with 'less than good' self-rated health. This effect appears to be more important for people on a low income.

National healthy cities networks: a powerful force for health and sustainable development in Europe

National healthy cities networks are the backbone of the Healthy Cities movement in Europe. They provide political, strategic and technical support to their members, are a national resource of experience and expertise in health development, and offer a dynamic platform for public health advocacy at the national and international level. Each national network is unique. Each one develops in response to the needs of its member cities, with the resources available and within its own cultural and legal framework. This publication has two parts: analysis of the multifaceted work and achievements of national networks across Europe, and a profile of each network focusing on its special features, successes and aspirations.