Obesogenic environments as major determinants of a disease: It is time to re-shape our cities.

Obesity rates are increasing in almost all high- and low-income countries, and population-based approaches are necessary to reverse this trend. The current global efforts are focused on identifying the root causes of obesity and developing effective methods for early diagnosis, screening, treatment, and long-term management, both at an individual and health system level. However, there is a relative lack of effective options for early diagnosis, treatment, and long-term management, which means that population-based strategies are also needed. These strategies involve conceptual shifts towards community- and environment-focused approaches. This review aimed to provide evidence on how environmental factors contribute to the risk of obesity and how reshaping cities can help slow down obesity prevalence rates and improve long-term management.

Pollution and endometriosis: A deep dive into the environmental impacts on women's health.

BACKGROUND: The interaction between pollution and endometriosis is a pressing issue that demands immediate attention. The impact of pollution, particularly air and water pollution, or occupational hazards, on hormonal disruption and the initiation of endometriosis remains a major issue. OBJECTIVES: This narrative review aims to delve into the intricate connection between pollution and endometriosis, shedding light on how environmental factors contribute to the onset and severity of this disease and, thus, the possible public health policy implications. DISCUSSION: Endocrine-disrupting chemicals (EDCs) in pollutants dysregulate the hormonal balance, contributing to the progression of this major gynaecological disorder. Air pollution, specifically PM2.5 and PAHs, has been associated with an increased risk of endometriosis by enhancing chronic inflammation, oxidative stress, and hormonal imbalances. Chemical contaminants in water and work exposures, including heavy metals, dioxins, and PCBs, disrupt the hormonal regulation and potentially contribute to endometriosis. Mitigating the environmental impact of pollution is required to safeguard women's reproductive health. This requires a comprehensive approach involving stringent environmental regulations, sustainable practices, responsible waste management, research and innovation, public awareness, and collaboration among stakeholders. CONCLUSION: Public health policies have a major role in addressing the interaction between pollution and endometriosis in a long-term commitment.

Long-term care needs and the risk of household poverty across Europe: a comparative secondary data study.

PURPOSE: Population ageing and rising poverty are two of the most pressing issues today, even in Western European nations, growing as a result of the recent global economic crisis and the COVID-19 containment measures. This study explores the relationship between long-term care (LTC) needs and risk of poverty at household level in eight European countries, representing the different European care regimes. METHODS: The main international databases were scoured for study variables, categorized according to the following conceptual areas: home care, residential care, health expenditure, service coverage, cash benefits, private services, population, family, education, employment, poverty, disability and care recipients, and life expectancy. We initially identified 104 variables regarding 8 different countries (Austria, Finland, Germany, the Netherlands, Italy, Spain, Poland, Romania). Statistical analyses were conducted as described hereafter: analysis of the Pearson's Bivariate Correlation between the dependent variable and all other variables; a Multivariable Linear Regression Model between the Poverty Index (dependent variable) and the covariates identified in the preceding step; a check for geographical clustering effects and a reduced Multivariable Linear Regression Model for each identified European cluster. RESULTS: The variables that addressed the risk of poverty pertained to the area of policy intervention and service provision. Rising private out-of-pocket health expenditures and proportion of "poor" couples with at least one child are two factors that contributed significantly to poverty increasing. Moreover, rising private out-of-pocket health expenditures for covering LTC needs (even in presence of public financial contribution to the family) is the main contributor to household poverty increasing in presence of ADL disability. CONCLUSION: The results reveal the existence of a clear correlation between the need for LTC and the risk of poverty in households across Europe. These results highlight the central relevance of LTC policies, which are often still treated as marginal and sectoral, for the future sustainability of integrated care strategies.

Coping strategies of food insecure households with children and adolescents in Uruguay, a high-income Latin American country: A qualitative study through the lens of Bourdieu's theories of capitals and practice.

Food insecurity has been associated with negative short, medium, and long-term health consequences, which are more detrimental for children and adolescents. These effects may depend on the coping strategies developed to deal with food shortages. The present research aimed at exploring coping strategies in food insecure households with children and adolescents in Uruguay, incorporating sociological theoretical insights from Bourdieu. A qualitative approach based on individual semi-structured interviews was used. A total of 40 interviews were conducted with adults who had parental responsibilities of children and adolescents and who received different types of food assistance, between July and December 2022, in four cities. Results showed that adults tend to develop a wide range of coping strategies aimed at: reducing food expenditure, increasing the availability of money for purchasing food, increasing food availability and/or rationing the food available in the household. Some of the strategies were implemented regardless of the severity of food insecurity, whereas others were characteristic of the moderate and severe levels of the construct. Evidence to support the mediation effect of coping strategies on health outcomes was found. Discourses suggested that lower accumulation of economic and cultural capital may be aligned with the adoption of less socially accepted mechanisms to access to food. Expressions of a specific habitus aimed at securing food were identified among participants with more deprivations. Taken together, the findings suggest that coping strategies may not be a universal or invariant sequence according to the severity of food insecurity and stress the importance of considering households' resources and local context for the development of strategies to improve access to food.

Air, land, and water pollutants and public health expenditures: Empirical data from selected EU countries in the transport sector.

The increase in economic activity, particularly in transport, leads to a significant increase in emissions of pollutants, such as ammonia, arsenic and cadmium, at the European Union (EU) level. This can seriously impact human health and, consequently, public health spending. Based on data from 15 European Union countries from 1992 to 2020, a panel co-integration approach is used to study these pollutants' short- and long-term co-movements and per capita health expenditure. The results show a long-term relationship between ammonia, arsenic and cadmium emissions and per capita health spending, as they are panel-cointegrated. Ammonia and cadmium emissions exert a statistically significant positive effect on health expenditure in the short run, and arsenic emissions have a statistically significant positive impact in the long run. The forecast assessment of reductions in health spending resulting from policies to reduce emissions of air, land and water pollutants, such as ammonia, arsenic and cadmium, from the transport sector supports investments in its policies that reduce pressure on health spending. The reduction in annual healthcare expenditure is greater when these reductions are made sooner and more severely. Indeed, varying the reduction in emissions for each pollutant by 10% and 100%, respectively, from the first year for all countries over a 3-year period results in an average annual reduction in health spending of 2.05% and 51.02%, respectively. However, if we wait until the third year, the annual reduction is only 0.77% and 17.63% respectively.

The Labor Market Integration of Women Having Suffered Gender Violence: Some Critical Questions.

The integration of women victims of gender-based violence (WVGBV) in the labor market is key to women's autonomy and empowerment. After pursuing some personal stability in different domains (emotional, physical, relational, etc.), these women require a further step toward recovery, which is often related to financial independence and, therefore, to their integration in the labor market. In this article, we describe the results of a study that focused on the actions aimed at integrating WVGBV into the labor market in the region of Andalusia (Spain). Based on a qualitative methodology, we collected the narratives and perspectives of the different actors involved in these processes (public administrations, nongovernmental organizations, the business world, and the WVGBV). The results revealed a series of deficiencies in social intervention methodologies that can sometimes lead to greater social exclusion. In conclusion, we believe that more participatory methodologies in their design, incorporating the views of woman themselves, are necessary.

COVID-19 vaccination and governance in the case of low, middle and high-income countries.

BACKGROUND: Global crises, regardless of the place where they started to spread or of the factors that triggered them, require a comprehensive approach, primarily based on good communication, cooperation and mutual support. No individual and no institution should remain indifferent to crises but, on the contrary, be fully aware that any involvement in curbing them matters. Although humanity can be affected by various types of crises, in this paper we refer to the one related to COVID-19 pandemic. There are certain reasons that come to justify our choice: first of all, being a shock with a strong impact on people, its analysis should be performed from several angles; this may bring to light an image with its disparate propagation and measures to counteract it both in developed countries, and especially in those with a shortage of resources. Secondly, in the context of the emergence of vaccines against COVID-19, it is helpful to have an overview of COVID-19 through the lens of the relationship between the vaccination process and the elements that characterize governance, with a differentiated dashboard by country categories worldwide: low, middle and high-income countries. Our study is far from capturing the complexity arising from such social problem, but rather aims to outline the defining role of governance when it comes to providing firm reactions to the COVID-19 crisis. METHODS: Given that our sample consists of a large number of countries, namely 170, first, examined all together, and then, split into three groups (high, middle and low-income), it is challenging to address governance in association with COVID-19 vaccination, in order to see how much they interact and how each of the six aggregate governance indicators of the World Bank (Worldwide Governance Indicators) is reflected in this process. Even if they do not oscillate strongly over relatively short periods of time, reporting on health issues requires a sequential inventory, considering closer time intervals, so as to be able to act promptly. Thus, to better distinguish how the COVID-19 vaccination process evolved in low, middle and high-income countries, but also how it was imprinted by governance, we present the situation quarterly (March, June, September and December), in 2021, the year when the immunization campaigns were the most intense at the global level. Regarding the applied methods, we mention both OLS regressions with robust estimators and a panel model, used to investigate the determinants of COVID-19 vaccination, some of them describing the good governance, as well as other dimensions. RESULTS: The findings point out that the influence of governance on COVID-19 vaccination differs depending on whether a country belongs to high, middle or low-income typology: the strongest determinism of governance on vaccination is encountered in high-income countries, and the weakest in low-income ones; in some cases, governance does not matter significantly. However, exploring the three groups of states included in the research, it is observed that the most relevant factors in this relationship are government effectiveness, regulatory quality and control of corruption. CONCLUSIONS: Besides the order of importance of governance indicators on COVID-19 vaccination, our study indicates that, overall, governance positively shapes the vaccination rate at the level of the chosen sample. In normative terms, these findings can be translated particularly by the fact that they can serve as information to raise awareness on the relevance of the existence of an institutional framework that allows the formulation of strategies according to the patterns of each country, especially since the actionable tools depend on the available resources. As a general conclusion, public policies should be designed in such a way as to strengthen trust in vaccination regulations and in governments, to reduce the multifaceted negative effects of this health crisis and to hope for its total end.

Children and adolescents continue to be exposed to early work in Brazil.

2 million children and adolescents between 11 and 19 years old have not yet finished basic education and had left school. The current Brazilian scenario reflects the reality in which these children and adolescents are inserted, without sufficient resources for the continuity of basic or elementary education, and often the parents' lack of income leads these young people to seek work, as can be seen in several capitals and inland cities: children selling food at traffic lights, bars, restaurants, and similar situations5. According to a study carried out by Abrinq Foundation (Fundação Abrinq), in the last quarter of 2021, there were about 2.36 million adolescents aged between 14 and 17 years old in the labor market or looking for a job, of which 1.2 million were in child labor in disagreement with Brazilian legislation, including work similar to slavery, and activities harmful to health, development, and morality.

An unethical trial and the politicization of the COVID-19 pandemic in Brazil: The case of Prevent Senior.

The Brazilian Federal Senate created a Parliamentary Inquiry Commission (CPI) to investigate the Bolsonaro government's irregularities in the management of the COVID-19 pandemic. One of the cases that drew attention was the research conducted by Prevent Senior, a private health insurance company, on the early treatment of COVID-19. The article analyzes the scientific validity of the research and the ethical problems related to its implementation. It is based on analysis of Prevent Senior's report of the clinical study, the Brazilian and USA clinical trial registries, the Senate's CPI report, and on the information reported by the media. This case of scientific fraud and political-ideological bias exemplifies how Prevent Senior, using a questionable protocol to enhance its reputation and gain government support, was instrumental in building the "early treatment" narrative for COVID-19, and shows how it served as a basis for a government public policy that promoted the use of ineffective drugs.

Defining Long-Term-Care Need Levels for Older Adults: Towards a Standardized European Classification.

International comparisons of long-term care (LTC) are hampered by inconsistencies in how to define the need for care. This is especially relevant for the European Union, whose Aging Working Group, which is tasked to project aging expenditure in the long term, has over time used two competing definitions - one based on inability to perform Activities of Daily Living (ADL) and another based on the more subjective Global Activity Limitation Index (GALI). The inconsistency in measurement, as well as problems in defining the intensity of needs, will acquire growing significance as longevity progresses. This paper investigates how the two measures are linked, by analyzing a large European sample survey where respondents replied to both questions. This allows a calibration of the two measures and an investigation of their areas of overlap and difference. The paper concludes by proposing a simple new 4-scale measure of care needs which, by combining the two metrics, introduces some gradation of the intensity of care. Using a consistent measure incorporating intensity, such as the one proposed, will facilitate international comparisons, improve long-term expenditure projections, and aid policy discussion, including the transfer of best practice.

The Potential of Social Policies in Preventing Dementia: An Ecological Study Using Systematic Review and Meta-Analysis.

Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer's disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.

Multi-level policy responses to tackle socioeconomic inequalities in the incidence of COVID-19 in a European urban area.

BACKGROUND: Spain has been hit hard by COVID-19 since March 2020, especially in its metropolitan areas. We share experiences from Barcelona in measuring socioeconomic inequalities in the incidence of COVID-19 in the different waves, and in implementing coordinated and equity-oriented public health policy responses. METHODS: We collected daily data on confirmed COVID-19 cases, geocoded the address of residence to assign each case to one of the 73 neighborhoods and 1068 census tracts, and calculated the cumulative incidence of COVID-19 by neighborhood and five income groups (quintiles of census tracts) by sex across four waves of the pandemic. We adjusted hierarchical Bayesian spatial models to obtain the relative risk (RR) of cumulative incidences in each quintile compared with the richest areas. A variety of public health policies implemented to tackle the pandemic and especially these inequalities in COVID-19 incidence and vaccination are selected and described. RESULTS: Area-level income inequalities in the incidence of COVID-19 were present at different degree in all four waves. In the second wave (10/1/2020 to 12/6/2020), RR for the poorest income quintile census tracts compared with the richest was 1.43 (95% credible interval-CI-: 1.22-1.67) for men and 1.58 (95% CI: 1.35-1.83) for women. Later, inequalities in vaccination coverage also arose. Equity-oriented policy responses included: "health hotels" or home delivery of basic products for individuals with COVID-19 and without adequate conditions for isolation; new emergency facilities for homeless people, including those with active drug use; mass screening in high incidence areas; contingency plans for nursing homes and schools; adapting community health programs for their early reactivation; digital self-appointment support points and community vaccination days. CONCLUSION: COVID-19 hit Barcelona neighborhoods unequally, with variations between waves. The rapid availability of geolocalized data and by socioeconomic level helped public authorities to implement targeted policies and collaborative interventions for the most vulnerable populations. Further studies would be needed to evaluate their impact.

Nutrition policies in Germany: a systematic assessment with the Food Environment Policy Index.

OBJECTIVE: To systematically assess Germany's nutrition policies, to benchmark them against international best practices and to identify priority policy actions to improve population-level nutrition in Germany. DESIGN: We applied the Food Environment Policy Index (Food-EPI), a methodological framework developed by the International Network for Food and Obesity/non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) network. Qualitative content analysis of laws, directives and other documents formed the basis of a multistaged, structured consultation process. SETTING: Germany. PARTICIPANTS: The expert consultation process included fifty-five experts from academia, public administration and civil society. RESULTS: Germany lags behind international best practices in several key policy areas. For eighteen policy indicators, the degree of implementation compared with international best practices was rated as very low, for twenty-one as low, for eight as intermediate and for none as high. In particular, indicators on food taxation, regulation of food marketing as well as retail and food service sector policies were rated as very low to low. Identified priority actions included the binding implementation of nutrition standards for schools and kindergartens, a reform of the value added tax on foods and beverages, a sugar-sweetened beverage tax and stricter regulation of food marketing directed at children. CONCLUSIONS: The results show that Germany makes insufficient use of the potential of evidence-informed health-promoting nutrition policies. Adopting international best practices in key policy areas could help to reduce the burden of nutrition-related chronic disease and related inequalities in nutrition and health in Germany. Implementation of relevant policies requires political leadership, a broad societal dialogue and evidence-informed advocacy by civil society, including the scientific community.

Changes in Health-Related Quality of Life and Physical Activity Among Older Adults in the First-Wave COVID-19 Outbreak: A Longitudinal Analysis.

The current study aimed to follow the effects of social/physical distancing strategies on health-related daily physical activity and quality of life among older adults during the COVID-19 pandemic. Seventy-two older adults who were enrolled in a University-Community program in March 2020 (age = 66.8 ± 4.82 years, ♀59) answered five phone-based surveys up to 120 days after the COVID-19 outbreak (from April to August 2020). The Short Form 6D and international physical activity (short version) questionnaires were applied. A significant reduction was observed in daily physical activity levels, metabolic equivalent of task, and health-related quality of life scores as well as an increase in sitting time during the week and on weekend days (all p < .01). The authors noted differences in lifestyle conditions at the beginning of the social/physical distancing in the community assessed (p < .01). Health vulnerabilities among older adults have been emphasized during the COVID-19 outbreak, impacting daily physical activity and health-related quality of life.

Slums and pandemics.

How do slums shape the economic and health dynamics of pandemics? A difference-in-differences analysis using millions of mobile phones in Brazil shows that residents of overcrowded slums engaged in less social distancing after the outbreak of Covid-19. We develop and calibrate a choice-theoretic equilibrium model in which individuals are heterogeneous in income and some people live in high-density slums. Slum residents account for a disproportionately high number of infections and deaths and, without slums, deaths increase in non-slum neighborhoods. Policy analysis of reallocation of medical resources, lockdowns and cash transfers produce heterogeneous effects across groups. Policy simulations indicate that: reallocating medical resources cuts deaths and raises output and the welfare of both groups; mild lockdowns favor slum individuals by mitigating the demand for hospital beds, whereas strict confinements mostly delay the evolution of the pandemic; and cash transfers benefit slum residents to the detriment of others, highlighting important distributional effects.

Future assessment of the impact of the COVID-19 pandemic on the electricity market based on a stochastic socioeconomic model.

This paper proposes a time-series stochastic socioeconomic model for analyzing the impact of the pandemic on the regulated distribution electricity market. The proposed methodology combines the optimized tariff model (socioeconomic market model) and the random walk concept (risk assessment technique) to ensure robustness/accuracy. The model enables both a past and future analysis of the impact of the pandemic, which is essential to prepare regulatory agencies beforehand and allow enough time for the development of efficient public policies. By applying it to six Brazilian concession areas, results demonstrate that consumers have been/will be heavily affected in general, mainly due to the high electricity tariffs that took place with the pandemic, overcoming the natural trend of the market. In contrast, the model demonstrates that the pandemic did not/will not significantly harm power distribution companies in general, mainly due to the loan granted by the regulator agency, named COVID-account. Socioeconomic welfare losses averaging 500 (MR$/month) are estimated for the equivalent concession area, i.e., the sum of the six analyzed concession areas. Furthermore, this paper proposes a stochastic optimization problem to mitigate the impact of the pandemic on the electricity market over time, considering the interests of consumers, power distribution companies, and the government. Results demonstrate that it is successful as the tariffs provided by the algorithm compensate for the reduction in demand while increasing the socioeconomic welfare of the market.

Identifying stakeholders and discussing a strategy for the participatory management of a protected area: the case of Engenho Pequeno, in Rio de Janeiro State, Brazil.

This paper identifies the potential main social actors involved in and affected by the conservation and use of the Environmental Protection Area (EPA) of Engenho Pequeno, in Rio de Janeiro State, Brazil, and discusses how environmental education can be shaped to engage them in participatory, socially progressive and environmentally sustainable management for that area. Therefore, semi-structured interviews were conducted with individuals and entities related to the EPA. The snowball method complemented the mapping of non-official social actors. The discussion was based on the critical approach of environmental education, polycentric governance, adaptive management, environmental advocacy and case studies about education in protected areas. Results showed nine key stakeholders to be considered in a network program for the EPA's participatory management, including government, schools, local and nearby residents and religious groups. In the end, we recommend the hosting of a one day workshop, built around existing local and national environmental goals, as an entry point for trust building and the search for shared interests.

Challenges in the context of single-use plastics and bioplastics in Brazil: A legislative review.

Plastic has been present in our lives for the past century as an essential material for many commodity items. However, the same properties that make plastic convenient are also responsible for the current dramatic environmental pollution. As an alternative, most of the world has been working with technological innovations, and one of its strategies is the use of bioplastics. Despite being considered environmentally beneficial by some people, there are still developments and discussions that need to be made. This article aims to present a legislative review and discusses the difficulty in implementing policies related to the incentive of the bioplastics market, as well as presenting some state and municipal laws, already prohibiting single-use plastics in Brazil. These laws aim to encourage the substitution of these plastics for biodegradable ones. However, it still has gaps and a lack of clarification on how the banning of disposable plastics and their substitution will be beneficial since composting is still an incipient process in the country. It is also the purpose of this article to discuss the challenges in the context of the Circular Economy, as well as the potential solution based on the creation of public policies aimed at improving waste management, in addition to clearer legislation on alternatives to single-use plastics.

Not all poor are equal: the perpetuation of poverty through blaming those who have been poor all their lives.

The economic crisis of 2008 severely affected the welfare states. As the economic situation of a country worsens, the resources that the public administration can devote to improve the situation of the people also decrease, endangering the advancement of those in a disadvantaged situation. People who have always lived in poverty, besides having their opportunities reduced, also face negative public views that affect the perceived legitimacy of such public aid, which can in turn be a mechanism for perpetuating their situation. Two studies (N = 252 and N = 266) analyse how a person in persistent poverty is perceived compared to a person in poverty due to the crisis-a circumstantial poverty. We also study some feasible mechanisms underlying this different perception, as well as their effects on attitudes toward social protection policies. In Study 1, results indicated that people showed more favourable attitudes toward social protection policies when they perceived someone in poverty due to the crisis, compared to the target who had been in poverty all his/her life. Individualistic attributions for poverty mediated this effect: when people think of someone in persistent poverty, they make more individualistic attributions concerning their situation, which leads to worse attitudes toward social protection policies. Identification with the group moderates this relation. Furthermore, Study 2 showed that participants perceive people who are in poverty because of economic crisis as more deserving of help than people who have always been poor. Some theoretical and practical implications for intergroup relations and public policy are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03804-6.

NAFLD: Challenges and opportunities to address the public health problem in Latin America.

Non-alcoholic fatty liver disease (NAFLD) is reaching epidemic proportions worldwide. Collectively, Latin American countries have some of the highest obesity rates in the world and the fastest-growing prevalence of type 2 diabetes mellitus (T2DM). Since obesity and T2DM are intrinsically linked with NAFLD, epidemiological projections are worrisome. In addition to this adverse epidemiological setting, the region of Latin America faces unique challenges and obstacles to addressing the growing burden of NAFLD. In this article, on the occasion of the International NASH Day on June 10, 2021, we describe the main challenges and opportunities to improve care of people living with NAFLD in Latin America. Among the major challenges to be tackled are: lack of disease awareness, limited educational opportunities for healthcare personnel and general public, health system fragmentation, and lack of effective strategies for the prevention and effective treatment of NAFLD and common comorbidities, namely obesity and T2DM. Wide dissemination of current concepts on NAFLD, and extensive collaboration between scientific societies, governments, non-governmental organizations, pharmaceutical industry, and other stakeholders is urgently needed to advance the NAFLD public health policies agenda that allows us to address this disease with a whole of society approach.