October 30 | 2017

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Healthy Cities of Tomorrow: the Case for Large Scale Built Environment-Health Studies.

Sarkar C , Webster C.

J Urban Health. 2017 Feb;94(1):4-19. DOI: 10.1007/s11524-016-0122-1

EXCERPT FROM INTRODUCTION: New scientific evidence generated over the past decade points to a significant role played by a myriad of attributes of our cities’ built environments (BE) in shaping human behaviour, health and well-being [3, 4, 5, 6]. This has resulted in a renaissance of interest in an environmentalmodel of public health, comprising interventions specific to physical and social environments [7, 8]. We view this as similar to the wave of public health interest that gave birth to modern town planning in the mid to late twentieth century. Non-clinical environmental interventions in the form of health-specific planning and design of neighbourhoods and cities have been scientifically shown to have significant potential in playing a role in creating healthy cities of tomorrow. In addition to enabling healthier lifestyles, such interventions can produce higher cost effectiveness ratios in health service provision and can thus play a part in reducing future health expenditures [9]. The creation of healthy cities will entail a much closer integration and synergy between the disciplines of public health, epidemiology, transport planning, urban planning and design.

In the recent years several ongoing projects have emerged that aim specifically to measure health-specific components of urban environments at a large scale. The ultimate objective is to eventually link them with existing health cohorts enabling interdisciplinary collaborations and evidence generation towards creation of healthy cities. The Place, Health and Liveability project is one such national-level study aiming to create neighbourhood-level spatial measures of urban liveability across seven domains of employment, food, housing, public open space, social infrastructure, transport and walkability in Australia [10]. Algorithms measuring weighted street distance of individual dwellings to amenities and public transit have been developed to produce composite Walk Scores and Transit Scores in most US cities and some Canadian and Australian cities at the level of individual properties [11]. These are being linked with existing health cohorts to decipher associations with individual’s active travel behaviours [12]. Furthermore, there are many large scale health studies being conducted around the world, including the UK Biobank study (described in the subsequent section), 45 and Up Study in New South Wales, Australia1 (N = 250,000 participants); EpiHealth Study, Sweden2 (N = 300,000); China Kadoorie Biobank, China3 (N = 500,000); Million Death Study, India4 (N = 1,000,000) and Hong Kong FAMILY Cohort5 (N = 46,000) to name just a few. These present us (BE and urban planners and designers, epidemiologists, health economists, public health researchers and policy makers) with a well-timed opportunity to join expertise and resources for an integrated and multi-disciplinary global consortium to model and create national-level BE-health databases that can be turned into fine-tuned professional decision support and guidance systems. In the remaining part of this paper, we shall discuss some of the key issues and challenges in creation of healthy cities and ways to overcome them through interdisciplinary evidence generation on a large scale, planning and forecasting.

October 23 | 2017

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A Difference-in-Differences Approach to Assess the Effect of a Heat Action Plan on Heat-Related Mortality, and Differences in Effectiveness According to Sex, Age, and Socioeconomic Status (Montreal, Quebec)

Benmarhnia T, Bailey Z, Kaiser D, Auger N, King N, Kaufman J.

Environ Health Perspect. 2016.  124:1694–1699; http://dx.doi.org/10.1289/EHP203

Abstract

Background: The impact of heat waves on mortality and health inequalities is well documented. Very few studies have assessed the effectiveness of heat action plans (HAPs) on health, and none has used quasi-experimental methods to estimate causal effects of such programs.

Objectives: We developed a quasi-experimental method to estimate the causal effects associated with HAPs that allows the identification of heterogeneity across subpopulations, and to apply this method specifically to the case of the Montreal (Quebec, Canada) HAP.

Methods: A difference-in-differences approach was undertaken using Montreal death registry data for the summers of 2000–2007 to assess the effectiveness of the Montreal HAP, implemented in 2004, on mortality. To study equity in the effect of HAP implementation, we assessed whether the program effects were heterogeneous across sex (male vs. female), age (≥ 65 years vs. < 65 years), and neighborhood education levels (first vs. third tertile). We conducted sensitivity analyses to assess the validity of the estimated causal effect of the HAP program.

Results: We found evidence that the HAP contributed to reducing mortality on hot days, and that the mortality reduction attributable to the program was greater for elderly people and people living in low-education neighborhoods.

Conclusion: These findings show promise for programs aimed at reducing the impact of extreme temperatures and health inequities. We propose a new quasi-experimental approach that can be easily applied to evaluate the impact of any program or intervention triggered when daily thresholds are reached.

October 13 | 2017

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Lead author and CANUE Director Dan Crouse talks about his recent paper on Radio Canada. http://www.rcinet.ca/en/2017/10/13/new-canadian-study-suggests-that-trees-can-play-a-part-in-a-longer-life/

October 16 | 2017

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Urban greenness and mortality in Canada’s largest cities: a national cohort study

Dan L Crouse, Lauren Pinault, Adele Balram, Perry Hystad, Paul A Peters, Hong Chen, Aaron van Donkelaar, Randall V Martin, Richard Ménard, Alain Robichaud, Paul J Villeneuve

The Lancet Planetary Health Volume 1, Issue 7, October 2017, Pages e289-e29  DOI: http://dx.doi.org/10.1016/S2542-5196(17)30118-3

Summary

Background

Findings from published studies suggest that exposure to and interactions with green spaces are associated with improved psychological wellbeing and have cognitive, physiological, and social benefits, but few studies have examined their potential effect on the risk of mortality. We therefore undertook a national study in Canada to examine associations between urban greenness and cause-specific mortality.

Methods

We used data from a large cohort study (the 2001 Canadian Census Health and Environment Cohort [2001 CanCHEC]), which consisted of approximately 1·3 million adult (aged ≥19 years), non-immigrant, urban Canadians in 30 cities who responded to the mandatory 2001 Statistics Canada long-form census. The cohort has been linked by Statistics Canada to the Canadian mortality database and to annual income tax filings through 2011. We measured greenness with images from the moderate-resolution imaging spectroradiometer from NASA’s Aqua satellite. We assigned estimates of exposure to greenness derived from remotely sensed Normalized Difference Vegetation Index (NDVI) within both 250 m and 500 m of participants’ residences for each year during 11 years of follow-up (between 2001 and 2011). We used Cox proportional hazards models to estimate associations between residential greenness (as a continuous variable) and mortality. We estimated hazard ratios (HRs) and corresponding 95% CIs per IQR (0·15) increase in NDVI adjusted for personal (eg, education and income) and contextual covariates, including exposures to fine particulate matter, ozone, and nitrogen dioxide. We also considered effect modification by selected personal covariates (age, sex, household income adequacy quintiles, highest level of education, and marital status).

Findings

Our cohort consisted of approximately 1 265 000 individuals at baseline who contributed 11 523 770 person-years. We showed significant decreased risks of mortality in the range of 8–12% from all causes of death examined with increased greenness around participants’ residence. In the fully adjusted analyses, the risk was significantly decreased for all causes of death (non-accidental HR 0·915, 95% CI 0·905–0·924; cardiovascular plus diabetes 0·911, 0·895–0·928; cardiovascular 0·911, 0·894–0·928; ischaemic heart disease 0·904, 0·882–0·927; cerebrovascular 0·942, 0·902–0·983; and respiratory 0·899, 0·869–0·930). Greenness associations were more protective among men than women (HR 0·880, 95% CI 0·868–0·893 vs 0·955, 0·941–0·969), and among individuals with higher incomes (highest quintile 0·812, 0·791–0·834 vs lowest quintile 0·991, 0·972–1·011) and more education (degree or more 0·816, 0·791–0·842 vs did not complete high school 0·964, 0·950–0·978).

Interpretation

Increased amounts of residential greenness were associated with reduced risks of dying from several common causes of death among urban Canadians. We identified evidence of inequalities, both in terms of exposures to greenness and mortality risks, by personal socioeconomic status among individuals living in generally similar environments, and with reasonably similar access to health care and other social services. The findings support the development of policies related to creating greener and healthier cities.

October 10 | 2017

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BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe’s blue spaces.

Grellier J, White MP, Albin M, Bell S, Elliott LR, Gascón M, Gualdi S, Mancini L, Nieuwenhuijsen MJ, Sarigiannis DA, van den Bosch M, Wolf T, Wuijts S, Fleming LE.

BMJ Open. 2017 Jun 14;7(6)   http://dx.doi.org/10.1136/bmjopen-2017-016188

 

Abstract

INTRODUCTION:

Proximity and access to water have long been central to human culture and accordingly deliver countless societal benefits. Over 200 million people live on Europe’s coastline, and aquatic environments are the top recreational destination in the region. In terms of public health, interactions with ‘blue space’ (eg, coasts, rivers, lakes) are often considered solely in terms of risk (eg, drowning, microbial pollution). Exposure to blue space can, however, promote health and well-being and prevent disease, although underlying mechanisms are poorly understood.

AIMS AND METHODS:

The BlueHealth project aims to understand the relationships between exposure to blue space and health and well-being, to map and quantify the public health impacts of changes to both natural blue spaces and associated urban infrastructure in Europe, and to provide evidence-based information to policymakers on how to maximise health benefits associated with interventions in and around aquatic environments. To achieve these aims, an evidence base will be created through systematic reviews, analyses of secondary data sets and analyses of new data collected through a bespoke international survey and a wide range of community-level interventions. We will also explore how to deliver the benefits associated with blue spaces to those without direct access through the use of virtual reality. Scenarios will be developed that allow the evaluation of health impacts in plausible future societal contexts and changing environments. BlueHealth will develop key inputs into policymaking and land/water-use planning towards more salutogenic and sustainable uses of blue space, particularly in urban areas.

ETHICS AND DISSEMINATION:

Throughout the BlueHealth project, ethics review and approval are obtained for all relevant aspects of the study by the local ethics committees prior to any work being initiated and an ethics expert has been appointed to the project advisory board. So far, ethical approval has been obtained for the BlueHealth International Survey and for community-level interventions taking place in Spain, Italy and the UK. Engagement of stakeholders, including the public, involves citizens in many aspects of the project. Results of all individual studies within the BlueHealth project will be published with open access. After full anonymisation and application of any measures necessary to prevent disclosure, data generated in the project will be deposited into open data repositories of the partner institutions, in line with a formal data management plan. Other knowledge and tools developed in the project will be made available via the project website (www.bluehealth2020.eu). Project results will ultimately provide key inputs to planning and policy relating to blue space, further stimulating the integration of environmental and health considerations into decision-making, such that blue infrastructure is developed across Europe with both public health and the environment in mind.

October 2 | 2017

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Association of Long-Term Exposure to Transportation Noise and Traffic-Related Air Pollution with the Incidence of Diabetes: A Prospective Cohort Study.

Clark C, Sbihi H, Tamburic L2, Brauer M, Frank LD, Davies HW.

Environ Health Perspect. 2017 Aug 31;125(8):087025.  https://doi.org/10.1289/EHP1279

Abstract

BACKGROUND:

Evidence for an association between transportation noise and cardiovascular disease has increased; however, few studies have examined metabolic outcomes such as diabetes or accounted for environmental coexposures such as air pollution, greenness, or walkability.

OBJECTIVES:

Because diabetes prevalence is increasing and may be on the causal pathway between noise and cardiovascular disease, we examined the influence of long-term residential transportation noise exposure and traffic-related air pollution on the incidence of diabetes using a population-based cohort in British Columbia, Canada.

METHODS:

We examined the influence of transportation noise exposure over a 5-y period (1994-1998) on incident diabetes cases in a population-based prospective cohort study (n=380,738) of metropolitan Vancouver (BC) residents who were 45-85 y old, with 4-y of follow-up (1999-2002). Annual average transportation noise (Lden), air pollution [black carbon, particulate matter with aerodynamic diameter <2.5μm (PM2.5), nitrogen oxides], greenness [Normalized Difference Vegetation Index (NDVI)], and neighborhood walkability at each participant’s residence were modeled. Incident diabetes cases were identified using administrative health records.

RESULTS:

Transportation noise was associated with the incidence of diabetes [interquartile range (IQR) increase, 6.8 A-weighted decibels (dBA); OR=1.08 (95% CI: 1.05, 1.10)]. This association remained after adjustment for environmental coexposures including traffic-related air pollutants, greenness, and neighborhood walkability. After adjustment for coexposure to noise, traffic-related air pollutants were not associated with the incidence of diabetes, whereas greenness was protective.

CONCLUSION:

We found a positive association between residential transportation noise and diabetes, adding to the growing body of evidence that noise pollution exposure may be independently linked to metabolic health and should be considered when developing public health interventions.