Lifestyle Choices and Societal Behavior Changes as Local Climate Strategy

The Asia-Pacific region is witnessing rapid economic growth. Along with rising incomes, the lifestyles of the large middle class are moving quickly towards a buy-and-discard consumer model that involves carbon-intensive products and services. These increase dependency on the Earth's finite natural resources and simultaneously produces waste, putting a significant strain on the environment. Such lifestyles, coupled with scarce resources and frequent natural hazards associated with climate change, pose serious threats to the future of the planet. Developed countries with high footprint per capita are under pressure to adjust their lifestyles that respect the Earths' carrying capacity. As far as countries in the Asia and Pacific region are concerned, mere technological solutions such as improving production efficiency will not be adequate to address climate change; a paradigm shift to more resource-efficient and low-carbon lifestyles, that promote inclusive and efficient consumption is the need of the hour. Several examples of good practices and community initiatives can be found around the world, but these have yet to be brought to the mainstream in order to achieve tangible results. Governments and policy makers in the Asia-Pacific can join hands with businesses and civil society to accelerate this transition - from a consumption-oriented economic paradigm, to a more sustainable way of production and consumption. This paper attempts to identify lifestyle changes at the individual level, and behavioral changes at the community level that could offer high carbon abatement potential. It also provides some good practices of public policies and policy recommendations that can be pivotal in making a business case of low-carbon and eco-efficient lifestyles, strengthening collective awareness, and influencing public decision-making in developing countries in Asia

Creative Accounts: Reimagining Culture and Wellbeing by Tapping into the Global Movement to Redefine Progress

A citizen-based global progress measurement movement has emerged in the past decade, with the potential for realisation of a new paradigm for democracy, good governance and authentic cultural engagement. The benefits already resulting from this movement appear to be significant. These include new and more dynamic forms of democratic engagement; the demonstration of clearer linkages between strong democratic and human rights regimes, and broader individual and societal wellbeing; new ways to define and measure a 'healthy' democracy; and, perhaps most importantly, a re-examination of the nature of progress and democracy in the twenty-first century. The extent to which cultural indicators have, or have not, featured in the emergence of the global progress measurement movement and its democratising ambitions is the focus of this chapter, raising serious questions for proponents of both perspectives

Health impacts of the M74 urban motorway extension: a natural experimental study

Background: Increasing people's mobility can improve access to diverse opportunities, but new roads are associated with noise and community severance, and their effects on physical activity, injuries, and health inequalities are poorly understood. This study investigated how an urban motorway, opened in Glasgow in 2011, affected travel and activity patterns, injuries, and wellbeing in local communities, and how these impacts were experienced and brought about. Methods: This was a mixed-method, controlled, before and after natural experimental study. We conducted multivariable cohort, cross-sectional, and repeat cross-sectional analyses of survey responses from adults resident in the M74 corridor (intervention area) and two matched control areas, one surrounding the existing M8 motorway and one with no motorway (numbers by area: baseline [in 2005] 449, 431, 465, respectively; follow-up [in 2013] 430, 446, 467; cohort participants 126, 112, 127). We also conducted interrupted time-series analyses of police casualty data (STATS19 forms, 1997–2014; n=78 919), and thematic analysis of ethnographic data from 42 participants using constant comparison. Graded exposure measures based on the log distance of the motorway from each participant's home served as a further basis for controlled comparisons. The study was approved by the University of Glasgow Faculty of Medicine (ref FM01304) and Social Sciences (refs 400120077, 400130156, and 400130157) ethics committees. Findings: Living closer to the new motorway was associated with an estimated 3·6 unit (95% CI 0·7–6·6) reduction over time in mental wellbeing (mental component summary score [MCS-8] of SF-8) per unit of proximity in cohort analysis, and associated with a greater likelihood of car use at follow-up in repeat cross-sectional analysis (odds ratio 3·4, 95% CI 1·1–10·7). We found some evidence that participation in physical activity declined among cohort participants living closer to the existing M8 motorway (0·4, 0·2–0·9). We found no evidence of changes in active travel (survey data) or casualties (STATS19 data). Although the new motorway improved connectivity for individuals with more dispersed social networks and access to a motor vehicle, the impacts on those with neither of them were more complex and sometimes negative. Changes in community composition and cohesion, and perceptions of personal safety, were widely perceived as more important influences than was the opening of the motorway. Interpretation: Although the study identified both benefits and harms, overall these findings highlight the potential for new major road infrastructure to add further burdens to already disadvantaged communities, exacerbating inequalities and contributing to poorer health outcomes

Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study

Background: In the UK, women are invited for 3-yearly mammography screening, through the NHS Breast Screening Programme (NHSBSP), from the ages of 47–50 years to the ages of 69–73 years. Women with family histories of breast cancer can, from the age of 40 years, obtain enhanced surveillance and, in exceptionally high-risk cases, magnetic resonance imaging. However, no NHSBSP risk assessment is undertaken. Risk prediction models are able to categorise women by risk using known risk factors, although accurate individual risk prediction remains elusive. The identification of mammographic breast density (MD) and common genetic risk variants [single nucleotide polymorphisms (SNPs)] has presaged the improved precision of risk models. Objectives: To (1) identify the best performing model to assess breast cancer risk in family history clinic (FHC) and population settings; (2) use information from MD/SNPs to improve risk prediction; (3) assess the acceptability and feasibility of offering risk assessment in the NHSBSP; and (4) identify the incremental costs and benefits of risk stratified screening in a preliminary cost-effectiveness analysis. Design: Two cohort studies assessing breast cancer incidence. Setting: High-risk FHC and the NHSBSP Greater Manchester, UK. Participants: A total of 10,000 women aged 20–79 years [Family History Risk Study (FH-Risk); UK Clinical Research Network identification number (UKCRN-ID) 8611] and 53,000 women from the NHSBSP [aged 46–73 years; Predicting the Risk of Cancer At Screening (PROCAS) study; UKCRN-ID 8080]. Interventions: Questionnaires collected standard risk information, and mammograms were assessed for breast density by a number of techniques. All FH-Risk and 10,000 PROCAS participants participated in deoxyribonucleic acid (DNA) studies. The risk prediction models Manual method, Tyrer–Cuzick (TC), BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm) and Gail were used to assess risk, with modelling based on MD and SNPs. A preliminary model-based cost-effectiveness analysis of risk stratified screening was conducted. Main outcome measures: Breast cancer incidence. Data sources: The NHSBSP; cancer registration. Results: A total of 446 women developed incident breast cancers in FH-Risk in 97,958 years of follow-up. All risk models accurately stratified women into risk categories. TC had better risk precision than Gail, and BOADICEA accurately predicted risk in the 6268 single probands. The Manual model was also accurate in the whole cohort. In PROCAS, TC had better risk precision than Gail [area under the curve (AUC) 0.58 vs. 0.54], identifying 547 prospective breast cancers. The addition of SNPs in the FH-Risk case–control study improved risk precision but was not useful in BRCA1 (breast cancer 1 gene) families. Risk modelling of SNPs in PROCAS showed an incremental improvement from using SNP18 used in PROCAS to SNP67. MD measured by visual assessment score provided better risk stratification than automatic measures, despite wide intra- and inter-reader variability. Using a MD-adjusted TC model in PROCAS improved risk stratification (AUC = 0.6) and identified significantly higher rates (4.7 per 10,000 vs. 1.3 per 10,000; p < 0.001) of high-stage cancers in women with above-average breast cancer risks. It is not possible to provide estimates of the incremental costs and benefits of risk stratified screening because of lack of data inputs for key parameters in the model-based cost-effectiveness analysis. Conclusions: Risk precision can be improved by using DNA and MD, and can potentially be used to stratify NHSBSP screening. It may also identify those at greater risk of high-stage cancers for enhanced screening. The cost-effectiveness of risk stratified screening is currently associated with extensive uncertainty. Additional research is needed to identify data needed for key inputs into model-based cost-effectiveness analyses to identify the impact on health-care resource use and patient benefits. Future work: A pilot of real-time NHSBSP risk prediction to identify women for chemoprevention and enhanced screening is required. Funding: The National Institute for Health Research Programme Grants for Applied Research programme. The DNA saliva collection for SNP analysis for PROCAS was funded by the Genesis Breast Cancer Prevention Appeal