Framework for Participatory Quantitative Health Impact Assessment in Low- and Middle-Income Countries

Background: Conducting health impact assessments (HIAs) is a growing practice in various organizations and countries, yet scholarly interest in HIAs has primarily focused on the synergies between exposure and health outcomes. This limits our understanding of what factors influence HIAs and the uptake of their outcomes. This paper presents a framework for conducting participatory quantitative HIA (PQHIA) in low- and middle-income countries (LMICs), including integrating the outcomes back into society after an HIA is conducted. The study responds to the question: what are the different components of a participatory quantitative model that can influence HIA implementation in LMICs? Methods: To build the framework, we used a case study from a PQHIA fieldwork model developed in Port Louis (Mauritius). To explore thinking on the participatory components of the framework, we extract and analyze data from ethnographic material including fieldnotes, interviews, focus group discussions and feedback exercises with 14 stakeholders from the same case study. We confirm the validity of the ethnographic data using five quality criteria: credibility, transferability, dependability, confirmability, and authenticity. We build the PQHIA framework connecting the main HIA steps with factors influencing HIAs. Results: The final framework depicts the five standard HIA stages and summarizes participatory activities and outcomes. It also reflects key factors influencing PQHIA practice and uptake of HIA outcomes: costs for participation, HIA knowledge and interest of stakeholders, social responsibility of policymakers, existing policies, data availability, citizen participation, multi-level stakeholder engagement and multisectoral coordination. The framework suggests that factors necessary to complete a participatory HIA are the same needed to re-integrate HIA results back into the society. There are three different areas that can act as facilitators to PQHIAs: good governance, evidence-based policy making, and access to resources. Conclusions: The framework has several implications for research and practice. It underlines the importance of applying participatory approaches critically while providing a blueprint for methods to engage local stakeholders. Participatory approaches in quantitative HIAs are complex and demand a nuanced understanding of the context. Therefore, the political and cultural contexts in which HIA is conducted will define how the framework is applied. Finally, the framework underlines that participation in HIA does not need to be expensive or time consuming for the assessor or the participant. Yet, participatory quantitative models need to be contextually developed and integrated if they are to provide health benefits and be beneficial for the participants. This integration can be facilitated by investing in opportunities that fuel good governance and evidence-based policy making

Sociodemographic inequalities in residential nighttime light pollution in urban Bulgaria : an environmental justice analysis

Introduction: Outdoor nighttime light (NTL) is a potential anthropogenic stressor in urban settings. While ecological studies have identified outdoor NTL exposure disparities, uncertainties remain about disparities in individual exposure levels, particularly in Europe. Aim: To assess whether some populations are disproportionately affected by outdoor NTL at their residences in urban Bulgaria. Methods: We analyzed 2023 data from a representative cross-sectional survey of 4,270 adults from the five largest Bulgarian cities. Respondents' annual exposures to outdoor artificial nighttime luminance were measured using satellite imagery and assigned at their places of residence. We calculated the Gini coefficient as a descriptive NTL inequality measure. Associations between respondents’ NTL exposure levels and sociodemographic characteristics were assessed by estimating quantile mixed regression models. Stratified regressions were fitted by gender and for each city. Results: We found moderate distributive NTL inequalities, as indicated by a Gini coefficient of 0.214. Regression analyses showed associations between greater NTL exposure and higher educational attainment. Respondents with incomes perceived as moderate experienced less NTL exposure at the 0.5 and 0.8 quantiles, while unemployed respondents experienced lower exposure at the 0.2 and 0.5 quantiles. We observed null associations for the elderly and non-Bulgarian ethnicities. Regardless of the quantile, greater population density was associated with higher NTL levels. Stratification by sex did not yield substantial differences in the associations. We observed notable city-specific heterogeneities in the associations, with differences in the magnitudes and directions of the associations and the NTL quantiles. Conclusions: NTL exposures appeared to embody an environmental injustice dimension in Bulgaria. Our findings suggest that some sociodemographic populations experience higher exposure levels to NTL; however, those are not necessarily the underprivileged or marginalized. Identifying populations with high exposure levels is critical to influencing lighting policies to ease related health implications

Data for a city-level health impact assessment of urban transport in Mauritius

Participatory quantitative Health Impact Assessments (HIAs) in developing countries are rare partly due to data scarcity. This paper reports on primary data collected in the city of Port Louis to complete a HIA of urban transport planning in Mauritius. We conducted a full-chain participatory HIA to assess health impacts on the basis of a transport mode shift in Port Louis, Mauritius [1]. By applying mixed-methods, we estimated averted deaths per year and economic outcomes by assessing the health determinants of air pollution, traffic deaths and physical activity. The participatory quantitative HIA included [1] baseline data collection [2] co-validation of transport policy scenarios with stakeholders and [3] quantitative modelling of health impacts. We used the risk assessment method for HIA appraisal. The data can be reused for epidemiological analysis and different types of impact assessments

More green, less lonely? A longitudinal cohort study.

BACKGROUND: Urban greening may reduce loneliness by offering opportunities for solace, social reconnection and supporting processes such as stress relief. We (i) assessed associations between residential green space and cumulative incidence of, and relief from, loneliness over 4 years; and (ii) explored contingencies by age, sex, disability and cohabitation status. METHODS: Multilevel logistic regressions of change in loneliness status in 8049 city-dwellers between 2013 (baseline) and 2017 (follow-up) in the Household, Income and Labour Dynamics in Australia study. Associations with objectively measured discrete green-space buffers (e.g. parks) (30% green space, respectively. Compared with the 30% green space, respectively. These associations were stronger again for people living alone, with 10-20% (OR = 0.608, 95% CI = 0.448 to 0.826), 20-30% (OR = 0.649, 95% CI = 0.436 to 0.966) and >30% (OR = 0.480, 95% CI = 0.278 to 0.829) green space within 1600 m. No age, sex or disability-related contingencies, associations with green space within 400 or 800 m or relief from loneliness reported at baseline were observed. CONCLUSIONS: A lower cumulative incidence of loneliness was observed among people with more green space within 1600 m of home, especially for people living alone. Potential biopsychosocial mechanisms warrant investigation

Environmental, health, wellbeing, social and equity effects of urban green space interventions: A meta-narrative evidence synthesis

© 2019 The Authors Background: As populations become increasingly urbanised, the preservation of urban green space (UGS) becomes paramount. UGS is not just dedicated recreational space such as public parks, but other types of informal green space are important, for example, street trees and roof gardens. Despite the potential from cross-sectional evidence, we know little about how to design new, or improve or promote existing UGS for health, wellbeing, social and environmental benefits, or known influencing factors such as physical activity. Objectives: To perform a meta-narrative review of the evidence regarding the health, wellbeing, social, environmental and equity effects, or known influencing factors of these outcomes, of UGS interventions. Data sources: Eight electronic databases were searched ((Medline, PsycINFO, Web of Science (Science and Social Science Citation Indices), PADDI (Planning Architecture Design Database Ireland), Zetoc, Scopus, Greenfiles, SIGLE (System for Information on Grey Literature in Europe)), and reference lists of included studies and relevant reviews were hand searched for further relevant studies. Study eligibility criteria, participants, and interventions: Eligibility criteria included: (i) evaluation of an UGS intervention; and (ii) health, wellbeing, social or environmental outcome(s), or known influencing factors of these outcomes, measured. Interventions involving any age group were included. Interventions must have involved: (a) physical change to green space in an urban-context including improvements to existing UGS or development of new UGS, or (b) combination of physical change to UGS supplemented by a specific UGS awareness, marketing or promotion programme to encourage use of UGS. Study appraisal and synthesis methods: Following a meta-narrative approach, evidence was synthesised by main intervention approach, including: (i) park-based; (ii) greenways/trails; (iii) urban greening; (iv) large green built projects for environmental purposes. Outcomes such as economic (e.g. cost effectiveness and cost–benefit analyses), adverse effects and unintended consequences were also extracted. Evidence was synthesised following the RAMESES guidelines and publication standards, the PROGRESS-plus tool was used to explore equity impact, and risk of bias/study quality was assessed. The findings from the evidence review were presented at an expert panel representing various disciplines in a workshop and these discussions framed the findings of the review and provide recommendations that are relevant to policy, practice and research. Results: Of the 6997 studies identified, 38 were included. There was strong evidence to support park-based (7/7 studies) and greenway/trail (3/3 studies) interventions employing a dual-approach (i.e. a physical change to the UGS and promotion/marketing programmes) particularly for park use and physical activity; strong evidence for the greening of vacant lots (4/4 studies) for health, wellbeing (e.g. reduction in stress) and social (e.g. reduction in crime, increased perceptions of safety) outcomes; strong evidence for the provision of urban street trees (3/4 studies) and green built interventions for storm water management (6/7 studies) for environmental outcomes (e.g. increased biodiversity, reduction in illegal dumping). Park-based or greenway/trail interventions that did not employ a dual-approach were largely ineffective (7/12 studies showed no significant intervention effect). Overall, the included studies have inherent biases owing to the largely non-randomized study designs employed. There was too little evidence to draw firm conclusions regarding the impact of UGS interventions on a range of equity indicators. Limitations; conclusions and implications of key findings: UGS has an important role to play in creating a culture of health and wellbeing. Results from this study provide supportive evidence regarding the use of certain UGS interventions for health, social and environmental benefits. These findings should be interpreted in light of the heterogeneous nature of the evidence base, including diverging methods, target populations, settings and outcomes. We could draw little conclusions regarding the equity impact of UGS interventions. However, the true potential of UGS has not been realised as studies have typically under-evaluated UGS interventions by not taking account of the multifunctional nature of UGS. The findings have implications for policymakers, practitioners and researchers. For example, for policymakers the trajectory of evidence is generally towards a positive association between UGS and health, wellbeing, social and environmental outcomes, but any intervention must ensure that negative consequences of gentrification and unequal access are minimised

Fourteen pathways between urban transportation and health: A conceptual model and literature review

Introduction: Transportation is an integral part of our daily lives, giving us access to people, education, jobs, services, and goods. Our transportation choices and patterns are influenced by four interrelated factors: the land use and built environment, infrastructure, available modes, and emerging technologies/disruptors. These factors influence how we can or choose to move ourselves and goods. In turn, these factors impact various exposures, lifestyles and health outcomes. / Aim and methods: We developed a conceptual model to clarify the connections between transportation and health. We conducted a literature review focusing on publications from the past seven years. We complemented this with expert knowledge and synthesized information to summarize the health outcomes of transportation, along 14 identified pathways. / Results: The pathways linking transportation to health include those that are beneficial, such as when transportation serves as means for social connectivity, independence, physical activity, and access. Some pathways link transportation to detrimental health outcomes from air pollution, road travel injuries, noise, stress, urban heat islands, contamination, climate change, community severance, and restricted green space, blue space, and aesthetics. Other possible effects may come from electromagnetic fields, but this is not definitive. We define each pathway and summarize its health outcomes. We show that transportation-related exposures and associated health outcomes, and their severity, can be influenced by inequity and intrinsic and extrinsic effect modifiers. / Conclusions: While some pathways are widely discussed in the literature, others are new or under-researched. Our conceptual model can form the basis for future studies looking to explore the transportation-health nexus. We also propose the model as a tool to holistically assess the impact of transportation decisions on public health

Differences between Adolescents and Emerging Adults with regard to Schoolrelated Riskfactors, Physical Distress and School Drop-Outs

Emerging adulthood (18-25 jaar) onderscheidt zich van adolescentie (12-17 jaar) door piekende risicogedragingen. In een longitudinaal onderzoek onder 1150 eerstejaars MBO leerlingen van het ROC Midden Brabant te Tilburg werd nagegaan of dit ook opgaat voor schoolgerelateerde risicofactoren (verwachtingen van ouders, affiniteit met leerkracht, sociale vaardigheden, ervaren schoolstress, negatieve faalangst en –schoolbeleving), lichamelijke klachten en vroegtijdig schoolverlaten. Data werd verzameld met de ‘Vragenlijst voor Schoolbeleving’ en uit het leerlingen- registratiesysteem van het ROC. Er zijn een drietal significante verschillen naar voren gekomen tussen emerging adults en adolescenten. Het percentage voortijdig schoolverlaten was bij emerging adults hoger, zij hadden meer lichamelijke klachten en voelden minder affiniteit met de leerkracht. Vastgesteld is ook dat het patroon van meervoudige risicofactoren dat zich voordoet in de adolescentieperiode voortduurt in de periode van emerging adulthood. Tenslotte bleken alle risicofactoren, alsook lichamelijke klachten, samen te hangen met negatieve schoolbeleving welke vroegtijdig schoolverlaten voorspelde. Implicaties betreffen aanwijzingen voor vervolgonderzoek en preventieve acties voor docenten en mentoren

Early Kidney Damage in a Population Exposed to Cadmium and Other Heavy Metals

BACKGROUND: Exposure to heavy metals may cause kidney damage. The population living near the Avonmouth zinc smelter has been exposed to cadmium and other heavy metals for many decades. OBJECTIVES: We aimed to assess Cd body burden and early signs of kidney damage in the Avonmouth population. METHODS: We used dispersion modeling to assess exposure to Cd. We analyzed urine samples from the local population (n = 180) for Cd (U-Cd) to assess dose (body burden) and for three biomarkers of early kidney damage [N-acetyl-β-d-glucosaminidase (U-NAG), retinol-binding protein, and α-1-microglobulin]. We collected information on occupation, intake of homegrown vegetables, smoking, and medical history by questionnaire. RESULTS: Median U-Cd concentrations were 0.22 nmol/mmol creatinine (nonsmoking 0.18/smoking 0.40) and 0.34 nmol/mmol creatinine (nonsmoking 0.31/smoking 0.46) in non-occupationally exposed men and women, respectively. There was a significant dose–response relationship between U-Cd and the prevalence of early renal damage—defined as U-NAG > 0.22 IU/mmol—with odds ratios of 2.64 [95% confidence interval (95% CI), 0.70–9.97] and 3.64 (95% CI, 0.98–13.5) for U-Cd levels of 0.3 to < 0.5 and levels ≥ 0.5 nmol/mmol creatinine, respectively (p for trend = 0.045). CONCLUSION: U-Cd concentrations were close to levels where kidney and bone effects have been found in other populations. The dose–response relationship between U-Cd levels and prevalence of U-NAG above the reference value support the need for measures to reduce environmental Cd exposure