A Synergistic Approach to Human Rights and Public Health Ethics: Effective or a Source of Conflict?

Commentaire / CommentaryLes inquiétudes concernant les disparités croissantes en matière de santé et de richesses entre les membres de la société ont incité Stephanie Nixon et Lisa Forman, dans leur article de 2008 Exploring synergies between human rights and public health ethics: A whole greater than the sum of its parts, à proposer que les principes de droits de l’homme et de l’éthique de la santé publique soient utilisés en combinaison afin d'élaborer des normes pour les actions de santé. Ce commentaire renvoie aux avantages ainsi qu'aux difficultés qui pourraient surgir suite à l'adoption d'une telle approche.Concerns over the growing disparities in health and wealth between members of society incited Stephanie Nixon and Lisa Forman, in their 2008 article Exploring synergies between human rights and public health ethics: A whole greater than the sum of its parts, to propose that the principles of human rights and public health ethics should be used in combination to develop norms for health action. This commentary reflects on the benefits as well as the difficulties that could arise from taking such an approach

Assessing inequities in active transportation : does the effect of walkable built environments vary according to neighbourhood socioeconomic status?

Certains chercheurs veulent que les gouvernements modifient les déterminants de l’environnement urbain du transport actif dans des régions à bas statut socioéconomique pour réduire les inégalités en activité physique et santé. Mais, des individus de différents sousgroupes de la population pourraient réagir différemment à l’environnement urbain. Plusieurs chercheurs ont examiné si l’influence d’un environnement urbain propice aux piétons sur le transport actif diffère entre les personnes ayant un statut socioéconomique de quartier différent et ont obtenu des résultats mixtes. Ces résultats équivoques pourraient être dus à la façon dont les mesures de l’environnement urbain étaient déterminées. Plus spécifiquement, la plupart des études ont examiné l’effet de la propicité à la marche des lieux résidentiels et n’ont pas pris en compte les destinations non-résidentielles dans leurs mesures. Cette étude a examiné le statut socioéconomique du quartier comme modérateur de la relation entre l’environnement urbain et le transport actif en utilisant des mesures d’environnement urbain qui proviennent de toute la trajectoire spatiale estimé des individus. Les trois variables de l’environnement urbain, la connectivité, la densité des commerces et services et la diversité du territoire avaient une plus grande influence sur le transport actif de ceux avec un haut statut socioéconomique. Nos résultats suggèrent que même quand la configuration de l’environnement urbain est favorable pour le transport actif, il peut y avoir des barrières sociales ou physiques qui empêchent les gens qui habitent dans un quartier à bas statut socioéconomique de bénéficier d’un environnement urbain favorable au transport actif.Researchers have called for policymakers to modify the built environment determinants of active travel in low SES areas in the hopes of reducing disparities in physical activity and health. However, different population sub-groups may be differently responsive to the built environment. Researchers have examined whether the influence of walkable built environments on active transportation differs for those of different socio-economic status and have obtained mixed results. These equivocal findings could be due to the way the built environment measures were determined. More specifically, most studies have examined walkability in residential settings ignoring non-residential destinations. This study examined socio-economic status as a moderator of the relationship between the built environment and active transportation using a trip level analyses with measures of built environment exposure derived from the estimated spatial trajectory of transport trips. All three of the environmental variables, connectivity, density of business and services, and land-use mix, were found to have a greater association with AT if the individual undergoing the trip was from a high socioeconomic status neighbourhood. Our findings suggest that even when the built environment is favourable for AT there may be social or physical barriers that prevent those from low socio-economic status neighbourhoods from benefitting from built environments that are conducive to active transportation

Place matters: A longitudinal analysis measuring the association between neighbourhood walkability and walking by age group and population center size in Canada.

This study examined the influence of walkability on walking behaviour and assessed whether associations varied according to life-stage and population center (PC) size. Walkability scores were obtained for the six-digit postal codes of residential neighbourhoods of 11,200 Canadians, who participated in biennial assessments of the National Population Health Survey from 1994 to 2010. Participants were stratified by age-group. Mixed-effects logistic regression models were used to estimate the influence of cumulative exposure to neighborhood walkability on utilitarian and exercise walking by PC size and life-stage. Associations of neighbourhood walkability with utilitarian and exercise walking varied according to age-group and PC size. Exposure to high walkable neighborhoods was associated with utilitarian walking in younger and older adults in all PC sizes, except for older adults living in a medium PC. Living in a highly walkable neighborhood in a large PC was associated with walking for exercise in younger (OR: 1.42; 95%CI: 1.20-1.67) and older adults (OR: 2.09; 95%CI: 1.51-2.89). Living in highly walkable neighbourhood in a medium PC was associated with walking for exercise in older adults (OR: 1.62; 95%CI: 1.15-2.29). These results emphasize the need to consider the size and nature of every community, and the age-group of a population when implementing strategies to promote walking

Example of cumulative exposure time calculation.

<p>Example of cumulative exposure time calculation.</p

Descriptive Statistics at baseline (1994) of the total sample, young (18 to 45 years old) and older adults (65 to 90 years old): National Population Health Survey.

<p>Descriptive Statistics at baseline (1994) of the total sample, young (18 to 45 years old) and older adults (65 to 90 years old): National Population Health Survey.</p

Mixed effects logistic regression models of utilitarian walking for the total sample, young and older adults: National Population Health Survey (1994–2010).

<p>Mixed effects logistic regression models of utilitarian walking for the total sample, young and older adults: National Population Health Survey (1994–2010).</p

Mixed effects logistic regression models of exercise walking for the total sample, young and older adults: National Population Health Survey (1994–2010).

<p>Mixed effects logistic regression models of exercise walking for the total sample, young and older adults: National Population Health Survey (1994–2010).</p

Do social characteristics influence smoking uptake and cessation during young adulthood?

Objectives This study uses a Bourdieusian approach to assess young adults’ resources and examines their association with smoking initiation and cessation. Methods Data were drawn from 1450 young adults participating in the Interdisciplinary Study of Inequalities in Smoking, a cohort study in Montreal, Canada. We used logistic regression models to examine the association between young adults’ income, education, and peer smoking at baseline and smoking onset and cessation. Results Young adults where most or all of their friends smoked had greater odds of smoking onset. Young adults that had completed pre-university postsecondary education also had higher odds of smoking onset after controlling for social support, employment status, and lacking money to pay for expenses. Income and the sociodemographic variables age and sex were not associated with smoking onset. Young adults where half of their friends smoked or where most to all of their friends smoked had lowers odds of smoking cessation. Men were more likely to cease smoking than women. Education, income and age were not associated with cessation. Conclusions Interventions focusing on peer smoking may present promising avenues for tobacco prevention in young adults

Is gentrification all bad? Positive association between gentrification and individual’s perceived neighborhood collective efficacy in Montreal, Canada

Abstract Background Collective efficacy has been associated with many health benefits at the neighborhood level. Therefore, understanding why some communities have greater collective efficacy than others is important from a public health perspective. This study examined the relationship between gentrification and collective efficacy, in Montreal Canada. Methods A gentrification index was created using tract level median household income, proportion of the population with a bachelor’s degree, average rent, proportion of the population with low income, and proportion of the population aged 30–44. Multilevel linear regression analyses were conducted to measure the association between gentrification and individual level collective efficacy. Results Gentrification was positively associated with collective efficacy. Gentrifiers (individuals moving into gentrifying neighborhoods) had higher collective efficacy than individuals that lived in a neighborhood that did not gentrify. Perceptions of collective efficacy of the original residents of gentrifying neighborhoods were not significantly different from the perceptions of neighborhood collective efficacy of gentrifiers. Conclusions Our results indicate that gentrification was positively associated with perceived collective efficacy. This implies that gentrification could have beneficial health effects for individuals living in gentrifying neighborhoods