As safe as houses? Why standards for urban development matter

Standards for designing, improving, and maintaining the built environment have conceptual and practical value for health. Yet, their importance runs the risk of being subsumed in tangential discourses, including over their applicability for particular populations or in particular contexts. This paper applies an integrative systems perspective to several relevant scenarios, while broadly revisiting the health rationale for built environment standards. As with any intervention, standards can have negative unintended consequences, in some cases inducing adverse outcomes. Yet, forgoing standards is not an acceptable answer for sustainable urbanization. The systems perspective adopted here surveys some of the driving forces that underlie adverse outcomes, and suggests potential leverage points and criteria for action

Association of socioeconomic position with smoking and mortality: the contribution of early life circumstances in the 1946 birth cohort

BACKGROUND: A large part of the socioeconomic mortality gradient can be statistically accounted for by social patterning of adult health behaviours. However, this statistical explanation does not consider the early life origins of unhealthy behaviours and increased mortality risk. METHODS: Analysis is based on 2132 members of the MRC National Survey of Health and Development with mortality follow-up and complete data. Smoking behaviour was summarised by pack-years of exposure. Socioeconomic circumstances were measured in childhood (father's social class (age 4), maternal education (age 6)) and age 26 (education attainment, home ownership, head of household social class). We estimated the direct effect of early circumstances, the indirect effect through smoking and the independent direct effect of smoking on inequality in all-cause mortality from age 26 to 66. RESULTS: Mortality risk was higher in those with lower socioeconomic position at age 26, with a sex-adjusted HR (relative index of inequality) of 1.97 (95% CI 1.18 to 3.28). Smoking and early life socioeconomic indicators together explained 74% of the socioeconomic gradient in mortality (the gradient). Early life circumstances explained 47% of the gradient, 23.5% directly and 23.0% indirectly through smoking. The explanatory power of smoking behaviour for the gradient was reduced from 50.8% to 28% when early life circumstances were added to the model. CONCLUSIONS: Early life socioeconomic circumstances contributed importantly to social inequality in adult mortality. Our life-course model focusing on smoking provides evidence that social inequalities in health will persist unless prevention strategies tackle the intergenerational transmission of disadvantage and risk

Mapping interactions between the sustainable development goals: lessons learned and ways forward

Pursuing integrated research and decision-making to advance action on the sustainable development goals (SDGs) fundamentally depends on understanding interactions between the SDGs, both negative ones (“trade-offs”) and positive ones (“co-benefits”). This quest, triggered by the 2030 Agenda, has however pointed to a gap in current research and policy analysis regarding how to think systematically about interactions across the SDGs. This paper synthesizes experiences and insights from the application of a new conceptual framework for mapping and assessing SDG interactions using a defined typology and characterization approach. Drawing on results from a major international research study applied to the SDGs on health, energy and the ocean, it analyses how interactions depend on key factors such as geographical context, resource endowments, time horizon and governance. The paper discusses the future potential, barriers and opportunities for applying the approach in scientific research, in policy making and in bridging the two through a global SDG Interactions Knowledge Platform as a key mechanism for assembling, systematizing and aggregating knowledge on interactions

Exploring the relationships between housing, neighbourhoods and mental wellbeing for residents of deprived areas

<p><b>Background:</b> Housing-led regeneration has been shown to have limited effects on mental health. Considering housing and neighbourhoods as a psychosocial environment, regeneration may have greater impact on positive mental wellbeing than mental ill-health. This study examined the relationship between the positive mental wellbeing of residents living in deprived areas and their perceptions of their housing and neighbourhoods.</p> <p><b>Methods:</b> A cross-sectional study of 3,911 residents in 15 deprived areas in Glasgow, Scotland. Positive mental wellbeing was measured using the Warwick-Edinburgh Mental Wellbeing Scale.</p> <p><b>Results:</b> Using multivariate mulit-nomial logistic regressions and controlling for socio-demographic characteristics and physical health status, we found that several aspects of people's residential psychosocial environments were strongly associated with higher mental wellbeing. Mental wellbeing was higher when respondents considered the following: their neighbourhood had very good aesthetic qualities (RRR 3.3, 95% CI 1.9, 5.8); their home and neighbourhood represented personal progress (RRR 3.2 95% CI 2.2, 4.8; RRR 2.6, 95% CI 1.8, 3.7, respectively); their home had a very good external appearance (RRR 2.6, 95% CI 1.3, 5.1) and a very good front door (both an aesthetic and a security/control item) (RRR 2.1, 95% CI 1.2, 3.8); and when satisfaction with their landlord was very high (RRR 2.3, 95% CI 2.2,4.8). Perception of poor neighbourhood aesthetic quality was associated with lower wellbeing (RRR 0.4, 95% CI 0.3, 0.5).</p> <p><b>Conclusions:</b> This study has shown that for people living in deprived areas, the quality and aesthetics of housing and neighbourhoods are associated with mental wellbeing, but so too are feelings of respect, status and progress that may be derived from how places are created, serviced and talked about by those who live there. The implication for regeneration activities undertaken to improve housing and neighbourhoods is that it is not just the delivery of improved housing that is important for mental wellbeing, but also the quality and manner of delivery.</p&gt

Tackling health inequalities: moving theory to action

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Trends and determinants of excess winter mortality in New Zealand: 1980 to 2000

<p>Abstract</p> <p>Background</p> <p>Although many countries experience an increase in mortality during winter, the magnitude of this increase varies considerably, suggesting that some winter excess may be avoidable. Conflicting evidence has been presented on the role of gender, region and deprivation. Little has been published on the magnitude of excess winter mortality (EWM) in New Zealand (NZ) and other Southern Hemisphere countries.</p> <p>Methods</p> <p>Monthly mortality rates per 100,000 population were calculated from routinely collected national mortality data for 1980 to 2000. Generalised negative binomial regression models were used to compare mortality rates between winter (June–September) and the warmer months (October–May).</p> <p>Results</p> <p>From 1980–2000 around 1600 excess winter deaths occurred each year with winter mortality rates 18% higher than expected from non-winter rates. Patterns of EWM by age group showed the young and the elderly to be particularly vulnerable. After adjusting for all major covariates, the winter:non-winter mortality rate ratio from 1996–2000 in females was 9% higher than in males. Mortality caused by diseases of the circulatory system accounted for 47% of all excess winter deaths from 1996–2000 with mortality from diseases of the respiratory system accounting for 31%. There was no evidence to suggest that patterns of EWM differed by ethnicity, region or local-area based deprivation level. No decline in seasonal mortality was evident over the two decades.</p> <p>Conclusion</p> <p>EWM in NZ is substantial and at the upper end of the range observed internationally. Interventions to reduce EWM are important, but the surprising lack of variation in EWM by ethnicity, region and deprivation, provides little guidance for how such mortality can be reduced.</p

The SHARP study: a quantitative and qualitative evaluation of the short-term outcomes of housing and neighbourhood renewal

&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; The SHARP study was set up to evaluate the short (1 year) and longer-term (2 year) effects on health and wellbeing of providing new social housing to tenants. This paper presents the study background, the design and methods, and the findings at one year.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; Data were collected from social tenants who were rehoused into a new, general-purpose socially-rented home developed and let by a Scottish Registered Social Landlord (the "Intervention" group). These data were collected at three points in time: before moving (Wave 1), one year after moving (Wave 2) and two years after moving (Wave 3). Data were collected from a Comparison group using the same methods at Baseline (Wave 1) and after two years of follow-up (Wave 3). Qualitative data were also collected by means of individual interviews. This paper presents the quantitative and qualitative findings at 1 year (after Wave 2).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; 339 Intervention group interviews and 392 Comparison group interviews were completed. One year after moving to a new home there was a significant reduction in the proportion of Intervention group respondents reporting problems with the home, such as damp and noise. There was also a significant increase in neighbourhood satisfaction compared with Baseline (χ2 = 35.51, p &lt; 0.0001). Many aspects of the neighbourhood improved significantly, including antisocial behaviour. In terms of environmental aspects and services the greatest improvements were in the general appearance of the area, the reputation of the area, litter and rubbish, and speeding traffic. However, lack of facilities for children/young people and lack of safe children's play areas remained a concern for tenants.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusion:&lt;/b&gt; This study found that self-reported health changed little in the first year after moving. Nonetheless, the quantitative and qualitative data point to improvements in the quality of housing and of the local environment, as well as in tenant satisfaction and other related outcomes. Further analyses will explore whether these effects are sustained, and whether differences in health outcomes emerge at 2 years compared with the Comparison group.&lt;/p&gt

Monitoring health inequalities: life expectancy and small area deprivation in New Zealand

BACKGROUND: Socioeconomic and ethnic inequalities in health are of great concern, and life expectancy provides a readily understood means of monitoring such inequalities. The objectives of this study are to (1) measure life expectancy by socioeconomic deprivation and ethnicity, and (2) describe trends in the deprivation gradient in life expectancy since the mid-1990s. METHODS: Three years of national mortality data have been combined with mid-point population denominators to produce life tables within nationally determined levels of small area deprivation (NZDep96) for three ethnic group: European, Mäori and Pacific peoples. This process has been repeated for the periods 1995–97, 1996–98, 1997–99 and 1998–2000. RESULTS: There was a strong relationship between increasing small area deprivation and decreasing life expectancy. Through the mid- to late 1990s, males living in the most deprived small areas in New Zealand experienced life expectancies at birth approximately nine years less than their counterparts living in the least deprived areas; for females the corresponding difference was under seven years. Mäori and Pacific life expectancies at birth were lower than those of Europeans at each level of deprivation. Over the study period (1995–2000) the gradient in life expectancy across deprivation deciles remained stable. CONCLUSION: Small area deprivation analyses of life expectancy could be repeated routinely at regular intervals, which would provide a useful approach to monitoring trends in socioeconomic, geographic, ethnic and gender inequalities in mortality