Why precision medicine is not the best route to a healthier world

Precision medicine has been announced as a new health revolution. The term precision implies more accuracy in healthcare and prevention of diseases, which could yield substantial cost savings. However, scientific debate about precision medicine is needed to avoid wasting economic resources and hype. In this commentary, we express the reasons why precision medicine cannot be a health revolution for population health. Advocates of precision medicine neglect the limitations of individual-centred, high-risk strategies (reduced population health impact) and the current crisis of evidence-based medicine. Overrated “precision medicine” promises may be serving vested interests, by dictating priorities in the research agenda and justifying the exorbitant healthcare expenditure in our finance-based medicine. If societies aspire to address strong risk factors for non-communicable diseases(such as air pollution, smoking, poor diets, or physical inactivity), they need less medicine and more investment in population prevention strategies

Why precision medicine is not the best route to a healthier world

ABSTRACT Precision medicine has been announced as a new health revolution. The term precision implies more accuracy in healthcare and prevention of diseases, which could yield substantial cost savings. However, scientific debate about precision medicine is needed to avoid wasting economic resources and hype. In this commentary, we express the reasons why precision medicine cannot be a health revolution for population health. Advocates of precision medicine neglect the limitations of individual-centred, high-risk strategies (reduced population health impact) and the current crisis of evidence-based medicine. Overrated “precision medicine” promises may be serving vested interests, by dictating priorities in the research agenda and justifying the exorbitant healthcare expenditure in our finance-based medicine. If societies aspire to address strong risk factors for non-communicable diseases (such as air pollution, smoking, poor diets, or physical inactivity), they need less medicine and more investment in population prevention strategies

The impact of urban environmental exposures on health: An assessment of the attributable mortality burden in Sao Paulo city, Brazil

Background Currently, more than half of the global population lives in cities. Contemporary urban planning practices result in environmental risk factors (e.g. air pollution, noise, lack of green space, excess heat) that put health and well-being of city dwellers at risk and contribute to chronic diseases and premature death. Despite a growing body of evidence on adverse health impacts related to current urban and transport planning practices, especially for cities in the Global North, not much is known about associated health impacts in South American cities. Therefore, we estimated the mortality burden attributable to breaching internationally-recommended or locally-preferable exposure levels of urban planning related environmental exposures in Sao Paulo, Brazil. Methods We carried out a health impact assessment study, following the comparative risk assessment framework, to assess preventable mortality impacts of breaching exposure recommendations for air pollution, green spaces and temperature at the census tract (CT) level (n = 18,363). We also assessed the distribution thereof by socioeconomic vulnerability. Results We estimated that annually 11,372 (95% CI: 7921; 15,910) attributable deaths could be prevented by complying with recommended exposure levels. The largest proportion of preventable mortality was due to breaching air pollution limits (i.e. 8409 attributable deaths), followed by insufficient green space (i.e. 2593), and excess heat (i.e. 370). Adverse health impacts were larger in CTs of lower socioeconomic vulnerability, due to demographic profile, traffic density and residential area configurations. Discussion Not complying with the health limits for air pollution, green space and temperature exposures resulted in a considerable preventable mortality burden (i.e. 17% of total expected deaths) in Sao Paulo. This burden can be reduced by improving current urban and transport planning practices

Social consequences and mental health outcomes of living in high-rise residential buildings and the influence of planning, urban design and architectural decisions: A systematic review

Different types of high-rise residential buildings have proliferated in different countries at least since the 1940s, for a range of reasons. This paper aims to provide an overview of the current state of evidence on how planning, urban design and architectural aspects of high-rise residential buildings may influence social well-being and mental health. A systematic review following the PRISMA guidelines was conducted. Searches for peer-reviewed papers were conducted in MEDLINE, Embase, PsycInfo, Scopus, SciELO, and Web of Science; 4100 papers were assessed. 23 empirical studies published between 1971 and 2016 were included. The review found that house type, floor level, as well as spaces intrinsic to high-rise residential buildings (e.g. shared stairwells) are associated with social well-being and mental health. However, conceptual gaps and methodological inconsistencies still characterise most of the research in this field. We expect that research about and policy attention to this subject may intensify due to its strategic relevance in the face of global challenges such as increasing urbanization and loneliness. This paper concludes by highlighting a number of recommendations for future research

<b>Validation of the scale for evaluation of environment perception for physical activity practice in adults living in region of low socioeconomic level.</b> http://dx.doi.org/10.5007/1980-0037.2012v14n6p647

The objective of this study was to verify the validity of the perception of environ­ment scale for engagement in physical activity in adult population. Two samples were drawn: the first, to compare the scale results with built environment and engagement in physical activity (767 individuals with 18 years or more); and the latter, for the analyses of repeat­ability (30 individuals with 60 years or more). Both studies were carried out in Ermelino Matarazzo District, eastern zone of the city of São Paulo. The perception of environment scale was developed based on the NEWS scale and on a social support for physical activity scale, and the final version comprised 38 questions. Data analysis: The scale results were compared to built environment and physical activity level, and for repeatability measure. The correlation coefficients for questions varied from r=0.51 to r=0.89, and for scores they varied from r=0.72 to r=0.94. There was significant agreement between means of percep­tion of environment score of facilities for physical activity and the respective classification of built environment (p<0.001). The individuals who had any engagement in leisure-time physical activities had higher means for the scores of facilities (p<0.001), safe perception (p=0.033), and social support (p=0.001). The scale provided reliable and valid results for assessing the perception of environment for physical activity, mainly for the perception of the facilities of the environment

Social consequences and mental health outcomes of living in high-rise residential buildings and the influence of planning, urban design and architectural decisions: A systematic review

Different types of high-rise residential buildings have proliferated in different countries at least since the 1940s, for a range of reasons. This paper aims to provide an overview of the current state of evidence on how planning, urban design and architectural aspects of high-rise residential buildings may influence social well-being and mental health. A systematic review following the PRISMA guidelines was conducted. Searches for peer-reviewed papers were conducted in MEDLINE, Embase, PsycInfo, Scopus, SciELO, and Web of Science; 4100 papers were assessed. 23 empirical studies published between 1971 and 2016 were included. The review found that house type, floor level, as well as spaces intrinsic to high-rise residential buildings (e.g. shared stairwells) are associated with social well-being and mental health. However, conceptual gaps and methodological inconsistencies still characterise most of the research in this field. We expect that research about and policy attention to this subject may intensify due to its strategic relevance in the face of global challenges such as increasing urbanization and loneliness. This paper concludes by highlighting a number of recommendations for future research

Air pollution, physical activity and health : A mapping review of the evidence

Highlights • Air pollution (AP) and physical activity (PA) are important health risk factors; • We reviewed current evidence of AP and PA interactions for health; • PA behaviour and health effects might be moderated by AP exposure; • Epidemiological studies provide mixed results on AP and PA interaction; • More research collaboration is needed to study AP and PA relations.Background Exposure to air pollution and physical inactivity are both significant risk factors for non-communicable diseases (NCDs). These risk factors are also linked so that the change in exposure in one will impact risks and benefits of the other. These links are well captured in the active transport (walking, cycling) health impact models, in which the increases in active transport leading to increased inhaled dose of air pollution. However, these links are more complex and go beyond the active transport research field. Hence, in this study, we aimed to summarize the empirical evidence on the links between air pollution and physical activity, and their combined effect on individual and population health. Objectives and methods We conducted a non-systematic mapping review of empirical and modelling evidence of the possible links between exposure to air pollution and physical activity published until Autumn 2019. We reviewed empirical evidence for the (i) impact of exposure to air pollution on physical activity behaviour, (ii) exposure to air pollution while engaged in physical activity and (iii) the short-term and (iv) long-term health effects of air pollution exposure on people engaged in physical activity. In addition, we reviewed (v) public health modelling studies that have quantified the combined effect of air pollution and physical activity. These broad research areas were identified through expert discussions, including two public events performed in health-related conferences. Results and discussion The current literature suggests that air pollution may decrease physical activity levels during high air pollution episodes or may prevent people from engaging in physical activity overall in highly polluted environments. Several studies have estimated fine particulate matter (PM2.5) exposure in active transport environment in Europe and North-America, but the concentration in other regions, places for physical activity and for other air pollutants are poorly understood. Observational epidemiological studies provide some evidence for a possible interaction between air pollution and physical activity for acute health outcomes, while results for long-term effects are mixed with several studies suggesting small diminishing health gains from physical activity due to exposure to air pollution for long-term outcomes. Public health modelling studies have estimated that in most situations benefits of physical activity outweigh the risks of air pollution, at least in the active transport environment. However, overall evidence on all examined links is weak for low- and middle-income countries, for sensitive subpopulations (children, elderly, pregnant women, people with pre-existing conditions), and for indoor air pollution. Conclusions Physical activity and air pollution are linked through multiple mechanisms, and these relations could have important implications for public health, especially in locations with high air pollution concentrations. Overall, this review calls for international collaboration between air pollution and physical activity research fields to strengthen the evidence base on the links between both and on how policy options could potentially reduce risks and maximise health benefits

What next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policy

This Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Available standards and targets were often insufficient to promote health and wellbeing, and health-supportive urban design and transport features were often inadequate or inequitably distributed. City planning decisions affect human and planetary health and amplify city vulnerabilities, as the COVID-19 pandemic has highlighted. Hence, we offer an expanded framework of pathways through which city planning affects health, incorporating 11 integrated urban system policies and 11 integrated urban and transport interventions addressing current and emerging issues. Our call to action recommends widespread uptake and further development of our methods and open-source tools to create upstream policy and spatial indicators to benchmark and track progress; unmask spatial inequities; inform interventions and investments; and accelerate transitions to net zero, healthy, and sustainable cities.BG-C was supported by an RMIT Vice-Chancellor's Fellowship. CH was supported through an NHMRC Centre for Research Excellence in Healthy Liveable Communities grant (number 1061404) and The Australian Prevention Partnership Centre (number 9100003). DA was supported by an Impact Acceleration Award from the Economic and Social Research Council and funding from the Global Challenges Research Fund administered by the Department for the Economy, Northern Ireland, UK. EC's research was supported by the Australian Catholic University. SL was supported by the experiential fellowships from College of Social Science and Humanities, Northeastern University. JFS was supported by Australian Catholic University. DS was supported by Washington University in St Louis (MO, USA), Center for Diabetes Translation Research (number P30DK092950 from the US National Institute of Diabetes and Digestive and Kidney Diseases of the US National Institute of Health) and by the Cooperative Agreement Number U48DP006395 from the US Centers for Disease Control and Prevention. SB was supported by an Australian Research Council Linkage Grant (LP160100324) and European Union's Horizon 2020 research and innovation programme under grant agreement #730426 (Urban GreenUP). We would like to thank Belinda Nemec and Judy Boyce. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated