Environmental Determinants Of Health Research Articles

Developing evidence for building sanitation justice: A multi methods approach to understanding public restroom quantity, quality, accessibility, and user experiences.

Access to basic sanitation is a human right and a critical environmental determinant of health. In this paper, we detail the development of three tools to investigate sanitation justice: (1) our public restroom spatial database, (2) our field assessment tool, and (3) survey of restroom access experiences. We document our process to collect these data in a consistent, health equity-driven framework. Together, these tools comprise a suite of methods for the examination of public restrooms from the macro- to the micro-level, and highlight key opportunities to promote health and well-being among restroom-reliant populations (e.g., people experiencing homelessness) by advancing sanitation justice in the built environment. With an illustrative case study, we demonstrate how methods triangulation, using the tools in concert, can provide a comprehensive assessment of basic sanitation access in a given region-San Diego, CA. We also detail how each tool can also be used separately to assess key sanitation justice and health equity questions that may be of interest to researchers, public health practitioners, policymakers, and advocates, including: (1) where do public restrooms exist (mapping)?; (2) how accessible are public restroom facilities, and what health-supportive features do they have (field assessment)?; and (3) what are the experiences of people most reliant on the available public restroom facilities (survey)? The results of our case study demonstrate that these adaptable tools can be used to provide meaningful data on and a holistic picture of public restroom quantity, quality, accessibility, and the experiences of public restroom users in a given region.

Differences in Breast Cancers Among American Indian/Alaska Native and non-Hispanic Whites in the USA.

Breast cancer (BC) death rates have not improved for American Indian/Alaska Native (AI/AN) women, whereas, it has significantly decreased for non-Hispanic White (White) women. Delineate the differences in patient and tumor characteristics among AI/AN and Whites with BC, and its impact on age and stage at diagnosis as well as overall survival (OS). Hospital-based, cohort study using the National Cancer Database to identify female AI/AN and Whites diagnosed with BC between the years 2004 and 2016. BC in 6866 AI/AN (0.3%) and 1,987,324 Whites (99.7%) were studied. The median age at diagnosis was 58 for AI/AN and 62 for Whites. AI BC patients traveled double the distance for treatment, lived in lower median income zip codes, had a higher percentage of uninsured, higher comorbidities, lower percentage of Stage 0/I, larger tumor size, greater number of positive lymph nodes, higher proportion of triple negative and HER2-positive BC than Whites. All the above comparisons were significant, p<0.001. Association between patient/tumor characteristics with age and stage at diagnosis was not significantly different between AI/AN and Whites. Unadjusted OS was worse for AI/AN as compared to Whites (HR=1.07, 95% CI=1.01-1.14, p=0.023). After adjustment of all covariates, OS was not different (HR=1.038, 95%CI=0.902-1.195, p=0.601). There were significant differences in patient/tumor characteristics among AI/AN and White BC which adversely impacted OS in AI/AN. However, when adjusted for various covariates, the survival was similar, suggesting that the worse survival in AI/AN is mostly the impact of known biological, socio-economic, and environmental determinants of health.

Alzheimer`s disease mortality in the United States: Cross-sectional analysis of county-level socio-environmental factors

BackgroundGeographical disparities in mortality among Alzheimer`s disease (AD) patients have been reported and complex sociodemographic and environmental determinants of health (SEDH) may be contributing to this variation. Therefore, we aimed to explore high-risk SEDH factors possibly associated with all-cause mortality in AD across US counties using machine learning (ML) methods. MethodsWe performed a cross-sectional analysis of individuals ≥65 years with any underlying cause of death but with AD in the multiple causes of death certificate (ICD-10,G30) between 2016 and 2020. Outcomes were defined as age-adjusted all-cause mortality rates (per 100,000 people). We analyzed 50 county-level SEDH and Classification and Regression Trees (CART) was used to identify specific county-level clusters. Random Forest, another ML technique, evaluated variable importance. CART`s performance was validated using a “hold-out” set of counties. ResultsOverall, 714,568 individuals with AD died due to any cause across 2,409 counties during 2016–2020. CART identified 9 county clusters associated with an 80.1% relative increase of mortality across the spectrum. Furthermore, 7 SEDH variables were identified by CART to drive the categorization of clusters, including High School Completion (%), annual Particulate Matter 2.5 Level in Air, live births with Low Birthweight (%), Population under 18 years (%), annual Median Household Income in US dollars ($), population with Food Insecurity (%), and houses with Severe Housing Cost Burden (%). ConclusionML can aid in the assimilation of intricate SEDH exposures associated with mortality among older population with AD, providing opportunities for optimized interventions and resource allocation to reduce mortality among this population.

보건복지분야 도시건강 관련 연구의 동향

This paper discusses the trend of research on urban health in the disciplines of health and welfare by reviewing publications on urban health. Publications were searched using city and health related keywords in Korean Health and Welfare Institute’s open access repository. Research on urban health mainly discussed social issues, including family, housing, homelessness, socio-economic and physical environments in urban and rural areas. Local governments’ health and welfare policy budgets were also commonly addressed in studying the wellbeing of the residents in disadvantaged urban areas.&#x0D; Research on health impact assessments were found to address the broader social and environmental determinants of health in cities. As the findings illustrate, urban health research needs to continuously address those environmental and social determinants of urban health with a focus on transforming policy and governance through community empowerment.

Integrating the social environment with an equity perspective into the exposome paradigm: A new conceptual framework of the Social Exposome

The importance of the social environment and social inequalities in disease etiology is well-known due to the profound research and conceptual framework on social determinants of health. For a long period, in exposome research with its classical orientation towards detrimental health effects of biological, chemical, and physical exposures, this knowledge remained underrepresented. But currently it gains great awareness and calls for innovations in rethinking the role of social environmental health determinants. To fill this gap that exists in terms of the social domain within exposome research, we propose a novel conceptual framework of the Social Exposome, to integrate the social environment in conjunction with the physical environment into the exposome concept. The iterative development process of the Social Exposome was based on a systematic compilation of social exposures in order to achieve a holistic portrayal of the human social environment – including social, psychosocial, socioeconomic, sociodemographic, local, regional, and cultural aspects, at individual and contextual levels. In order to move the Social Exposome beyond a mere compilation of exposures, three core principles are emphasized that underly the interplay of the multitude of exposures: Multidimensionality, Reciprocity, and Timing and continuity. The key focus of the conceptual framework of the Social Exposome is on understanding the underlying mechanisms that translate social exposures into health outcomes. In particular, insights from research on health equity and environmental justice have been incorporated to uncover how social inequalities in health emerge, are maintained, and systematically drive health outcomes. Three transmission pathways are presented: Embodiment, Resilience and Susceptibility or Vulnerability, and Empowerment. The Social Exposome conceptual framework may serve as a strategic map for, both, research and intervention planning, aiming to further explore the impact of the complex social environment and to alter transmission pathways to minimize health risks and health inequalities and to foster equity in health.

Urban distance to mental healthcare units and public transport increases duration of untreated psychosis in first-episode patients.

There is a growing interest in environmental and social determinants of mental health. However, how distance to healthcare and public transportation affect illness is neglected in schizophrenia research. Here, we are interested in how the availability of mental healthcare and the ways to reach it may be associated with psychosis. We aim to investigate the association between distances to healthcare units and subway stations and duration of untreated psychosis (DUP) and greater initial severity in an antipsychotic-naïve first episode of psychosis (FEP) sample. Using 212 untreated FEP patients' data, we calculated the distances from their residences to the places of interest. Diagnoses comprehended schizophrenia spectrum disorders, depressive and bipolar affective disorders, and substance-induced disorders. Linear regressions were performed with distances as independent variables, DUP and Positive and Negative Syndrome Scale (PANSS) scores as dependent variables. Longer distance to emergency mental healthcare was related to longer DUP (95% CI: p = .034, B = 0.152) and higher total PANSS (95% CI: p = .007, B = 0.0189); longer distance to community mental healthcare units was related to longer DUP (95% CI: p = .004, B = 0.0204) and higher total PANSS (95% CI: p = .030, B = 0.152). Moreover, a longer distance to the closest subway station predicted longer DUP (95% CI: p = .019, B = 0.170). Our results indicate that poor healthcare access is related to longer DUP and higher initial PANSS scores. Future research should investigate how investments in mental health access and actions to improve public transport access could impact DUP and treatment outcomes in psychosis patients.

Rethinking diabetes in the United States.

Despite the availability of effective medical treatments, the diabetes epidemic has accelerated in the United States, efforts to translate treatments into routine clinical practice have stalled, and health inequities have persisted. The National Clinical Care Commission (NCCC) was established by the Congress to make recommendations to better leverage federal policies and programs to more effectively prevent and control diabetes and its complications. The NCCC developed a guiding framework that incorporated elements of the Socioecological and Chronic Care Models. It gathered information from both health-related and non-health-related federal agencies, held 12 public meetings, solicited public comments, met with interested parties and key informants, and performed comprehensive literature reviews. The final report of the NCCC was transmitted to the Congress in January 2022. It called for a rethinking of the problem of diabetes in the United States, including the recognition that the lack of progress is due to a failure to confront diabetes as both a complex societal problem as well as a biomedical problem. To prevent and control diabetes, public policies and programs must be aligned to address both social and environmental determinants of health and health care delivery as they impact diabetes. In this article, we discuss the findings and recommendations of the NCCC as they relate to the social and environmental factors that influence the risk of type 2 diabetes and argue that the prevention and control of type 2 diabetes in the U.S. must begin with concrete population-level interventions to address social and environmental determinants of health.

Sociodemographic correlates of greenness within public parks in three U.S. cities

Equitable access to urban vegetation (also known as greenness), an environmental determinant of health, is an important environmental justice issue. Researchers often consider parks a source of greenness but there is a lack of research explicitly investigating the sociodemographic correlates of greenness within city parks. Using a high-resolution landcover dataset, publicly available park boundaries, and American Community Survey data, we investigated the relationship between greenness within urban public parks and the sociodemographic characteristics of surrounding neighborhoods. We found that parks were substantially greener than surrounding neighborhoods and that Black race, Hispanic/Latino ethnicity, and socioeconomic deprivation was associated with less tree canopy and more grass and impervious surface or soil within parks. Public parks are indeed an important source of greenness for urban populations, but the type of vegetation in those spaces depends on the city and sociodemographic characteristics of neighborhoods. Future research and interventions should consider both the type and amount of vegetation within parks.

White blood cells in a healthy adolescent population according to social and health characteristics

BackgroundThe immune system constitutes a sensory system both for heritable and non-heritable factors. Among the latter, social and environmental determinants of health may influence and shape the immune system in early life. To study the relationship between leukocytes and determinants of health in adolescence, we assessed total and differential white blood cells (WBC) according to social and environmental determinants of health in a healthy adolescent population. MethodsAs part of the population-based cohort Epidemiological Health Investigation of Teenagers in Porto (EPITeen), 1213 adolescents were evaluated at the age of 13. Total and differential WBC were evaluated through a venous blood sample using an automated blood counter (Sysmex®XE-5000, Hyogo, Japan). Sociodemographic, behavioral, and clinical data were collected through self-administered questionnaires. ResultsParticipants with better socioeconomic conditions (enrolled at private schools or higher parental education) had significantly lower total WBC levels, and the latter showed a lower percentage of neutrophils and higher percentage of lymphocytes. Those who practiced sports had significantly lower total WBC levels and neutrophil percentage, as well as a significantly higher percentage of eosinophils and lymphocytes. Adolescents with chronic disease, chronic medication, or allergic diseases had a significantly higher percentage of eosinophils and a lower percentage of monocytes. With increasing body mass index and systemic inflammation, we found a significant increase in total WBC levels. ConclusionWBC linked to different immune response patterns are associated with several social and environmental determinants of health in adolescence.

Global health officers’ competency gaps on knowledge and skills and its associated factors in Vietnam

Objective: This study aimed to characterize the gaps in competencies related to global health knowledge and skills among global health officers (GHOs) in Vietnam. Methods: A cross-sectional study was conducted with the participation of 181 GHOs who engaged in global health activities in health facilities across Vietnam. The study employed a self-development questionnaire to measure the gaps in knowledge and skills among the GHOs. Results: The results showed that the domain with the highest competency gap score for global health knowledge was Social, Economic, and Environmental Determinants of Health (mean score = 5.3, SD = 6.2). Regarding global health skills, Strategic Analysis (mean score = 5.8, SD = 5.4) was the domain with the highest competency gap score. Program Management (mean score = 4.7, SD = 5.9) was the domain with the lowest competency gap score for global health knowledge. Responders gave the Ethics and Professionalism (mean score = 5.1, SD = 5.5) and Global Health Governance (mean score = 5.1, SD = 5.4) domains the lowest competency gap scores for global health skills. Furthermore, the study identified that gender, education level, working organization, and specialty were associated with the competency gaps in global health knowledge and skills among GHOs. Conclusion: The study showed significant gaps in competencies related to global health knowledge and skills among GHOs in Vietnam. The findings highlight the need for targeted training and education in specific skill areas such as: Capacity Strengthening for workforce, Ethics and Professionalism, Communication, Collaboration, and Partnership, Program Management for non-medical field GHOs to enhance their overall global health competency.

Community knowledge, practices, and perceptions regarding environmental determinants of health in Melusi, Pretoria, South Africa

Community knowledge, practices, and perceptions regarding environmental determinants of health in Melusi, Pretoria, South Africa

“Make Stories That Will Always Be There”: Eagle Books’ Appeal, Sustainability, and Contributions to Public Health, 2006–2022

We aimed to determine why the Eagle Books, an illustrated series for American Indian and Alaska Native (AIAN) children to address type 2 diabetes, remain viable long after their release. We sought to answer 2 questions: Why did the books maintain popularity? What factors have sustained them? Type 2 diabetes burgeoned in the US after World War II, compounding a long legacy of injustices for AIAN peoples. By the 1980s, their rates soared above those of White people. Concerned for future generations, Tribal Leaders suggested that the Centers for Disease Control and Prevention and Indian Health Service use traditional storytelling to teach children about staying healthy. Public health interventions are most effective when culture and history are integrated into health education, particularly stories to address a relatively new disease for AIAN peoples. From 2008 through 2013, we conducted a case study among 8 tribal communities to evaluate the uptake of the Eagle Books across Indian Country. To understand the Eagle Books' sustained appeal, in 2022 we reanalyzed the original case study themes and analyzed for the first time themes that emerged from evaluation results in the Eagle Books' program literature. These were programs that had independently evaluated their use of the Eagle Books and published their findings. Outcomes demonstrated continuous application of the Eagle Books in diverse community interventions, influencing children's healthy choices. Community implementers described sustainability components, such as the books' versatility, flexibility of use, and availability online and in print. Historical, social, economic, and environmental health determinants intersect with biological and behavioral factors to weave a complex web of causation for type 2 diabetes, beginning early in life. Compelling, colorful stories reflecting traditional wisdom and respect for Western and Indigenous science - through the eyes of a wise eagle, a clever rabbit, a tricky coyote, and kids in T-shirts and sneakers - can positively influence community health.

SEnDAE: A resource for expanding research into social and environmental determinants of health

Background and ObjectiveSocial and Environmental Determinants of Health (SEDoH) are of increasing interest to researchers in personal and public health. Collecting SEDoH and associating them with patient medical record can be challenging, especially for environmental variables. We announce here the release of SEnDAE, the Social and Environmental Determinants Address Enhancement toolkit, and open-source resource for ingesting a range of environmental variables and measurements from a variety of sources and associated them with arbitrary addresses. MethodsSEnDAE includes optional components for geocoding addresses, in case an organization does not have independent capabilities in that area, and recipes for extending the OMOP CDM and the ontology of an i2b2 instance to display and compute over the SEnDAE variables within i2b2. ResultsOn a set of 5000 synthetic addresses, SEnDAE was able to geocode 83%. SEnDAE geocodes addresses to the same Census tract as ESRI 98.1% of the time. ConclusionDevelopment of SEnDAE is ongoing, but we hope that teams will find it useful to increase their usage of environmental variables and increase the field's general understanding of these important determinants of health.

Abstract 1923: Ancestry-associated differences in somatic mutation rates from tumor profiling data of a pan-cancer cohort of 100,000 patients

Abstract Racial and ethnic disparities span the continuum of cancer care and adversely impact screening, detection, diagnosis, treatment, and outcomes of cancer. These disparities are driven by a complex interplay among social, psychosocial, lifestyle, environmental, healthcare, and biological determinants of health. A challenge is that the social constructs of race and ethnicity may not fully capture shared genetic background. Genomics can capture ancestry in a more precise way, allowing genetic influences to be teased apart from the impact of social and environmental factors. Here, we searched for associations between continental genetic ancestry and somatic mutations in cancer genes in a pan-cancer cohort of 100,000 patients. A sample of de-identified records from patients who underwent tumor profiling with the Tempus xT 648-gene assay was selected from the Tempus Database. We inferred global African (AFR), Amerindian (AMR), East Asian (EAS), European (EUR), and South Asian (SAS) continental ancestry proportions with a custom set of 658 ancestry informative markers. To properly account for the collinearity of ancestry proportions, we performed logistic compositional data analysis between mutation counts and ancestry proportions from data of cancer types with at least 300 patients and for genes for which a minimum of 10 and at least 1% of patients harbored variants. Odds ratios (ORs) represent the effect of a doubling in ancestry proportion, adjusted for age, gender, assay version, and all other ancestries. We examined associations for the presence of nonsynonymous somatic mutations and predicted driver mutations with the boostDM algorithm. We adjusted for multiple comparisons at a 5% false discovery rate (FDR) with the Benjamini-Hochberg method. We identified previously reported significant (p&amp;lt;0.001) associations between EAS and predicted driver mutations in EGFR (OR=1.08) in lung cancer, and between AFR and APC (OR=1.03) and KRAS (OR=1.04) in colorectal cancer. Moreover, we found several novel associations, including AFR with TP53 (OR=1.06) and PTEN (OR=0.90) in endometrial cancer and BRAF (OR=0.93) in colorectal cancer, and EAS with CTNNB1 (OR=1.17) in lung cancer. The latter is noteworthy as CTNNB1, which has been proposed as a TTK inhibitor response biomarker, is overall infrequently mutated in lung cancer but activating mutations have been reported in East Asian patients. Indeed, we found that 7% of East Asian lung cancer patients in our cohort harbor a driver mutation in this gene vs. 1.6% in the other groups. Additionally, an association with nonsynonymous mutations was found between AMR with PTPN22 (OR=1.26) in colorectal cancer. While these associations can be the result of a combination of environmental, social, and biological factors, our results suggest that genetic ancestry can be useful to understand disparities in cancer incidence, progression, and outcomes. Citation Format: Brooke Rhead, Yannick Pouliot, Justin Guinney, Francisco M. De La Vega. Ancestry-associated differences in somatic mutation rates from tumor profiling data of a pan-cancer cohort of 100,000 patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1923.

Socioeconomic Determinants of Remote Patient Monitoring Implementation Among Rural and Urban Hospitals.

Introduction: Remote patient monitoring (RPM) is a form of telehealth that improves quality of care for chronic disease treatment and reduces hospital readmission rates. Geographical proximity to health care is important for individuals of low socioeconomic status (SES) who face additional financial and transportation barriers. The goal of this study was to assess the association between social determinants of health and adoption of RPM. Methods: This cross-sectional study analyzed data from hospitals that responded to the American Hospital Association's Annual Survey (2018) and spatially linked census tract-level environmental and social determinants of health obtained from the Social Vulnerability Index (2018). Results: A total of 4,206 hospitals (1,681 rural and 2,525 urban hospitals) met study criteria. Rural hospitals near households in the lower middle quartile SES were associated with a 33.5% lower likelihood of having adopted RPM for chronic care management compared with rural hospitals near households in the highest quartile SES (adjusted odds ratios [aOR] = 0.665; 95% confidence interval [CI]: 0.453-0.977). Urban hospitals near households in the lowest quartile SES were associated with a 41.9% lower likelihood of having adopted RPM for chronic care management compared with urban hospitals near households in the highest quartile SES (aOR = 0.581; 95% CI: 0.435-0.775). Similar trends in accessibility were found with RPM for postdischarge services among urban hospitals. Conclusion: Our findings highlight the importance of hospital responsibility and state and federal policy approaches toward ensuring equitable access to RPM services for patients characterized by lower SES.

Healthy Cities, A comprehensive dataset for environmental determinants of health in England cities

This paper presents a fine-grained and multi-sourced dataset for environmental determinants of health collected from England cities. We provide health outcomes of citizens covering physical health (COVID-19 cases, asthma medication expenditure, etc.), mental health (psychological medication expenditure), and life expectancy estimations. We present the corresponding environmental determinants from four perspectives, including basic statistics (population, area, etc.), behavioural environment (availability of tobacco, health-care services, etc.), built environment (road density, street view features, etc.), and natural environment (air quality, temperature, etc.). To reveal regional differences, we extract and integrate massive environment and health indicators from heterogeneous sources into two unified spatial scales, i.e., at the middle layer super output area (MSOA) and the city level, via big data processing and deep learning. Our data holds great promise for diverse audiences, such as public health researchers and urban designers, to further unveil the environmental determinants of health and design methodology for a healthy, sustainable city.

Adolescent nutrition and health: characteristics, risk factors and opportunities of an overlooked life stage.

Adolescence is a pivotal, yet frequently overlooked, period of life, with this age group often no longer receiving the focus, care and protection devoted to other life stages. Nutritional vulnerability increases in adolescence due to heightened nutritional requirements, yet the quality of the diets consumed by this age group often deteriorates significantly. Poor-quality dietary patterns and insufficient nutrient intakes are frequently observed amongst adolescents both in Ireland and globally. This deterioration in diet quality is greatly influenced by individual, social and environmental determinants of behaviour and health. The influences of each of these factors change and increase as adolescents begin to interact independently with the surrounding world. Poor nutrition during adolescence can result in several immediate and long-term health consequences, including micronutrient deficiencies, increased risk of overweight/obesity and increased presentation of cardiometabolic risk factors, all of which have been observed as persistent issues amongst adolescents in Ireland and internationally. Adolescence is a critical period of intervention to protect youth both now and into their future lives. This age group can be particularly receptive to the influence of society and the surrounding environment, posing several avenues in which to influence adolescents towards more health-promoting behaviour. This review aims to summarise the key nutritional and dietary characteristics of adolescents, to provide an overview of the causes and consequences of poor nutrition in adolescence, and to highlight potential opportunities for intervention to protect the health of this age group, with a particular focus on evidence from an Irish context.

Grounding Wellness: Coloniality, Placeism, Land, and a Critique of “Social” Determinants of Indigenous Mental Health in the Canadian Context

Authored by a small team of settler and Indigenous researchers, all of whom are deeply involved in scholarship and activism interrogating ongoing processes of coloniality in lands now known to many as Canada, this paper critically examines "social" and grounded determinants of Indigenous mental health and wellness. After placing ourselves on the grounds from which we write, we begin by providing an overview of the social determinants of health (SDOH), a conceptual framework with deep roots in colonial Canada. Though important in pushing against biomedical framings of Indigenous health and wellness, we argue that the SDOH framework nevertheless risks re-entrenching deeply colonial ways of thinking about and providing health services for Indigenous people: SDOH, we suggest, do not ultimately reckon with ecological, environmental, place-based, or geographic determinants of health in colonial states that continue to occupy stolen land. These theoretical interrogations of SDOH provide an entry point to, first, an overview of Indigenous ways of understanding mental wellness as tethered to ecology and physical geography, and second, a collection of narrative articulations from across British Columbia: these sets of knowledge offer clear and unequivocal evidence, in the form of Indigenous voices and perspectives, about the direct link between land, place, and mental wellness (or a lack thereof). We conclude with suggestions for future research, policy, and health practice actions that move beyond the current SDOH model of Indigenous health to account for and address the grounded, land-based, and ecologically self-determining nature of Indigenous mental health and wellness.

Public Health Framework for Smart Cities within the Comprehensive Approach to Sustainability in Europe: Case Study of Diabetes

European cities should address the climate change challenges, improving quality of life and reducing costs. They need potential smart and digital approaches. Public health (PH) has recognized climate change as a major challenge. The development of urban policies should be guided by evidence-based PH practices. The environmental health determinants and the climate crisis now represent a clear PH threat. The core of the Smart City is sustainability, and its basic condition is active PH. The inclusion of public health into the pillars of the Smart City concept to contribute toward mitigating PH crises, such as the COVID-19 pandemic, is a framework for action. Design Science Research Methodology (DSRM) is used to elicit a Smart Public Health City (SPHEC) framework. A set of PH and smart city experts participated in the DSRM process, using diabetes as a case study. The European Green Deal served as a blueprint for this transformational change toward a healthier and more sustainable city. The SPHEC framework was defined by elucidating clearly the several dimensions of the PH functions within a digital city, via the identification of a set of digital PH services that are required to support the SPHEC framework. This allows for an assessment of the actual benefits that are obtained with the digital health services, and provides evidence for guiding decision-making. The role of digital PH services emerges from the analysis of the SPHEC framework, through the development of proper digital health services within the smart city, strengthening capacity and resilience in future climate emergencies, and motivating policy makers to take this challenge more seriously.

Public Health Security

Public health security refers to the ability of a society to protect and promote the health of its population, particularly in the face of emerging health threats. Ensuring public health security is essential for the well-being of communities and is a key responsibility of government agencies and health care systems.&#x0D; One significant aspect of public health security is the ability to identify, track, and respond to emerging health threats. This includes diseases that are transmitted from person to person, such as infectious diseases like influenza, as well as diseases that are transmitted through the environment, such as waterborne illnesses. In order to effectively respond to these threats, it is important for public health agencies to have access to reliable data and surveillance systems, as well as the resources and capacity to implement effective interventions [1].&#x0D; Another important aspect of public health security is the ability to prepare for and respond to disasters and emergencies. This includes natural disasters, such as hurricanes and earthquakes, as well as man-made disasters, such as chemical spills or acts of terrorism. Ensuring that communities have the necessary resources and infrastructure in place to respond to these events can save lives and prevent further suffering.&#x0D; Finally, public health security also involves addressing social and environmental determinants of health, such as poverty, housing, and access to clean water and sanitation. These issues can have a significant impact on the health and well-being of communities and must be addressed in order to ensure the long-term health and security of the population [2].&#x0D; Public health security is a significant concern in Pakistan, as the country faces a range of health threats, including infectious diseases, environmental hazards, and natural disasters. One of the major public health challenges in Pakistan is the high burden of infectious diseases, such as malaria, tuberculosis, and HIV/AIDS. The country also faces outbreaks of vaccine-preventable diseases, such as measles and polio, due to low vaccination rates and inadequate vaccination coverage. Pakistan is also vulnerable to natural disasters, such as earthquakes, floods, and cyclones, which can have a significant impact on the health of the population. In addition to infectious diseases and natural disasters, Pakistan also faces environmental health hazards, such as air pollution and water contamination. Poor air quality has been linked to a range of health problems, including respiratory and cardiovascular diseases, while access to clean water is a major concern in many parts of the country.&#x0D; In conclusion, public health security is a critical issue that affects the well-being of communities around the world. Ensuring that we have the necessary systems and resources in place to identify, track, and respond to emerging health threats, as well as prepare for and respond to disasters and emergencies, is essential for the health and security of the population.