Environmental Determinants Of Health Research Articles

‘Nexus’ Narratives in Urban Vulnerable Places: Pathways to Sustainability via Municipal Health Programs in Brazil

In recent years, the water–energy–food (WEF) nexus approach has been widely used as a framework in the context of urban Sustainability. However, some elements of the approach are normative, leading to a technical view of resources and technocratic policy implementation. To avoid such tendencies, this study uses the framework of ‘nexus of humility’. We used insights from the Science and Technology Studies to better assess the interactions between water, energy, and food, and consider the social construction aspects of the nexus itself. The approach of Pathways to Sustainability is combined with this framework to analyze two government programs in the cities of São Paulo and Guarulhos, Brazil; namely, the Green and Healthy Environments Program and the Environmental Health Program, respectively. We interviewed 20 individuals linked to these policies and analyzed narratives inductively and deductively. The results showed six groups of narratives, namely: environmental and social determinants of health, health prevention and promotion, intersectorality, politics and economy, territory, learning, and participation. Moreover, we concluded that narratives related to the WEF nexus, even if not explicitly part of the government guidelines, are present within the existing axes of action. Public health was understood as an important support pillar for the development of synergies related to Sustainability in urban areas. Finally, we sought to contribute to the literature by showing how this new framework can ‘open up’ avenues for sustainability within the contexts of high urban vulnerability and social inequality.

How do medical students learn in an online community diagnostics program?

BackgroundThe need to engage medical students in understanding the social and environmental determinants of health in disparate communities is increasing. However, previous reviews have noted the limited community diagnosis programs and program evaluation. Given the feasibility of the programs, it is expected to be widely available online. Therefore, this study used a realist approach to identify learning patterns through an online community diagnosis program, namely context (C), mechanism (M), and outcomes (O) patterns.MethodsA 2-week general medicine clinical practice program was conducted for 4th- and 5th-year medical students at a medical university in Japan. The program included a one-hour zoom-based lecture, feedback for students on their presentations on community diagnosis, and a structural report on community diagnosis. We developed the program based on variation theory, which views discernment and variation in situations having time, space, and social dimensions as core learning. The students' reflections on their learning through the program were thematically analyzed through CMO perspectives. The realist approach used in the online diagnosis program evaluation allows us to explore, test, and refine what mechanisms work under what conditions (context) and with what interventions (including opportunities and resources), from which we can describe iteratively explainable results.ResultsFirst, the medical students, who spent most of their time in the limited residential areas they lived in, discovered the characteristics of their own community by discovery learning and comparison among peers. Second, they increased their intrinsic interest in the community by discerning specific issues in their familiar community through community diagnosis. Third, they valued community diagnosis by identifying relationships between local data on health issues under their learning responsibility. Fourth, they become more flexible in their thinking and created new knowledge that would fit the local community, and their reflection on themselves was encouraged.ConclusionIn this online community diagnosis program, medical students learned about the community through four types of learning patterns. Medical students may develop an understanding of community with interest using variation theory as a program development perspective and cognitive flexibility theory surrounding the essential ambiguity and abstraction of community.

Assessing and Addressing the Determinants of Appalachian Population Health: A Scoping Review.

Residents of Appalachia experience elevated rates of morbidity and mortality compared to national averages, and these disparities are associated with inequitable exposures to various determinants of population health. Social and environmental determinants of health are a useful lens through which to develop and evaluate programs to mitigate regional health disparities. This 2023 scoping review was conducted of studies linking determinants of Appalachian health with leading causes of regional mortality and morbidity. The search strategy employed a keyword search that included geographic terms for the Appalachian Region and the primary adverse health outcomes in that region. Studies meeting the following inclusion criteria were reviewed: original article, published in the last five years, involving an Appalachian population, and includes a rigorous assessment of an association between a population health determinant and one or more leading causes of Appalachian morbidity and mortality. The search returned 221 research articles, including 30 interventional studies. The top three health outcomes included cancer (43.59%), diseases of despair (23.08%), and diabetes (12.82). Access to care (27.3%), rurality (18.9%), and education (14.8%) were the most common population health determinants identified. Interventional studies were categorized by program types: education, technology, partnerships, and multilevel interventions. Due to the heterogeneity of study types, the studies were combined using a narrative synthesis. The results of this work can inform the development and evaluation of additional programs to promote Appalachian population health. Our study team will use these results to inform community-based discussions that develop strategic plans to mitigate health disparities in Central and Southcentral Appalachian Virginia.

Development of a social and environmental determinants of health informatics maturity model.

Integrating social and environmental determinants of health (SEDoH) into enterprise-wide clinical workflows and decision-making is one of the most important and challenging aspects of improving health equity. We engaged domain experts to develop a SEDoH informatics maturity model (SIMM) to help guide organizations to address technical, operational, and policy gaps. We established a core expert group consisting of developers, informaticists, and subject matter experts to identify different SIMM domains and define maturity levels. The candidate model (v0.9) was evaluated by 15 informaticists at a Center for Data to Health community meeting. After incorporating feedback, a second evaluation round for v1.0 collected feedback and self-assessments from 35 respondents from the National COVID Cohort Collaborative, the Center for Leading Innovation and Collaboration's Informatics Enterprise Committee, and a publicly available online self-assessment tool. We developed a SIMM comprising seven maturity levels across five domains: data collection policies, data collection methods and technologies, technology platforms for analysis and visualization, analytics capacity, and operational and strategic impact. The evaluation demonstrated relatively high maturity in analytics and technological capacity, but more moderate maturity in operational and strategic impact among academic medical centers. Changes made to the tool in between rounds improved its ability to discriminate between intermediate maturity levels. The SIMM can help organizations identify current gaps and next steps in improving SEDoH informatics. Improving the collection and use of SEDoH data is one important component of addressing health inequities.

Environmental Parasitic Disease Affecting the Health Status in Rwanda

The analysis gleaned from Rwanda’s history following the 1994 genocide to the post-war aftermath has provided the ability to examine the improvements in life expectancy, health care, and social disparities within this country. The following paper describes Rwanda’s environmental and social health determinants, examines health literacy, and evaluates the inequalities within this country. Understanding the multiple influences surrounding the ecological living conditions that lead to tungiasis was pursued to reduce the prevalence of the parasitic disease. Policies should be established to enhance better environmental living conditions so Rwandan citizens can overcome several health barriers. Low socioeconomic status is associated with impoverished housing conditions and unhygienic living environments. Poor housing conditions, elevated indoor relative humidity levels, and unhygienic living environments expose Rwandan citizens to bacterial, viral, and parasitic risks. Therefore, examinations of peer-reviewed scholarly articles assist with determining the efforts used through governmental policies and programs to reduce health disparities in Rwanda. Finally, developing policies can help reduce exposure to a prevalent parasitic disease affecting many Rwandan individuals. Rwanda has many obstacles to reducing exposure to tungiasis, like managing healthy living environments, large city populations, access to quality sanitation systems, contaminated water, and funding for improved water treatment. Approximately 23% of the participants in three primary schools acquired tungiasis by walking barefoot in the sand, with unclean feet, in poor living environments, with elevated relative humidity levels, and in impoverished housing with dirt floors [5 & 12]. Aligned with overcoming Rwandans' barriers, tungiasis can be reduced and eliminated through paved concrete floors in residential housing, controlling indoor atmospheric conditions, education on tungiasis, knowledge of proper hygiene, environmental remedies, social policy reformation, and cultural modifications. In conclusion, goals should be established to create social change to protect at-risk Rwandan citizens from exposure to Tungiasis, especially school children.

Health impact studies of climate change adaptation and mitigation measures – A scoping review

Climate change affects both mental and physical health. Besides limiting the extent and consequences of climate change, mitigation and adaptation measures can have additional and potentially unintended health impacts. This scoping review outlines how health effects of climate mitigation and adaptation measures have been studied in the scientific literature. We conducted a systematic literature search in the databases PubMed, Scopus and Web of Science without time restriction. All peer-reviewed articles reporting quantified health impacts linked to specific climate change adaptation and mitigation measures were included. Overall, the 89 included articles considered only a narrow range of health determinants and health outcomes. Adaptation- and mitigation-related articles most frequently investigated the environmental health determinants air temperature and air pollution, respectively. Non-communicable diseases were predominantly studied while other relevant health outcome categories, such as mental health, food- and nutrition-related issues, and communicable diseases were rarely reported. The scarcity of studies focusing on the social health determinants and providing stratified health impacts among vulnerable population groups in assessments points to an inadequate consideration of health equity aspects. Increased efforts to quantify health impacts more comprehensively and to identify underlying vulnerability factors among specific population groups seem needed. This information could provide policymakers with more accurate evidence to address health equity aspects, limit adverse health impacts and promote health co-benefits of climate change adaptation and mitigation measures.

Physicochemical and bacteriological assessment of borehole water from Etsako west local government.

One of the environmental determinants of health is the quality of drinking water, and water of good quality is void of impurities and pathogenic microbes. Poor quality water has deleterious effects on man's health and wholeness. Conducting a periodic evaluation to ascertain the likely water pollution in the environment is imperative. The study evaluated the physical-chemical parameters (pH, temperature, total dissolved solids, electrical conductivity, total Hardness, Calcium Hardness, Magnesium Hardness, salinity, appearance, odour, Sulphate, Nitrate, Carbonate and Bicarbonate, Sodium, Calcium, and Magnesium contents), heavy metals (Cadmium, Arsenic, and Lead) concentrations and bacterial qualities (total heterotrophic bacteria count and total coliform count) of groundwater from twelve (12) boreholes in four different locations in Etsako West Local Government Area. All the physicochemical indicators analyzed in this study were within the recommended standards except for pH, which is acidic. The heavy metal concentrations and the total heterotrophic bacterial count mean values surpassed the WHO permissible limits. The research identified six genera of bacteria: Klebsiella spp, Staphylococcus spp, Streptococcus spp, Neisseria spp, Enterococcus spp, and E. coli. This study shows that groundwater quality from different boreholes across the LGA is unsuitable for consumption due to toxic metal contamination and high bacteria load. Therefore, there is a need for proper treatment of the water from different borehole sources by boiling or chlorination before consumption. Key words: Contamination; drinking water; heavy metal; heterotrophic; physicochemical; quality

Using COVID-19 to Address Environmental Threats to Health and Leverage for Prison Reform in South Africa, Malawi and Zimbabwe

Abstract Health rights of prisoners has long been a neglected political issue in Africa, where over one million people are detained, and almost half of whom are in pre-trial detention. African prisons constitute high-risk environments for communicable disease transmission. During the COVID-19 pandemic, the public health literature on African prison responses focused on preparedness as it related to testing capacity, quarantine practices and personal protective measures to mitigate disease spread. This article combines the right to health as narrowly defined by a prisoner’s right to access non-discriminatory equivalent health care, with a broader focus on assessing normative standards of detention. A comparative legal realist assessment of prison operations in South Africa, Malawi and Zimbabwe during COVID-19 state disaster measures is presented, focusing on the environmental determinants of health (ventilation, minimum floor space, water, sanitation, hygiene and nutrition) in prisons. It reveals the inherent tensions in ensuring a balance between respecting the fundamental rights of people living and working in prisons, ensuring adequate environmental health standards and mitigating disease during public health emergencies. Despite insufficient government resourcing and inadequate coverage of COVID-19 responses, few severe outbreaks were reported. This could be due to lack of testing, reporting or other factors (asymptomatic infection, acquired immunity). Prison congestion and unrest however affected prisoners and staff fearful of hazardous living and occupational health conditions. COVID-19 as public health emergency amplifies the need to address systemic deficits in infrastructure, resourcing and efficiency of criminal justice systems. Policy level and pragmatic recommendations for enhanced human rights practice are outlined.

COP27 Climate Change Conference: urgent action needed for Africa and the world

COP27 Climate Change Conference: urgent action needed for Africa and the world

Identifying and evaluating environmental determinants of health in Hashtpar city, Iran

ABSTRACT This paper aimed to identify and evaluate the environmental factors that influence human health in Hashtpar. The town locates in the coastal plain of northern Iran and has an area of 1378 ha and a population of about 53,000 people. Fourteen indicators were included in the dataset and the data was collected in 34 data collection points through the evaluation of at least 5 experienced people or by calculations using Geographical Information System (GIS) and related shape files. First, it is used a descriptive and qualitative method and statistical parameters to analyze each determinant of health, regardless of its spatial differences, then the data entered into GIS to produce zoning maps using the Kriging interpolation tool. Findings show that generally, healthy environment indicators are higher than average level and the indicators are in better condition in central parts of the town than in its outskirts.

Truth and Transparency, Compromise and Climate Change

Truth and Transparency, Compromise and Climate Change

Wildlife health in environmental impact assessments: are we missing a key metric?

Environmental impact assessments (EIAs) aim to assess the predicted effects of future projects on the environment, human health, and the economic potential of a region. They are an instrumental tool for sustainable development and to reduce the impact of large-scale industrial projects on biodiversity. The accurate assessment of the effects of projects on wildlife populations has a variety of ecological, cultural, and economic implications. However, assessments are commonly done using indirect indicators such as the predicted impact of changes in the quantity and quality of wildlife habitat and (or) predicted changes in nonspecific wildlife population metrics (e.g., relative abundance). In recent decades, the interpretation of wildlife health has moved from the classical dichotomous state of “disease presence/absence” to a broader concept that integrates the interaction of biological, social, and environmental health determinants. We sought to determine how wildlife health metrics are used in EIA processes and propose a framework to characterize, quantify, and monitor wildlife health in future EIAs. First, we performed a targeted review of EIA documents from three jurisdictions in Canada to characterize the relevance and use of “wildlife health” in these documents. Then, we reviewed case studies and research examples to understand wildlife health in different contexts associated with conservation biology to propose a framework to incorporate wildlife health into baseline monitoring and mitigation processes in EIAs. Our targeted review illustrates that while wildlife health and related terminology is often invoked in the main and specific objectives of EIAs, it is rarely tracked and quantified in EIAs and related processes. We identified approaches that can be used to effectively incorporate wildlife health in EIAs, including context-specific wildlife health metrics, participatory epidemiology, community-based sampling, and local ecological knowledge. We illustrate case studies where wildlife health can facilitate the inclusion of communities, Indigenous governments, and local ecological knowledge into the evaluation process of projects and developments and into comanagement practices of wildlife. Our work highlights the critical need to move towards incorporating wildlife health into EIA processes to provide a more direct and holistic perspective on the potential environmental impacts and improve the opportunities for early implementation of mitigation measurements.

Documentation of Social, Environmental, and Behavioral Determinants of Health in Administrative Claims Data in US Medicare and Commercially Insured Populations

Documentation of Social, Environmental, and Behavioral Determinants of Health in Administrative Claims Data in US Medicare and Commercially Insured Populations

PMON219 Disparities in Musculoskeletal Health Profiles Across Race and Ethnicity in United States-Based Women with Polycystic Ovary Syndrome per the 2018 International Guideline

Abstract The magnitude and direction to which alterations in non-fat components of musculoskeletal composition (bone, muscle) may disproportionately impact diverse populations of women with polycystic ovary syndrome (PCOS) are unknown, despite clinical relevance. The uncertainty stems, partly, from heterogeneity in PCOS diagnostic criteria used and technical barriers in the reliable assessment of PCOS. We evaluated whether musculoskeletal (total and regional lean body mass [LBM] and bone mineral density [BMD]) outcomes were different in PCOS (n=126) across 4 prospectively recruited groups matched for age, body mass index, waist to hip ratio, and lack of recent (<3 mos) hormonal contraceptive and metformin use: self-identified (1) White (n=86); (2) Black (n=17); (3) Asian (n=12); and, (4) Hispanic (n=11) women in 3 academic medical centers in NY. PCOS was defined by the Rotterdam criteria using the recommended thresholds of the most recent (2018) PCOS Guideline. Fat and lean tissue mass and BMD were evaluated by dual-energy X-ray absorptiometry. Within the PCOS group, percentages of total body, trunk fat, and appendicular lean mass were comparable across races and ethnicities (All: P≥0.40); in contrast, total LBM and total and regional BMD were different across the groups (All: P<0.002). Post hoc pairwise comparisons revealed Asian women (mean±standard deviation; 39.64±6.42) exhibited lower total LBM vs. Black (53.93±10.60) and White (49.47±8.87; All: P<0.01) but not vs. their Hispanic (46.30±8.77 kg; P=0.29) counterparts. Total, upper, and lower limb BMD were higher in Black women (1.28±1.13; 0.82±0.09; 1.28±0.12) vs. all other counterparts: (White [1.12±0.9; 0.75±0.09; 1.18±0.10;]; Asian [1.09±0.09; 0.67±0.03; 1.08±0.05]; and, Hispanic [1.09±0.09; 0.72±0.15; 1.07±0.10] g/cm2; All: P<0.04), respectively. Similarly, lower limb BMD was compromised in Asian and Hispanic vs. White women (All: P≤0.03). Groups exhibited comparable glucoregulatory status (insulin and glucose responses to a standard 75-g oral glucose tolerance test), blood pressure, androgen status (Ferriman-Gallwey scores, total, free, and bioavailable testosterone), and intermenstrual interval length (All: P≥0.14). Conversely, groups differed by insulin-like-growth-factor-1 (IGF-1) and IGF-2 levels (All: P≤0.05). Post hoc pairwise comparisons showed lower IGF-1 in Black (255.92±145.12) and White (325.42±140.25) vs. Hispanic (549.21±266.26 ng/mL) women (All: P≤0.04). Also, Black women (426.74±82.66) had lower IGF-2 vs. White women (553.07±111.10 ng/mL; P≤0.4). Collectively, Asian women with PCOS show the lowest LBM and BMD, whereas their Black counterparts exhibit higher BMD after matching for age, body mass index, waist to hip ratio, lack of hormonal contraceptive and metformin use, and percentages of total body and trunk fat. Future research should delineate the true effects of PCOS-specific endocrine milieu (e.g., IGF axis) and relevance of genetic variants and/or environmental determinants of musculoskeletal health in this understudied clinical population. If confirmed by larger studies, our observations support the need for population-specific preventative and management considerations in future Guideline recommendations (e.g., PCOS-specific physical activity) to improve musculoskeletal health and associated reproductive and metabolic comorbidities. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Engaging and supporting national public health institutes as key climate actors

Abstract The International Association of National Public Health Institutes (IANPHI) collectively builds public health capacity by connecting, developing and strengthening national public health institutes worldwide. IANPHI recognizes climate action as a critical global public health intervention and acknowledges that public health interventions on environmental and socio-economic determinants of health are essential drivers of climate adaptation and mitigation. Recovery from the COVID-19 pandemic also provides a unique opportunity to reset business as usual and strengthen actions on climate change, biodiversity and health, while reducing social and health inequities in the long term. However, effective contributions of National Public Health Institutes (NPHIs) to adaptation plans and mitigation strategies for climate change have remained limited, with a primary focus on health surveillance to date. In this context, IANPHI developed a roadmap to support and reinforce the role of NPHIs in climate change mitigation and adaptation policies. Five priority actions were identified: 1. Advocate for strengthening NPHIs capacities to contribute effectively to climate and biodiversity research, policies, and action 2. Enhance capacity, competence and training through peer-to-peer support and knowledge sharing between NPHIs 3. Increase collaboration with international and regional organizations active in the fields of public health and climate change 4. Support the greening of public health services 5. Monitor progress in the NPHIs’ involvement in climate change policies through key indicators In addition to discussing the roadmap, the presentation will focus on actions that IANPHI's Climate Change and Health committee initiated to reinforce the role of NPHIs in climate change mitigation and adaptation policies. This presentation will also provide information on how IANPHI can engage and support national public health institutes as key actors in the fight against climate change.

Assessment of Environmental Impacts on Health: Examples from the Pacific Basin.

Assessing environmental impacts on health in the Pacific Basin is challenged by significantly varying data types - quantities, qualities, and paucities - because of varying geographic sizes, environments, biodiversity, ecological assets, and human population densities, with highly varied and unequal socio-economic development and capacity to respond to environmental and health challenges. We discuss three case-based methodological examples from Pacific Basin environmental health impact assessments. These methods could be used to improve environmental health evidence at all country and regional levels across a spectrum of big data availability to no data. These methods are, 1) a risk assessment of airborne particulate matter in Korea based on the chemical composition of these particulates; 2) the use of system dynamics to appraise the influences of a range of environmental health determinants on child health outcomes in remote Solomon Islands; and 3) precision environmental public health methodologies based on comprehensive data collection, analyses, and modelling (including Bayesian belief networks and spatial epidemiology) increasing precision for good environmental health decision making to prevent and control a zoonotic disease in Fiji Islands. We show that while a common theme across the three examples is the value of high quality and quantity data to support stronger policy decisions and appropriate prioritizing of investment, it is also clear that for many countries in the Pacific Basin, sufficient data will remain a challenge to inform decision makers about environmental impact on health.

COP27 Climate Change Conference: urgent action needed for Africa and the world

COP27 Climate Change Conference: urgent action needed for Africa and the world

78.2 Impact of Climate Change on the Health and Well-Being of Indigenous Communities in Australia

78.2 Impact of Climate Change on the Health and Well-Being of Indigenous Communities in Australia

Two-Eyed Seeing: Seeking Indigenous Knowledge to strengthen climate change adaptation planning in public health

Indigenous Peoples of Turtle Island have intimate knowledge of the environment and a long history of adapting to a changing climate. Yet, a scoping review of the literature on climate change adaptation measures identified only one document that provided an Indigenous perspective. On reflection, this pointed to a systemic issue in public health practice. To fill the gap, Cambium Indigenous Professional Services was retained to provide an Indigenous perspective. This paper highlights some of the lessons learned from this experience, not only when it comes to climate change, but also when addressing the broader social and environmental determinants of health. It presents factors public health authorities must consider to meaningfully engage with Indigenous Peoples and reduce health inequities. Significant and purposeful relationships will be developed when public health practitioners take the time to build trust, learn the history of Indigenous Peoples and embrace decolonization. This allows the creation of an ethical space where “Two-Eyed Seeing” can weave the different streams of evidence when developing and implementing climate change adaptation policies and programs.

Climate change and health in the Caribbean: A review highlighting research gaps and priorities

• The Caribbean has fewer peer-reviewed climate and health publications than other regions • There is limited research on public health preparedness and response to storms, floods, drought and on the environmental determinants of health • There are virtually no regional surveys on climate and health awareness and public perceptions • Limited data exists at the national level on the relationships between climate and health Climate change is a reality in the Caribbean that will continue to have a significant impact on human health and the health sector. The health impacts are exacerbated due to the vulnerabilities inherent in populations residing in tropical Small Island Developing States. A review of original research studies related to health and climate change in the Caribbean was conducted using online academic databases. The aim of the review was to synthesize evidence around the nexus between climate and health in the Caribbean, thereby presenting a more concise understanding of the current impact on vulnerable low-lying and coastal communities. Twenty-seven original studies published between 2006 and 2021 were identified. These studies were grouped into categories by health issue. The synthesis of existing Caribbean evidence on climate change and health outcomes will facilitate the prioritization of mitigation and adaptation efforts, support novel proposals for health and climate financing and identify gaps in the research agenda. In most categories a limited amount of research exists, especially when considering the increasing impact from climate on Caribbean life and well-being. In addition to the health impacts noted, gaps in research include reaching vulnerable populations, national application of health mitigation/adaptation strategies and efforts to increase climate and health research capacity.