Quantitative Health Impact Assessment Research Articles

Health impacts of E-Scooters sharing systems in Atlanta and Portland, USA

BACKGROUND AND AIM: Since 2017 electric kick scooters (E-Scoters) have been expanded across cities around the globe. E-Scooter share systems provide a micro-mobility solution in urban areas. To our knowledge, no previous studies have quantified the health risks and benefits of E-Scooters. METHODS: This study followed a quantitative health impact assessment approach, to estimate the risks and benefits of e-scooter sharing systems. Specifically, we quantified the health impacts related to three exposures: physical activity, air pollution, and traffic incidents. We analyzed E-scooter systems, in Atlanta, Georgia, and Portland, Oregon. Input data on transport, traffic safety, air quality, and physical activity were collated from public records and scientific publications. We modeled the health impacts on adult users related to mortality, disease incidence, disability-adjusted life years, and health economic impacts (related to morbidity and mortality). RESULTS:In Atlanta,15,792 E-scooter trips were made each day. From those 42% substituted car trips, 48% walk trips, 4% bike trips, and 2% transit trips. Among all travelers, we estimated an increment of 3.4 million USD in health economic impacts of E-Scooters, mainly derived by the increment in traffic injuries. In Portland, 4,885 E-scooter trips were made each day, with a similar mode shift than in Atlanta. Among Portland travelers, we estimated a reduction of 1.5 million USD in health economic impacts of E-Scooters, mainly derived from the reduction in traffic fatalities. When we disaggregate the analysis by mode of transport, the substitution of public transit, bike or walk trips by E-Scooter resulted in more health risks, and the substitution of car trips by E-Scooter resulted as a health benefit. CONCLUSIONS:E-scooters implementation will benefit from a health lens. Depending on the modal shift, and the traffic safety measures implemented around E-Scooters, this micro-mobility solution could be a health risk or benefit. This study supports the E-scooter implementation that prioritizes car trip substitution. KEYWORDS: Transport, E-Scooter, Urban health, Health Impact Assessment, Traffic incidents, Air Pollution

Health impacts of bike sharing systems in the U.S

BACKGROUND AND AIM: Bike-sharing systems (BSS) are short-term bike rentals, that can be borrowed from one location and retired to another at the conclusion of the trip. In 2019, the top 10 US largest BSS fleets counted more than 33,500 bikes. To our knowledge, no assessment has quantified the health risk and benefits of multiple BSS in the US. METHODS: This study followed a quantitative health impact assessment approach, to estimate the risks and benefits of BSS. Specifically, we quantified the health impacts related to three exposures: physical activity, air pollution, and traffic incidents. We analyzed all the trips made by BSS systems in the US. Input data on transport, traffic safety, air quality, and physical activity were collated from public records and scientific publications. We modeled the health impacts on adult users related to mortality, disease incidence, disability-adjusted life years (DALYs), and health economic impacts (related to morbidity and mortality). RESULTS:In the US,109,589 BSS trips were made each day. From those 45% substituted car trips, 28% walk trips, and 9% transit trips. Among all travelers, we estimated an annual reduction of 36 million USD in health economic impacts, 737 DALYs, and 4.7 premature deaths related to BSS trips, mainly derived from the increment in physical activity. When we disaggregate the analysis by mode of transport, in all the cases the substitution of public transport, walk and car trips by BSS resulted in more health benefits. In the US, the average estimated health benefit-risk ratio for BSS was 19:1. CONCLUSIONS:BSS in the US provides a health benefit for travelers. Improvements in air quality and traffic safety across the US cities will maximize the health benefits of BSS. This study supports the implementation and expansion of BSS across cities in the US. KEYWORDS: Transport, Bicycling, Bike-sharing systems, Health Impact Assessment, Physical activity, Air Pollution

Health and equity opportunities of commercial corridors revitalization in Colorado

BACKGROUND AND AIM: In the U.S. transport corridors have received large attention as an opportunity area for urban regeneration. AIM. This study aims to quantify the health and equity impacts of land-use changes from low-density commercial corridors to high-density mixed-use commercial corridors with special attention on affordable housing and green spaces in Fort Collins and Denver, Colorado. METHODS: This study quantified opportunities on housing, employment, and green space of commercial corridors regeneration, based on land use scenarios at the parcel level. For the health assessment, we quantified health impacts on mortality and disease incidence related to increases of urban vegetation at parcel level in both cities through a quantitative health impact assessment approach. We developed two main policy scenarios: a) transforming low-dense commercial parcels into mixed-use developments; and b) transform vacant and parking surface lots into green spaces. RESULTS:In Denver, commercial corridors revitalization based on shifting low-density commercial parcels to mixed-use developments could absorb a 22% increment in city inhabitants, 29% new dwelling units, 59% new affordable housing, and 16% new jobs. In the same commercial corridors, the revitalization of vacant and parking surface lots to green spaces will increase 715 acres of green spaces across the city, resulting in a reduction of 35 premature deaths. In Fort Collins, commercial corridors revitalization could absorb a 77% increment in city inhabitants, 115% new dwelling units, 600% new affordable housing, and 63% new jobs. In the same commercial corridors, the revitalization of vacant and parking surface lots to green spaces will increase 54 acres of green spaces across the city, resulting in a reduction of 5 premature deaths. CONCLUSIONS:The regeneration of commercial corridors in Colorado could help to reduce urban sprawl, increase affordable housing, employment, green spaces, and health equity-related benefits. KEYWORDS: Commercial corridors, affordable housing, sprawl, green spaces, equity, health impact assessment

Health impacts of bike-sharing systems in the U.S.

BackgroundBike-sharing systems (BSS) are short-term bike rentals that can be borrowed from one location and retired to another at the conclusion of the trip. In 2019, 109,589 BSS trips were made each day in the U.S, and half of those in New York City (NYC). AimThis study aims to quantify the health risks and benefits of BSS in the U.S. and NYC. MethodsThis study followed a quantitative health impact assessment approach to estimate the risks and benefits of BSS. Specifically, we quantified the health impacts of physical activity, air pollution, and traffic incidents. We analyzed all the trips made by BSS in the U.S. and NYC. Input data on transport, traffic safety, air quality, and physical activity were collated from public records and scientific publications. We modeled the health impacts on adult users related to mortality, disease incidence, disability-adjusted life years (DALYs), and health economic impacts (related to morbidity and mortality). ResultsWe estimated that in the U.S. BSS trips resulted in an annual reduction of 4.7 premature deaths, 737 DALYs, and 36 million $USD in health economic impacts, mainly derived from the increment in physical activity. In NYC, we estimated an annual reduction of 2 premature deaths, 355 DALYs, and 15 million $USD in health economic impacts. ConclusionBSS in the U.S. and NYC provide a health benefit for bicyclists. Improvements in air quality and traffic safety across U.S. cities will maximize the health benefits of BSS.

Covid-19 Lockdown in Spring 2020 in France Provided Unexpected Opportunity to Assess Health Impacts of Falls in Air Pollution

Lockdown measures to limit the spread of Covid-19 in France in spring 2020 sharply reduced activities and lowered air-pollution concentrations. This study sought to determine the short- and long-term impacts on mortality in metropolitan France resulting from the temporary decrease in the population's exposure to air pollution. The reduction in exposure to air pollution was estimated by calculating the difference between modeled exposure of the population during the strict lockdown and the gradual lifting, and the simulated exposure that would have been observed in the absence of lockdown. A quantitative health impact assessment was used to estimate both the short-term impact of PM10 and NO2 reductions, and the long-term impact of PM2.5 and NO2 reductions on mortality. Reduced activities during the lockdown lowered NO2 and PM concentrations, resulting in about 2,300 deaths postponed for PM2.5 and nearly 1,200 for NO2, mainly due to avoided long-term effects. This study shows that, even in an unprecedented context that is certainly neither realistic nor desirable to improve air quality in the long run, public interventions appear to have a significant impact on health through reductions in air-pollution levels. In a long-term perspective, the study also reminds us that the total burden of air pollution on health remains a significant risk factor in France. Efforts to reduce ambient air pollution must thus be pursued sustainably for all sources of air pollution with suitably adapted but ambitious policies. Finally, the lockdown restrictions had other consequences, both positive and negative, on the population's health. These consequences highlight the need to conduct more integrated assessments of health impacts that include the multisectoral consequences of interventions, particularly in terms of population compliance with mitigating restrictions, behavior and mental health and, more broadly, climate change.

Health Impacts of Urban Bicycling in Mexico.

Background: Bicycling has been associated with health benefits. Local and national authorities have been promoting bicycling as a tool to improve public health and the environment. Mexico is one of the largest Latin American countries, with high levels of sedentarism and non-communicable diseases. No previous studies have estimated the health impacts of Mexico’s national bicycling scenarios. Aim: Quantify the health impacts of Mexico urban bicycling scenarios. Methodology: Quantitative Health Impact Assessment, estimating health risks and benefits of bicycling scenarios in 51,718,756 adult urban inhabitants in Mexico (between 20 and 64 years old). Five bike scenarios were created based on current bike trends in Mexico. The number of premature deaths (increased or reduced) was estimated in relation to physical activity, road traffic fatalities, and air pollution. Input data were collected from national publicly available data sources from transport, environment, health and population reports, and surveys, in addition to scientific literature. Results: We estimated that nine premature deaths are prevented each year among urban populations in Mexico on the current car-bike substitution and trip levels (1% of bike trips), with an annual health economic benefit of US $1,897,920. If Mexico achieves similar trip levels to those reported in The Netherlands (27% of bike trips), 217 premature deaths could be saved annually, with an economic impact of US $45,760,960. In all bicycling scenarios assessed in Mexico, physical activity’s health benefits outweighed the health risks related to traffic fatalities and air pollution exposure. Conclusion: The study found that bicycling promotion in Mexico would provide important health benefits. The benefits of physical activity outweigh the risk from traffic fatalities and air pollution exposure in bicyclists. At the national level, Mexico could consider using sustainable transport policies as a tool to promote public health. Specifically, the support of active transportation through bicycling and urban design improvements could encourage physical activity and its health co-benefits.

Premature mortality due to air pollution in European cities: a health impact assessment

Ambient air pollution is a major environmental cause of morbidity and mortality worldwide. Cities are generally hotspots for air pollution and disease. However, the exact extent of the health effects of air pollution at the city level is still largely unknown. We aimed to estimate the proportion of annual preventable deaths due to air pollution in almost 1000 cities in Europe. We did a quantitative health impact assessment for the year 2015 to estimate the effect of air pollution exposure (PM2·5 and NO2) on natural-cause mortality for adult residents (aged ≥20 years) in 969 cities and 47 greater cities in Europe. We retrieved the cities and greater cities from the Urban Audit 2018 dataset and did the analysis at a 250 m grid cell level for 2015 data based on the global human settlement layer residential population. We estimated the annual premature mortality burden preventable if the WHO recommended values (ie, 10 μg/m3 for PM2·5 and 40 μg/m3 for NO2) were achieved and if air pollution concentrations were reduced to the lowest values measured in 2015 in European cities (ie, 3·7 μg/m3 for PM2·5 and 3·5 μg/m3 for NO2). We clustered and ranked the cities on the basis of population and age-standardised mortality burden associated with air pollution exposure. In addition, we did several uncertainty and sensitivity analyses to test the robustness of our estimates. Compliance with WHO air pollution guidelines could prevent 51 213 (95% CI 34 036-68 682) deaths per year for PM2·5 exposure and 900 (0-2476) deaths per year for NO2 exposure. The reduction of air pollution to the lowest measured concentrations could prevent 124 729 (83 332-166 535) deaths per year for PM2·5 exposure and 79 435 (0-215 165) deaths per year for NO2 exposure. A great variability in the preventable mortality burden was observed by city, ranging from 0 to 202 deaths per 100 000 population for PM2·5 and from 0 to 73 deaths for NO2 per 100 000 population when the lowest measured concentrations were considered. The highest PM2·5 mortality burden was estimated for cities in the Po Valley (northern Italy), Poland, and Czech Republic. The highest NO2 mortality burden was estimated for large cities and capital cities in western and southern Europe. Sensitivity analyses showed that the results were particularly sensitive to the choice of the exposure response function, but less so to the choice of baseline mortality values and exposure assessment method. A considerable proportion of premature deaths in European cities could be avoided annually by lowering air pollution concentrations, particularly below WHO guidelines. The mortality burden varied considerably between European cities, indicating where policy actions are more urgently needed to reduce air pollution and achieve sustainable, liveable, and healthy communities. Current guidelines should be revised and air pollution concentrations should be reduced further to achieve greater protection of health in cities. Spanish Ministry of Science and Innovation, Internal ISGlobal fund.

Relationship-building around a policy decision-support tool for urban health.

Contemporary challenges linked to public health and climate change demand more effective decision-making and urban planning practices, in particular by taking greater account of evidence. In order to do this, trust-building relationships between scientists and urban practitioners through collaborative research programmes is required. Based on a policy-relevant research project, Complex Urban Systems for Sustainability and Health (CUSSH), this project aims to support the transformation of cities to meet environmental imperatives and to improve health with a quantitative health impact assessment. A case study in Rennes, France, focuses on the role of a policy decision-support tool in the production and use of knowledge to support evidence-informed decision-making. Although the primary objective of informing decision-making through evidence-based science is not fulfilled, the use of a decision-making support tool can lay the foundations for relationship-building. It can serve as a support for boundary-spanning activities, which are recognised for their effectiveness in linking science to action. This case study illustrates that the path of knowledge transfer from science to policy can be challenging, and the usefulness of using models may not be where it was thought to have been.

A health impact assessment of lack of air conditioning during extreme heat in a temperate climate

Introduction: Air conditioning (AC) ownership and use can mitigate the effects of summer heat on health. With increasing temperatures, increasing economic disparities, and the unequal distribution of electricity production harms (e.g., air pollution) and benefits (e.g., AC), heat-related health disparities are of increasing concern. We reviewed the literature on the protective effects of AC and performed a quantitative health impact assessment of AC in Wayne County, Michigan, USA.Methods: We used: 1) a model of central AC prevalence based on American Housing Survey and tax assessor’s data; 2) heat-mortality and -hospitalization association estimates; 3) estimates of the AC relative risk ratio (RRR), or relative risk of the health event during vs. not during extreme heat among those without AC vs. the relative risk among those with AC; and 4) mortality, hospitalization, and population estimates to calculate and map extreme-heat attributable health burden and costs (2020 $USD) by census tract (500-5,000 persons).Results: RRRs ranged widely (1.02-11.5) depending on extreme-heat definitions, health outcomes (e.g., all-cause mortality or heatstroke), and AC geographic resolution (community or individual). Ten-year extreme-heat (defined at the 99th percentile of temperature) associated health rates ranged widely across census tracts (0.6-5.6 deaths/100,000 persons and 2.0-26 hospitalizations/100,000 persons), as did monetized health costs ($11,000-$1,640,000 per census tract).Conclusions: Health impacts of lack of AC vary spatially. In future work, we will consider the added effects of low usage among those with AC, the cumulative burden of exposure to power plant emissions and lack of AC, and the impacts of heat during an extended power outage. Quantifying and mapping the cumulative health impacts of energy production can inform neighborhoods of air- and climate-associated risk disparities and inform energy mix and utility rate regulatory decisions.

Open streets in Latin-America: Health impacts related to physical activity

Introduction. Open streets (OS)(also called “Ciclovías Recreativas” in Spanish), are city streets temporarily repurpose into car-free spaces for leisure activities. OS had a quick expansion in Latin America (LA), arriving to cover 77 Latin American cities in 2019. Aim. This study aims to quantify the health of OS related to physical activity (PA), in 15 Latin American cities. Methods. Quantitative Health Impact Assessment approach, estimating annual deaths, disease incidence (ischemic heart disease (IHD), ischemic stroke, type 2 diabetes (DM2), colon cancer, breast cancer, and dementia), disability-adjusted life years (DALYs) and economic values (on mortality), related to PA. Health and demographic data from each city and country were collected from official records and scientific publications. An OS survey was designed and distributed to city authorities through the Americas Open Street network. Results. This study found that the OS in the 15 LA cities included has an estimated benefit of 1,101 annual deaths avoided due to the increment of PA, with an annual economic impact of $1,575 million USD, and an annual reduction of 3,070 DALYs. In terms of the type of PA, the most benefits between the 15 cities were derived from cyclists (1648 DALYs), followed by pedestrians (359 DALYs). Conclusion. This study found that OS in Latin America can provide important health and health-economic benefits related to physical activity. In those cities where OS already exist, increase the number of OS events, kilometers, and duration could result in a greater number of users, OS related PA, and their health benefits.

IMPACT OF COVID-19 AND STRICT HOME CONFINEMENT RELATED CHANGES IN AIR POLLUTION, NOISE, AND PHYSICAL ACTIVITY ON CARDIOVASCULAR HEALTH FOR BARCELONA CITIZENS

Background: To decelerate the infection rate of the coronavirus disease 2019 (COVID-19), the Spanish Government implemented strict home confinement measures. Within weeks, changes in environmental exposures and health behaviours were observed. We aimed to estimate the impact of COVID-19 related changes in air pollution, noise and physical activity exposures on cardiovascular health for Barcelona-citizens.Methods: In a quantitative health impact assessment for Barcelona residents (age>=20 years; n=1,361,973), we assessed the impact of changes in nitrogen dioxide (NO2) as a proxy for air pollution, and walking-related physical activity on the incidence of stroke and myocardial infarction (MI) events for the period of strict home confinement from 15th March to 25th April 2020. Additionally, we assessed the impact of changes in road-traffic noise on annoyance, a known short-term effect associated with cardiovascular health when noise reductions are maintained for longer periods.Results: During confinement, NO2 levels were reduced by 59% (95% CI: 52-64%) at a mean concentration of 13µg/m3 (SD:4.7µg/m3). Physical activity dropped by 94% (SD: 2.2%). We estimated that 1% (95% CI: 1-2%) of expected stroke and 2% (95% CI: 2-3%) of expected MI events were avoided due to the decrease in NO2. In contrast, an additional 9% of expected stroke (95% CI: 0-20%) and MI events (95%CI: 3-16%), respectively, were estimated due to the decrease in physical activity. Noise levels were reduced by 9% (SD: 0.1%), averaging at 59dB Lden (SD: 2.5dB Lden), which was estimated to reduce the percentage of highly annoyed citizens by 45% (SD: 3.0%). Conclusions: The health impact of the drastic reduction in physical activity appears to outweigh the reduction in NO2 on stroke and MI events during six weeks of strict home confinement. Long-term effects of noise reductions on stroke and MI events via a decrease in noise-annoyance still needs to be further assessed.

Framework for Participatory Quantitative Health Impact Assessment in Low- and Middle-Income Countries.

Background: Conducting health impact assessments (HIAs) is a growing practice in various organizations and countries, yet scholarly interest in HIAs has primarily focused on the synergies between exposure and health outcomes. This limits our understanding of what factors influence HIAs and the uptake of their outcomes. This paper presents a framework for conducting participatory quantitative HIA (PQHIA) in low- and middle-income countries (LMICs), including integrating the outcomes back into society after an HIA is conducted. The study responds to the question: what are the different components of a participatory quantitative model that can influence HIA implementation in LMICs? Methods: To build the framework, we used a case study from a PQHIA fieldwork model developed in Port Louis (Mauritius). To explore thinking on the participatory components of the framework, we extract and analyze data from ethnographic material including fieldnotes, interviews, focus group discussions and feedback exercises with 14 stakeholders from the same case study. We confirm the validity of the ethnographic data using five quality criteria: credibility, transferability, dependability, confirmability, and authenticity. We build the PQHIA framework connecting the main HIA steps with factors influencing HIAs. Results: The final framework depicts the five standard HIA stages and summarizes participatory activities and outcomes. It also reflects key factors influencing PQHIA practice and uptake of HIA outcomes: costs for participation, HIA knowledge and interest of stakeholders, social responsibility of policymakers, existing policies, data availability, citizen participation, multi-level stakeholder engagement and multisectoral coordination. The framework suggests that factors necessary to complete a participatory HIA are the same needed to re-integrate HIA results back into the society. There are three different areas that can act as facilitators to PQHIAs: good governance, evidence-based policy making, and access to resources. Conclusions: The framework has several implications for research and practice. It underlines the importance of applying participatory approaches critically while providing a blueprint for methods to engage local stakeholders. Participatory approaches in quantitative HIAs are complex and demand a nuanced understanding of the context. Therefore, the political and cultural contexts in which HIA is conducted will define how the framework is applied. Finally, the framework underlines that participation in HIA does not need to be expensive or time consuming for the assessor or the participant. Yet, participatory quantitative models need to be contextually developed and integrated if they are to provide health benefits and be beneficial for the participants. This integration can be facilitated by investing in opportunities that fuel good governance and evidence-based policy making.

Estimating the health benefits associated with a speed limit reduction to thirty kilometres per hour: A health impact assessment of noise and road traffic crashes for the Swiss city of Lausanne

Reductions of speed limits for road traffic are effective in reducing casualties, and are also increasingly promoted as an effective way to reduce noise exposure.The aim of this study was to estimate the health benefits of the implementation of 30 km/h speed limits in the city of Lausanne (136′077 inhabitants) under different scenarios addressing exposure to noise and road crashes.The study followed a standard methodology for quantitative health impact assessments to derive the number of attributable cases in relation to relevant outcomes. We compared a reference scenario (without any 30 km/h speed limits) to the current situation with partial speed limits and additional scenarios with further implementation of 30 km/h speed limits, including a whole city scenario.Compared to the reference scenario, noise reduction due to the current speed limit situation was estimated to annually prevent 1 cardiovascular death, 72 hospital admissions from cardiovascular disease, 17 incident diabetes cases, 1′127 individuals being highly annoyed and 918 individuals reporting sleep disturbances from noise. Health benefits from a reduction in road traffic crashes were less pronounced (1 severe injury and 4 minor injuries). The whole city speed reduction scenario more than doubled the annual benefits, and was the only scenario that contributed to a reduction in mortality from road traffic crashes (one death per two years). Implementing 30 km/h speed limits in a city yields health benefits due to reduction in road traffic crashes and noise exposure. We found that the benefit from noise reduction was more relevant than safety benefits.

Participatory quantitative health impact assessment of urban transport planning: A case study from Eastern Africa

BackgroundHigh rates of motorization in urban areas of Africa have adverse effects on public health. Transport-related mortality will increase as a result of inadequate transport infrastructure, air pollution and sedentary lifestyles. Health Impact Assessments (HIAs) have proven to be a successful tool to predict and mitigate negative health impact of urban transport planning policies, programmes or projects. Yet, there is a gap of evidence on transport and health in African countries. The aim of this study is assessing the health impacts of transport scenarios in Port Louis (city of 119,018 inhabitants in Mauritius) using a full chain participatory HIA model. MethodsWe estimated health and economic impacts associated to transport scenarios with qualitative data and quantitative comparative risk assessment methods. The health impact modeling was based on differences between the baseline and three transport scenarios (worse, good, ideal), estimating the averted deaths per year and economic outcomes by assessing health determinants of air pollution (AP), traffic deaths and physical activity (PA). Data on air pollution and traffic fatalities were obtained from public data sources. Data used to construct scenarios, establish baseline travel mode shares and physical activity were collected through (a) open-ended individual interviews (IDIs) with 14 stakeholders (b) closed-ended survey questions to 600 citizens and (c) 2 focus group discussions (FGDs) with the same 14 stakeholders from (a). ResultsIn Port Louis, the worse-case transport scenario (doubling in car trips and a reduction in walking, motorcycle, and public transport), resulted in a total increment of 3.28 premature deaths per year. The good-case scenario (reducing car trips by half and increasing walking, motorcycle, and public transport trips) resulted in a total increment of 0.79 premature deaths per year. The ideal-case scenario (reduction in car and motorcycle trips and an increase in walking and public transport trips) resulted in a total reduction of 13.72 premature deaths per year. We estimated USD 23 millions of economic benefits related to mortality if the ideal-case was achieved. ConclusionParticipatory HIA shows that implementing transport policies aiming for less than an ideal situation may not be adequate or sufficient to avoid negative transport-related mortality in Mauritius. Urban transport planning is an opportunity to encourage physical activity in rapidly urbanizing settings of Africa. Transport policies should aim to restrict all forms of private motorized vehicles and promote active and public transport to support public health. We highly recommend the use of participatory approaches in quantitative HIA to ensure context specificity and policy relevance.

Equity impacts of interventions to increase physical activity among older adults: a quantitative health impact assessment

BackgroundBehavioural interventions may increase social inequalities in health. This study aimed to project the equity impact of physical activity interventions that have differential effectiveness across education groups on the long-term health inequalities by education and gender among older adults in Germany.MethodsWe created six intervention scenarios targeting the elderly population: Scenarios #1–#4 applied realistic intervention effects that varied by education (low, medium high). Under scenario #5, all older adults adapted the physical activity pattern of those with a high education. Under scenario #6, all increased their physical activity level to the recommended 300 min weekly. The number of incident ischemic heart disease, stroke and diabetes cases as well as deaths from all causes under each of these six intervention scenarios was simulated for males and females over a 10-year projection period using the DYNAMO-HIA tool. Results were compared against a reference-scenario with unchanged physical activity.ResultsUnder scenarios #1–#4, approximately 3589–5829 incident disease cases and 6248–10,320 deaths could be avoided among males over a 10-year projection period, as well as 4381–7163 disease cases and 6914–12,605 deaths among females. The highest reduction for males would be achieved under scenario #4, under which the intervention is most effective for those with a high education level. Scenario #4 realizes 2.7 and 2.4% of the prevented disease cases and deaths observed under scenario #6, while increasing inequalities between education groups. In females, the highest reduction would be achieved under scenario #3, under which the intervention is most effective amongst those with low levels of education. This scenario realizes 2.7 and 2.9% of the prevented disease cases and deaths under scenario #6, while decreasing inequalities between education groups. Under scenario #5, approximately 31,687 incident disease cases and 59,068 deaths could be prevented among males over a 10-year projection period, as well as 59,173 incident disease cases and 121,689 deaths among females. This translates to 14.4 and 22.2% of the prevented diseases cases among males and females under scenario #6, and 13.7 and 27.7% of the prevented deaths under scenario #6.ConclusionsThis study shows how the overall population health impact varies depending on how the intervention-induced physical activity change differs across education groups. For decision-makers, both the assessment of health impacts overall as well as within a population is relevant as interventions with the greatest population health gain might be accompanied by an unintended increase in health inequalities.

To what extent could cardiovascular diseases be reduced if Germany applied fiscal policies to increase fruit and vegetable consumption? A quantitative health impact assessment

This study aimed to dynamically model and quantify expected health effects of four scenarios: (i) a reference scenario with an unchanged fruit and vegetable intake, (ii) the removal of value-added tax (VAT) on fruits and vegetables, (iii) the implementation of a 20 % subsidy on fruits and vegetables and (iv) a guideline scenario with a population-wide fruit and vegetable intake of five portions per day. Baseline fruit and vegetable intake data was derived from the GEDA 2012 study. We used price elasticities for Germany to calculate the change in fruit and vegetable consumption under the zero VAT and the 20 % subsidy scenario. All scenarios were modelled over a 10-year projection period using DYNAMO-HIA. Germany. A projected real-life population. Cumulated over the 10-year projection period, an estimated 4450 incident ischaemic heart disease (IHD) cases, 7010 stroke cases and 13 960 deaths would be prevented under the zero VAT scenario. Under the 20 % subsidy scenario, 17990 incident IHD cases, 27390 stroke cases and 54880 deaths would be averted. Although this corresponds to only a fraction of the incidents that would occur under the reference scenario, the averted cases translate to 2 % (for the zero VAT scenario) and 9 % (for the 20 % subsidy scenario) of IHD, stroke and death cases that would be prevented if the whole population consumed the recommended five portions of fruits and vegetables per day. Fiscal policies on fruits and vegetables provide a non-negligible step towards the removal of the health burden induced by low fruit and vegetable intake.

Health Impacts from Ambient Particle Exposure in Southern Sweden.

A health impact assessment (HIA) is an important tool for making informed decisions regarding the design and evaluation of environmental interventions. In this study, we performed a quantitative HIA for the population of Scania (1,247,993), the southernmost county in Sweden, in 2016. The impact of annual mean concentrations of particulate matter with an aerodynamic diameter <2.5 µm (PM2.5), modeled at their home residences for the year 2011, on mortality, asthma, dementia, autism spectrum disorders, preeclampsia and low birth weight (LBW) was explored. Concentration–response (C-R) functions were taken from epidemiological studies reporting meta-analyses when available, and otherwise from single epidemiological studies. The average level of PM2.5 experienced by the study population was 11.88 µg/m3. The PM2.5 exposure was estimated to cause 9–11% of cases of LBW and 6% of deaths from natural causes. Locally produced PM2.5 alone contributed to 2–9% of the cases of diseases and disorders investigated. Reducing concentrations to a maximum of 10 µg/m3 would, according to our estimations, reduce mortality by 3% and reduce cases of LBW by 2%. Further analyses of separate emission sources’ distinct effects were also presented. Reduction of air pollution levels in the study area would, as expected, have a substantial effect on both mortality and adverse health outcomes. Reductions should be aimed for by local authorities and on national and even international levels.

Quantitative health impact assessment of construction noise exposure on the nearby region for noise barrier optimization

As construction noise has become one of the most harmful pollutants for nearby residents, it is essential to quantify the health impacts of noise exposure to reduce them and reduce the number of resident disputes. Accordingly, this study aims to propose a method to assess the quantitative health impact of construction noise exposure on nearby residents and optimize noise barriers based on this health impact. To this end, the health impact of construction noise exposure on nearby residents was quantified as a health damage cost by estimating the environmental burden of disease (EBD) and its economic value based on noise simulations. The results show that the estimated health damage cost reflects the health impact of construction noise exposure on nearby residents within a feasible range of compensation costs compared with the existing compensation criteria. In addition, the optimal noise barrier heights reduce the health damage cost on a nearby region by 8.8% (USD 7213), and the barrier installation cost is also reduced by 0.7% (USD 1409). The proposed method can help the general contractor establish a noise mitigation plan to reduce the health impact of construction noise exposure on nearby residents as well as to prevent additional expenses for disputes or compensations. Furthermore, it can help the government reduce the social cost of solving disputes related to construction noise by providing a quantitative metric for compensation criteria based on the health impact of construction noise exposure.

Health equity and burden of childhood asthma - related to air pollution in Barcelona

BackgroundAir pollution is one of the major health risk factors in urban populations. Air pollution has been associated with asthma in children. Air pollution has also been suggested to be distributed unequally within the cities, something that can lead to urban health inequalities. AimWe aimed to estimate the number of childhood asthma cases attributable to three main air pollutants; Nitrogen dioxide (NO2), Particulate Matter (PM 2.5), and Black Carbon (BC) in the city of Barcelona, Spain. We also aimed to describe the distribution of those impacts depending on the social deprivation index in Barcelona. MethodsWe estimated the number of childhood asthma cases in Barcelona by applying a quantitative Health Impact Assessment (HIA) approach. Air pollution (NO2, PM2.5, and BC) exposure assessment was estimated using a land-use regression model. Two scenarios were assessed and compared the current levels of air pollution with 1) achieving the World Health Organization (WHO) guideline on exposure levels for NO2 and PM2.5 (scenario 1); and 2) achieving the minimum reported levels in a previously published meta-analysis (scenario 2), from where we also obtained the exposure-response functions. The relative risk and population attributable fraction (PAF) for each scenario and pollutant were estimated. Using the asthma incidence rate in Spain the expected number of asthma cases in Barcelona attributable to NO2, PM2.5, and BC for each scenario was estimated. ResultsThe annual average levels of NO2, PM2.5, and BC at census levels were 56 μg/m3, 17.11 μg/m3, and 2.88 μg/m3, respectively. The number of asthma cases attributable to NO2 and PM2.5 (percentage of total cases) estimated in scenario 1 was 454 (18%) and 478 (19%) respectively. For scenario 2, the estimated number of cases attributable to NO2, PM2.5, and BC were 1230 (48%), 992 (39%) and 789 (31%) respectively. Although NO2 and BC showed differences between asthma cases and areas with different deprivation index, only BC differences were statistically significant between less and more deprived areas. ConclusionsThis study estimated that up to 1230 (48%) of asthma cases in Barcelona could be attributable to air pollution each year. This study also found that in Barcelona, less socially deprived groups could be more affected by asthma-related to air pollution than those more socially deprived.

Health impact assessment by the implementation of Madrid City air-quality plan in 2020

ObjectivesAir pollutant concentrations in many urban areas are still above the legal and recommended limits that are set to protect the citizens’ health. Madrid is one of the cities where traffic causes high NO2 levels. In this context, Madrid City Council launched the Air Quality and Climate Change Plan for the city of Madrid (Plan A), a local strategy approved by the previous government in 2017. The aim of this study was to conduct a quantitative health impact assessment to evaluate the number of premature deaths that could potentially be prevented by the implementation of Plan A in Madrid in 2020, at both citywide and within-city level. The main purpose was to support decision-making processes in order to maximize the positive health impacts from the implementation of Plan A measures. MethodsThe Regional Statistical Office provided information on population and daily mortality in Madrid. For exposure assessment, we estimated PM2.5, NO2 and O3 concentration levels for Madrid city in 2012 (baseline air-quality scenario) and 2020 (projected air-quality scenario based on the implementation of Plan A), by means of an Eulerian chemical-transport model with a spatial resolution of 1 km × 1 km and 30 vertical levels. We used the concentration-response functions proposed by two relevant WHO projects to calculate the number of attributable annual deaths corresponding to all non-accidental causes (ICD-10: A00-R99) among all-ages and the adult population (>30 years old) for each district and for Madrid city overall. This health impact assessment was conducted dependant on health-data availability. ResultsIn 2020, the implementation of Plan A would imply a reduction in the Madrid citywide annual mean PM2.5 concentration of 0.6 μg/m3 and 4.0 μg/m3 for NO2. In contrast, an increase of 1 μg/m3 for O3 would be expected. The annual number of all-cause deaths from long-term exposure (95% CI) that could be postponed in the adult population by the expected air-pollutant concentration reduction was 88 (57–117) for PM2.5 and 519 (295–750) for NO2; short-term exposure accounted for 20 (7–32) for PM2.5 and 79 (47–111) for NO2 in the total population. According to the spatial distribution of air pollutants, the highest mortality change estimations were for the city centre – including Madrid Central and mainly within the M-30 ring road –, as compared to peripheral districts. The positive health impacts from the reductions in PM2.5 and NO2 far exceeded the adverse mortality effects expected from the increase in O3. ConclusionsEffective implementation of Plan A measures in Madrid city would bring about an appreciable decline in traffic-related air-pollutant concentrations and, in turn, would lead to significant health-related benefits.