Post on 18-Jan-2018
description
Urban environments and their impact on
population healthDr Daniela Fecht
UK Small Area Health Statistics Unit
MRC-PHE Centre for Environment and Health
Imperial College London
Historic background
Health status in urban areas historically
lower compared with rural areas, e.g.
higher mortality rates from infectious
diseases
Historic background
Health status in urban areas historically
lower compared with rural areas, e.g.
higher mortality rates from infectious
diseases
Industrialisation in 19th century
accounted for poorer health in urban areas
e.g. higher infant mortality, shorter life
span
Historic background
Sanitary awakening in the late 19th
century led to significantly improved
health status for urban residents
The situation today
Differences is health status between urban and rural areas still persist today
Not all are due to socio-economic differences
Kyte L, Wells C. 2010. Variations in life expectancy between rural and urban areas of England, 2001-07. Health Statistics Quarterly 46. Office for National Statistics.
Index of Multiple Deprivation 2007
Why focus on urban areas?
Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2011 Revision.
Main challenges facing
urban areas:
Obesity epidemic
Climate change
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
0
1000000
2000000
3000000
4000000
5000000
6000000
7000000Rural population (thousands)
Urban population (thousands)
Wor
ld p
opul
atio
n
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
0
100000
200000
300000
400000
500000
600000
700000Rural populationUrban population
Year
Euro
pean
pop
ulat
ion
Factors influencing urban health
Social support network
Neighbourhood
cohesion Crime
Diet Smoking Drinking habits Substance abuse Physical activity
Topography
Geology Meteorology
Hydrology
Air pollution
Noise
Radon
EMF
Land cover mix Transport network Street layout Population density
Genetic factors Demographic
factors
Age & sex
Ethnicity
Education
Occupation
Socio-economic s
tatus
Lifestyle
choices
Social environ-ment
Health care provision
Phys
ical
featu
res
Urban structure
Enviro-
mental
exposure
Demographic factors
Genetic factors Demographic
factors
The Marmot Review 2012: Fair Society, Healthy Lives.
Age & sex Ethnicity Education Occupation Socio-economic status
1999 - 2003
Life expectancyDisability-free life expectancyPension age increase 2026 - 2046
Lifestyle choices
Genetic factors Demographic
factors
Lifestyle
choices
Diet Smoking Drinking habits Substance abuse Physical activity
Health Survey for England, 2009
Prevalence of obesity among adults, by gender, 1993 to 2009
1993 20090%
5%
10%
15%
20%
25%
30%
men women
Social environment
Genetic factors Demographic
factors
Lifestyle
choices
Social support network Neighbourhood cohesion Crime Socio-economic status Number of hospitals and
special care units
Social environ-mentHealth
care provision
Environmental exposure
Genetic factors Demographic
factors
Lifestyle
choices
Air pollution (indoor & outdoor) Noise pollution (indoor & outdoor) Water contamination Electromagnetic fields
Social environ-mentHealth
care provision
Environ-
mental
exposure
Urban structure
Genetic factors Demographic
factors
Lifestyle
choices
Land cover mix Transport network Street layout Population density
Social environ-mentHealth
care provision
Environ-
mental
exposure
Urban structure
Physical features
Genetic factors Demographic
factors
Lifestyle
choices
Topography Geology Meteorology Hydrology
Social environ-mentHealth
care provision
Environ-
mental
exposure
Phys
ical
featu
res
Urban structure
Factors influencing urban health
Social support network
Neighbourhood
cohesion Crime
Diet Smoking Drinking habits Substance abuse Physical activity
Topography
Geology Meteorology
Hydrology
Air pollution
Noise
Radon
EMF
Land cover mix Transport network Street layout Population density
Genetic factors Demographic
factors
Age & sex
Ethnicity
Education
Occupation
Socio-economic s
tatus
Lifestyle
choices
Social environ-ment
Health care provision
Phys
ical
featu
res
Urban structure
Environ-
mental
exposure
Can we detect any associations between urban form and mortality rates in cities in Great Britain?
Research question
Study aims: To create measures to quantify the probable influence of population distribution,
land cover, transport network and geographical characteristics (e.g. location, terrain)
on human health,
To select relevant health outcomes that are potentially influenced by urban form,
To investigate whether physical features within a city and the urban structure are
factors that influence the health of the urban population.
Fecht D, Fortunato L, Morley D, Hansell A, Gulliver J. 2016. Associations between urban metrics and mortality rates in England. Environmental Health. In press.
Study design Units of analysis:
City levelAll cities in England with > 100,000 residents (N=50)
Urban metrics:
Computation of urban metrics for each city
Health outcomes:All death and cause-specific mortality (2002-2009): Cardiovascular disease (CVD: heard disease, stroke) Road traffic accidents
Separate analysis for men and womenAll ages and premature mortality (< 65 years olds)
Confounders:Socio-economic status: Income domain from IMD 2004 (city level)Smoking: using lung cancer mortality as proxyAir pollution: PM10 (µg/m3) concentrations, city average
Genetic factors Dem
ographic
factors
Lifestyle
choices
Social environ-mentHealth care
provision
Phys
ical
featu
res
Urban structure
Environ-
mental
exposure
Theme Urban characteristic
Urban metrics Potential health related benefits Potential health related concerns
Population Population density
Population density (pop/km2) city average
easy to walk/cycleincrease of physical activity
spread of infectious diseases elevated air pollution levels potential loss of green spacesocial stress
Road network
Walkability of cities
Minor road density (km/km2) easy to walk/cycleincrease of physical activity
elevated pollution levelshigher road-traffic noise levels
Connectivity of road network
Junction density (N/km2): number of junctions over city area (km2)
easy to walk/cycleincrease of physical activity
elevated air pollution levelshigher road-traffic noise levelsincreased number of road traffic accidents
Urban sprawl Population within 100m of major roads (%)
higher noise and air pollution exposure across city population less likely to walk/cycle and reduction in physical activity increased number of road traffic accidents related to higher speed
Land cover Land cover mix Shannon’s diversity index (SDI) [24]:
where pi is the proportion of land cover i relative to the total number of land cover classes
easy to walk/cycle increase of physical activityless car usagelower air pollution levels
residential areas potentially close to polluted areas
Urban metrics
Descriptive results
Premature mortality (<65 years) for men in England
Socioeconomic status (tertiles)
most affluent
most deprived
Cardiovascular mortality Traffic accident mortality
Urban metrics Women 0 – 65 yrs Men 0 – 65 yrs Women 0 – 65 yrs Men 0 – 65 yrs
Population density
Low 1.00 1.00 1.00 1.00
Medium 1.04 (0.99 – 1.09) 1.04 (1.01 – 1.07)* 0.90 (0.73 – 1.11) 0.91 (0.82 – 1.00)
High 1.13 (1.07 – 1.18)* 1.10 (1.06 – 1.13)* 0.75 (0.60 – 0.93)* 0.77 (0.70 – 0.85)*
Minor road density
Low 1.00 1.00 1.00 1.00
Medium 1.05 (0.99 – 1.11) 1.05 (1.01 – 1.09)* 0.83 (0.66 – 1.05) 0.87 (0.78 – 0.97)*
High 1.10 (105 – 1.16)* 1.09 (1.06 – 1.13)* 0.75 (0.60 – 0.93)* 0.71 (0.64 – 0.78)*
Junction density Low 1.00 1.00 1.00 1.00
Medium 1.12 (1.07 – 1.18)* 1.09 (1.06 – 1.12)* 0.93 (0.72 – 1.15) 0.99 (0.89 – 1.10)
High 1.16 (1.10 – 1.22)* 1.12 (1.09 – 1.16)* 0.90 (0.72 – 1.13) 0.81 (0.73 – 0.91)*
Population next to main roads
Low 1.00 1.00 1.00 1.00
Medium 1.01 (0.96 – 1.06) 0.98 (0.95 – 1.01) 0.68 (0.55 – 0.85)* 0.98 (0.89 – 1.09)
High 1.04 (0.99 – 1.09) 1.04 (1.01 – 1.07)* 0.87 (0.72 – 1.05) 0.86 (0.78 – 0.95)*
Shannon’s Diversity Index
Low 1.00 1.00 1.00 1.00
Medium 0.97 (0.93 – 1.01) 1.02 (0.99 – 1.04) 1.13 (0.93 – 1.40) 1.09 (1.00 – 1.19)*
High 0.95 (0.91 – 1.00) 0.97 (0.94 – 1.00) 1.39 (1.12 – 1.73)* 1.22 (1.10 – 1.35)*
* p < 0.05Models account for age, socio-economic deprivation and smoking
Risk of premature mortality
Conclusions
We found an association between transport patterns and population density and risk
of premature mortality but only weak associations with land cover patterns.
We have seen a similar increase in the risk of all deaths and CVD mortality with
increasing population, minor road and junction density whilst the risk of death from
traffic accidents decreased.
Associations between urban form and mortality observed in this study suggest that
characteristics of city structure might have negative effects on the overall health of
urban communities.
Future urban planning and regeneration strategies can benefit from such knowledge
to promote a healthy living environment for an increasing urban population.
Acknowledgements
The work of the UK Small Area Health Statistics Unit is funded by Public Health
England as part of the MRC-PHE Centre for Environment and Health, funded also by
the UK Medical Research Council.
The mortality and population data were supplied by the ONS, derived from the
national mortality registrations and the Census.