Conducting environmental health research in the Arabian Middle East: lessons learned and opportunities

Background: The Arabian Gulf nations are undergoing rapid economic development, leading to major shifts in both the traditional lifestyle and the environment. Although the pace of change is brisk, there is a dearth of environmental health research in this region.Objective: We describe challenges and successes of conducting an environmental epidemiologic study in the United Arab Emirates (UAE), a Gulf nation in the Middle East, with an inter-disciplinary team that includes in-country academic and government collaborators as well as U.S. academic collaborators.Discussion: We present several issues, including study and data collection design, exposure assessment, scheduling and time coordination, quality assurance and quality control, and institutional review board protocols. These topics are considered in a cultural context. Benefits of this research included building linkages among multinational, interdisciplinary team members, generating data for local environmental decision making, and developing local epidemiologic research capacity. The Middle Eastern culture of hospitality greatly benefited the project team.Conclusion: Cultural differences impact multiple aspects of epidemiologic research and should be respectfully addressed. Conducting international population-based environmental research poses many challenges; these challenges can be met successfully with careful planning, cultural knowledge, and flexibility. Lessons learned are applicable to interdisciplinary research all over the world. The research conducted will benefit the environmental and public health agencies of the UAE and provide the nation’s leadership with country-specific environmental health data that can be used to protect the public’s health in a rapidly changing environment.     

基于共生理论的城市医联体绩效的影响因素及路径分析

目的：探索城市医联体绩效实现高水平的影响因素和路径,为我国城市医联体绩效管理提供参考依据。方法：基于共生理论的基本要素构建城市医联体影响因素框架,利用25个城市医联体典型案例,通过清晰集定性比较方法,分析影响城市医联体绩效的关键因素和路径。结果：协作制度、机构间资源互补度、业务关联度、经济关联度、考核激励、政府支持和信息平台均是影响城市医联体绩效的前因条件,并形成了业务融合型、管理融合型、组织合并型3种高水平绩效的城市医联体类型。结论：城市医联体应坚持医保医疗改革协同发展,以学科和健康服务为触点,以资源协同治理为核心,加强信息化建设,完善政府正向考核激励,提高城市医联体建设水平,促进城市医联体成为四个共同体。     

Health and equity impacts of a large oil project in Africa

A system of external reviewers was established by the World Bank Group to promote a thorough environmental and health impact assessment for the 3.5 billion US dollars Chad Oil Export Project, based on a loan request from Chad, Cameroon and a consortium of oil companies. The environmental and health assessment process showed evidence of its ability to minimize the number of deaths from malaria, traffic accidents and construction accidents and the occurrence of minor sexually transmitted diseases, diarrhoeal diseases and respiratory diseases; it also probably limited adverse impacts on wildlife and tropical ecology along the pipeline route. However, the system was unable to deal with the larger issues, which included: the intrinsic unsustainability of this kind of extraction project; its eventual contribution to large amounts of greenhouse gases in the atmosphere; the lack of equity in sharing the risks, negative impacts, benefits and decision-making among the various participants in the project; and the possible acceleration of transmission of the AIDS virus into central Africa. Unfortunately, the international panel of experts appointed by the World Bank Group was largely ignored by the project proponents, and had little success in minimizing the most serious impacts or in improving the social equity of the project.     

Opportunities for integrating public health and urban planning approaches to promote active community environments

The growing emphasis on promoting environmental change as a means to increase physical activity has motivated conversation and collaboration between researchers and practitioners in the fields of public health and urban planning. Although these fields share similar objectives, their methodological approaches for examining the association between the environment and behavior often differ in significant ways. To facilitate communication, this article discusses ways these fields can collaborate in developing and applying conceptual frameworks, adopting behavioral and environmental measures, and strengthening study designs. By collaborating to build synergism in research and dissemination, public health and urban planning professionals can enhance efforts to increase the number of communities that promote active living.     

Urban and transport planning,environmental exposures and health-new concepts,methods and tools to improve health in cities

Background

The majority of people live in cities and urbanization is continuing worldwide. Cities have long been known to be society’s predominant engine of innovation and wealth creation, yet they are also a main source of pollution and disease.

Methods

We conducted a review around the topic urban and transport planning, environmental exposures and health and describe the findings.

Results

Within cities there is considerable variation in the levels of environmental exposures such as air pollution, noise, temperature and green space. Emerging evidence suggests that urban and transport planning indicators such as road network, distance to major roads, and traffic density, household density, industry and natural and green space explain a large proportion of the variability. Personal behavior including mobility adds further variability to personal exposures, determines variability in green space and UV exposure, and can provide increased levels of physical activity.Air pollution, noise and temperature have been associated with adverse health effects including increased morbidity and premature mortality, UV and green space with both positive and negative health effects and physical activity with many health benefits. In many cities there is still scope for further improvement in environmental quality through targeted policies. Making cities ‘green and healthy’ goes far beyond simply reducing CO2 emissions. Environmental factors are highly modifiable, and environmental interventions at the community level, such as urban and transport planning, have been shown to be promising and more cost effective than interventions at the individual level. However, the urban environment is a complex interlinked system.Decision-makers need not only better data on the complexity of factors in environmental and developmental processes affecting human health, but also enhanced understanding of the linkages to be able to know at which level to target their actions. New research tools, methods and paradigms such as geographical information systems, smartphones, and other GPS devices, small sensors to measure environmental exposures, remote sensing and the exposome paradigm together with citizens observatories and science and health impact assessment can now provide this information.

Conclusion

While in cities there are often silos of urban planning, mobility and transport, parks and green space, environmental department, (public) health department that do not work together well enough, multi-sectorial approaches are needed to tackle the environmental problems. The city of the future needs to be a green city, a social city, an active city, a healthy city.

     

Microbial pollution in wildlife: Linking agricultural manuring and bacterial antibiotic resistance in red-billed choughs

The spread of pathogens in the environment due to human activities (pathogen pollution) may be involved in the emergence of many diseases in humans, livestock and wildlife. When manure from medicated livestock and urban effluents is spread onto agricultural land, both residues of antibiotics and bacteria carrying antibiotic resistance may be introduced into the environment. The transmission of bacterial resistance from livestock and humans to wildlife remains poorly understood even while wild animals may act as reservoirs of resistance that may be amplified and spread in the environment. We determined bacterial resistance to antibiotics in wildlife using the red-billed chough Pyrrhocorax pyrrhocorax as a potential bioindicator of soil health, and evaluated the role of agricultural manuring with waste of different origins in the acquisition and characteristics of such resistance. Agricultural manure was found to harbor high levels of bacterial resistance to multiple antibiotics. Choughs from areas where manure landspreading is a common agricultural practice harbor a high bacterial resistance to multiple antibiotics, resembling the resistance profile found in the waste (pig slurry and sewage sludge) used in each area. The transfer of bacterial resistance to wildlife should be considered as an important risk for environmental health when agricultural manuring involves fecal material containing multiresistant enteric bacteria including pathogens from livestock operations and urban areas. The assessment of bacterial resistance in wild animals may be valuable for the monitoring of environmental health and for the management of emergent infectious diseases influenced by the impact of different human activities in the environment.     

International environmental law and global public health

The environment continues to be a source of ill-health for many people, particularly in developing countries. International environmental law offers a viable strategy for enhancing public health through the promotion of increased awareness of the linkages between health and environment, mobilization of technical and financial resources, strengthening of research and monitoring, enforcement of health-related standards, and promotion of global cooperation. An enhanced capacity to utilize international environmental law could lead to significant worldwide gains in public health.     

The urban environment and health in a world of increasing globalization: issues for developing countries

Urban living is the keystone of modern human ecology. Cities have multiplied and expanded rapidly worldwide over the past two centuries. Cities are sources of creativity and technology, and they are the engines for economic growth. However, they are also sources of poverty, inequality, and health hazards from the environment. Urban populations have long been incubators and gateways for infectious diseases. The early industrializing period of unplanned growth and laissez-faire economic activity in cities in industrialized countries has been superseded by the rise of collective management of the urban environment. This occurred in response to environmental blight, increasing literacy, the development of democratic government, and the collective accrual of wealth. In many low-income countries, this process is being slowed by the pressures and priorities of economic globalization. Beyond the traditional risks of diarrhoeal disease and respiratory infections in the urban poor and the adaptation of various vector-borne infections to urbanization, the urban environment poses various physicochemical hazards. These include exposure to lead, air pollution, traffic hazards, and the "urban heat island" amplification of heatwaves. As the number of urban consumers and their material expectations rise and as the use of fossil fuels increases, cities contribute to the large-scale pressures on the biosphere including climate change. We must develop policies that ameliorate the existing, and usually unequally distributed, urban environmental health hazards and larger-scale environmental problems.     

The urban environment, poverty and health in developing countries

The process of urbanization could be described as one of the major global environmental changes directly affecting human health today. Populations particularly affected are in developing countries where rapid urban growth has been accompanied by massive urban poverty. Urban environmental health impacts, particularly the impact on adults of an environment of poverty, are still poorly understood. Definitions of the urban environment tend to be physical, excluding the complex ramifications of a social setting of disadvantage. This paper provides a brief overview of existing knowledge on the links between environment, poverty and health in urban areas of developing countries, with an emphasis on the policy implications implied by research on health differential between groups within cities. The paper argues that urban poverty and inequalities in conditions between groups within cities present a central crisis confronting urban policy in terms of human health and quality of life. The paper suggests that definitions of the urban environment tend to consider only the physical, and not the social complexity of the urban setting. The review concludes that the scale and the complexity of the urban crisis in developing countries demands a real commitment to re-thinking the management of cities to address multiple deprivation. The paper suggests that this challenges urban professionals who continue to act with a bias towards unintegrated single sector solutions despite claims to the contrary.     

Building a Methodological Foundation for Impactful Urban Planetary Health Science

Anthropogenic environmental change will heavily impact cities, yet associated health risks will depend significantly on decisions made by urban leaders across a wide range of non-health sectors, including transport, energy, housing, basic urban services, and others. A subset of planetary health researchers focus on understanding the urban health impacts of global environmental change, and how these vary globally and within cities. Such researchers increasingly adopt collaborative transdisciplinary approaches to engage policy-makers, private citizens, and other actors in identifying and evaluating potential policy solutions that will reduce environmental impacts in ways that simultaneously promote health, equity, and/or local economies—in other words, maximising ‘co-benefits’. This report presents observations from a participatory workshop focused on challenges and opportunities for urban planetary health research. The workshop, held at the 16th International Conference on Urban Health (ICUH) in Xiamen, China, in November 2019, brought together 49 participants and covered topics related to collaboration, data, and research impact. It featured research projects funded by the Wellcome Trust’s Our Planet Our Health (OPOH) programme. This report aims to concisely summarise and disseminate participants’ collective contributions to current methodological practice in urban planetary health research.     

Environmental health impact assessment: evaluation of a ten-step model.

"Environmental impact assessment" denotes the attempt to predict and assess the impact of development projects on the environment. A component dealing specifically with human health is often called an "environmental health impact assessment." It is widely held that such impact assessment offers unique opportunities for the protection and promotion of human health. The following components were identified as key elements of an integrated environmental health impact assessment model: project analysis, analysis of status quo (including regional analysis, population analysis, and background situation), prediction of impact (including prognosis of future pollution and prognosis of health impact), assessment of impact, recommendations, communication of results, and evaluation of the overall procedure. The concept was applied to a project of extending a waste disposal facility and to a city bypass highway project. Currently, the coverage of human health aspects in environmental impact assessment still tends to be incomplete, and public health departments often do not participate. Environmental health impact assessment as a tool for health protection and promotion is underutilized. It would be useful to achieve consensus on a comprehensive generic concept. An international initiative to improve the situation seems worth some consideration.     

Health and environment in Villeurbanne. Opinions of the population

The interactions between health and the environment are at the heart of the concerns of the political actors in Villeurbanne. Their participation in the network "Villes-Santé" and the adoption of the Municipal Plan for the Environment, has incited them to promote a local approach based on the identification of the health problems linked to the environment that are expressed and felt by the inhabitants. The study, carried out among 567 individuals (1/150 of the inhabitants of Villeurbanne), showed that overall, 73% complain of two important environmental problems linked to their state of health: air pollution (48% of inhabitants), and noise (district noise 37%, and noise from the neighbours 24%). Traffic is the main source of these urban nuisances. Despite this, the environment is not very important in the minds of many people (36.5%) when compared to unemployment (68.1%), drugs (48.5%), and violence (58%).     

Herbal medicine research and global health: an ethical analysis

Governments, international agencies and corporations are increasingly investing in traditional herbal medicine research. Yet little literature addresses ethical challenges in this research. In this paper, we apply concepts in a comprehensive ethical framework for clinical research to international traditional herbal medicine research. We examine in detail three key, underappreciated dimensions of the ethical framework in which particularly difficult questions arise for international herbal medicine research: social value, scientific validity and favourable risk-benefit ratio. Significant challenges exist in determining shared concepts of social value, scientific validity and favourable risk-benefit ratio across international research collaborations. However, we argue that collaborative partnership, including democratic deliberation, offers the context and process by which many of the ethical challenges in international herbal medicine research can, and should be, resolved. By "cross-training" investigators, and investing in safety-monitoring infrastructure, the issues identified by this comprehensive framework can promote ethically sound international herbal medicine research that contributes to global health.     

Radiological protection of the environment from the Swedish point of view.

The current system of radiological protection is aimed at protecting human health, and largely neglects both the effects of radiation on the environment and the managerial aspects of environmental protection. The Swedish Radiation Protection Act was revised in 1988 and includes environmental protection as one of its aims. In practice, little guidance had been given in the regulations based on the Act until 1998, when the Swedish Radiation Protection Authority (SSI) formulated environmental aims in its regulations concerning protection of human health and the environment in connection to the final management of spent nuclear fuel and waste. These regulations focus on protection of biodiversity and biological resources, based on ecosystem characterisation. In a broader perspective, the Swedish Parliament established 15 national environmental quality objectives in 1999, covering all aspects of protecting the environment, including the effects of radiation. This paper reviews the background for radiological protection of the environment from both an international and a Swedish perspective, describing the aims and current activities in establishing a system for assessing environmental effects and their consequences that can be used in decision-making. Such activities are largely a result of the European Union research project FASSET (Framework for Assessment of Environmental Impact), carried out under the 5th Framework Programme of the Union. This work is complemented at the Swedish national level by government support to initiate a national environmental monitoring and assessment programme for characterising the radiation environment, which will provide the foundation for decision-making.     

Health impacts of frequent heavy automobile traffic on children and adolescents

This paper assesses the extent to which particulate, elemental and organic carbon emissions from heavy traffic in urban city roads affect the health of children and the adolescent health. Although the health effects of exposures may be cumulative, it is in the adolescence that the manifestations are realized. This paper therefore, assesses the best way forward for monitoring and preventing the environmental health impacts of heavy traffic on children and adolescents who live within the vicinity of urban city transportation systems. Major urban cities such as Houston, New York, and California are cited as examples of cities where health-related problems have already been reported. The particulate, elemental and organic carbon emissions are reviewed as the sources by which heavy traffic and the hazardous chemical emissions affect the health of the populace. The role of accessory loading and engine speed on idling emissions in direct health risks of children and adolescents is evaluated. The association of particulate, elemental, and organic carbon emission with respiratory effects (including, allergies and asthma), and the related behavior problems in children and the adolescents are discussed. The best strategies in preventing the effects of heavy traffic in the urban cities are suggested by introducing new effective monitoring techniques and exposure assessment methods. It is visualized that a more comprehensive research is needed to develop robust regulatory systems that would control the efficiency of automobiles and prevent the adverse health effects relating to heavy traffics in urban city roads. Strong city environmental health authorities-community partnerships relevant to exposure information should be encouraged.     

Pathogens of domestic and free-ranging ungulates: global climate change in temperate to boreal latitudes across North America

In North America broad-based research networks explore the interaction of vertebrates, their characteristic arrays of pathogens and emergent disease. A diversity of programmes address the impact of environmental change on animal health, zoonoses, and human health, but as yet no comprehensive framework or strategy has emerged to develop and implement policy and planning. In a regime of climate change and ecological perturbation, the need to document and understand the health, agricultural, societal and economic impact of pathogens and emerging infectious disease is urgent. An integrated and proactive planning process linking national and international resources can lead to informed predictions aboutthe impact of environmental change and can identify pathways for potential management and mitigation. An effective and comprehensive programme will have components for establishing priorities, developing primary data for faunal structure and biodiversity, a capacity for monitoring and surveillance (including scanning and targeted activities), and linkage to historical and contemporary baselines (against which to assess change) established through archival biological collections. Field and laboratory studies are also necessary to determine developmental thresholds, tolerances and tipping points for many pathogens to establish a context for recognising current constraints and future perturbation, and to explore factors that promote emergence for a variety of pathogens, vectors and pest species. Predictive modelling and risk assessment utilising a range of scenarios for climate change is a final step in this multidisciplinary process.     

Looking at environmental justice from an environmental health perspective

Although scientific evidence is scarce and uneven, there are mounting concerns that environmental health risks are borne disproportionately by members of the population who are poor and nonwhite. From an environmental health perspective, research to reduce critical uncertainties in health risk assessment must necessarily be at the heart of efforts to evaluate and resolve issues of environmental justice--helping to define the dimensions of the problem, understand its causes, and identify effective and efficient solutions. The full range of environmental health sciences, including exposure analysis, epidemiology, toxicology, biostatistics, and surveillance monitoring, is needed to build a strong scientific foundation for informed decision making. This is the best and surest way to promote health and safety for all members of our society, regardless of age, ethnicity, gender, health condition, race, or socioeconomic status.     

Out of our inner city backyards: re-scaling urban environmental health inequity assessment

In this paper, we report the results of a three-year research project (2008-2011) that aimed to identify urban environmental health inequities using a photography-mediated qualitative approach adapted for comparative neighbourhood-level assessment. The project took place in Vancouver, Toronto, and Winnipeg, Canada and involved a total of 49 inner city community researchers who compared environmental health conditions in numerous neighbourhoods across each city. Using the social determinants of health as a guiding framework, community researchers observed a wide range of differences in health-influencing private and public spaces, including sanitation services, housing, parks and gardens, art displays, and community services. The comparative process enabled community researchers to articulate in five distinct ways how such observable conditions represented system level inequities. The findings inform efforts to shift environmental health intervention from constricted action within derelict urban districts to more coordinated mobilization for health equity in the city.     

Future needs of occupational epidemiology of extremely low frequency electric and magnetic fields: review and recommendations

The occupational epidemiological literature on extremely low frequency electric and magnetic fields (EMF) and health encompasses a large number of studies of varying design and quality that have addressed many health outcomes, including various cancers, cardiovascular disease, depression and suicide, and neurodegenerative diseases, such as Alzheimer disease and amyotrophic lateral sclerosis (ALS). At a 2006 workshop we reviewed studies of occupational EMF exposure with an emphasis on methodological weaknesses, and proposed analytical ways to address some of these. We also developed research priorities that we hope will address remaining uncertainties. Broadly speaking, extensive epidemiological research conducted during the past 20 years on occupational EMF exposure does not indicate strong or consistent associations with cancer or any other health outcomes. Inconsistent results for many of the outcomes may be attributable to numerous shortcomings in the studies, most notably in exposure assessment. There is, however, no obvious correlation between exposure assessment quality and observed associations. Nevertheless, for future research, the highest priorities emerge in both the areas of exposure assessment and investigation of ALS. To better assess exposure, we call for the development of a more complete job-exposure matrix that combines job title, work environment and task, and an index of exposure to electric fields, magnetic fields, spark discharge, contact current, and other chemical and physical agents. For ALS, we propose an international collaborative study capable of illuminating a reported association with electrical occupations by disentangling the potential roles of electric shocks, magnetic fields and bias. Such a study will potentially lead to evidence-based measures to protect public health.