International Journal of Environmental Research and Public Health

Editorial

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Addressing Environmental Health Inequalities

by Nelson Gouveia

Int. J. Environ. Res. Public Health 2016, 13(9), 858; https://doi.org/10.3390/ijerph13090858 - 27 Aug 2016

Cited by 12 | Viewed by 5310

Abstract

Environmental health inequalities refer to health hazards disproportionately or unfairly distributed among the most vulnerable social groups, which are generally the most discriminated, poor populations and minorities affected by environmental risks. Although it has been known for a long time that health and [...] Read more.

Environmental health inequalities refer to health hazards disproportionately or unfairly distributed among the most vulnerable social groups, which are generally the most discriminated, poor populations and minorities affected by environmental risks. Although it has been known for a long time that health and disease are socially determined, only recently has this idea been incorporated into the conceptual and practical framework for the formulation of policies and strategies regarding health. In this Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), “Addressing Environmental Health Inequalities—Proceedings from the ISEE Conference 2015”, we incorporate nine papers that were presented at the 27th Conference of the International Society for Environmental Epidemiology (ISEE), held in Sao Paulo, Brazil, in 2015. This small collection of articles provides a brief overview of the different aspects of this topic. Addressing environmental health inequalities is important for the transformation of our reality and for changing the actual development model towards more just, democratic, and sustainable societies driven by another form of relationship between nature, economy, science, and politics. Full article

(This article belongs to the Special Issue Addressing Environmental Health Inequalities – Proceedings from ISEE Conference 2015)

Research

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Mapping Environmental Inequalities Relevant for Health for Informing Urban Planning Interventions—A Case Study in the City of Dortmund, Germany

by Johannes Flacke, Steffen Andreas Schüle, Heike Köckler and Gabriele Bolte

Int. J. Environ. Res. Public Health 2016, 13(7), 711; https://doi.org/10.3390/ijerph13070711 - 13 Jul 2016

Cited by 61 | Viewed by 11165

Abstract

Spatial differences in urban environmental conditions contribute to health inequalities within cities. The purpose of the paper is to map environmental inequalities relevant for health in the City of Dortmund, Germany, in order to identify needs for planning interventions. We develop suitable indicators [...] Read more.

Spatial differences in urban environmental conditions contribute to health inequalities within cities. The purpose of the paper is to map environmental inequalities relevant for health in the City of Dortmund, Germany, in order to identify needs for planning interventions. We develop suitable indicators for mapping socioeconomically-driven environmental inequalities at the neighborhood level based on published scientific evidence and inputs from local stakeholders. Relationships between socioeconomic and environmental indicators at the level of 170 neighborhoods were analyzed continuously with Spearman rank correlation coefficients and categorically applying chi-squared tests. Reclassified socioeconomic and environmental indicators were then mapped at the neighborhood level in order to determine multiple environmental burdens and hotspots of environmental inequalities related to health. Results show that the majority of environmental indicators correlate significantly, leading to multiple environmental burdens in specific neighborhoods. Some of these neighborhoods also have significantly larger proportions of inhabitants of a lower socioeconomic position indicating hotspots of environmental inequalities. Suitable planning interventions mainly comprise transport planning and green space management. In the conclusions, we discuss how the analysis can be used to improve state of the art planning instruments, such as clean air action planning or noise reduction planning towards the consideration of the vulnerability of the population. Full article

(This article belongs to the Special Issue Addressing Environmental Health Inequalities – Proceedings from ISEE Conference 2015)

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Temporal and Spatial Trends in Childhood Asthma-Related Hospitalizations in Belo Horizonte, Minas Gerais, Brazil and Their Association with Social Vulnerability

by Cláudia Silva Dias, Maria Angélica Salles Dias, Amélia Augusta de Lima Friche, Maria Cristina de Mattos Almeida, Thaís Claudino Viana, Sueli Aparecida Mingoti and Waleska Teixeira Caiaffa

Int. J. Environ. Res. Public Health 2016, 13(7), 704; https://doi.org/10.3390/ijerph13070704 - 12 Jul 2016

Cited by 16 | Viewed by 6323

Abstract

Introduction: Asthma is a multifactorial disease and a serious public health problem. Environmental factors and poverty are the main determinants of this disease. Objective: To describe the spatial and temporal distribution of asthma-related hospitalizations and identify the areas with the highest [...] Read more.

Introduction: Asthma is a multifactorial disease and a serious public health problem. Environmental factors and poverty are the main determinants of this disease. Objective: To describe the spatial and temporal distribution of asthma-related hospitalizations and identify the areas with the highest prevalence of and vulnerability to severe asthma in a major Brazilian city. Methods: An ecological study of hospitalizations for asthma from 2002 to 2012, in children and adolescents under 15 years of age, living in Belo Horizonte, Southeast Brazil. All events were geocoded by residence address using Hospital Information System data. The socioeconomic vulnerability of residence address was ranked using the Health Vulnerability Index. Raster surfaces were generated and time-series plots were constructed to determine spatial and time trends in the frequency of asthma-related hospitalizations, respectively. Results: Asthma-related hospitalization rates were highest in children aged 0–4 years and in boys. There was a decreasing trend in the number of asthma-related hospitalizations across the study period. Approximately 48% of all hospitalizations were children living in health vulnerable areas. Seasonal trends showed a hospitalization peak in March, April, and May, coinciding with the post-rainy period. Conclusion: Our findings suggest that social and environmental factors may be determinants of disparities in severe asthma. Full article

(This article belongs to the Special Issue Addressing Environmental Health Inequalities – Proceedings from ISEE Conference 2015)

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Air Quality and Health Impacts of Future Ethanol Production and Use in São Paulo State, Brazil

by Noah Scovronick, Daniela França, Marcelo Alonso, Claudia Almeida, Karla Longo, Saulo Freitas, Bernardo Rudorff and Paul Wilkinson

Int. J. Environ. Res. Public Health 2016, 13(7), 695; https://doi.org/10.3390/ijerph13070695 - 11 Jul 2016

Cited by 14 | Viewed by 8605

Abstract

It is often argued that liquid biofuels are cleaner than fossil fuels, and therefore better for human health, however, the evidence on this issue is still unclear. Brazil’s high uptake of ethanol and role as a major producer makes it the most appropriate [...] Read more.

It is often argued that liquid biofuels are cleaner than fossil fuels, and therefore better for human health, however, the evidence on this issue is still unclear. Brazil’s high uptake of ethanol and role as a major producer makes it the most appropriate case study to assess the merits of different biofuel policies. Accordingly, we modeled the impact on air quality and health of two future fuel scenarios in São Paulo State: a business-as-usual scenario where ethanol production and use proceeds according to government predictions and a counterfactual scenario where ethanol is frozen at 2010 levels and future transport fuel demand is met with gasoline. The population-weighted exposure to fine particulate matter (PM_2.5) and ozone was 3.0 μg/m³ and 0.3 ppb lower, respectively, in 2020 in the scenario emphasizing gasoline compared with the business-as-usual (ethanol) scenario. The lower exposure to both pollutants in the gasoline scenario would result in the population living 1100 additional life-years in the first year, and if sustained, would increase to 40,000 life-years in year 20 and continue to rise. Without additional measures to limit emissions, increasing the use of ethanol in Brazil could lead to higher air pollution-related population health burdens when compared to policy that prioritizes gasoline. Full article

(This article belongs to the Special Issue Addressing Environmental Health Inequalities – Proceedings from ISEE Conference 2015)

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Health Impact Assessment of Air Pollution in São Paulo, Brazil

by Karina Camasmie Abe and Simone Georges El Khouri Miraglia

Int. J. Environ. Res. Public Health 2016, 13(7), 694; https://doi.org/10.3390/ijerph13070694 - 11 Jul 2016

Cited by 73 | Viewed by 9175

Abstract

Epidemiological research suggests that air pollution may cause chronic diseases, as well as exacerbation of related pathologies such as cardiovascular and respiratory morbidity and mortality. This study evaluates air pollution scenarios considering a Health Impact Assessment approach in São Paulo, Brazil. We have [...] Read more.

Epidemiological research suggests that air pollution may cause chronic diseases, as well as exacerbation of related pathologies such as cardiovascular and respiratory morbidity and mortality. This study evaluates air pollution scenarios considering a Health Impact Assessment approach in São Paulo, Brazil. We have analyzed abatement scenarios of Particulate Matter (PM) with an aerodynamic diameter <10 μm (PM₁₀), <2.5 μm (PM_2.5) and ozone concentrations and the health effects on respiratory and cardiovascular morbidity and mortality in the period from 2009 to 2011 through the APHEKOM tool, as well as the associated health costs. Considering World Health Organization (WHO) standards of PM_2.5 (10 μg/m³), São Paulo would avoid more than 5012 premature deaths (equivalent to 266,486 life years’ gain) and save US$15.1 billion annually. If São Paulo could even diminish the mean of PM_2.5 by 5 μg/m³, nearly 1724 deaths would be avoided, resulting in a gain of US$ 4.96 billion annually. Reduced levels of PM₁₀, PM_2.5 and ozone could save lives and an impressive amount of money in a country where economic resources are scarce. Moreover, the reduced levels of air pollution would also lower the demand for hospital care, since hospitalizations would diminish. In this sense, Brazil should urgently adopt WHO air pollution standards in order to improve the quality of life of its population. Full article

(This article belongs to the Special Issue Addressing Environmental Health Inequalities – Proceedings from ISEE Conference 2015)

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Environmental Health Related Socio-Spatial Inequalities: Identifying “Hotspots” of Environmental Burdens and Social Vulnerability

by Rehana Shrestha, Johannes Flacke, Javier Martinez and Martin Van Maarseveen

Int. J. Environ. Res. Public Health 2016, 13(7), 691; https://doi.org/10.3390/ijerph13070691 - 9 Jul 2016

Cited by 60 | Viewed by 9659

Abstract

Differential exposure to multiple environmental burdens and benefits and their distribution across a population with varying vulnerability can contribute heavily to health inequalities. Particularly relevant are areas with high cumulative burdens and high social vulnerability termed as “hotspots”. This paper develops an index-based [...] Read more.

Differential exposure to multiple environmental burdens and benefits and their distribution across a population with varying vulnerability can contribute heavily to health inequalities. Particularly relevant are areas with high cumulative burdens and high social vulnerability termed as “hotspots”. This paper develops an index-based approach to assess these multiple burdens and benefits in combination with vulnerability factors at detailed intra-urban level. The method is applied to the city of Dortmund, Germany. Using non-spatial and spatial methods we assessed inequalities and identified “hotspot” areas in the city. We found modest inequalities burdening higher vulnerable groups in Dortmund (CI = −0.020 at p < 0.05). At the detailed intra-urban level, however, inequalities showed strong geographical patterns. Large numbers of “hotspots” exist in the northern part of the city compared to the southern part. A holistic assessment, particularly at a detailed local level, considering both environmental burdens and benefits and their distribution across the population with the different vulnerability, is essential to inform environmental justice debates and to mobilize local stakeholders. Locating “hotspot” areas at this detailed spatial level can serve as a basis to develop interventions that target vulnerable groups to ensure a health conducive equal environment. Full article

(This article belongs to the Special Issue Addressing Environmental Health Inequalities – Proceedings from ISEE Conference 2015)

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Sounding the Alarm: Health in the Anthropocene

by Colin D. Butler

Int. J. Environ. Res. Public Health 2016, 13(7), 665; https://doi.org/10.3390/ijerph13070665 - 30 Jun 2016

Cited by 44 | Viewed by 17818

Abstract

There is growing scientific and public recognition that human actions, directly and indirectly, have profoundly changed the Earth system, in a still accelerating process, increasingly called the “Anthropocene”. Planetary transformation, including of the atmosphere, climate, ecosystems and biodiversity, has enormous implications for human [...] Read more.

There is growing scientific and public recognition that human actions, directly and indirectly, have profoundly changed the Earth system, in a still accelerating process, increasingly called the “Anthropocene”. Planetary transformation, including of the atmosphere, climate, ecosystems and biodiversity, has enormous implications for human health, many of which are deeply disturbing, especially in low-income settings. A few health consequences of the Anthropocene have been partially recognized, including within environmental epidemiology, but their long-term consequences remain poorly understood and greatly under-rated. For example Syria could be a “sentinel” population, giving a glimpse to a much wider dystopian future. Health-Earth is a research network, co-founded in 2014, which seeks, with other groups, to catalyse a powerful curative response by the wider health community. This paper builds on a symposium presented by Health-Earth members at the 2015 conference of the International Society for Environmental Epidemiology. It reviews and synthesizes parts of the large literature relevant to the interaction between the changing Earth system and human health. It concludes that this topic should be prominent within future environmental epidemiology and public health. Created by our species, these challenges may be soluble, but solutions require far more understanding and resources than are currently being made available. Full article

(This article belongs to the Special Issue Addressing Environmental Health Inequalities – Proceedings from ISEE Conference 2015)

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Residential Proximity to Major Roadways Is Not Associated with Cardiac Function in African Americans: Results from the Jackson Heart Study

by Anne M. Weaver, Gregory A. Wellenius, Wen-Chih Wu, DeMarc A. Hickson, Masoor Kamalesh and Yi Wang

Int. J. Environ. Res. Public Health 2016, 13(6), 581; https://doi.org/10.3390/ijerph13060581 - 13 Jun 2016

Cited by 13 | Viewed by 5307

Abstract

Cardiovascular disease (CVD), including heart failure, is a major cause of morbidity and mortality, particularly among African Americans. Exposure to ambient air pollution, such as that produced by vehicular traffic, is believed to be associated with heart failure, possibly by impairing cardiac function. [...] Read more.

Cardiovascular disease (CVD), including heart failure, is a major cause of morbidity and mortality, particularly among African Americans. Exposure to ambient air pollution, such as that produced by vehicular traffic, is believed to be associated with heart failure, possibly by impairing cardiac function. We evaluated the cross-sectional association between residential proximity to major roads, a marker of long-term exposure to traffic-related pollution, and echocardiographic indicators of left and pulmonary vascular function in African Americans enrolled in the Jackson Heart Study (JHS): left ventricular ejection fraction, E-wave velocity, isovolumic relaxation time, left atrial diameter index, and pulmonary artery systolic pressure. We examined these associations using multivariable linear or logistic regression, adjusting for potential confounders. Of 4866 participants at study enrollment, 106 lived <150 m, 159 lived 150–299 m, 1161 lived 300–999 m, and 3440 lived ≥1000 m from a major roadway. We did not observe any associations between residential distance to major roads and these markers of cardiac function. Results were similar with additional adjustment for diabetes and hypertension, when considering varying definitions of major roadways, or when limiting analyses to those free from cardiovascular disease at baseline. Overall, we observed little evidence that residential proximity to major roads was associated with cardiac function among African Americans. Full article

(This article belongs to the Special Issue Addressing Environmental Health Inequalities – Proceedings from ISEE Conference 2015)

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Greenness and Birth Outcomes in a Range of Pennsylvania Communities

by Joan A. Casey, Peter James, Kara E. Rudolph, Chih-Da Wu and Brian S. Schwartz

Int. J. Environ. Res. Public Health 2016, 13(3), 311; https://doi.org/10.3390/ijerph13030311 - 11 Mar 2016

Cited by 94 | Viewed by 9254

Abstract

Living in communities with more vegetation during pregnancy has been associated with higher birth weights, but fewer studies have evaluated other birth outcomes, and only one has been conducted in the Eastern United States, in regions with a broad range, including high levels, [...] Read more.

Living in communities with more vegetation during pregnancy has been associated with higher birth weights, but fewer studies have evaluated other birth outcomes, and only one has been conducted in the Eastern United States, in regions with a broad range, including high levels, of greenness. We evaluated associations between prenatal residential greenness and birth outcomes (term birth weight, small for gestational age, preterm birth, and low 5 min Apgar score) across a range of community types using electronic health record data from 2006–2013 from the Geisinger Health System in Pennsylvania. We assigned greenness based on mother’s geocoded address using the normalized difference vegetation index from satellite imagery. We used propensity scores to restrict the study population to comparable groups among those living in green vs. less-green areas. Analyses were adjusted for demographic, clinical, and environmental covariates, and stratified by community type (city, borough, and township). In cities, higher greenness (tertiles 2–3 vs. 1) was protective for both preterm (OR = 0.78, 95% CI: 0.61–0.99) and small for gestational age birth (OR = 0.73, 95% CI: 0.58–0.97), but not birth weight or Apgar score. We did not observe associations between greenness and birth outcomes in adjusted models in boroughs or townships. These results add to the evidence that greener cities might be healthier cities. Full article

(This article belongs to the Special Issue Addressing Environmental Health Inequalities – Proceedings from ISEE Conference 2015)

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Review

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Prevention of Asbestos-Related Disease in Countries Currently Using Asbestos

by Daniela Marsili, Benedetto Terracini, Vilma S. Santana, Juan Pablo Ramos-Bonilla, Roberto Pasetto, Agata Mazzeo, Dana Loomis, Pietro Comba and Eduardo Algranti

Int. J. Environ. Res. Public Health 2016, 13(5), 494; https://doi.org/10.3390/ijerph13050494 - 12 May 2016

Cited by 53 | Viewed by 11698

Abstract

More than 40 years of evaluation have consistently confirmed the carcinogenicity of asbestos in all of its forms. This notwithstanding, according to recent figures, the annual world production of asbestos is approximatively 2,000,000 tons. Currently, about 90% of world asbestos comes from four [...] Read more.

More than 40 years of evaluation have consistently confirmed the carcinogenicity of asbestos in all of its forms. This notwithstanding, according to recent figures, the annual world production of asbestos is approximatively 2,000,000 tons. Currently, about 90% of world asbestos comes from four countries: Russia, China, Brazil and Kazakhstan; and the wide use of asbestos worldwide represents a global threat. The purpose of this paper is to present a review of the asbestos health impact and to discuss the role of epidemiological investigations in countries where asbestos is still used. In these contexts, new, “local” studies can stimulate awareness of the size of the problem by public opinion and other stakeholders and provide important information on the circumstances of exposure, as well as local asbestos-related health impacts. This paper suggests an agenda for an international cooperation framework dedicated to foster a public health response to asbestos, including: new epidemiological studies for assessing the health impact of asbestos in specific contexts; socio-cultural and economic analyses for contributing to identifying stakeholders and to address both the local and global implications of asbestos diffusion; public awareness on the health and socio-economic impact of asbestos use and banning. Full article

(This article belongs to the Special Issue Addressing Environmental Health Inequalities – Proceedings from ISEE Conference 2015)

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