Christine E. Dunn

Public views on the links between air pollution and health in Northeast England.

We investigated how public perceptions of the links between air pollution and health varied with contextual factors describing individuals and their locality. Information was collected via postal surveys on 2744 adults resident in five neighborhoods in Northeast England. Perceptions were compared by individual factors (health status, age, and gender) and locality factors (relative deprivation, proximity to industry and district-Teesside or Sunderland, with different amounts of heavy industry). There was relatively little variation in views about air pollution and health links between neighborhoods. The greatest contrasts were found when comparing those living near or further from industry and between the two districts. Any differences were related more to awareness of illness in the neighborhood thought to be affected by air pollution, rather than belief that a particular disease was linked to air pollution. Chronic illness status and age were sometimes found to be associated with perceptions of disease affected by air pollution, but gender and material deprivation were not central to differences in risk perceptions among the population studied. In understanding public perceptions about the links between air quality and health, research should focus on the characteristics of places as well as of people.

Does living near a constellation of petrochemical, steel, and other industries impair health?

OBJECTIVES: To investigate concern that local industrial air pollution in Teesside, England, was causing poor health, several areas there were compared with parts of the City of Sunderland. METHODS: Populations in similar social and economic circumstances but varying in their proximity to major industries were compared. Study populations lived in 27 housing estates in Teesside and Sunderland, north east England, with some data from subsets of estates. The estates were aggregated into zones (designated as A, B, and C in Teesside where A is closest to and C furthest from industry, and S in Sunderland). Zone S provided a reference area. The hypothesis was that a health gradient both within Teesside (A > B > C) and between Teesside and Sunderland (ABC > S) would indicate a possible health effect of local industrial air pollution. Data presented were: mortality (1981-91) from 27 housing estates; population self completion questionnaire survey data (1993, 9115 subjects) from 15 housing estates; and general practitioner (GP) consultation data (1989-94) from 2201 subjects in 12 Teesside estates. RESULTS: The populations in the four zones were comparable for indicators including smoking habits, residential histories, and unemployment. All cause and cause specific mortalities were high compared with England and Wales. Mortality in all Teesside zones (ABC) combined was mostly higher than in zone S. In people aged 0-64, lung cancer and respiratory disease showed gradients with highest mortality in areas closest to industry (A > B > C and ABC > S). The association was clearest for lung cancer in women (0-64 years old, trend across zones ABC, p = 0.07, directly standardised rate ratio relative to zone S was 169 (95% confidence interval (95% CI) 116-122)). There were no important, consistent gradients in the hypothesised direction between zones in consultation rates in general practice, and self reported respiratory and nonrespiratory health including asthma. CONCLUSIONS: There was no clear evidence that living close to industry was associated with morbidity, including asthma, or for most measures of mortality. For lung cancer in women the gradients indicated a health effect of local industrial air pollution. In the age group 0-64 observed gradients in lung cancer in men and mortality from respiratory disease in men and women were consistent with the study hypothesis, although not significant. The reasons for the different patterns at different ages, and between men and women, remain a puzzle.

Keeping the public informed? Public negotiation of air quality information:

Air quality information has been made available to the public in the UK since 1990. However, relatively little work has been done to explore the impact of this information and the ways in which it ...

The Spatial Pattern of Risk from Arsenic Poisoning: A Bangladesh Case Study

Abstract Arsenic poisoning in Bangladesh has been one of the biggest environmental health and social disasters of recent times. About seventy million people in Bangladesh are exposed to toxic levels of arsenic (0.05 mg/L) in drinking water. It is ironic that so many tubewells have been installed in recent times to provide drinking water that is safe from water-borne diseases but that the water pumped is contaminated with toxic levels of arsenic. Along with the clinical manifestations, some social problems have also emerged due to arsenic toxicity. Analysing the spatial risk pattern of arsenic in groundwater is the main objective of this paper. Establishing the extent of arsenic exposure to the people will facilitate an understanding of the health effects and estimating the population risk over the area. This paper seeks to explore the spatial pattern of arsenic concentrations in groundwater for analyzing and mapping ‘problem regions’ or ‘risk zones’ for composite arsenic hazard information by using GIS-based data processing and spatial analysis along with state-of-the-art decision-making techniques. Quantitative data along with spatial information were employed and analyzed for this paper.

GIS in Participatory Research: Assessing the Impact of Landmines on Communities in North‐west Cambodia

The view of GIS, adopted by many, as an undemocratic and divisive technology is perhaps most poignant in settings where financial and skills-based resources are limited, notably in lower-income countries. Where those countries are also recovering from a period of military conflict there would at first sight seem to be little opportunity for employing GIS as part of a socially-sensitive approach to ‘development’. This paper explores the potential for using GIS in participatory approaches to gathering and analysing geographical information on human-environment interactions in post-conflict settings. We discuss empirical work from northwest Cambodia where GIS and participatory methods have been integrated to assess risk to local communities from landmines and to develop priorities for landmine clearance. In juxtaposing ‘official’, spatially-referenced data with indigenous geographical knowledge in this study we seek to privilege meaningful geographical understandings over conventional notions of spatial ‘accuracy’. In so doing we carry out a Participatory Mine Impact Assessment (PMIA) to explore spatial activities among local populations in mine-contaminated communities and to help identify improved strategies for returning refugees in re-establishing livelihoods.

Health impacts of pedestrian head-loading: A review of the evidence with particular reference to women and children in sub-Saharan Africa

Across sub-Saharan Africa, women and children play major roles as pedestrian load-transporters, in the widespread absence of basic sanitation services, electricity and affordable/reliable motorised transport. The majority of loads, including water and firewood for domestic purposes, are carried on the head. Load-carrying has implications not only for school attendance and performance, womens time budgets and gender relations, but arguably also for health and well-being. We report findings from a comprehensive review of relevant literature, undertaken June-September 2012, focussing particularly on biomechanics, maternal health, and the psycho-social impacts of load-carrying; we also draw from our own research. Key knowledge gaps and areas for future research are highlighted.

Establishing links between air quality and health: Searching for the impossible?

Traditional approaches in environmental spatial epidemiology have relied on assessing postulated links between environmental pollution and ill health, often as a response to a perceived public health problem; clearly it may be necessary to go beyond this stage in order to establish the nature of potential causal mechanisms. Different disciplines approach this issue in different ways. Many toxicologists favour approaches based on air quality monitoring, where raised levels of candidate pollutants may subsequently generate hypotheses about adverse health effects. Epidemiologists, however, assess the health of a population and then look for an associated cause. This paper suggests that neither approach is completely satisfactory and that a combination of both is needed. If spatially referenced data are available for both health status and air quality, then geographical analysis is needed to examine possible links, by using techniques such as atmospheric dispersion modelling and Geographical Information Systems. We discuss the benefits and constraints of these approaches, using empirical examples of environmental epidemiology studies for northern England. Taking into account the problems involved in such studies, allied to the high costs incorporated, the paper asks the question: Are we searching for the impossible?

Clustered randomised controlled trial of two education interventions designed to increase physical activity and well-being of secondary school students: the MOVE Project

Objective To assess the effectiveness of 2 interventions in improving the physical activity and well-being of secondary school children. Design A clustered randomised controlled trial; classes, 1 per school, were assigned to 1 of 3 intervention arms or a control group based on a 2×2 factorial design. The interventions were peer-mentoring and participative learning. Year 7 children (aged 11–12) in the peer-mentoring intervention were paired with year 9 children for 6 weekly mentoring meetings. Year 7 children in the participative learning arm took part in 6 weekly geography lessons using personalised physical activity and Global Positioning System (GPS) data. Year 7 children in the combined intervention received both interventions, with the year 9 children only participating in the mentoring sessions. Participants 1494 year 7 students from 60 schools in the North of England took part in the trial. Of these, 43 students opted out of taking part in the evaluation measurements, 2 moved teaching group and 58 changed school. Valid accelerometry outcome data were collected for 892 students from 53 schools; and well-being outcome data were available for 927 students from 52 schools. Main outcome measures The primary outcomes were mean minutes of accelerometer-measured moderate-to-vigorous intensity physical activity per day, and well-being as evaluated by the KIDSCREEN-27 questionnaire. These data were collected 6 weeks after the intervention; a 12-month follow-up is planned. Results No significant effects (main or interaction) were observed for the outcomes. However, small positive differences were found for both outcomes for the participative learning intervention. Conclusions These findings suggest that the 2 school-based interventions did not modify levels of physical activity or well-being within the period monitored. Change in physical activity may require more comprehensive individual behavioural intervention, and/or more system-based efforts to address wider environmental influences such as family, peers, physical environment, transport and educational policy. Trial registration number ISRCTN82956355.

Environmental Irony: Summoning Death in Bangladesh

The arsenic crisis that affects at least thirty million water consumers in Bangladesh has been called the worlds greatest ever environmental health disaster. Although the problem and the potential solutions have been presented confidently in the media, the argument of this paper is that, ironically, very little of the science or the technology is certain. From the spatial and depth variabilities of contamination, through safety thresholds, to the accuracy of field testing kits, we find indeterminacy. We argue that rather than shying away from such uncertainty, however, mitigation policies must acknowledge and embrace it if any real progress is to be made.

Is it feasible to construct a community profile of exposure to industrial air pollution

OBJECTIVE An epidemiological investigation to assess the validity of residential proximity to industry as a measure of community exposure. METHODS 19 Housing estates in Teesside (population 1991: 77 330) in north east England were grouped into zones: A=near; B=intermediate; C=further from industry. With residential proximity of socioeconomically matched populations as a starting point a historical land use survey, historical air quality reports, air quality monitoring, dispersion modelling data, and questionnaire data, were examined. RESULTS The populations in zones A, B, and C were similar for socioeconomic indicators and smoking history. Areas currently closest to industry had also been closest for most of the 20th century. Historical reports highlighted the influence of industrial emissions to local air quality, but it was difficult to follow spatial pollution patterns over time. Whereas contemporary NOx and benzene concentrations showed no geographical variation, dispersion modelling of emissions (116 industrial stacks, traffic, and domestic sources) showed a gradient associated with industry. The presumed exposure gradient of areas by proximity to industry (A>B>C) was evident for all of zone A and most of zones B and C. CONCLUSIONS It was feasible to assemble a picture of community exposure by integration of measurements from different sources. Proximity of residence was a reasonable surrogate for complex community exposure.