Esther Rind

Life Course, Green Space and Health: Incorporating Place into Life Course Epidemiology

Researchers interested in the relationships between place and health have been slow to incorporate a life course perspective, probably due to the lack of readily available historical environmental data. This hinders the identification of causal relationships. It also restricts our understanding as to whether there are accumulative effects over the life course and if there are critical periods in people’s lives when places are particularly pertinent. This study considers the feasibility of constructing longitudinal data on the availability of urban green space. The suitability of various historical and contemporary data sources is considered, including paper maps, aerial photographs and tabular land use data. Measures of urban green space are created for all neighbourhoods across the Edinburgh region of Scotland at various points during the past 100 years. We demonstrate that it is feasible to develop such measures, but there are complex issues involved in doing so. We also test the utility of the measures via an analysis of how accessibility to green space might alter over the life course of both people, and their residential neighbourhoods. The findings emphasise the potential for utilising historical data to significantly enhance understanding of the relationships between nature and health, and between health and place more generally. We encourage researchers to use data from other locations to consider including a longitudinal perspective to examine relationships between people’s health and their environment.

Effect of sewage treatment plants and diffuse pollution on the occurrence of protozoal parasites in the course of a small river.

In Germany, protozoal parasites are detected frequently in surface waters. This study aims to assess the parasitological pollution in a river course and two of its tributaries under regular weather conditions. Cryptosporidium was detected in 67% of all samples. The median concentration was 4 oocysts/100l. Giardia lamblia were detected in 90% of the samples. The median concentration of G. lamblia was 22 cysts/100l and increased significantly following the river course. A statistically significant correlation was found between both parasites and the faecal indicators Clostridium perfringens and Escherichia coli. The intermittent occurrence of Cryptosporidium in the streams investigated was ascribed primarily to diffuse pollution, particularly during rainfall events. The relatively frequent detection of G. lamblia derived mainly from sewage treatment plants. The pathogen concentrations observed present a relevant public health risk as the river is used for recreational activities and agricultural purposes.

The impact of land use on microbial surface water pollution.

Our knowledge relating to water contamination from point and diffuse sources has increased in recent years and there have been many studies undertaken focusing on effluent from sewage plants or combined sewer overflows. However, there is still only a limited amount of microbial data on non-point sources leading to diffuse pollution of surface waters. In this study, the concentrations of several indicator micro-organisms and pathogens in the upper reaches of a river system were examined over a period of 16 months. In addition to bacteria, diffuse pollution caused by Giardia lamblia and Cryptosporidium spp. was analysed. A single land use type predestined to cause high concentrations of all microbial parameters could not be identified. The influence of different land use types varies between microbial species. The microbial concentration in river water cannot be explained by stable non-point effluent concentrations from different land use types. There is variation in the ranking of the potential of different land use types resulting in surface water contamination with regard to minimum, median and maximum effects. These differences between median and maximum impact indicate that small-scale events like spreading manure substantially influence the general contamination potential of a land use type and may cause increasing micro-organism concentrations in the river water by mobilisation during the next rainfall event.

Integrating Environmental Justice and Socioecological Models of Health to Understand Population-Level Physical Activity

The uneven geographical distribution of environmental pathogens and salutogens, as well as the political, social, and cultural antecedents leading to this sociospatial arrangement, have been posited as a partial explanation for the stark inequalities in health across many high-income nations. Whilst there is significant international evidence for the maldistribution of health-related environmental features, few studies have examined the material outcomes (including health) of this unequal environmental ‘exposure’. In this paper we utilise the theoretical stances offered by work in the fields of environmental justice and socioecological models of health to consider the pathway between physical environmental deprivation and health. We consider the influence of multiple aspects of the ‘natural’ physical environment on individual-level levels of physical activity—both utilitarian and physical activity for leisure. We found that, for physical activity conducted for recreational purposes, there is a strong relationship with the natural physical environment: those living in the least deprived physical environments are most likely to engage in physical activity. However, for utilitarian physical activity, physical activity whose primary purpose is not the activity itself, we observed increased levels in the most environmentally deprived areas. Finally, the important role that the environment may play in shaping capabilities, particularly during the current economic and political climate, is recognised. Our results show that the environment matters and that rhetoric regarding ‘lifestyle choice’ needs to be viewed in a broader environmental context.

Are income-related differences in active travel associated with physical environmental characteristics? A multi-level ecological approach

BackgroundRates of active travel vary by socio-economic position, with higher rates generally observed among less affluent populations. Aspects of both social and built environments have been shown to affect active travel, but little research has explored the influence of physical environmental characteristics, and less has examined whether physical environment affects socio-economic inequality in active travel. This study explored income-related differences in active travel in relation to multiple physical environmental characteristics including air pollution, climate and levels of green space, in urban areas across England. We hypothesised that any gradient in the relationship between income and active travel would be least pronounced in the least physically environmentally-deprived areas where higher income populations may be more likely to choose active transport as a means of travel.MethodsAdults aged 16+ living in urban areas (n = 20,146) were selected from the 2002 and 2003 waves of the UK National Travel Survey. The mode of all short non-recreational trips undertaken by the sample was identified (n = 205,673). Three-level binary logistic regression models were used to explore how associations between the trip being active (by bike/walking) and three income groups, varied by level of multiple physical environmental deprivation.ResultsLikelihood of making an active trip among the lowest income group appeared unaffected by physical environmental deprivation; 15.4% of their non-recreational trips were active in both the least and most environmentally-deprived areas. The income-related gradient in making active trips remained steep in the least environmentally-deprived areas because those in the highest income groups were markedly less likely to choose active travel when physical environment was ‘good’, compared to those on the lowest incomes (OR = 0.44, 95% CI = 0.22 to 0.89).ConclusionsThe socio-economic gradient in active travel seems independent of physical environmental characteristics. Whilst more affluent populations enjoy advantages on some health outcomes, they will still benefit from increasing their levels of physical activity through active travel. Benefits of active travel to the whole community would include reduced vehicle emissions, reduced carbon consumption, the preservation or enhancement of infrastructure and the presentation of a ‘normalised’ behaviour.

Tobacco Retail Environments and Social Inequalities in Individual-Level Smoking and Cessation Among Scottish Adults

INTRODUCTION Many neighborhood characteristics may constrain or enable smoking. This study investigated whether the neighborhood tobacco retail environment was associated with individual-level smoking and cessation in Scottish adults, and whether inequalities in smoking status were related to tobacco retailing. METHODS Tobacco outlet density measures were developed for neighborhoods across Scotland using the September 2012 Scottish Tobacco Retailers Register. The outlet data were cleaned and geocoded (n = 10,161) using a Geographic Information System. Kernel density estimation was used to calculate an outlet density measure for each postcode. The kernel density estimation measures were then appended to data on individuals included in the 2008-2011 Scottish Health Surveys (n = 28,751 adults aged ≥16), via their postcode. Two-level logistic regression models examined whether neighborhood density of tobacco retailing was associated with current smoking status and smoking cessation and whether there were differences in the relationship between household income and smoking status, by tobacco outlet density. RESULTS After adjustment for individual- and area-level confounders, compared to residents of areas with the lowest outlet densities, those living in areas with the highest outlet densities had a 6% higher chance of being a current smoker, and a 5% lower chance of being an ex-smoker. There was little evidence to suggest that inequalities in either current smoking or cessation were narrower in areas with lower availability of tobacco retailing. CONCLUSIONS The findings suggest that residents of environments with a greater availability of tobacco outlets are more likely to start and/or sustain smoking, and less likely to quit.

The geography of recreational physical activity in England

Levels of physical activity have declined considerably over recent decades in England, and there is evidence that activity patterns vary across areas. Previous studies of the geography of physical activity have frequently relied on model based synthetic estimates. Using data from a large population survey this study develops a direct measure of recreational physical activity and investigates variations in activity patterns across English Local Authorities. For both sexes the results show a distinct geography of recreational physical activity associated with north/south variations and urban/rural status. The environmental and behavioural factors driving those patterns are still poorly understood. We conclude that the variations observed might reflect recreational opportunities and the socio-cultural context of areas.

How is post-industrial decline associated with the geography of physical activity? Evidence from the Health Survey for England

In recent decades, the prevalence of physical activity has declined considerably in many developed countries, which has been related to rising levels of obesity and several weight-related medical conditions, such as coronary heart disease. There is evidence that areas exhibiting particularly low levels of physical activity have undergone a strong transition away from employment in physically demanding occupations. It is proposed that such processes of deindustrialisation may be causally linked to unexplained geographical disparities in physical activity. This study investigates how geographical variations in deindustrialisation are associated with current levels of physical activity across different activity domains and relevant macro-economic time periods in England. The analysis includes data on 27,414 adults from the Health Survey for England 2006 and 2008 who reported total, occupational, domestic, recreational and walking activity. Based on employment change in industries associated with heavy manual work, a local measurement of industrial decline was developed, covering the period 1841–2001. We applied a multilevel modelling approach to study associations between industrial decline and physical activity. Results indicate that the process of deindustrialisation appears to be associated with patterns of physical activity and that this is independent of household income. The effects observed were generally similar for men and women. However, the nature of the association differed across areas, time periods and employment types; in particular, residents of districts characterised by a history of manufacturing and mining employment had increased odds of reporting low activity levels. We conclude that post-industrial change may be a factor in explaining present-day variations in physical activity, emphasising the plausible impact of inherited cultures and regional identities on health related behaviours.

Declining Physical Activity and the Socio-Cultural Context of the Geography of Industrial Restructuring: A Novel Conceptual Framework

BACKGROUND At the population level, the prevalence of physical activity has declined considerably in many developed countries in recent decades. There is some evidence that areas exhibiting the lowest activity levels are those which have undergone a particularly strong transition away from employment in physically demanding occupations. We propose that processes of deindustrialization may be causally linked to unexplained geographical disparities in levels of physical activity. While the sociocultural correlates of physical activity have been well studied, and prior conceptual frameworks have been developed to explain more general patterns of activity, none have explicitly attempted to identify the components of industrial change that may impact physical activity. METHODS In this work we review the current literature on sociocultural correlates of health behaviors before using a case study centered on the United Kingdom to present a novel framework that links industrial change to declining levels of physical activity. RESULTS We developed a comprehensive model linking sociocultural correlates of physical activity to processes associated with industrial restructuring and discuss implication for policy and practice. CONCLUSIONS A better understanding of sociocultural processes may help to ameliorate adverse health consequences of employment decline in communities that have experienced substantial losses of manual employment.

Alcohol risk environments, vulnerability and social inequalities in alcohol consumption

Alcohol and alcohol-related harm are key public health challenges. Research has shown that individual-level factors, such as age and sex, are important predictors of alcohol consumption, but such factors provide only a partial account of the drivers of consumption. In this article, we argue that individual-level factors interact with features of the risk environment to increase the vulnerability of individuals to such environments. Features of the alcohol risk environment include the density of alcohol premises in a neighborhood. Previous research has shown that neighborhoods with a higher density of alcohol outlets have higher levels of both alcohol consumption and alcohol-related harm. There has, however, been a distinct lack of attention paid to the differential ways in which particular sociodemographic groups might be more vulnerable to such risk environments. In this article, we address the risk environment through a primary focus on the local supply and availability of alcohol products (captured using a measure of outlet density) and the relationship with the harmful use of alcohol. Using responses to the Scottish Health Survey (2008–2011), we explore vulnerability through the interaction between individual-level socioeconomic position, measured using household income, and environmental risk to assess differential social vulnerability to such environments. We report findings showing that those in the lowest income groups might be disproportionately affected by outlet density. This evidence suggests that risk environments might not affect us all equally and that there could be socially differentiated vulnerability to such environments.