José G. Siri

Changes in European greenhouse gas and air pollutant emissions 1960–2010: decomposition of determining factors

This paper analyses factors that contributed to the evolution of SO2, NOx and CO2 emissions in Europe from 1960 to 2010. Historical energy balances, along with population and economic growth data, are used to quantify the impacts of major determinants of changing emission levels, including energy intensity, conversion efficiency, fuel mix, and pollution control. Time series of emission levels are compared for countries in Western and Eastern Europe, throwing light on differences in the importance of particular emission-driving forces. Three quarters of the decline in SO2 emissions in Western Europe resulted from a combination of reduced energy intensity and improved fuel mix, while dedicated end-of-pipe abatement measures played a dominant role in the reduction of NOx emissions. The increase in atmospheric emissions in Eastern Europe through the mid-1990s was associated with the growth of energy-intensive industries, which off-setted the positive impact of better fuel quality and changes in fuel mix. A continuous decrease in energy intensity and higher conversion efficiencies have been the main factors responsible for the moderate rate of growth of European CO2 emissions.

Recent Acquisition of Helicobacter pylori by Baka Pygmies

Both anatomically modern humans and the gastric pathogen Helicobacter pylori originated in Africa, and both species have been associated for at least 100,000 years. Seven geographically distinct H. pylori populations exist, three of which are indigenous to Africa: hpAfrica1, hpAfrica2, and hpNEAfrica. The oldest and most divergent population, hpAfrica2, evolved within San hunter-gatherers, who represent one of the deepest branches of the human population tree. Anticipating the presence of ancient H. pylori lineages within all hunter-gatherer populations, we investigated the prevalence and population structure of H. pylori within Baka Pygmies in Cameroon. Gastric biopsies were obtained by esophagogastroduodenoscopy from 77 Baka from two geographically separated populations, and from 101 non-Baka individuals from neighboring agriculturalist populations, and subsequently cultured for H. pylori. Unexpectedly, Baka Pygmies showed a significantly lower H. pylori infection rate (20.8%) than non-Baka (80.2%). We generated multilocus haplotypes for each H. pylori isolate by DNA sequencing, but were not able to identify Baka-specific lineages, and most isolates in our sample were assigned to hpNEAfrica or hpAfrica1. The population hpNEAfrica, a marker for the expansion of the Nilo-Saharan language family, was divided into East African and Central West African subpopulations. Similarly, a new hpAfrica1 subpopulation, identified mainly among Cameroonians, supports eastern and western expansions of Bantu languages. An age-structured transmission model shows that the low H. pylori prevalence among Baka Pygmies is achievable within the timeframe of a few hundred years and suggests that demographic factors such as small population size and unusually low life expectancy can lead to the eradication of H. pylori from individual human populations. The Baka were thus either H. pylori-free or lost their ancient lineages during past demographic fluctuations. Using coalescent simulations and phylogenetic inference, we show that Baka almost certainly acquired their extant H. pylori through secondary contact with their agriculturalist neighbors.

Factorization of air pollutant emissions: Projections versus observed trends in Europe

This paper revisits the emission scenarios of the European Commissions 2005 Thematic Strategy on Air Pollution (TSAP) in light of todays knowledge. We review assumptions made in the past on the main drivers of emission changes, i.e., demographic trends, economic growth, changes in the energy intensity of GDP, fuel-switching, and application of dedicated emission control measures. Our analysis shows that for most of these drivers, actual trends have not matched initial expectations. Observed ammonia and sulfur emissions in European Union in 2010 were 10% to 20% lower than projected, while emissions of nitrogen oxides and particulate matter exceeded estimates by 8% to 15%. In general, a higher efficiency of dedicated emission controls compensated for a lower-than-expected decline in total energy consumption as well as a delay in the phase-out of coal. For 2020, updated projections anticipate lower sulfur and nitrogen oxide emissions than those under the 2005 baseline, whereby the degree to which these emissions are lower depends on what assumptions are made for emission controls and new vehicle standards. Projected levels of particulates are about 10% higher, while smaller differences emerge for other pollutants. New emission projections suggest that environmental targets established by the TSAP for the protection of human health, eutrophication and forest acidification will not be met without additional measures.

Independent associations of maternal education and household wealth with malaria risk in children

Despite evidence that they play similar but independent roles, maternal education and household wealth are usually conflated in studies of the effects of socioeconomic status (SES) on malaria risk. Demographic and Health Survey and Malaria Indicator Survey data from nine countries in sub-Saharan Africa were used to explore the relationship of malaria parasitemia in children with SES factors at individual and cluster scales, controlling for urban/rural residence and other important covariates. In multilevel logistic regression modeling, completion of six years of maternal schooling was associated with significantly lower odds of infection in children (OR = 0.73), as was a household wealth index at the 40th percentile compared to the lowest percentile (OR = 0.48). These relationships were nonlinear, with significant quadratic terms for both education and wealth. Cluster-level wealth index was also associated with a reduction in risk (OR = 0.984 for a one percentile increase in mean wealth index), as was urban residence (OR = 0.59). Among other covariates, increasing child’s age and household size category were positively correlated with infection, and sleeping under an insecticidetreated bednet the previous night (OR = 0.80) was associated with a moderate reduction in risk. Considerable variation in parameter estimates was observed among country-specific models. Future work should clearly distinguish between maternal education and household resources in assessing malaria risk, and malaria prevention and control efforts should be aware of the potential benefits of supporting the development of human capital.

Improving health in cities through systems approaches for urban water management

BackgroundAs human populations become more and more urban, decision-makers at all levels face new challenges related to both the scale of service provision and the increasing complexity of cities and the networks that connect them. These challenges may take on unique aspects in cities with different cultures, political and institutional frameworks, and at different levels of development, but they frequently have in common an origin in the interaction of human and environmental systems and the feedback relationships that govern their dynamic evolution. Accordingly, systems approaches are becoming recognized as critical to understanding and addressing such complex problems, including those related to human health and wellbeing. Management of water resources in and for cities is one area where such approaches hold real promise.ResultsThis paper seeks to summarize links between water and health in cities and outline four main elements of systems approaches: analytic methods to deal with complexity, interdisciplinarity, transdisciplinarity, and multi-scale thinking. Using case studies from a range of urban socioeconomic and regional contexts (Maputo, Mozambique; Surat and Kolkata, India; and Vienna, Austria).ConclusionWe show how the inclusion of these elements can lead to better research design, more effective policy and better outcomes.

Significance of Travel to Rural Areas as a Risk Factor for Malarial Anemia in an Urban Setting

The epidemiology of malaria in urban environments is poorly characterized, yet increasingly problematic. We conducted an unmatched case-control study of risk factors for malarial anemia with high parasitemia in urban Kisumu, Kenya, from June 2002 through February 2003. Cases (n = 80) were hospital patients with a hemoglobin level < or = 8 g/dL and a Plasmodium parasite density > or = 10,000/microL. Controls (n = 826) were healthy respondents to a concurrent citywide knowledge, attitude, and practice survey. Children who reported spending at least one night per month in a rural area were especially at risk (35% of cases; odds ratio = 9.3, 95% confidence interval [CI] = 4.4-19.7, P < 0.0001), and use of mosquito coils, bed net ownership, and house construction were non-significant, potentially indicating that malaria exposure during rural travel comprises an important element of risk. Control of severe malaria in an urban setting may be complicated by Plasmodium infections acquired elsewhere. Epidemiologic studies of urban malaria in low transmission settings should take travel history into account.

Urban governance and the systems approaches to health-environment co-benefits in cities

“Co-beneficios” e um termo que se refere aos impactos positivos de uma politica alem do que se era esperado inicialmente. No contexto urbano, politicas executadas em um setor especifico (como transporte, energia ou residuos) frequentemente podem gerar multiplos co-beneficios em outras areas, como reducao dos impactos ambientais globais e locais, e se extendendo a saude publica. Um ponto chave para se poder identificar e gerar co-beneficios e adotar a abordagem por sistemas para entender as ligacoes inter-setoriais. Esta abordagem tambem pode ajudar no entendimento de como podemos melhorar um setor especifico e a governanca urbana em geral. Assim, este artigo faz uma revisao da literatura de varias politicas que geram co-beneficios climaticos e de saude em diversos setores e ilustra atraves de uma serie de casos como a abordagem por sistemas pode levar a inovacoes em governanca urbana que levem ao desenvolvimento de cidades mais sustentaveis e saudaveis.

The Tsinghua–Lancet Commission on Healthy Cities in China: unlocking the power of cities for a healthy China

Executive summary: Over the past four decades, rapid urbanisation in China has brought unprecedented health benefits to its urban population, but has also created new challenges for protection of and promotion of health in cities. With the shift from rural to urban living, more people than ever enjoy the health advantages that cities can provide, such as better access to health services and improved sanitation. For example, the average life expectancy of male urban residents in 2010 was estimated to be 7·09 years longer than that of of their counterparts in rural China; urban females lived 6·64 years longer.1 Other changes associated with rapid urbanisation– including large-scale migration, ageing, pollution, shifts in diet and lifestyle, and social inequality–have created new health challenges.2 For example, about 52% of people over 60 years old lived in urban areas in 2015 compared with 34% in 2000,3 thus increasing the burden of senior care in Chinese cities. Non-communicable diseases have replaced infectious diseases as the leading cause of death among urban residents; the percentage of years of life lost because of such diseases as a fraction of all-cause years of life lost increased from 50·0% (95% CI 48·5–53·0) in 1990 to 77·3% (76·5–78·1) in 2015.4 Health inequality also increased in urban areas.5 China has acted to address urban health challenges by passing strict environmental regulations and investing heavily in urban infrastructure. Major reforms have been passed to increase the transparency of environmental governance to control pollution over the short term, while moving to reform whole industries and thus provide long-term solutions. Programmes like the Hygienic Cities movement have invested heavily in urban infrastructure to promote health, including major improvements in urban sanitation.6 China has also increased coverage of and accessibility to health services in urban areas. In 2016, around 93·8% of the urban population was covered by urban medical insurance programmes, a substantial increase from 4·1% in 1998 when the programmes started.7,8 Meanwhile, cities in China are also testing new strategies for urban health management, such as China’s pilot Healthy Cities project.9 Management of chronic diseases and mental disorders in cities has improved dramatically and major progress has been made regarding access to preventive and primary health services. All these efforts have contributed to the reduction of exposure to health risks and health improvement in urban China. However, despite these successes, major gaps remain, including but not limited to an over-reliance on a top-down-approach to environmental management, a narrow focus on health care in urban health management, and a scarcity of intersectoral action. Given that the urbanisation rate in China is predicted to reach 71% by 2030,10 urban health challenges will continue to emerge and expand. If innovative strategies are not used to address these issues, they will become major obstacles to the achievement of improved health and development for millions of people. It has also become clear that the health sector alone, with its traditional piecemeal approach, cannot effectively resolve the modern challenges to urban health in China. The country is now in a transitional period in which the pursuit of economic growth at any cost is being replaced by sustainable development. In 2013, President Xi Jinping declared China’s intention to develop a so-called ecological civilisation (ecocivilisation), the core principles of which involve balancing the relationship between humanity and nature. During this transition, health is recognised as the centrepiece of sustainable development in China, as highlighted in the Healthy China 2030 plan that was adopted in 2016.11 As a result, people-centred and health-oriented urban development will hopefully prevail in China; however, major efforts, political will, and investments will be needed to put this vision into practice. The Tsinghua–Lancet Commission on Healthy Cities in China aimed to characterise, understand, and address urban health challenges in the unique context of China’s rapid and dynamic urban development. Experts from a wide range of disciplines examined environmental and social determinants of health, identified key stakeholders,and assessed actions for the prevention, management, and control of adverse health outcomes associated with the country’s urban experience. We conclude that key efforts are needed to combat urban health challenges in China and these should be unified with the Healthy Cities movement, which uses a systems approach to urban health management and provides a clear path to the realisation of the Healthy China 2030 plan. Actions taken to build healthy cities in China have contributed to global knowledge on the development of healthy cities in other parts of the world. China’s strategic, simultaneous rollout of diverse trials in different cities— in areas such as health education and promotion—and its rapid adoption of effective approaches at the national scale is a valuable lesson for other countries facing rapid urbanisation. Despite such successes, we believe that there is room for substantial improvement and make the following five key recommendations. Integrate health into all policies China should take advantage of new, human-centred urbanisation strategies. For example, cities should integrate health into urban planning and design as a first step towards the integration of health into all policies. Increase participation Cities should increase participation by residents, the private sector, non-governmental organisations (NGOs), and community groups in health management. This increase can be achieved through investment in community capacity building and engagement with the private sector. Promote intersectoral action To motivate and sustain intersectoral action in the design, building, and management of healthy cities, cities should develop ways to assess the health effects of urban management by use of measures that span multiple and diverse sectors. Set local goals for 2030 and assess progress periodically Cities should view the health goals specified in the Healthy China 2030 plan as long-term goals that are achieved through the building of healthy cities. Indicator systems should be put in place to assess progress and inform the public. Enhance research and education on healthy cities To develop new theories and practical solutions, cities should increase investment and form partnerships with universities, research institutes, and the private sector to support research and education on the best ways to create healthy cities.

Urbanization, Extreme Events, and Health The Case for Systems Approaches in Mitigation, Management, and Response

Extreme events, both natural and anthropogenic, increasingly affect cities in terms of economic losses and impacts on health and well-being. Most people now live in cities, and Asian cities, in particular, are experiencing growth on unprecedented scales. Meanwhile, the economic and health consequences of climate-related events are worsening, a trend projected to continue. Urbanization, climate change and other geophysical and social forces interact with urban systems in ways that give rise to complex and in many cases synergistic relationships. Such effects may be mediated by location, scale, density, or connectivity, and also involve feedbacks and cascading outcomes. In this context, traditional, siloed, reductionist approaches to understanding and dealing with extreme events are unlikely to be adequate. Systems approaches to mitigation, management and response for extreme events offer a more effective way forward. Well-managed urban systems can decrease risk and increase resilience in the face of such events.

Sustainable, healthy cities: making the most of the urban transition

The world is undergoing a massive urban transition, which is now both the greatest driver of global environmental change and the most significant influence on human health. Cities offer real opportunities for improving health, but managed poorly, they can also create or reinforce significant health deficits while putting severe stresses on the natural systems which support human civilization. Management of urban problems is rarely straightforward, as complexity across scales and sectors, in causal structures, actors and incentives, can lead to ineffective policies and unintended consequences. Systems thinking offers a promising way forward in its ability to deal with non-linear relationships and simultaneous actions and outcomes. Encompassing, on the one hand, analytic frameworks and methods that can provide important causal insights and a test bed for urban policy, and on the other, broad processes of inter- and trans-disciplinary engagement to better define problems and feasible solutions, systems approaches are critical to the current and future design and management of sustainable healthy cities.