Julii Brainard

Modelling environmental equity: access to air quality in Birmingham, England

Many studies in the USA have noted inequities with regard to the socioeconomic status or racial character of communities and their relative exposure to environmental disamenities. In this paper the authors focus particularly on the environmental equity of air pollution in the English city of Birmingham. Using statistical methodologies they examine the pattern of exposure to two key air pollutants: carbon monoxide (CO) and nitrogen dioxide (NO2) across certain population groups in the city. Estimated emission levels of CO and NO2 were mapped by using modelled associations between vehicle densities and measured emissions at existing monitoring stations. These data were input to a geographical information system (GIS) for subsequent comparisons with population maps. Three types of variables were considered to distinguish possibly disadvantaged populations: age profile, ethnic make-up, and poverty indicators. From the 1991 Census, relevant statistics were derived for each enumeration district in the city. No relationship could be established on the age variable (that is, neither children nor pensioners appear to differ from the general population in their likely exposure patterns). However, there was a striking relationship between modelled emissions and poverty indicators and ethnicity. The effects are difficult to separate out but there is strong evidence to suggest that the two factors (poverty and ethnicity) operate in an independent manner. The implications of these findings, with regard to the causes of the disparities and the likely impacts of possible efforts to improve air quality in Birmingham, are discussed.

Developing a Methodology for Benefit Transfers Using Geographical Information Systems: Modelling Demand for Woodland Recreation

BATEMAN I. J., LOVETT A. A. and BRAINARD J. S. (1999) Developing a methodology for benefit transfers using geographical information systems: modelling demand for woodland recreation, Reg. Studies 33 , 191-205. This paper develops a methodology for implementing benefit transfers through the medium of a geographical information system. Data from a survey of visitors to a woodland site in eastern England were used to estimate an arrivals function which was then utilized to predict visits to other locations. The validity of this function was tested against actual arrivals at locations in Wales and was found to be a satisfactory estimator of visits. This function was then used to generate predictions of visitor arrivals across Wales to simulate the impact of sites being converted into woodland. The visitor demand map generated by this analysis was then converted to a monetary equivalent using values derived from a cross-study analysis of the existing UK literature on the value of recreational visits to woodlan...

Limiting long term illness and its associations with mortality and indicators of social deprivation

STUDY OBJECTIVE--To examine geographical variation in limiting long-term illness in England and Wales and assesses the extent of its similarity with the distribution of mortality rates and of deprivation. DESIGN--A geographically based study using data from the 1991 census on limiting long term illness. Maps and regression analysis are used to compare the distribution of standardised illness ratios with standardised mortality ratios and indicators of social deprivation. SETTING--A total of 401 local authority districts in England and Wales. PARTICIPANTS--The population of England and Wales enumerated in the 1991 census. MAIN RESULTS--The geographical pattern of limiting long term illness shows many similarities with that of mortality but there are also some differences. Both are positively associated with indicators of social deprivation, with limiting long term illness tending to show stronger correlations, particularly in the elderly. Most of Wales and many industrial areas of northern England have higher rates of long term illness than would be expected from their mortality rates, while much of south eastern England has lower than expected rates. CONCLUSIONS--Moves towards using data on limiting long term illness instead of standardised mortality rates would have important implications for NHS resource allocations. Further assessment of the reliability of these data on self reported morbidity is required. in particular, there is a need to assess how much they reflect real differences in ill health rather than the influence of socioeconomic or cultural factors affecting the likelihood of a positive answer to the census question on limiting long term illness.

Exposure to Environmental Urban Noise Pollution in Birmingham, UK

This paper examines the extent to which inequalities in noise exposure are present in the city of Birmingham in the English Midlands. Estimates of road and rail noise levels were made using established sound propagation models and were combined with data on noise generated from the citys airport. Demographic details from the 1991 UK Census provided information on population age, ethnic make-up and deprivation. No relationship was established between noise exposure and population age, and there was only rather weak evidence of an association between noise exposure and ethnicity. Similarly weak disparities were observed in estimated noise exposures and levels of socioeconomic deprivation. The implications of these findings with regard to possible efforts to reduce urban noise levels are discussed.

Assessing hazardous waste transport risks using a GIS

Abstract The transport phase is an often neglected element in the risk assessment of non-nuclear hazardous waste life cycles. Data on special and hazardous waste movements are difficult to acquire, but information collected by the London Waste Regulation Authority during the 1980s gives details of waste consignments from cradle to grave, including U.K. grid references for waste producer and disposal sites. A GIS was used to model the routing of aqueous waste cargoes and assess the potential impacts of such movements. Deficiencies in the consignment records required many assumptions to be made and various scenarios were explored. Roads predicted to see passage of these wastes, together with the estimated levels of tanker traffic, were integrated with the distribution of population, groundwater vulnerability and accident probabilities to evaluate the transportation risks for different localities. Comparisons and evaluations of the implications of different routing scenarios across the study region were made.

Risk factors for transmission of Ebola or Marburg virus disease: a systematic review and meta-analysis

Abstract Background: The Ebola virus disease outbreak that started in Western Africa in 2013 was unprecedented because it spread within densely populated urban environments and affected many thousands of people. As a result, previous advice and guidelines need to be critically reviewed, especially with regard to transmission risks in different contexts. Methods: Scientific and grey literature were searched for articles about any African filovirus. Articles were screened for information about transmission (prevalence or odds ratios especially). Data were extracted from eligible articles and summarized narratively with partial meta-analysis. Study quality was also evaluated. Results: A total of 31 reports were selected from 6552 found in the initial search. Eight papers gave numerical odds for contracting filovirus illness; 23 further articles provided supporting anecdotal observations about how transmission probably occurred for individuals. Many forms of contact (conversation, sharing a meal, sharing a bed, direct or indirect touching) were unlikely to result in disease transmission during incubation or early illness. Among household contacts who reported directly touching a case, the attack rate was 32% [95% confidence interval (CI) 26–38%]. Risk of disease transmission between household members without direct contact was low (1%; 95% CI 0–5%). Caring for a case in the community, especially until death, and participation in traditional funeral rites were strongly associated with acquiring disease, probably due to a high degree of direct physical contact with case or cadaver. Conclusions: Transmission of filovirus is unlikely except through close contact, especially during the most severe stages of acute illness. More data are needed about the context, intimacy and timing of contact required to raise the odds of disease transmission. Risk factors specific to urban settings may need to be determined.

Groundwater vulnerability assessment: two case studies using GIS methodology

Abstract In the first case study presented here, a geographic information system (GIS) is used to create a groundwater vulnerability map of the Midlands and northwest of England by overlaying regional information on the solid geology, Quaternary drift cover and soil cover. The map reveals that areas of extreme and high groundwater vulnerability occur in the vicinities of Birmingham, Liverpool and Manchester. In the second study, a GIS is used to create a groundwater vulnerability map for southeast England and to combine this information with results from a routing model for the transport of hazardous aqueous waste within the region. The routing mode utilizes an accident-minimizing scenario and expresses the potential pollution threat to groundwater as the number of tanker-kilometers directed over each groundwater vulnerability class. It is concluded that a GIS methodology is very suitable for groundwater vulnerability mapping, providing an ability to integrate multiple layers of information and to derive additional information, for example on pollution risks. A GIS also allows flexibility in the revision of maps should existing information become obsolete, or revision of the groundwater vulnerability classification scheme be necessary.

Using isochrone surfaces in travel-cost models

The zonal travel-cost method is a popular technique for assessing the value of non-priced recreational goods. It requires identification of zones of origin, frequently defined by administrative boundaries, for surveyed visitors to a recreation site. More appropriate zones of origin, based on areas of constant time (i.e., an isochrone surface), can be generated using a geographical information system, although the quality of input data and assumptions about isochrone behaviour must be considered. Using surfaces generated under various scenarios, several models were created to predict visitor arrivals to a public-access woodland in eastern England. The analysis indicates that the approach is robust even under diverse model forms.

Presence and Persistence of Ebola or Marburg Virus in Patients and Survivors: A Rapid Systematic Review

Background The 2013–15 Ebola outbreak was unprecedented due to sustained transmission within urban environments and thousands of survivors. In 2014 the World Health Organization stated that there was insufficient evidence to give definitive guidance about which body fluids are infectious and when they pose a risk to humans. We report a rapid systematic review of published evidence on the presence of filoviruses in body fluids of infected people and survivors. Methods Scientific articles were screened for information about filovirus in human body fluids. The aim was to find primary data that suggested high likelihood of actively infectious filovirus in human body fluids (viral RNA). Eligible infections were from Marburg virus (MARV or RAVV) and Zaire, Sudan, Taï Forest and Bundibugyo species of Ebola. Cause of infection had to be laboratory confirmed (in practice either tissue culture or RT-PCR tests), or evidenced by compatible clinical history with subsequent positivity for filovirus antibodies or inflammatory factors. Data were extracted and summarized narratively. Results 6831 unique articles were found, and after screening, 33 studies were eligible. For most body fluid types there were insufficient patients to draw strong conclusions, and prevalence of positivity was highly variable. Body fluids taken >16 days after onset were usually negative. In the six studies that used both assay methods RT-PCR tests for filovirus RNA gave positive results about 4 times more often than tissue culture. Conclusions Filovirus was reported in most types of body fluid, but not in every sample from every otherwise confirmed patient. Apart from semen, most non-blood, RT-PCR positive samples are likely to be culture negative and so possibly of low infectious risk. Nevertheless, it is not apparent how relatively infectious many body fluids are during or after illness, even when culture-positive, not least because most test results come from more severe cases. Contact with blood and blood-stained body fluids remains the major risk for disease transmission because of the known high viral loads in blood.

Do complexity-informed health interventions work? A scoping review

BackgroundThe lens of complexity theory is widely advocated to improve health care delivery. However, empirical evidence that this lens has been useful in designing health care remains elusive. This review assesses whether it is possible to reliably capture evidence for efficacy in results or process within interventions that were informed by complexity science and closely related conceptual frameworks.MethodsSystematic searches of scientific and grey literature were undertaken in late 2015/early 2016. Titles and abstracts were screened for interventions (A) delivered by the health services, (B) that explicitly stated that complexity science provided theoretical underpinning, and (C) also reported specific outcomes. Outcomes had to relate to changes in actual practice, service delivery or patient clinical indicators. Data extraction and detailed analysis was undertaken for studies in three developed countries: Canada, UK and USA. Data were extracted for intervention format, barriers encountered and quality aspects (thoroughness or possible biases) of evaluation and reporting.ResultsFrom 5067 initial finds in scientific literature and 171 items in grey literature, 22 interventions described in 29 articles were selected. Most interventions relied on facilitating collaboration to find solutions to specific or general problems. Many outcomes were very positive. However, some outcomes were measured only subjectively, one intervention was designed with complexity theory in mind but did not reiterate this in subsequent evaluation and other interventions were credited as compatible with complexity science but reported no relevant theoretical underpinning. Articles often omitted discussion on implementation barriers or unintended consequences, which suggests that complexity theory was not widely used in evaluation.ConclusionsIt is hard to establish cause and effect when attempting to leverage complex adaptive systems and perhaps even harder to reliably find evidence that confirms whether complexity-informed interventions are usually effective. While it is possible to show that interventions that are compatible with complexity science seem efficacious, it remains difficult to show that explicit planning with complexity in mind was particularly valuable. Recommendations are made to improve future evaluation reports, to establish a better evidence base about whether this conceptual framework is useful in intervention design and implementation.